LRTI 2 Flashcards
healthcare associated pneumonia
caused by infectious agents not present or incubating at the time of admission
multi drug resistant
examples of healthcare associated pneumonia
ESBLs
acinetobacter
pseudomonas aeruginosa
MRSA
ESBL
extended spectrum beta lactamases
destroy beta lactatese antibiotics
HCAP symptoms
as per CAP
patient may be unconscious or unable to describe symptoms
new onset fevers and chest x ray infiltrates
may be aspiration pneumonia
particularly affects upper lobes
VAP
ventilation associated pneumonia
common complication of mechanical ventilation
10% of patients on ICU
most risk during first 5 days
3 main factors of VAP
oropharynx colonisation - replaced by pathogens
aspiration - endotracheal tube bypasses mechanisms preventing aspiration
compromised defences - trauma
HAP/VAP diagnosis
sputum collection is difficult
must avoid contamination
via endotracheal tube - use quantitative culture
- in special circumstances use invasive techniques - BAL, open lung biopsy
HAP/VAP treatment
antibiotic selection pressure lease to MDR bacteria as a cause for HCAP
high risk - IV pipericillin - Tazocin
chronic pneumonia caused by
caused by mycobacterium tuberculosis nocardia species fungi - pneumocystis jiroveci crytococcus neoformans aspergillus
TB
1 in 3 infected world wide
MAC pneumonia
mycobacterium avian and M intracellular complex
environmental, soil and water
chronic pneumonia in patients with pre existing lung disease
also elderly women with no previous lung disease
pleurisy and empyema
pleural cavity a relative vacuum in the space keeps the visceral and parietal pleura in close proximity surface tension helps expansion small volume of pleural fluid a lubricant to facilitate movement
pleurisy
inflammation of the pleura
cause fever and pleuritic chest pain
may be bacterial or viral or TB
pleural effusion
abnormal collection of fluid in the pleural space
excess fluid production of decreased absorption or both
common manifestation of pleural disease
transudates
result from an imbalance in oncocitic and hydrostatic pressures - cardiac failure, cirrhosis, hypoalbuminaemia
exudates
the result of inflammation of the pleura and/or decreased lymphatic drainage - infection, cancer, inflammatory, PE
parapneumonic pleural effusions - uncomplicated
exudative, neutrophilic
no organisms
increasing passage of interstitial fluid as a result of inflammation associated with pneumonia
parapneumonic pleural effusions - complicated
bacterial invasion into pleural space
increased number of neutrophils, decreased glucose levels, pleural fluid. acidosis, and an elevated lactic dehydrogenase concentration
bacteria may be seen and cultured
empyema
frank pus in the pleural space preexisting pleural fluid is required for the development bacterial invasion thick, vicious and opaque need draining using. a chest tube
bronchiectasis
abnormal and permanent dilatation of the bronchi
can be localised of diffuse
inability to clear secretions
a consequence of inflammation dn destruction of the bronchial architecture
causes of bronchiectasis
infection, autoimmune disease, cystic fibrosis
bronchiectasis sequelae
colonised with pseudomonas and heamophilus influenzas release protease and toxins host immune response triggered further damage, mucus plugging chronic cough, haemoptysis acute exacerbations
lung abscesses
most often follows aspiration
also complication of pneumonia or blood stream infection
particularly nectrotising infection
pus filled cavities
high bacterial burden, inadequate clearance, anaerobes most common, gram negatives
tropical pneumonia
burkhoderia pseudomallei acute septicaemia and pneumonia associated with wet season predisposed hosts - diabetes, alcoholism endemic in NT, northern Queensland
