LRTIs - Empyema, Lung Abscess and Bronchiectasis Flashcards
What is empyema
infection of pleural space
When does empyema often occur?
following pneumonia
What organism causes the majority of empyema?
Streptococcus
What other organisms cause empyema?
Staph aureas
Anaerobes
Symptoms of empyema
Chest pain
Absence of cough
High swinging fever
Investigations for empyema
CT thorax
Pleural ultrasound
How do you diagnose empyema?
Diagnostic pleural aspiration (pH <7.2)
Treatment of empyema
Chest drain and prolonged antibiotics
Sometimes t-PA/DNase required to improve drainage
Surgery if above don’t work
Definition of lung abscess
Destruction of tissue leaving hole in the lung where pus gathers
What other diseases can lead to a lung abscess?
Infection distal to obstructed bronchus Aspiration pneumonia Pyaemia Obstructed bronchus by tumour Second degree infection of necrotic lung
What organisms are most likely to result in a cavitating pneumonia?
Staph aureus
Pseudomonas
Anaerobes
What organisms can cause a lung abscess?
Staph aureus Pneumococci Klebsiella Pseudomonas Anaerobes
Symptoms of lung abscess
Lethargy
High swinging fever
Weight loss
Investigations for lung abscess
CT thorax
Sputum culture
Treatment for lung abscess
Prolonged antibiotics
Drainage, usually by bronchial tree but may be percutaneously
What is bronchiectasis?
Chronic condition where there is abnormal dilatation of bronchi
Excessive inflammatory response which breaks down airways and they can’t clear secretions
What are the causes of bronchiectasis?
Idiopathic - usually Immotile cilia syndrome Cystic fibrosis Childhood infection eg measles Hypogammaglobulinaemia (no IgG) ABPA (allergic bronchopulmonary aspergillosis)
Definite symptoms of bronchiectasis
Chronic cough
Abundant, purulent foul sputum
Symptoms sometimes seen with bronchiectasis
Haemoptysis Wheeze Dyspnnoea Tiredness Flitting chest pain
Signs of bronchiectasis
clubbing
inspiratory crepitations
Investigations for bronchiectasis
HRCT thorax Sputum culture Serum immunoglobins (test antibodies in blood) Total IgE and aspergillus precipitans CF genotyping
Treatment for bronchiectasis
Chest physiotherapy
Antibiotics
Surgery
Inhaled beta 2 agonists / ICS if wheeze
