LRTI 1 Flashcards
bronchitis/bronchiolitis
inflammation of the bronchi chest infection
usually develops during URTI
pertussis
bordetella pertussis
gram negative bacilli
vaccine preventable - rates increasing in Australia
80-100% infection rate in unimmunised
attaches to nasopharynx, produces toxins, damage to trachea/bronchi
phases of pertussis
catarrhal phase - fever, coryza, mild cough
paroxysmal phase - after 1-2 weeks - frequent repetitive bursts of coughing then single expiratory whoop
convalescent phase - after 2-4 weeks, lasts for months, diminishing cough
pertussis complications
subconjunctival haemorrhage, pneumothorax, rib fractures, hernias
peruses diagnosis
PCR of throat swab or NP aspirate
culture
serology
bronchopneumonia
infection of the lung parenchyma
5% fatality rate
pathogenesis of bronchopneumonia
microbes access lower respiratory tract
- aspiration from oropharynx e.g. sleep, elderly
- inhalation of contaminated droplets
- blood stream
proliferate within the alveoli
- macrophages and surfactant normally clear
- mucociliary elevator eliminates
four phases of bronchopneumonia
- oedema
- red hepatization
- grey hepatization
- resolution
pneumococcal pneumonia
strep pneumoniae
gram positive diplococci
commonest cause of pneumonia, severe illness and death
lasts weeks to months
vaccination has reduced severity and frequency
staphylococcal pneumonia
classically complicates flu
increasingly reported as a primary cause
including MRSA
may be associated with PVL
atypical pneumonia
caused by atypical organisms - difficult to culture in laboritory
- mycoplasma pneumonia
- chlamoydophila pneumonia
- legionella pneumophila
- chlamoydophila psittaci
legionnaires disease
- legionella pneumophila
hot water tanks, air conditioning, cooling towers, inhalation of aerosol
in. WA longbeachae is a bigger issue that pneumophila
chlamoydophila psittaci
- intracellular bacteria
- transmitted via inhalation, contact or ingestion
- feral bird and domesticated poultry
- headache predominant
- can cause severe pneumonia
coxiella burnetii
the cause of Q-fever
- Query fever
dust contaminated with birthing products, milk, meat
- vets, farmers, shearers at risk
pneumonia typical features
fever chills/rigors cough shortness of breath chest pain
atypical symptoms
In 20%
myalgia, arthralgia, headache, gastrointestinal symptoms - diarrhoea, vomiting
pneumonia upon physician examination
tachycardia, low blood pressure elevated respiratory rate reduced O2 saturation reduced air entry over affected lung added sounds - crepitations or crackles bronchial breathing
diagnosis of pneumonia
blood tests - full blood count
radiology - chest x ray, computerised tomography or CT scan
blood test to detect pneumonia
inflammatory markers e.g. c reactive protein
blood culture
microbiological diagnosis of pneumonia
microbiological - sputum gram stain and culture - 40% yield
serological tests - detection of antibodies, four fold rise in IgM, used for atypical pneumonia, includes urinary antigen
mild CAP
- pneumonia that doesn’t warrant admission
no confusion, hypoxia, low BP, should be reviewed after 24-48 hours
oral amoxycillin or oral doxycycline
atypical organisms to not respond to beta lactams
moderate CAP
requiring admission
intravenous antibiotics
doxycycline to cover atypical organisms plus penicillin
severe CAP
high risk of death or needing admission to ICU
IV therapy can be changed to orals after significant improvement
IV ceftriaxone or penecillin
plus iv azithromycin
aspiration pneumonia
aspiration risk reduced consciousness, impaired swallow includes oral organisms treatment requires addition or anaerobe cover tazocin covers all
