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pulmonology > pulm infectious disease > Flashcards

pulm infectious disease Flashcards

1
Q

inflammation that causes a cough

A

bronchitis

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2
Q
  • Cough
  • lower respiratory tract infection involving the bronchi without evidence of pneumonia that occurs in the absence of chronic obstructive pulmonary disease
  • symptoms result from inflammation of the lower respiratory tract and are
    most frequently due to viral infection
  • lasts for at least five days ***
  • typically self-limited, resolving within one to three week
A

acute bronchitis

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3
Q

The incidence of acute bronchitis is highest in _____ when
transmission of respiratory viruses peaks
* Influenza A and B
* Parainfluenza
* Coronavirus types 1 to 3
* Rhinoviruses
* Respiratory syncytial virus
* Human metapneumovirus

A

late fall and winter

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4
Q

what bacteria most likely causes prolonged cough (acute bronchitis)

(whooping cough, characteristic postussive vomiting, prolonged cough–up to 12 weeks)

A

B. pertussis

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5
Q

first choice to treat acute bronchitis caused by pertussis

A

azithromycin

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6
Q

what usually precedes bronchitis

A

URI

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7
Q

what is the cardinal symptom of acute bronchitis

A

cough (lasting at least 5 days)

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8
Q
  • Cough
  • Wheezing
  • Mild dyspnea
  • Rhonchi
  • With prolonged coughing, chest wall or substernal musculoskeletal pain can occur
A

signs and symptoms of acute bronchitis

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9
Q

diagnostics for acute bronchitis

A

clinical

make sure they don’t have any other concerning symptoms –> parenchymal consolidation, high fever, possessive emesis, inspiratory whoop

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10
Q

when do you do testing for acute bronchitis

A
  • Suspected pneumonia
  • clinical diagnosis is uncertain-suspect flu, pertussis, Covid-19
  • results would change management
  • a positive influenza test result in a patient who meets criteria for antiviral therapy
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11
Q

acute bronchitis treatment

A
  • mostly supportive
  • throat lozenges
  • hot tea, honey
  • stop smoking
  • OTC cough med
  • hydration
  • humidity
  • expectorants
  • dextromethorphan
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12
Q

develops outside of hospital

A

community acquired pneumonia

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13
Q
  • hospital acquired pneumonia
  • ventilator acquired pneumonia
A

nosocomial pneumonia

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14
Q

an infection that inflames the air sacs in one or both lungs.
* The air sacs may fill with fluid or purulent material
* cough with phlegm or pus, fever, chills, and difficulty breathing
* caused by variety of organisms, including bacteria, viruses and fungi

fluid in the alveoli

A

pneumonia

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15
Q

Pulmonary defense mechanisms normally prevent the development
of lower respiratory tract infections following aspiration of
oropharyngeal secretions containing bacteria or inhalation of infected
aerosols causing pneumonia

A
  • cough reflex
  • mucociliary clearance system
  • immune responses
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16
Q

when does CAP occur

A

when there is a defect in one or more of these:
* cough reflex
* mucociliary clearance system
* immune responses
or when a large infectious inoculation or a virulent pathogen overwhelms the immune response

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17
Q

what is the most common pathogen in CAP

A

strep pneumoniae

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18
Q

pneumonia classifications

A
  1. where you got the infection (CAP or HAP)
  2. types of pathogens (bacterial, viral,fungal)
  3. clinical presentation (typical/atypical)
  4. extent of involvement and CXR findings (lobar, interstitial, cavitary)
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19
Q
  • Fever or hypothermia
  • Cough
  • Dyspnea
  • Sweats/chills
  • Chest discomfort, pleuritic chest pain
  • Tachypnea, tachycardia
  • Hypoxia
  • May appear acutely ill
  • Inspiratory crackles, bronchial breath sounds***
  • Dullness to percussion if lobar consolidation or pleural
    effusion
A

