Pulm Infxs Flashcards
MC serious viral airway infxn of adults
Respiratory secretions
Freq in winter
Influenza (A & B)
Signs/Sxs (Flu)
Acute/SUDDEN onset
HA, FEVER, chills, sore throat, myalgias, arthralgias
Progressive dyspnea -> resp. failure
Dx / Tx / Prevention (Flu)
Rapid tests (nasopharyngeal) A & B
Supportive (rest, hydration, Tylenol)
Oseltamivir - within 3-4 days
Annual vaccine
Self-limited inflamm of trachea, bronchi, bronchioles 2/2 infxn
Mucus formation
90% viral
Acute Bronchitis
Etiology (Acute Bronchitis)
Rhinovirus, coronavirus
Mycoplasma pneum
Chlamydophila pneum
Bordetella pertussis
Signs/Sxs (Acute Bronchitis)
Cough +/- sputum
Concurrent URI
Fever rare (unless flu or PNA)
Dx / Tx (Acute Bronchitis)
CXR (for abnml VS / pulm findings) - NML!!!
NO ABX; no cough supp or expectorants
Reassurance, NSAIDS/APAP, decongest.
Etiology of acute exacerbation of COPD
Infxn (70-80%): H. flu, S. pneum, flu, paraflu, coronavirus, rhinovirus
Non-infxn: smoking, meds, non-compliance, HF, allergens
Signs/Sxs (AE COPD)
Chng sputum (volume, character) Chng cough (freq, severity) Inc dyspnea, RR
Dx (AE COPD)
Sputum gram stain / cx
Viral studies (NP swab)
CXR (r/o PNA if fever, hypoxia)
Tx (AE COPD)
O2
Bronchodilators (albut + ipratropium)
Systemic steroids
Abx (Uncomplicated: Doxy, Bactrim, Zpack; Complicated: Augmentin, Levoflox)
1 ID cause of death
CAP
Etiology (CAP)
Typicals: S.pneum (fever, rigors, multi-lobar consolidation), H.flu, M.cat
Atypicals: Legionella, Mycoplasma, Chlamydophila (interstitial; not consolidated)
Signs/Sxs (CAP)
Typicals -
Atypicals -
- High Fever, Rigors, Sweats, Productive Cough, Lobar consolidation
- Fever, Fatigue, Non-productive Cough, Patchy infiltrates
+/-
Dyspnea, Myalgia, HA, Anorexia, Abd cramp, Tachypnea, Tachycardia, Adventitious BS
PNA - MC High fever Single rigor Productive cough - rust colored / purulent Pleurisy Lobar consolidation - white out on CXR Gram + diplococci Lancet shaped
S.pneum
PNA
Unimmunized
Underlying obstructive lung dz (COPD)
Gram - coccobacillus
H.flu
High fever
Hyponatremia
DIARRHEA
Appearance worse than CXR
Legionella
Bullous myringitis
COLD AGGLUTININS
Young, healthy pop. (“walking PNA”)
Mycoplasma
Laryngitis
Older pts
Interstitial
Chlamydophila
Dx (CAP)
CXR +/- :
Sputum analysis
Blood cx
Antigen detection (urinary, NP swab)
Gram - diplococci
only seen in M.cat and Gonorrhea mening.
Tx (CAP)
OUT.PT: Doxy, Zpack (macrolide), Levoflox (FQ) IN.PT: cover for S.PNEUM and LEGIONELLA Ceftriaxone (gold stnd for S.pneum) \+ Zpack (gold stnd for Legionella); FQ for B-lactam allergy (? elderly)
Mycobacterium
Slow growing, obligate, intracellular
Acid fast bacilli
Transmitted by resp droplets
TB
Etiology (TB Infxn)
Exposure
Lymphatic uptake of infected macrophages
CAP-like presentation
Etiology (Latent TB Infxn)
Infected but not acutely ill
Asx
Cannot spread TB
Have + skin test / blood test
Etiology (Active TB Dz)
= Reactivation Dz.
