Microbiology - RTIs Flashcards
What is pneumonia, some symptoms and investigations?
Inflammation of lung alveoli
- Sx: Fever, cough, SOB, pleuritic chest pain
- Ix: CXR, CURB-65, sputum cultures, atypical screen
What is the general treatment for pneumonia?
Supportive (O2, fluids etc.)
- Abx (guided by CURB-65)
What are some examples of a lower respiratory tract infection (LRTI)?
- Pneumonia
- Bronchitis
- Empyema
- Abscess
What is bronchitis, what are its causes, investigations and treatment?
Inflammation of medium-sized airways, mostly in smokers
- Viral/bacterial cause
- CXR: No changes
- Tx: Bronchodilation, chest physio +/- Abx
How is hospital-acquired pneumonia defined?
After >48hrs of hospital admission
- Usually intubated + ventilated
What are soem common pathogens of hospital acquired pnuemonia?
- Staphylococcus. aureus
- Klebsiella
- Pseudomonas
- Haemophilus
What is the most common cause of hospital acquired pneumonia?
Pseudomonas aeruginosa
What are some basic features of typical pneumonia?
- Classic signs + symptoms
- Classic CXR changes (e.g. consolidation)
- Responds to penicillin Abx
What are some basic features of an atypical pneumonia?
- No/atypical signs + symptoms
- Not in keeping with CXR
- Doesn’t respond to penicillin Abx (no cell wall) - responds well to macrolides
- ?Extra-pulmonary features
What are some typical pneumonia causative pathogens?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Staphylococcus aureus
- Klebsiella pnuemoniae
What are some buzzwords of streptococcus pneumoniae, its microscope findings and which type of pneumonia is it associated with?
- Most common
- Rusty-coloured sputum
- +ve diplococci
CAP
What are some buzzwords of haemophilus influenzae, its microscope findings and which type of pneumonia is it associated with?
- A/w COPD/smoking
- Cavitating lesion
- -ve cocco-bacilli
CAP
What are some buzzwords of Moraxella catarrhalis, its microscope findings and which type of pneumonia is it associated with?
- A/w smoking
- -ve Cocci
CAP
What are some buzzwords of staphylococcus aureus, its microscope findings and which type of pneumonia is it associated with?
- A/w recent viral infection (post-influenza)
- Cavitation on CXR
- +ve cocci
- Grape-bunch clusters
HAP
What are some buzzwords of Klebsiella pneumoniae, its microscope findings and which type of pneumonia is it associated with?
- Alcoholic, elderly, haemoptysis, aspiration (stroke)
- Cavitating lesions
- -ve rod, enterobacter
HAP
What are some atypical pneumonia pathogens?
- Legionella pneumophilia
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Chlamydia psittaci
- Coxiella burnetti
What is the general treatment for atypical pneumonias?
Clarythromycin
What are some buzzwords associated with legionella pneumophilia?
- Travel
- Air conditioning
- Water towers
- Hepatitis
- Hyponatraemia
- Lymphopaenia
What are some buzzwords associated with Mycoplasma pneumoniae?
- Transverse myelitis
- University students/boarding schools
- Dry cough
- Arthralia
- Cold agglutinin test/AIHA
- Erythema multiforme
What are some buzzwords associated with chlamydia pneumoniae?
?Asthma patients
What are some buzzwords associated with chlamydia psittaci?
- Birds
- Dry cough
What are some buzzwords associated with coxiella burnetti?
- Farm animals
How is aspiration pneumonia caused and what is its treatment?
- Unsafe swallow
- Anaerobes from gut flora
- Tx: Metronidazole + Tazocin
What RTI is associated with HIV, its features, buzzwords and treatment?
P. jiroveci / PCP
- Ground glass shadowing (bat-wing)
- Silver stain
- Honeycombing + cystic appearance on CT
- Dry cough + desaturation
- Co-trimoxazole
What RTI pathogens are associated with a splenectomy?
NHS (encapsulated organisms)
- N. meningitidis
- H. influenzae
- S. pneumoniae
What RTI pathogens are associated with cystic fibrosis?
- Pseudomonas aeruginosa
- Burkholderia cepacia
What RTI pathogen is associated with neutropenia, its features, buzzwords and treatment?
Aspergillus
- Blood-streaked sputum
- Halo sign
- Amphotericin B
What is the treatment of CAP?
- Calculate CURB-65 score
0-1 (Mild):
- Amoxicillin PO 5/7
- 2nd line/pen alergy: Macrolide PO 5/7
- OPD Tx
2 (Moderate):
- Amoxicillin PO 5-7/7 + Clarithromycin PO 5-7/7
- ?Admission
3-5 (Severe):
- Co-amoxiclav IV 7/7 + Clarythromycin IV 7/7
- Admit +/- ?ITU
What are the elements of the CURB-65 score?
1 point each:
- Confusion
- Urea >7
- RR > 30
- BP < 90/69
- >=65yrs
What is the treatment of HAP?
Dependent on Trust guidelines
- Ciprofloxacin + Vancomycin
- IF Severe: Tazocin + Vancomycin
What is seen on a covid CXR + it’s treatment?
- Ground-glas shadowing
- Tx: Dexamethasone
What Abx is given for pneumonia if MRSA is confirmed?
Vancomycin
What Abx is given for pneumonia if Psuedomonas is confirmed?
Tazocin (piperacillin + tazobactam)