signs and symptoms of pneumonia

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20
Q
  • Diagnosed outside the hospital in ambulatory patients who are not
    residents of nursing homes or other long-term care facilities
  • May also be diagnosed in a previously ambulatory patient within 48 hours after admission to the hospital
  • Risk factors include: advanced age, alcoholism, tobacco use, comorbid
    medical conditions especially asthma or COPD, and immunosuppression
A

community acquired pneumonia

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21
Q

immunocompromised patients with pneumonia are at risk for

A
  • gram-negative empiric bacteria
  • mycobacterium avium complex
  • Fungi: aspergillosis
  • Viruses: CMV
  • pneumocystis jiroveci carinii
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22
Q

Patients with cystic fibrosis at risk for

A
  • Staph aureus in infancy
  • Pseudomonas aeruginosa or Burkholderia cepacia in older children
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23
Q

how to diagnose pneumonia (outpatient)

A

CXR- preferable to confirm diagnosis

(do not have to have definitive pathogen)

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24
Q

pneumonia diagnostics

what does bacterial, viral, and atypical show?

A
  • Bacterial pneumonia shows lobar infiltrates/consolidation, or a round
    pneumonia with pleural effusion
  • Viral pneumonia shows diffuse, streaky infiltrates in the bronchi and
    hyperinflation
  • Atypical pneumonia shows increased interstitial markings or
    bronchopneumonia
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25
Q

pneumonia inpatient testing

A
  • Hospitalized patients should have CBC, CMP
  • ABG
  • CXR: pulmonary opacity is required for diagnosis
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26
Q

classic sign of typical pneumonia

A

(one lobe affected)
- lobar infiltrates/consolodation

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27
Q

classic sign of atypical pneumonia

A

increased interstitial markings

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28
Q

classic sign of viral pneumonia

A

both sides affected
diffuse, streaky inflitrates

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29
Q

pneumonia inpatient testing to identify the pathogen

A

sputum culture/ gram stain before starting Abx

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30
Q

pneumonia treatment without complications (CAP outpatient empiric Abx)

A

make sure they are healthy persons who have not taken antibiotics within the past 3 months and not in an area of high macrolide resistant S. Pneumo

azithromycin (at least 5 days), doxy, or amoxicillin

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31
Q

pneumonia treatment if
* infants under 6 months of age with bacterial pneumonia
* concern for a pathogen with increased virulence (MRSA)
* concerns about the patient’s or caregiver’s ability to follow recommendations and to
assess symptom progression

A

hospitalization

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32
Q

CAP outpatient treatment if they have high risk for drug resistant like
* Abx therapy in last 90 days
* Age > 65
* Comorbidities
* Immunosuppression
* Exposure to a child in day car

A

Macrolide plus beta lactam (high dose amoxicillin or amox-clav are
preferred)
* Or Respiratory fluoroquinolone (levo, moxi, gemi

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33
Q

CAP – Inpatient Treatment not ICU

A

Macrolide + beta-lactam (ceftriaxone, cefotaxime, ceftaroline, ampicillin-
sulbactam)
* Or Respiratory Fluoroquinolone

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34
Q

CAP – Inpatient Treatment in ICU

A

Anti-pneumococcal beta-lactam (cefoxatime, ceftriaxone, ceftaroline, or
ampicillin-sulbactam) plus either azithromycin or a respiratory fluoroquinolone
(moxi, gemi, or levofloxacin)

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35
Q

CAP – Inpatient Treatment in ICU
If PCN allergy:

A

Fluoroquinolone + aztreonam

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36
Q

complications of pneumonia

A

empyema
lung abscess
sepsis

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37
Q

how to prevent pneumonia

A

Pneumococcal vaccine for adults age 65 and older and in those who
are immunocompromised or have chronic illnesses
* Annual influenza vaccine
* SARS-CoV-2 vaccine

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38
Q

when to admit for pneumonia

A

CRB-65 scale

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39
Q

When to admit to ICU for pneumonia?
Major Criteria:

