Lower Respiratory Tract Infections 2 Flashcards by Euler Log

what are the main problems associated with LRTIs?

Acute Bronchitis
COPD Exacerbations
Pneumonia
Empyema
Lung Abscess
Bronchiectasis

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What is acute bronchitis?

A viral infection causing inflammation of trachea & main airways

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How does bronchiectasis relate to LRTIs?

It dilates the airways making patients more prone to infection

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How common/severe is pneumonia?

5-11 per 1000 people
22-42% requires hospitalisation
5.7-12% mortality in the hospitalised patients

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Symptoms of Pneumonia?

Malaise
Fever
Pleuritic Chest Pain (sharp)
Cough
Purulent (infected) Sputum
Dyspnoea
Headache

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Why is it difficult to diagnose pneumonia?

Its initial symptoms are very vague and fit other LRTIs.

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What are the signs of pneumonia?

Pyrexia
Tachypnoea
Central Cyanosis
Dullness on Percussion of the affected Lobes
Bronchial Breath Sounds
Inspiratory Crackles
Increased Vocal Resonance

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How does increased vocal resonance occur in pneumonia?

Consolidation of the lobe leads to increased vocal resonance.

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How do we investigate Pneumonia?

Serum Biochem, FBC (Infection)
CRP (shows inflammation)
CXR (shows degree of consolidation)
Blood Culture (picking out specific pathogen in feverish patients)
Sputum Microscopy/Culture (picking out pathogen)
Throat Swab (for Atypical Pathogens e.g. Viruses)
Urinary Legionella Antigen (To check for Legionnaires disease)

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What is legionnaires?

A serious lung infection caused by legionella bacteria.

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What are the most common causes of Penumonia?

Strep. Pneumoniae (Gram +ve, Pneumococcus) [36%]
H. Influenzae [10.2%]
Legionella [0.4%]
Staph. Aureus [0.8%]
Viruses [13.1%]
Mycoplasma Pneumoniae [1.3%]
Chlamydia Psittaci [1.3%]

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Why dont the common causes of pneumonia add up to near 100%?

In the majority of cases the causative microorganism isnt found.

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Which pneumonia causing organisms are atypical?

Chlamydia Psittaci

Mycoplasma Pneumoniae

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How would strep Pneumoniae appear under gram staining & Microscopy?

Purple

Balls (cocci) forming chains

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What scale do we use to score the severity of penumonia?

The CURB 65 scale. Each letter + 65 stands for a criteria. The number they score determines how to respond.

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What are the criteria of the CURB 65 scale?

C - Confusion
U - Blood Urea>7
R - Respiratory Rate>30
B - Diastolic BP<60
65 - Age>65 yrs

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Do we hospitalize a 0 CURB65 score?

Assume low risk and treat in the community

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Do we hospitalise a curb65 score of 1-2?

Usually need hospital level treatment

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Do we hospitalise a CURB65 score of 3-5?

Assume a high risk of death and admit to ITU

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How do we treat a CURB65 score of 0-1?

Amoxycillin or Clarithromycin/Doxycycline

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How do we treat a CURB65 score of 2?

Amoxicillin AND Clarithromycin (or Levofloxacin)

How do we treat a CURB 65 score > 2?

Co-Amoxiclav & Clarithromycin. (Or levofloxacin if penicillin allergic)

Why do we use co-amoxiclav over standard amoxicillin in severe pneumonia cases?

It has a broader spectrum.

Why non-drug treatments do we sometimes give severe pneumonia patients?

Oxygen or if necessary CPAP
I.V. Fluids
In Very severe cases intubation & Ventilation

What are the common complications of Pneumonia?

``` Septicaemia Acute Kidney Injury Empyema Lung Abscess Haemolytic Anemia (Mycoplasma) ARDS ```

When do pneumonia patients generally get an Acute Kidney Injury?

When theyre elderly and/or suffer from co-morbidities.

How does Haemolytic Anaemia occur in pneumonia?

In Mycoplasma caused pneumonia an immune phenomenon can cause RBCs to be destroyed.

What do we do if a pneumonia patient develops ARDS?

Transfer to the ICU

What are other conditions that can appear to be Pneumonia?

``` TB Lung Cancer Pulmonary Embolism Cardiac Failure Pulmonary Vasculitis (Wagners Granulomatosis) ```

How do we tell TB from pneumonia?

TB tends to infect the upper lobes and generally occurs following something else so the patient will have been unwell for at least several weeks.

How is a pulmonary embolism mistaken for pneumonia?

It can produce infarcts that look like pneumonia, particularly in the elderly

What is Pulmonary Vasculitis?

A term used to describe conditions involving destruction of blood vessels in the lungs.

What is empyema?

Infection in the pleural cavity

What microorganisms tend to cause empyema?

Streptococcus [52%] Staph. Aureus [11%] Anaerobes [20%]

How do we tell an empyema apart from other LRTIs?

Chest pain, the lack of a cough and often a high swinging fever.

How do we investigate an Empyema?

A CT of the Thorax | Pleural Ultrasound

How do we diagnose/treat Empyema?

Diagnostic Pleural Aspiration (check if pH is <7.2), then culture. Then treat with a chest drain & relevant IV Antibiotics

What can we do if an empyema patient doesn't respond to antibiotics?

The Antibiotics can be extended for longer or surgery is available.

What are the symptoms of a lung abscess?

Pretty non-specific | Lethary, Weight Loss, high swinging fever

How do we investigate a lung abscess?

With a CT Thorax and a sputum culture (including TB culture)

What organisms are likely to cause abscesses?

Staph Aureus Pseudomonas Anaerobes

How do we treat a Lung Abscess?

Drain via the bronchial tree (or percutaneously) Then treat with prolonged antibiotics.

What are the most common potential causes of bronchiectasis?

``` Idiopathic (mainly) Immotile Cilia Syndrome Cystic Fibrosis Childhood infection Hypogammaglobulinaemia Allergic Bronchopulmonary Aspergillosis (ABPA) ```

How does Cystic fibrosis relate to bronchiectasis?

CF patients often have a severe case of bronchiectasis at a young age.

How do childhood infections relate to Bronchiectasis?

Theres a correlation between childhood infections like measles & whooping cough and bronchiectasis

How does hypogammaglobinaemia lead to bronchiectasis?

Immunoglobulin G isn't produced so infections are very common.

What does ABPA look like?

ABPA can present like asthma and if chronic lead to bronchiectasis.

What are the symptoms of bronchiectasis?

Chronic Cough Daily (often large) sputum production And not always but sometimes: - Wheeze - Dyspnoea - Chronic Tiredness - Flitting chest pain - Haemoptysis

What signs are there of bronchiectasis?

``` Finger Clubbing (generally only in V. Severe cases) Course inspiratory Crepitations ```

What do we do to investigate Bronchiectasis?

A High Resolution Thorax CT. Sputum Culture Serum immunoglobulins (looking for Immunoglobulin G deficiency) Total IgE & Aspergillus precipitins (Looking for ABPA) CF genotyping

How does bronchiectasis appear on a HRCT?

Some of the airways will be unusually dilated. Can often compare the two sides

What can we do to treat Bronchiectasis?

Inhaled Beta2 agonists & corticosteroids. (like Asthma) Chest Physiotherapy. Promptly treat infections with antibiotics.