Lower Respiratory Tract Infection in Adults Flashcards
What is the UK incidence of pneumonia?
5-11/1000 adult population
What percentage of community acquired pneumonia requires hospitalisation?
Between 22 and 42%
What is the mortality of hospitalised patients with pneumonia?
6-12%
What are some symptoms of pneumonia?
Malaise
Myalgia
Fever
Chest pain
Cough
Purulent sputum
Dyspnoea
What are some signs of pneumonia?
Pyrexia
Tachypnoea
Central cyanosis
Dullness on percussion of affected lobe
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance
What investigations are done for pneumonia?
Serum biochemistry, full blood count and C-reactive protein (CRP) test
Chest X-ray
Blood cultures
Throat swab
Urinary legionella antigen
Sputum microscopy and culture
HIV test
What microrganisms are the 3 three for causing pneumonia?
1) Strep pneumoniae (39%)
2) Chlamydophilia pneumoniae (13.1%)
3) All viruses (13.1%)
What is the severity of pneumonia measured by?
CURB 65
What does CURB 65 stand up for?
C confusion
U blood urea > 7
R respiratory rate > 30
B diastolic blood pressure < 60
What is each aspect of CURB 65 given a score of?
0 (low risk and could be treated in the community)
1-2 (hospital treatment usually required)
3 (high risk of death and need for ITU)
What is the treatment for a CURB score of 0-1?
Amoxycillin or clarithromycin/deoxycycline
What is the treatment for a CURB 65 score of 2?
Amoxycillin and clarithromycin or levoflaxacin
What is the treatment for a CURB 65 score of 3-5?
Co-amoxiclav and clarithromycin or levoflaxacin (if penicillin alergic)
What are some things that come before pneumonia?
Aspiration pneumonia
Haematological malignancy
Legionnaires disease
Influenza
Staph pneumonia including PVL toxin
MRSA
HIV
What treatment should be used for pneumonia caused by MRSA?
Vancomycin or linezolid
What are treatment for pneumonia other than antibiotics?
Oxygen
IV fluids
CPAP (continuous positive airway pressure, keeps airways open)
Intubation and ventilation
What does CPAP stand up for?
Continuous positive airway pressure
What are some possible complications of pneumonia treatment?
Septicaemia
Acute kidney injury
Empyema
Lung abscess
Metastatic infection
ARDS (acute respiratory distress syndrome)
What does ARDS stand up for?
Acute respiratory distress syndrome
What is acute respiratory distress syndrome?
Widespread inflammation of the lungs
What is differential diagnosis?
Process of differentiation between two or more conditions which share similar signs or symptoms
What is the process of differentiating between two or more conditions that share similar symptoms called?
Differential diagnosis
What does differential diagnosis of pneumonia exclude?
TB
Lung cancer
Pulmonary embolism
Pulmonary oedema
Pulmonary vasculitis
What is empyema?
Collection of pus in the pleural cavity caused by microorganisms
What is a collection of pus in the pleura cavity caused by microorganisms called?
Empyema
What may follow pneumonia?
Empyema
Lung abscess
Bronchiestasis
What are the top 3 organisms that cause empyema?
Steptococcus (52%)
Anarobes (20%)
Staph aureus (11%)
What is the prominant feature of empyema?
Chest pain
What symptoms is absent with empyema?
Cough
What is used to investigate empyema?
CT thorax and ultrasound
What is empyema diagnosed by?
Pleural aspiration (pH < 7.2)
What is the treatment for empyema?
Chest drain and IV antibiotics
Surgery for patients who do not improve
What is a lung abscess?
Necrosis of lung tissue leading to the formation of cavities containing necrotic debris or fluid caused by microbial infection
What is necrosis of lung tissue leading to the formation of cavities containing necrotic debris called?
Lung abscess
What are organisms that are more likely to cause lung abscess than others?
Staph aureus
Pseudonomas
Anaerobes
What can the symptoms of lung abscess be?
Nonspecific such as lethargy, weight loss and high swing fever
What is lethargy?
Lack of energy
What is a lack of energy called?
Lathargy
What is lung abscess investigated by?
CT thorax
Sputum culture
What is the treatment of lung abscess?
Prolonged antibiotics
How is drainage for a lung abscess done?
Via the bronchial tree, occasionally percutaneous draining
What is bronchiectasis?
Airways of the lung become abnormally widened, leading to excessive build up of mucus that can make the lungs more vulnerable to infection
What does bronchiectasis cause in the lungs?
Build up of mucus making them more vulnerable to infection
What is it called when the airways of the lungs become abnormally widened?
Bronchiectasis
What are some of the causes of bronchiectasis?
Idiopathic
Immotile cilia syndrome
Cystic fibrosis
Childhood infections such as measles
Hypogammaglobulinemia
Allergic bronchopulmonary aspergillus
What is immotile cilia syndrome?
Genetic disorder that causes defects in cilia
What is a genetic disorder that causes defects in cilia?
Immotile cilia syndrome
What is hypogammaglobulinemia?
Reduction in all types of gamma globulins
What is a reduction in all types of gamma globulins called?
Hypogammaglobulinemia
What does ABPA stand up for?
Allergic bronchopulmonary aspergillosis
What are the symptoms of bronchiectasis?
Chronic cough
Daily sputum production
Sometimes:
Wheeze
Dyspnoea
Tiredness
Flitting chest pains
Haemoptysis
What are signs of bronchiectasis?
Finger clubbing
Course onspiratory crepitation (auscultation)
What investigations are done for bronchiectasis?
High resolution CT thorax
Sputum culture
Serum immunoglobulins
Total IgE and aspergillus precipitins
CF genotyping
What is the treatment for bronchiectasis?
Chest physiotherapy
Prompt treatment of infections with antibiotics
May require inhaled therapy including B2 agonist and corticosteroid