1 major or 3 or more minor

A
  • Septic shock w/ need for
    vasopressor support
  • Respiratory failure w/
    need for mechanical
    ventilation
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40
Q

when to admit to ICU for pneumonia
* Minor criteria:

1 major or 3 or more minor

A
  • Respiratory rate 30
  • Hypoxemia
  • Hypothermia
  • Hypotension requiring
    aggressive fluid
    resuscitation
  • Confusion/disorientation
  • Multilobar pulmonary
    opacities
  • Leukopenia
  • Thrombocytopenia
  • Uremia
  • Metabolic acidosis
  • Elevated lactate leve
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41
Q

occurs > 48 hours after admission to
the hospital or other health care facility and excludes any infection
present at the time of admission

A

HAP (nosocomial pneumonia)

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42
Q

develops > 48 hours following
endotracheal intubation

A

VAP (nosocomial pneumonia)

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43
Q

nosocomial risk factors

A
  • Antibiotic therapy in the preceding 90 days
  • Acute care hospitalization for at least 2 days in the preceding 90 days
  • Residence in a nursing home or extended care facility
  • Home infusion therapy, including chemotherapy, within the past 30 days
  • Long-term dialysis within the past 30 days
  • Home wound care
  • Family member with an infection involving a multiple drug-resistant
    pathogen
  • Immunosuppressive disease or immunosuppressive therapy
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44
Q

what is the pathogenesis of nosocomial pneumonia

A

Colonization of the pharynx and possibly the stomach with bacteria

Pharyngeal colonization is promoted by exogenous factors:
* instrumentation used during procedures
* contamination by dirty hands
* Equipment
* contaminated aerosols
* treatment with broad spectrum antibiotics that promote the emergence of drug-resistant organisms

  • Patient factors also involved: malnutrition, advanced age, altered
    consciousness, swallowing disorders, underlying pulmonary and systemic diseases
  • Within 48 hours of admission, 75% of seriously ill hospitalized patients
    have their upper airway colonized with organisms from the hospital
    environment
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45
Q

most common organisms in nosocomial pneumonias

A

Gram positive cocci
* Staph aureus (MSSA, MRSA), Streptococcus

Gram negative bacilli
* Pseudomonas, Klebsiella, E. coli, Enterobacter

  • Anaerobic organisms-often polymicrobial
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46
Q

what may play a protective role against development of pneumonia

A

Gastric acid

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47
Q

why do patients taking antacids, H2 blockers, PPIs, or enteral feeding have a higher risk due to the alteration of the gastric pH

A
  • Change in pH can lead to gastric microbial overgrowth and tracheobronchial colonization
  • This leads to increased risk of esophageal, enteric infections, and lower respiratory tract infections
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48
Q

HAP – signs and symptoms

A

Can be non-specific
* Fever
* Leukocytosis
* Purulent sputum
* Worsening respiratory status

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49
Q

how to make a diagnosis for HAP

A

Two of these non specific symptoms + new or progressive opacity on CXR

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50
Q

labs for HAP

A
  • Blood cultures
51
Q

imaging/ labs for pleural effusion (HAP)

A

thoracentesis with pleural fluid analysis

52
Q

nosocomial pneumonia empiric treatment. ??

A

treatment based on risk factors:
* MRSA
* Multiple drug resistant pathogens
* Local antibiograms
* Mortality risk
* Duration is based on severity, response, comorbid condition
* Usually for 7 days, with some difference base
* HAP at high risk for mortality or VAP:
* Must consider and determine whether to cover:
* risk factors for MRSA
* risk factors for MDR
* Pseudomonas
* other gram-negative bacilli