Sxs - FEVER, NIGHT SWEATS, anorexia, WT LOSS, COUGH, pleuritic chest pain, SOB, hemoptysis
Lymphadenitis of neck (scrofula)
Skeletal/spinal TB (Pott’s dz)
Dx 1 (TB)
Mantoux TST = PPD (evaluates latent & active TB); look at induration, not errythema
>5mm immunocompromised or recent TB contact
>10mm recent immigrant, IVDU, healthcare/ prison/ homeless setting, very young, co-morbid condtion
>15mm no RF
Dx 2 (TB)
Interferon-gamma release assay (IGRA)
(evaluates both latent & active TB)
blood test
can distinguish b/n prior BCG and TB infxn
Dx 3+ (TB)
Sputum for AFB & cx - for active TB only
Tissue bx - CASEATING GRANULOMAS
CXR - UPPER lobe infiltrates, CAVITATION
Tx (TB)
LTBI (latent TB infxn): Isoniazid (INH) x 9 mo
Active TB: 4 drug regimen
Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA), Ethambutol (EMB) x 6-8 wks
Followed by…2 drugs (INH & RIF) x 16 wks
M. avium + M. intracellulare
Commonly seen in AIDS pts (CD4<50), COPD
TB-like sxs
MAC (Mycobacterium avium complex)
Whooping cough
Very contagious
Bordetella pertussis
3 stages of Bordetella pertussis
1) Catarrhal: URI (1-2 wks)
2) Paroxysmal: “Whooping” cough, post-tussive vomiting
3) Convalescent: lasts months
Dx & Tx (Bord pertussis)
NP swab
1st line: macrolides (erythromycin, azithro)
2nd line: sulfa
PNA
ETOH
Moraxella catarrhalis
Causes of CAP in newborns
S. agalactiae (GBS)
Listeria
TB
Causes of CAP in children < 5
Similar to adults but less atypicals
Causes of CAP in children > 5 - teens
More likely to have Mycoplasma or Chlamydophila
Causes of CAP in adults
MC - Atypicals (Mycoplasma, Chlamydophila; Legionella - less common) S. pneum - common (? %) Viruses - 20% (Flu, paraflu, RSV) H. flu E. coli, Klebsiella - more common in NH
Post influenza PNA
“Bronchitis”
Difficult to differ from bact
Viral PNA
Influenza A/B, RSV, Coronavirus (SARS)
PNA that is very dependent on geographic location and immune status
Fungal PNA
Mississippi and Ohio River Valleys
Fever, Cough, CP, HA
Pulm infiltrates +/- hilar lymph nodes
Histoplasma capsulatum
Midwest US
Fever, Cough, Night sweats, Wt loss
Lobar PNA
Blastomyces dermatitides
Desert areas Southwest (AZ)
Flu-like sxs, Fatigue, Sore throat, Cough
Residual pulm nodule
Coccidioides immitis
Opportunistic, unicellular fungi
AIDS defining dz; CD4
Pneumocystis jiroveci / carinii PNA (PCP)
Tx (PCP)
O2, intubate/ventilate
IV abx
Prophylaxis: TMP/SMX if CD4 < 200
Extrapulmonary TB
1) Miliary - disseminated (lungs, GI, CNS); CXR (buckshot pattern)
2) Vertebral (Pott’s Dz.)
INH… 2 major side effects…
Tx one with…
peripheral neuropathy & liver problems Vit B6 (pyridoxine)
Peds
URI c wheezing
RSV, Flu, Paraflu
Acute bronchiolitis
W/U & Tx (Acute bronchiolitis)
CXR, CBC, RSV nasal swab
Supportive, ? hospitalize, Ribavirin
Peds
Acute inflamm upper airway
MC etiology: H. flu
Rapid onset fever, stridor, drooling, tripod, toxic-appearing
Acute epiglottitis
W/U & Tx (Epiglottitis)
DO NOT EXAMINE AIRWAY
Secure airway
Soft tissue neck x-ray (THUMB SIGN)
IVF, Abx, steroids, neb epi
Peds
Viral subglottic inflamm (Paraflu)
Stridor, “BARKING” cough, worse at NIGHT
Laryngotracheobronchitis (CROUP)
Dx & Tx (Croup)
Soft tissue neck x-ray (STEEPLE SIGN)
neb epi, steroid, IVF
Common winter virus in peds < 2 (PNA or bronchiolitis)
Rhinorrhea, fever, intercostal retractions, tachypnea
Resp Syncytial Virus (RSV)
Supportive care
