Lower RTI Flashcards
Acute bronchitis
-etiology
bronchitis without pneumonia is ALWAYS viral
90% viral
- influenza viruses
- RSV
- other respiratory viruses
10% bacterial
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- bordetella pertussis
The Flu
- epidemiology (what time of year, who gets it, how many of us get it)
- major epidemics result of…
- winter months
- everyone gets it, but death highest among elderly and infants
- 10-20% attack rate
-Major epidemics are the result of rearrangement of the segmented genome (antigenic shift)
The Flu
- etiology
- H and N significance
- Influenza virus
- Hemagglutinin binds sialic acid on cell surface
- Neuraminidase cleaves new virions from cell surface
The Flu
-course of infection
- shedding 24-48h before symptoms
- sudden onset symptoms: fever, headache, myalgias, malaise, cough, rhinnorhea (like the cold, but worse)
- 2-7 days of symptoms
- viral shedding stops 6-7 days after symptom onset
The Flu
-Management
- supportive therapy
- antiviral therapy (oseltamivir) for high risk
The Flu
-Prevention
- Immunisation
- Chemoprophylaxis in nursing homes (oseltamivir)
- Droplet precautions
COPD
-general definition
- irreversible air flow limitation, usually associated with an inflammatory response
- chronic bronchitis +/- emphysema
Acute exacerbations of chronic bronchitis
-define chronic bronchitis, and an acute exacerbation
- Chronic bronchitis: productive cough for at least 3/12 for 2yrs
- Acute exacerbations: increased sputum volume, purulence +/- dyspnea
Acute exacerbation of chronic bronchitis
-prevention
COPD patients should receive the flu vaccine each year and pneumococcal vaccine (q6 yrs)
Acutre exacerbation of chronic bronchitis
-etiology
50% viral
Mild:
Haemophilus spp.
S. pneumoniae
M. cattarhalis
Moderate:
above + enterobacteriaciae
Severe:
above + P. aeruginosa
Acute exacerbation of chronic bronchitis
-management
- If antibiotics are given, amoxicillin for mild, amoxil-clav for moderate and levofloxacin for severe
Bronchiolitis
-epidemiology (who gets it? when?
- Infants and children
- fall—>spring
Bronchiolitis
-etiology
- RSV (50-80%)
- Influenza (6-25%)
- Rhinovirus (16-25%)
- Parainfluenza (7-18%)
Bronchiolitis
- S/S
- Diagnosis
- prominent cough, lethargy, inc. RR, signs of respiratory distress
- Can be seen on CXR unlike bronchitis
Diagnosis is clinical, but can do a viral nasopharyngeal swab
Bronchiolitis
-Management
-supportive care
Pneumonia
- definition
- CAP vs. HAP vs. HCAP vs. VAP
- inflammation of the alveoli, usually caused by viruses or bacteria
- Communit-acquired pneumonia
- Hospital acquired pneumonia
- Health-care associated pneumonia: non-hospital health care source
- Ventilator pneumonia
Pneumonia
- etiology in children and adults
- atypical pathogens
Children: RSV, Influenza, S. pneumoniae, H. influenzae, S. aureus
Adults: more often bacterial–> S. pneumoniae most common (others exist)
Typical:
S. pneumoniae
H. influenza
Atypical:
Mycoplasma penumoniae
Chlamydophila pneumoniae
Legionella pneumophila
Viral:
Influenza
Oppotunistic:
PJP
TB
fungal
Pneumonia
-predisposing conditions
- alcoholism
- diabetes
- CHF
- COPD
- smokers
- aspiration prone
- post-influenza
- cystic fibrosis (pseudomonas esp
Pneumonia
-diagnosis
Treatment depends on the ability to identify the pathogen!!
- Physical
- History
- Sputum smear and culture
- CXR
- CT
Pneumonia
-empiric therapy for outpatient CAP, inpatient CAP, nursing home CAP, HAP, VAP
Outpatient
- must use Ab that covers S. pneumoniae
- Amoxicillin
- If concerned about atypical pathogens add doxy or clarithromycin
- NOT macrolides (resistance of S. pneumo)
Inpatient
- use ceftriaxone
Nursing home patient
-Amoxil-clavulanate
HAP
-ceftriaxone
VAP
-pipercillin-tazobactam (want to cover P. aeruginosa)
Atypical pneumonia
-mycoplasma pneumoniae diagnosis and treatment
Diagnosis: serology and CXR
Treatment: erythromycin (macrolide)
Atypical pneumonia
-legionella pneumophila diagnosis
Diagnosis: consider in patients not responding to B-lactams and possible exposure (A/C, hot tubs, resp equipment). Urine antigen test
Treatment: quinolones or macrolides
Empyema
-definition
- collection of pus in the pleural space
Empyema
-etiology
- S. pneumoniae/pyogenes/aureus
- Anaerobes