53
Q
  • Atypical PNA
  • One of most common pathogens associated with CAP
  • mollicute genus of bacteria
  • Free living-can be passed person to person through respiratory
    droplets
  • Can also cause lower respiratory tract infection
  • Considered most common cause of “walking pneumonia”, as it usually causes a mild PNA
A

mycoplasma pneumonia

54
Q
  • Common cause of respiratory infection in children and young adults
  • may worsen asthma symptoms in children, adolescents, and adults and can also produce wheezing in children who do not have asthma
  • rates tend to rise in summer and peak in late fall
A

mycoplasma pneumonia

55
Q

mycoplasma pneumonia symptoms

A

often asymptomatic

56
Q

mycoplasma pneumonia treatment

A

URI and Acute bronchitis from Mycoplasma are usually self-limiting and don’t require treatment

57
Q

Gradual onset: may be heralded by headache, malaise, low-grade
fever, and sometimes sore throat
* Cough (either productive or nonproductive) typically follows and may be accompanied by pleuritic chest pain or shortness of breath.
* Chest soreness from persistent coughing is a common complaint

A

mycoplasma pneumonia

58
Q

what do you see on mycoplasma pneumonia chest x ray (varies a lot)

A

mild patchy hazy opacities

reticular nodular opacities or patchy consolidations

59
Q

What is treatment for CAP in a young healthy person (mycoplasma pneumonia)

A
  • M. pneumoniae infections may resolve spontaneously
  • Doxycycline, Azythromycin, Levofloxacin
60
Q
  • Atypical PNA
  • Outbreaks from contaminated water
  • showerheads, faucets, air conditioning
  • Most common in people who smoke, who have chronic lung disease or are immunocompromised
  • N/V/D are often prominent***
A

legionella pneumonia

61
Q

how to test for legionella pneumonia

A
  • Culture is 80-90% sensitive
  • Sputum PCR is also sensitive
62
Q

legionella pneumonia treatment

A

Azithromycin, Clarithromycin or a Fluoroquinolone (Levo)

63
Q
  • Aspiration of oropharyngeal secretions can lead to pneumonia caused by anaerobic bacteria
  • typically happens in people with altered consciousness
  • Periodontal disease and poor dental hygiene are risk factors
  • Pneumonia usually starts in dependent lung zones
  • Onset of symptoms is insidious: often by the time the patient seeks
    treatment, necrotizing pneumonia, lung abscess or empyema is present
  • Multiple species of anaerobic bacteria are common
A

anaerobic pneumonia and lung abscess

64
Q
  • alcoholic
  • aspirates
  • poor hygiene
A

anaerobic pneumonia and lung abscess

65
Q
  • Fever
  • Weight loss**
  • Malaise
  • Cough with expectoration of foul-smelling purulent sputum is common**
  • Often have poor dentition
A

signs and symptoms of anaerobic pneumonia and lung abscess

66
Q

labs and imaging for anaerobic pneumonia and lung abscess

A
  • Culture can only be done via transthoracic aspiration, thoracentesis, or bronchoscopy-can’t use sputum
  • lung abscess CXR – thick-walled solitary cavity surrounded by
    consolidation; air fluid level is usually present
  • necrotizing pneumonia CXR – multiple areas of cavitation within an
    area of consolidation
  • Empyema CXR or US – purulent pleural fluid and may have pleural
    loculations
67
Q

thick- walled cavity (white arrow) with a smooth inner margin (red
arrow), located in the right lung.
An air-fluid level is present
(black arrow)

A

lung abscess

68
Q

infected effusion and
pleural adhesions frequently
associated with anaerobic
organisms introduced into lung
by aspiration

