Lower RTI in adults + children Flashcards
What is acute bronchitis?
- inflammation of bronchi
- temporary ( < 3 weeks)
- viral infection
When will a patient need to see GP following acute bronchitis?
- longer than 3 weeks
- high temperature for >3 days
- coughing blood
- underlying heart/lung condition ( asthma, HF, emphysema)
- breathlessness
- repeated episodes of bronchitis
What is chronic bronchitis (COPD)
- inflammation of bronchi
- cough lasting 3 months of year for at least 2 years in a row
What is COPD exacerbation
-sudden worsening of COPD symptoms
- change in color sputum
- fevers
- increased breathlessness
- wheeze
- cough
What can cause COPD exacerbation?
- Streptococcus pneumoniae
- Haemophillus influenzae
- Moraxella catarrhalis
- VI
Treatment of COPD eacerbation
Steroids
Antibiotics: amaxicillin, doxyclcline, co-trimaoxazole, clarithomycin
+/- nebulisers
What is pneumoniae?
- inflammation of lung parenchyma
- acute bronchitis likely to lead to this
State the risk factors of pneumoniae
- smoking, alcohol XS?
- age
- preceding viral illness
- pre-existing lung disease
- chronic illness
- immunocomprised
- hospitalisation
- IVDU
- acute bronchitis ( 5%)
What causes consolidation in pneumoniae
- solidification due to cellular exudate in alveoli leads to impaired gas exchange
Clinical features of pneumoniae - Symptoms + signs
SYMPTOMS - Fever, rigors, myalgia -cough + sputum) -chest pain ( pleuritic) -dyspnoea -haemoptysis ( rust brown sputum caused by s.pneumoniae)
SIGNS
- tachypnoea
- tachycardia
- reduced expansion
- dull percusion
- bronchial breathing
- crepitations
- vocal resonance increased
Investigations of pneumoniae
- CXR in doubt
- community may have no outbreaks
Hospital
- Bloods; serum biochemistry, FBC, CRP
- Blood cultures
- CXR
- Sputum culture, viral throat swab
- legionella urinary antigen
Differential diagnosis of pneumoniae
- Tubersculosis
- Lung cancer
- pulmonary embolism
- pulmonary oedema
- pulmonary oedema
- pulmonary vasculitis ( wegners granumatosis)
Community acquired typical Pneumoniae causes(microbiology)
Pneumococcal pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Community acquired atypical pneumoniae (microbiology)
Legionella pneumophilia Chlamydia pneumoniae Chlamydia psittaci Coxiella burnetti Moraxella catarrhalis Viruses ( influenza, RSV, SARS, VZ)
Noscomial pneumoniae
Enterobacteria
Staphylococcus aureus
Pseudomonas aerigunosa
Klebsiella pneumoniae
Clostridia
Anaerobes
TB
Severity scoring of pneumoniae
CURB 65 C - confusion U - blood urea > 7mmol/L R - respiratory rate ≥ 30/min B - systolic BP < 90 mmHg, diastolic blood pressure < 60mmHg 65 age ≥ 65
A score of Risk of death
0-1 low risk - could be treated in community < 3%
2 moderate risk - hospital treatment usually required 9%
3-5 high risk of death and need for ITU 15-40%
Treatment
(slide 14 )
Complications of Pneumoniae
- Sepsis
- acute kidney injury
- adult respiratory distress syndrome
- parapneumonic effusion
- empyema
- lung abscess
- disseminated infection
Parapneumonic effusion / Empyema + lung abscess
slide 17
Recovery time of pneumoniae
- weeks
- repeat CXR 6 weeks if >50yrs, sokers
- cmoking cessation
Recurrent pneumoniae causes
- immuncomprised
- underlying structural lung disease?
- Aspiration?
Cuases of bronchiextasis
- idopathic
- childhood infection
- CF
- Ciliary dyskinesia
- hypogammaglobineaemia
- Allerigic broncho-pulmonary aspergillosis (ABPA)
Bronchiectasis symptoms
- chronic productive cough
- breathlessness
- recurrent LRTI
- haemotptysis
- finger clubbing
- course creptitations
- wheeze
- bstructive spirometry
Infective exacerbations of bronchiectasis
Staph aureus
Haemophilus influenzae
Pseudomonas aerigunosa
Sputum Cx essential (including AAFB) Chest physio Mucolytics Prolonged antibiotic course 10-14 days Vaccinations
Consider prophylactic abx
