Lower respiratory tract infections Flashcards
List some lower respiratory tract infections
Acute bronchitis Exacerbation of COPD Pneumonia Empyema Lung abscess Bronchiectasis
What are the symptoms of pneumonia?
Malaise fever pleuritic chest pain cough purulent sputum - rusty Dyspnoea headache
What are the signs of pneumonia?
pyrexia tachypnoea central cyanosis dullness on percussion of affected lobe bronchial breathing inspiratory crepitations increased vocal resonance
What are the investigations for pneumonia?
FBC CXR - opacities Blood cultures Throat swab Urinary legionella sample Sputum culture
List some microbiological causes of pneumonia
Strep pneumoniae Haemophilus influenzae Legionella Staph aureus Mycoplasma pneumoniae Chlamydia psittaci Viruses
What organism is mostly associated in pneumonia in younger people with a sub-acute course with non-respiratory complications such as haemolytic anaemia?
Mycoplasma pneumoniae
How do you score severity of pneumonia?
CURB 65 C - confusion U - blood urea >7 R - resp rate >30 B - diastolic pressure <60 65 - age >65yo
CURB score 0-1: home care
CURB score 2: hospital care
CURB score 3-5: ITU
How do you treat CURB 0-1 pneumonia?
Amoxycilin or clarithromycin or doxycycline
How do you treat CURB 2 pneumonia?
Amoxycillin and clarithromycin/levofloxacin
How do you treat CURB 3-5 pneumonia?
Co-amoxiclav and clarithromycin/levofloxacin
When is levofloxacin used?
In penicillin allergic individuals
What supportive treatments are given alongside antibiotics for pneumonia?
O2
Fluids
CPAP
Intubation and ventilation
What are some complications of pneumonia?
Septicaemia and shock Acute kidney injury Empyema Lung abscess Haemolytic anaemia (mycoplasma) ARDS
How can you distinguish TB from pneumonia?
TB often in upper lobes of the lungs and often has a much more chronic course
What are some differential diagnoses of pneumonia?
TB Lung cancer Pulmonary embolism Cardiac failure Pulmonary vasculitis
What is empyema?
Collection of pus in a cavity of the body, particularly in pleural cavity
What often causes empyema?
Streptococcus (52%)
Staph Aureus (11%)
Anaerobes (20%)
What are the symptoms and signs of empyema?
Chest pain
Cloudy pus
Absence of cough
High swinging fever
How do you diagnose empyema?
Pleural aspiration
CT
Pleural ultrasound
How do you treat empyema?
Chest drain IV antibiotics Intrapleural t-PA to degrade clots DNase Surgery if they don't improve
Describe a lung abscess
Type of liquefactive necrosis of lung tissue and formation of cavities >2cm containing necrotic debris or fluid, caused by microbial infections
What organisms usually cause lung abscesses?
Staph Aureus
Pseudomonas
Anaerobes
What are the symptoms of lung abscess?
lethargy
weight loss
swinging fever
How do you treat lung abscesses?
Prolonged antibiotics
Must check its not TB