A

empyema

69
Q

Anaerobic PNA/Lung abscess Treatment

A
  • 1st line: β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics
  • such as piperacillin-tazobactam or amoxicillin- clavulanate
  • Or a Carbapenem
70
Q

empyema treatment

A

Tube thoracostomy or open pleural drainage

71
Q

most common cause in infants

A

RSV

72
Q

most common in children older than age 5

A

mycoplasma pneumoniae

73
Q

risk factors for pneumonia in children

A
  • GERD (can occur in infants and children)
  • Neurologic impairment: aspiration
  • immunocompromised status
  • anatomic abnormalities of the respiratory tract: severe
    tracheomalacia
  • hospitalization especially if in an ICU
  • common when objects are inhaled
74
Q
  • Neonates – fever, hypoxia, subtle or absent physical exam findings
  • Young infant – apnea may be the only sign; +/- fever
  • Older infant and young children – fever, chills, tachypnea, cough,
    malaise, pleuritic chest pain, retractions, apprehension, difficulty
    breathing, shortness of breath
  • Older children present similarly to adults – fever, cough with or
    without sputum production, dyspnea
  • May also experience sweats, chills, rigors, chest discomfort, pleurisy,
    hemoptysis, fatigue, myalgias, anorexia, headache and abdominal pain
A

pneumonia in children signs and symptoms

75
Q
  • Causes annual outbreaks during winter –peak in Jan, Feb
  • Most significant LRI cause in young children worldwide
  • Leading cause of hospitalization in children in the US
A

RSV

76
Q

RSV prophylaxis

A
  • RSV antibody immunization is recommended for all infants who are
    younger than 8 months, born during or entering their first RSV season
  • IF birth parent did not receive RSV vaccine
  • or IF birth is within 14 days of vaccine administration
  • Additionally, a dose of RSV antibody (nirsevimab) is also recommended for children between the ages of 8 – 19 months entering their second RSV
    season who are in at least one of these groups:
  • Children who have chronic lung disease from being born premature and are requiring medical therapy for their lung disease
  • Children who are severely immunocompromised
  • Children with cystic fibrosis who have severe disease
  • American Indian and Alaska Native children
77
Q

major risk factor for RSV

A

prematurity

78
Q

what is RSV associated with later in life

A

airway reactivity (asthma)

79
Q

Proliferation and necrosis of
bronchiolar epithelium
produces obstruction and
increased mucus secretion

A

RSV pathophysiology

80
Q
  • Low grade fever

Bronchiolitis:***
* Wheezing
* Cough
* Tachypnea
* Difficulty feeding
* cyanosis

  • Grunting in an infant (characteristic)*****
  • Crackles**
  • Prolonged expiration
  • Retractions
  • Liver and spleen may be palpable because they are pushed down, but not actually enlarged
  • Apnea
  • Lethargy
A

RSV signs and symptoms

81
Q

how to diagnose RSV

A
  • Clinical diagnosis of bronchiolitis is made in infant or child with
    prodrome of upper respiratory infection lasting 1-3 days followed by
    persistent cough
  • plus tachypnea and/or chest retractions
  • plus wheeze and/or crackles on auscultation
82
Q

do you do RSV testing for a healthy kid

A

no (not routine)

83
Q

if you have RSV in a patient needing to be hospitalized what testing do you do to identify the pathogen

A

RT-PCR: reverse transcriptase-polymerase chain reaction with
nasopharyngeal swab

84
Q

chest xray: hyperinflation and slightly flattened diaphragms**

A

bronchiolitis (RSV)

85
Q

RSV treatment

A
  • Time
  • Hospitalize if hypoxic or unable to feed
  • Respiratory isolation
  • Supportive care
  • Hydration**
  • Humidifier or humidified oxygen
  • Nasal suction
  • Respiratory support as needed, rarely ventilation
86
Q
  • caused by Mycobacterium tuberculosis.
  • Slow growing bacteria
  • It can present as a pulmonary illness or have extrapulmonary
    involvement.
  • It is treatable
  • Higher rates among
  • Malnourished
    *Houseless/overcrowding/substandard housing
  • HIV-positive pts
  • IVDU
A

tuberculosis

87
Q

how is TB spread

A

aerosolized droplets
– then alveolar macrophages ingest TB

88
Q
  • TB spread by aerosolized droplets
  • Alveolar macrophages ingest TB
  • If macrophage microbicidal activity fails, infection follows
  • Lymph and hematogenous spread occurs, causing:
A

primary TB

89
Q

T cells and macrophages in health people surround the organisms and
contain them in granulomas, which prevents spread, and the disease
can remain dormant which is not infectious and not active

