Pneumonia & TB

Question 1

What is pneumonia?

Answer 1

Pneumonia is a lower respiratory tract infection in which consolidation can be seen on an Xray.

It can be caused by both bacteria and viruses.

Question 2

What are the common causative organisms in the following age ranges, neonates, infants, >5yo?

Answer 2

Newborns – organisms from the mothers genital tract i.e. group B strep and gram negative enterococci

Infants and young children – RSV is most common but also strep pneumoniae and H.influenzae.

Children over 5 - mycoplasma pneumoniae, strep pneumoniae and chlamydia pneumoniae.

Question 3

Describe how a patient with pneumonia may present?

Answer 3

Wet cough.
Breathlessness.
Localised chest pain.

Fever.
Headache.
Malaise.

O/e: 
Respiratory distress. 
Tachycardic
Dull to percussion over affect area.
Reduced breath sounds.
End inspiratory coarse crackles

Question 4

What investigations should be done in suspected pneumonia?

Answer 4

Bedside:
Obs
Urine dip (look for specific antigens legionella in severe)

Bloods:
FBC
U/E’s (hyponatraemia in legionella)
CRP (to monitor progress)

Microbiology:
Sputum culture
Nasal pharyngeal aspirate

Imaging:
CXR

Question 5

Describe the management of pneumonia?

Answer 5

Most cases treated in community.

Admit if severe tachypnoea, O2 sats less than 94%

Question 6

What causes Tb?

Answer 6

Mycoplasma Tuberculosis

Question 7

How can you categorise TB infection and describe the categories?

Answer 7

Primary: (usually in children)
Symptomatic infection after initial infection. The initial focus of infection is a small subpleural granuloma accompanied by granulomatous hilar lymph node infection. These are known as Ghon complexes and the primary infection almost always resolves.

Latent:
In which there is an infection with M. tuberculosis but no primary infection. May later reactive to cause a post primary infection (milliary tb) or to cause secondary Tb.

Secondary:
Seen mostly in adults as a reactivation of previous infection (or reinfection), particularly when health status declines. The granulomatous inflammation is much more florid and widespread. It can affect any area of the body but most commonly affects the lungs.

Question 8

How will latent Tb be discovered?

Answer 8

An asymptomatic person will test +ve on the matrix test.

Question 9

How would a person with secondary respiratory Tb present?

Answer 9

Respiratory:
Breathing difficulty.
Chest pain.
Productive cough and haemoptysis

Systemic:
Night sweats
Fatigue.
Fever.
Weight loss.

Question 10

What is the treatment for Tb?

Answer 10

Combined antibiotic therapy:
RIPE

Rifampacin
Isoniazid
Pyrazinamide
Ethambutol

Quadruple therapy for 2months, double therapy for 4 months.

For latent Tb treat with double therapy for 3 months.