Pneumonia & TB Flashcards
What is pneumonia?
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. (although in 50% of cases no pathogen is found)
What are the common causative organisms in the following age ranges, neonates, infants, children over 5?
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 (Hib vaccine now so not common)
Children over 5
- mycoplasma pneumoniae
- strep pneumoniae
- chlamydia pneumoniae
At all ages mycobacterium tuberculosis should be considered
Describe how a patient with pneumonia may present?
- Wet cough
- Breathlessness
- Localised chest pain (feature of pleural irritation)
- Fever
- Headache
- Malaise/lethargic/poor feeding
O/e:
- Respiratory distress
- Tachycardic
- Dull to percussion over affect area
- Reduced breath sounds
- End inspiratory coarse crackles over affected area
What investigations should be done in suspected pneumonia?
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 (can help with diagnosis viral vs bacterial)
Imaging:
- CXR (can confirm diagnosis but with exception of a classic lobar pneumonia - strep pneumoniae, can differentiate viral vs bacterial)
Describe the management of pneumonia?
Most cases treated in community.
Admit if severe tachypnoea, O2 sats less than 94%
What is the treatmet for pneumonia patients admitted to hospital?
General supportive care:
- Oxygen for hypoxia
- Analgesia for pain
- IV fluids to maintain adequate hydration and salt balance
- No physiotherapy
Antibiotics:
- Depends on age, severity and appearance on chest x-ray
- Newborns broad spectrum IV abx (i.e. co-amoxiclav)
- Older infants oral amoxicillin
- Other abx available for complicated or unresponsive children
What causes Tb?
Mycoplasma Tuberculosis
How can you categorise TB infection and describe the categories?
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
How will latent Tb be discovered?
An asymptomatic person will test +ve on the mantoux test.
(+ve if >10mm or >15mm if they have had the BCG immunisation)
How would a person with secondary respiratory Tb present?
Respiratory:
- Breathing difficulty
- Chest pain
- Productive cough and haemoptysis
Systemic:
- Night sweats
- Fatigue
- Fever
- Weight loss.
What is the treatment for Tb?
Combined antibiotic therapy:
RIPE
Rifampacin Isoniazid Pyrazinamide Ethambutol
Quadruple therapy for 2months, this is decreased to two drugs - double therapy (rifampicin and isoniazid) for 4 months
Total treatment time = 6 months usually
For latent Tb treat with double therapy for 3 months.