A

latent TB

90
Q

reactivation of TB

A

active TB

91
Q

TB screening for health care workers

A

tuberculin skin test (TST) and interferon-gamma release assays (IGRAs)

92
Q
  • Slowly progressive constitutional Sx
  • Malaise, anorexia, weight loss, fever, night sweats
  • Chronic cough-starts dry them changes to productive
  • most common symptom is productive cough for > 2 weeks
  • Blood-streaked sputum

PE:
* Chronically ill
* Malnourished
* No specific pulm findings

A

signs and symptoms of TB

93
Q

standard testing screening test for TB

A

Mantoux PPD test

  • 0.1 mL of purified protein derivative (PPD) containing 5 tuberculin
    units is injected intradermally on the volar surface of the forearm
    using a 27-gauge needle on a tuberculin syringe.
  • The transverse width in millimeters of induration at the skin test site
    is measured after 48–72 hours**
  • To optimize test performance, criteria for determining a positive
    reaction vary depending on the likelihood of infection
94
Q

size on induration of PPD
less than 5mm results

A

negative for TB

95
Q

size on induration of PPD
at least 5mm results positive if:

A
  • you’ve had recent contact with someone with TB
  • you are HIV positive
  • had an organ transplant
  • taking immunosuppressants
  • previously had TB
96
Q

size on induration of PPD
at least 10mm results positive if:

A
  • recently immigrated from a country with high incidence of TB
  • live in high risk environment
  • work in hospital, medical lab, or other high risk setting
  • child under age of 4
  • used injected drugs
97
Q

size on induration of PPD
at least 15mm results:

A

positive

98
Q
  • Previous TB vaccination with the bacille Calmette-Guérin (BCG)
    vaccine
  • Infection with nontuberculosis mycobacteria (mycobacteria other
    than M. tuberculosis)
  • Incorrect measurement or interpretation of reaction
  • Incorrect antigen used
  • TB blood tests–interferon-gamma release assays or IGRAs are
    preferred method for people who have received the vaccin
A

TB false positives for TST

99
Q

who should be tested for TB

A
  • People who have spent time with someone who has TB disease
  • People from a country where TB disease is common
  • People who live or work in high-risk settings (for example:
    correctional facilities, long-term care facilities or nursing homes, and
    homeless shelters)
  • Health-care workers who care for patients at increased risk for TB
    disease
  • Infants, children and adolescents exposed to adults who are at
    increased risk for latent tuberculosis infection or TB disease
100
Q

what do you do after positive screening TB test

A
  • Chest XR and Physical exam
  • May do other testing depending on suspicion
101
Q

latent TB treatment

A

Isoniazid plus rifapentine once weekly for 3 months recommended for adults and children aged ≥ 2 years, including persons with HIV if drug interactions allow.
* Rifampicin monotherapy daily for 4 months recommended for adults and
children without HIV.
* Isoniazid plus rifampicin daily for 3 months in adults and children without HIV and persons with HIV if drug interactions allow

102
Q

gold standard for suspected TB infection to identify pathogen

A

sputum culture-6-8 week return

103
Q

active TB treatment 6 month regimen

A
  • Directly observed therapy (DOT): requires that a health care worker
    physically observe the patient ingest antituberculous medications in
    the home, clinic, hospital, or elsewhere, also improves adherence to treatment.

6 month regimen:
* The initial phase of a 6-month regimen consists of 2 months of daily isoniazid, rifampin, pyrazinamide, and ethambutol
* Once the isolate is determined to be isoniazid-sensitive, ethambutol may be discontinued.

