pulm infectious disease Flashcards
inflammation that causes a cough
bronchitis
- 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
acute bronchitis
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
late fall and winter
what bacteria most likely causes prolonged cough (acute bronchitis)
(whooping cough, characteristic postussive vomiting, prolonged cough–up to 12 weeks)
B. pertussis
first choice to treat acute bronchitis caused by pertussis
azithromycin
what usually precedes bronchitis
URI
what is the cardinal symptom of acute bronchitis
cough (lasting at least 5 days)
- Cough
- Wheezing
- Mild dyspnea
- Rhonchi
- With prolonged coughing, chest wall or substernal musculoskeletal pain can occur
signs and symptoms of acute bronchitis
diagnostics for acute bronchitis
clinical
make sure they don’t have any other concerning symptoms –> parenchymal consolidation, high fever, possessive emesis, inspiratory whoop
when do you do testing for acute bronchitis
- 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
acute bronchitis treatment
- mostly supportive
- throat lozenges
- hot tea, honey
- stop smoking
- OTC cough med
- hydration
- humidity
- expectorants
- dextromethorphan
develops outside of hospital
community acquired pneumonia
- hospital acquired pneumonia
- ventilator acquired pneumonia
nosocomial pneumonia
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
pneumonia
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
- cough reflex
- mucociliary clearance system
- immune responses
when does CAP occur
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
what is the most common pathogen in CAP
strep pneumoniae
pneumonia classifications
- where you got the infection (CAP or HAP)
- types of pathogens (bacterial, viral,fungal)
- clinical presentation (typical/atypical)
- extent of involvement and CXR findings (lobar, interstitial, cavitary)
- 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
signs and symptoms of pneumonia
- 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
community acquired pneumonia
immunocompromised patients with pneumonia are at risk for
- gram-negative empiric bacteria
- mycobacterium avium complex
- Fungi: aspergillosis
- Viruses: CMV
- pneumocystis jiroveci carinii
Patients with cystic fibrosis at risk for
- Staph aureus in infancy
- Pseudomonas aeruginosa or Burkholderia cepacia in older children
how to diagnose pneumonia (outpatient)
CXR- preferable to confirm diagnosis
(do not have to have definitive pathogen)
pneumonia diagnostics
what does bacterial, viral, and atypical show?
- 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