LRTI Flashcards
Croup- aetiology
- usually in children
- COVID-19, parainfluenza virus, influenza virus, RSV, mycoplasma pneumoniae
Croup- symptoms
- seal’s bark, hoarseness
- precedent URTI (fever, laryngitis, tachypnea and wheezing, inspiratory stridor, hypoxemia)
- steeple sign on XR
Croup- diagnosis
- clinical
- viral antigen detection, PCR for NPA
Croup- treatment
oxygen therapy
ventilatory support
nebulised bronchodilator
Pertussis- Treatment
- macrolides
- supportive
Community acquired pneumonia- treatment
- beta lactam + macrolide/tetracycline
- supportive
Atypical pneumonia syndrome
- walking pneumonia
- No significant pathogen in routine culture
- not responding to beta lactam
- long course of illness
Atypical pneumonia syndrome- aetiology
- mycoplasma pnuemoniae (special culture)
- chlamydia trachomatis (cell culture)
- chlamydophila pneumoniae (cell culture)
- chlamydophila psittaci - parrot fever, psittacosis (cell culture)
- legionella pneumophila (special culture, antigen)
- respiratory viruses (cell culture, antigen)
PCR/nucleic acid amplification
Legionnaire/ legionellosis
- urine antigen detection, in fresh water
- charcoal based medium
- treatment: macrolides, fluoroquinolones
nosocomial pneumonia- predisposinng factors
- advanced age, underlying diseases
- gastric acid suppression
- intubations and use of respiratory equipment
Nosocomial pneumonia- aetiology
- MRSA, non-fermenters: pseudomonas, acinetobacter baumanii, legionella penumophila, gram negs
Aspiration pneumonia
- elderly, drunk, unconscious, iV drug addicts
- loss of gag and swallowing reflex, loss of consciousness
- obstruction, chemical pneumonitis, bacterial pneumonia
Complications- lung abscess
- necrotising lung parenchyma, with pus containing cavitations (air fluid level)
- bronchiectasis, bronchial obstruction, aspiration pneumonia, septic emboli
Secondary to aspiration: mixed oral flora, anaerobes
Secondary to bacteremia: monobacteria e.g. S. aureus, K. pneumoniae, P. aeroginosa
Complications- empyema thoracis
- predisposing factors: pneumonia, surgery, perforated oesophagus, mediastinitis
- Secondary to pneumonia: the one causing pneumonia
- Secondary to surgery or eosophagus: anaerobes, aerobic gram neg
TB- diagnosis
clinical, radiological, acid fast stain
culture: faster culture system and earlier sensitivity result from BACTEC
tuberculin skin test
PCR
Pneumocystosis- presentation
pneumocystis jirovecii
- commonly present as pneumonia
(pulmonary Pneumocystosis, extrapulmonary not common)
Pneumocystosis- epidemiology
- immunocompromised people (AIDS-defining illness, malnourished premature and overcrowded children)
- transplant recipient, high dose corticosteroid
- chronic lung disease
Pneumocystosis- diagnosis
Signs: diffuse bilateral infiltrate on CXR
hypoxemia
Definitive:
Sputum- induced sputum by nebulised hypertonic saline, expectorated not accepted
Bronchoalveolar lavage, transbonchial or open lung biopsy
Stain: methenamine silver stain, Giemsa stain and immunofluorescent stain
Pneumocystosis- treatment
high dose cotrimoxazole
Influenza symptoms
- systemic more prominent than respiratory
system: fever, headache, myalgia, malaise, arthralgia
respiratory: dry cough, sore throat, rhinorrhea
Influenza- complications
- pneumonia
- myositis, encephalitis, Reye syndrome (with NSAID and aspirin)
Influenza- diagnosis
- clinical/hx
- RT-PCR
- antigen detection: immunofluorescent study, immunochromatographic assay, ELISA
Influenza- treatment
- supportive: analgesics, antipyretics (do not use aspirin and NSAID)
- antivirals: adamantanes, neuraminidase inhibitors (oseltamivir, zanamivir, baloxivir)
Influenza- prevention
chemoprophylaxis: oseltamivir
vaccine: inactivated (not used, IM/ID), live attenuated (inhalation), recombinant hemagglutinin (not used)
composition: seasonal- trivalent or quadrivalent, pandemic- monovalent
