Lower respiratory tract infections Flashcards
What is examples of lower respiratory tract infections
Acute bronchitis Exacerbation of COPD Pneumonia Empyema Lung Abscess Bronchiectasis
What is the symptoms of pneumonia
Malaise - tirdness Fever Chest pain (pleuritic) - painful when breath Cough Purulent sputum Dyspnoea - breathlessness Headache
What is the sputum produced in pneumonia caused by Streptococcus pneumoniae and Klebsiella pneumoniae called
rusty sputum
What is the signs of pneumonia
Pyrexia Tachpnoea - fast respiratory rate Central cyanosis (blue tongue) Dullness on percussion of affected lobe(s) Bronchial breath sounds - harsh Inspiratory crepitations (rattes) Increased vocal resonance
What does the sign of central cyanosis indicate on a patient with pneumonia
Patient has become hypoxic
What is the different investigations used for pneumonia
Serum biochemistry and full blood count Chest X-Ray (CxR) Blood cultures Throat swab (for atypical pathogens) Urinary legionella antigen Sputum microscopy and culture
Why does a chest X-ray look white for a patient with pneumonia
looks white as alveoli filled with bacterial cells and inflammatory substances
Why are blood tests and sputum culture important in investigation of pneumonia
used to confirm an infection and to try to identify the type of organism causing the infection
What is the purpose of the Urinary legionella antigen investigation
To test for Legionnaires’ disease which is a form of atypical pneumonia caused by any type of Legionella bacteria
What is the greatest causing pathogens of pneumonia
Strep Pneumoniae 36% H. Influenzae 10.2% Legionella 0.4% Staph aureus 0.8% Mycoplasma pneumoniae 1.3% Chlamydia psittaci 1.3%
What are the risk factos affect the scoring on your severity of pneumonia
The CURB 65 C confusion U blood urea>7 R respiratory rate>30 B diastolic blood pressure<60 65 age>65
If you have 0 of the CURB 65 risk factors what is your severity and antibiotic treatment
low risk and could be treated in community with Amoxycillin or clarithromycin / doxycycline
If you have 1-2 of the CURB 65 risk factors what is your severity
if you have CURB2 how many antibiotics must you take and what are there names
hospital treatment usually required
2 -Amoxycillin and clarithromycin
If you have 3-5 of the CURB 65 risk factors what is your severity and antibiotic treatment
high risk of death and need for ITU
Co-amoxiclav and clarithromycin
When would levofloxacin be given in the treatment of pneumonia
CURB2 and above if patient is allergic to penicillin
What is the non antibiotic treatment for pneumonia
Oxygen
i.v. fluids
CPAP - continued positive airway pressure
Intubation and ventilation - if severe
What is continued positive airway pressure
a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who aren’t able to breathe spontaneously on their own
What is the complications of pneumonia
Septicaemia - infection in blood Acute Kidney Injury Empyema Lung Abscess Haemolytic anaemia (breakdown of RBC) Acute respiratory distress syndrome
What different diagnosis can be made instead of pneumonia
Tuberculosis Lung cancer Pulmonary embolism Cardiac failure Pulmonary vasculitis (Wegners granulomatosis)
If the symptoms carry on for a long time is it more likely to be pneumonia or TB
TB
What could be mistaken as pneumonia on an X-ray
pulmonary embolism
pulmonary vasculitis
What further condtions could follow pneumonia
Lung abscess
empyema
(bronchiectasis)
What pathogens are responsible for empyema
Streptococcus (52%),
Staph. Aureus (11%),
Anaerobes (20%)
What is empyema
collection of pus (infection) in the pleural cavity
What is the symptoms of empyema
Chest pain
High swimming fever
(no cough)
What is used to investigate and diagnose a empyema
investigate - CT thorax and pleural ultrasound
Diagnose - pleural aspiration
What pH of the pleural aspiration of a patient with empyema
< pH 7.2
What is the treatment for empyema
Treatment is chest drain and intravenous antibiotics
(antibiotics up to 6 weeks)
surgery if don’t respond
Define lung absces
necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection
What organisms are more likely to cause a lung abscess
Staph. Aureus, pseudomonas and anaerobes
What are the symptoms of a lung abscess
usually non specific i.e. weight loss, high swimming fever, lethargic
How is a lung abscess investigated
Investigate with CT thorax and sputum culture
What is the treatment of lung abscess
prolonged antibiotics
Where is drainage usually taken from,
bronchial tree
occasionally percutaneous drainage necessary
What is the pathology of bronchiectasis
damaged dilated airways, due to thickened airway wall and mucus production
What is the aetiology of bronchiectasis
Idiopathic
Immotile Cilia Syndrome
Cystic fibrosis
Childhood infections such as measles
Hypogammaglobulinaemia
- reduction in all types of gamma globulins, including antibodies that help fight infection
Allergic Bronchopulmonary Aspergillosis (ABPA)
- exaggerated response of the immune systemto the fungus Aspergillus
What is the symptoms of bronchiectasis
Chronic cough Daily sputum production (often copious) Sometimes, Wheeze Dyspnoea Tiredness Flitting chest pains Haemoptysis
What is the signs of bronchiectasis
Usually no signs
Finger clubbing
Course inspiratory crepitations - crackely noise
(only heard on auscultation)
What investigations take place for bronchiectasis
High resolution CT Thorax Sputum culture Serum immunoglobulins Total IgE and Aspergillus precipitins CF genotyping
(investigations look for underlying cause)
What is the potentially microbiology of bronchiectasis
haemophilus influenzae,
staph. aureus
pseudomonas aeruginosa
What is the treatment for bronchiectasis
Chest physiotherapy
Prompt treatment of infections with appropriate antibiotics
inhaled therapy including beta2 agonist and inhaled corticosteroid.
When would chest physiotherapy be useful
when you have a lot of mucus
When would inhaled therapy be needed in the treatment of bronchiectasis
when wheezing becomes present
What is the pathology of acute bronchitis
inflammation of trachea and main airways
What is the usual cause of acute bronchitis
viral infection
