lung infections

Question 1

Acute lung infection has the largest impact on?

Answer 1

Acute lung infection: has the larges impact on DALYs

Question 2

Pneumonia rates with age:

Answer 2

Pneumonia rates with age: increases exponentially after 60-69

Question 3

Typical v Atypical CAP pathogens:

Answer 3

Typical v Atypical CAP pathogens: common = Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis; uncommon = Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia

Atypical bacteria are not covered by penicillins and require additional agents

Question 4

risk factors

Answer 4

Risk factors:
<2 or >65 years age
Smoker
Xs alcohol consumption
Poverty, overcrowding and contact with children <15yrs
Inhaled corticosteroids, immunosuppressants, and proton pump inhibitor usage
COPD, Asthma, Heart/liver disease, diabetes, HIV, malignancy, aspiration risk factors

Question 5

examples of community acquired pneumonia

Answer 5

Community Acquired Pneumonia: Influenza A/B. Rhinovirus and Syncytial Viruses

Question 6

examples of hospital acquired pneumonia

Answer 6

Hospital Acquired Pneumonia: S. Aureus, Pseudomonas Aeruginosa, Klebsiella sp.

Question 7

differences between pneumonia and bronchitis

Answer 7

Pneumonia 
New resp. symptoms or signs 
Pleuritic chest pain 
Usually febrile 
Often hypoxic, confused 
New X ray changes 
Severe enough to be admitted 

Acute Bronchitis
Cough +++
Tracheal pain, not pleuritic
No new X ray changes

Question 8

What are the BTS guidelines for diagnosing pneumonia?

Answer 8

BTS Guidelines:
Acute left respiratory tract symptoms
Focal chest signs and CXR changes
>1 systemic feature (fever, shivers, aches and pains, temp >38)
No other explanation for illness
Low severity using CRB65: antibiotics at home
High severity using CRB65: Admit with antibiotics at hospital urgently

Question 9

supportive therapy

Answer 9

oxygen 
fluids 
analgesia 
nebulised saline 
chest physiotherapy

Question 10

what are the effects of viruses on the lung?

Answer 10

Viral infection of the lungs: lead to damaged epithelium and hence loss of cilia, bacterial growth, poor barrier to antigens and loss of chemoreceptors; coincides with mediator release, cellular inflammation and local immune memory
Lung: normally has a microbiome that can be largely increased by damage caused by viruses

Question 11

what causes severe flu?

Answer 11

Highly pathogenic strains  
Absence of prior immunity (immunodeficiency and T/B cell deficiency) 
Predisposing illness (frailty, COPD, asthma, diabetes, obesity and pregnancy)

Question 12

comparing influenza and RSV

Answer 12

Influenza: no re-infection by same strain but rapidly evolving; vaccine annually and has variable effectiveness
RSV: generally stable with limited evolution but no vaccine due to poor immunogenicity and vaccine enhanced disease. infectious form is filamentous

Question 13

RSV Bronchiolitis clinical features:

Answer 13

nasal flaring, hypoxaemia, cyanosis, chest wall retraction, croupy cough, expiratory wheezing and tachypnoea

Question 14

Bacterial pneumonias: usually result from ?

Answer 14

Bacterial pneumonias: usually result from normal acute viral infections