  • If the M tuberculosis isolate is susceptible to isoniazid and rifampin, the second phase of therapy consists of isoniazid and rifampin for a minimum of 4 additional
    months
  • treatment extends at least 3 months beyond documentation of conversion of sputum cultures to negative for M tuberculosis
104
Q

active TB treatment 9 month regimen

A

9 month regimen for those who cannot take pyrazinamide:
* daily isoniazid and rifampin along with ethambutol for 4–8 weeks
* If susceptibility to isoniazid and rifampin is demonstrated or drug
resistance is unlikely, ethambutol can be discontinued, and isoniazid
and rifampin may be given for a total of 9 months of therapy

105
Q

drug resistant TB is resistant to either

A

isoniazid or rifampin

106
Q

multidrug resistant TB is resistant to

A

both isoniazid or rifampin and possible others

107
Q

active TB precautions

A

Hospitalized patients with active disease require a private room with appropriate
environmental controls, including negative-pressure ventilation where available, until tubercle bacilli are no longer found in their sputum (“smear-negative”) on three
consecutive smears taken on separate days

108
Q
  • occurs due to lymphohematogenous spread and commonly involves
    multiple organs
  • millet seed-sized (1 to 2 mm) tuberculous foci—disseminated disease
  • accounts for 1%-2% of TB cases
  • typically presents 2-6 months after initial infection
A

miliary TB

109
Q

miliary TB treatment

A

same as pulmonary TB

110
Q

rifampin side effects

A

red-orange secretions and urine

111
Q
  • Disseminated:
  • at least two non-contiguous organ sites of the body
  • or infection of the blood, bone marrow or liver.
  • Miliary mottling on a chest radiograph is the classical hallmark
  • classified as both pulmonary and extrapulmonary tuberculosis
A

miliary TB

112
Q

ethambutol side effects

A

visual problems

113
Q

isoniazid side effects

A

peripheral neuritis

114
Q

pyrazinamide side effects

A

increased uric acid

115
Q

streptomycin side effects

A

ototoxic

116
Q

causes acute respiratory disease
* Transmitted primarily through respiratory droplets within close
contact
* Aerosol, fomites
* Dysregulated inflammatory response and a hypercoagulable state
* Viral protein binds the ACE2 receptors
* Causes dysregulation of renin-angiotensin-aldosterone system

A

covid 19

117
Q
  • Symptoms arise 2-14 days after exposure, mean incubation of 5 days
  • Fever or chills
  • Cough, SHOB
  • HA, muscle aches, dizziness, fatigue
  • Sore throat, congestion, runny nose
  • Loss of smell or taste***
  • N/V/D, abdominal pain, anorexia
  • Confusion, impaired consciousness
  • Rash
  • Asymptomatic in up to 30% of patients
A

covid 19

118
Q

current preferred
method of confirmation for covid 19

A

SARS-CoV-2 nucleic acid amplification test is current preferred
method of confirmation-usually done by nasal swab

119
Q
  • Infection from Aspergillus fumigatus
  • Lungs, sinuses and brain are most frequently involved organs
  • 3 clinical syndromes: Allergic, chronic, invasive
  • Invasive: disease of the immunocompromised or critically ill
  • At risk with COVID-19
  • Severe necrotizing PNA
  • Invasive sinus disease
  • Possible CNS or other organ involvement
A

aspergillosis

120
Q

covid 19 treatment

A
  • Hospitalization on a case-by-base basis

For non-hospitalized patients:
* Supportive care and try to reduce transmission

Consider for pts at high-risk for disease progression:
* Nirmatrelvir/ritonavir (Paxlovid)

121
Q

how to get a definitive diagnosis for invasive aspergillosis

A

tissue or culture

122
Q

what should you do if you have a clinical suspicion of invasive aspergillosis

A

chest CT: nodules, wedge shaped infarcts, halo sign

123
Q

Invasive Aspergillosis
* Prophylaxis for high risk Pts:

A
  • Posaconazole or voriconazole
124
Q

invasive aspergillosis treatment

A
  • 1st choice: IV voriconazole

pulmonology (8 decks)

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