Pulmonary infection Flashcards
Young lady with BM transplant presents with cough, skin abscess and listlessness. Sputum shows gram +ve bacteria. What is the cause?
Actinomyces israelii
Bacillius anthracis
Nocardia
PCP
TB
Nocardia
- cause triad of pneumonia, CNS involvement and skin abscess
- post-tx immunocompromised
- gram +ve, acid-fast
–>treat with septrin, amikacin or 3rd gen cephalosporin for 6-12months
Actino
- head and neck skin changes
- after dentist work or intrauterine contraceptive implant
- more indolent infection
- immunocompromised /COPD/poor oral hygiene
- gram +ve, yellow sulphur granules
–> treat penicillin
Bacillus
- flu-like symptoms
- skin abscess black
What big causes a pleural effusion with an alkaline pH?
Proteus mirabilis (due to ammonia production)
How is severity of PCP classified?
Mild = paO2>9.3
Mod/Sev = paO2≤9.3
Difference is that give oral steroids in mod/sev
What is the infectious profile of pt with well-controlled HIV?
Increased risk of pneumonia, TB, COPD, pulmonary HTN and lung cancer even if normal CD4 count
Increased risk of cavitation and empyema
What might you expect to see in immunoglobulin profile of pt on longterm steroids?
Isolate IgG deficiency
What might you expect on bloods in CVID?
IgG deficiency + IgA or M
Poor vaccine response
Nb. need age>4
What immunodefiency should you suspect if normal immunoglobulin levels?
Specific Ab deficiency
What kind of lung disease do you see with CVID/XLA?
Bronchiectasis
Asthma
ILD (resembling sarcoid)
Atypical lymphoid infiltrates (multiple nodules that may resolve spontaneously)
Nb. also get sinus infections
Nb. most common bacteria = encapsulated: pneumococcus and haemophilus
Nb. Get lots of viral infections
What kind of infections to pt with CVID tend to get?
Sinus
Viral
Encapsulated bacteria: pneumococcus and haemophilus
When might you suspect specific Ab deficincy vs CVID?
Also get sino-pulmonary/ear infections but less severe
Will have normal Ig levels and response to protein-based vaccines
Nb. treat with higher dose and prolonged abx. Occasionally need prophylaxis.
When might you suspect XLA?
<5yrs, male relative with disease
Recurrent pyogenic ifx (s.pneum, h.inf, s.aureus, pseud)
Nb. BTK gene mutation
Nb2. manage like bronchiectasis and IgG therapy
When might you suspect Good’s syndrome?
Looks a bit like CVID/XLA but late onset and have hx of thymectomy
What is hyper igE syndrome?
Immune deficiency - get high IgE and eosinophila
Get eczema and fungal infections and structural pulmonary and vascular dsiease
Does selective IgA deficiency tend to cause infections?
No
What infection should you be suspiciou of if been to farm?
Coxiella burnetti
Why might you suspect Mycoplasma pneumonia?
Lethargy, fevers, non-productive cough, headache
Widespread rash, sore throat/hoarse voice
Often young adult, smoker
CXR: peribronchial and perivascular reticular interstitial infiltrates
Tx: macrolide or tetracycline
Nb. won’t show up on gram stain
What is Loeffler’s syndrome?
(don’t confuse with Lofgrens = sarcoid: fever, erythema nodosum + bihilar infiltrates)
Benign pulmonary eosinophilia
- pulmonary infiltrates
- peripheral eosinophilia
- cough, sob, wheeze
- secondary allergic response to helminth: ascaris, strongyloides
Differential between:
1) Blastomycosis
2) Coccidiomycosis
3) Histoplasmosis
4) Mucormycosis
5) Paracoccidiomycosis
1) outdoor activities near water
cough/SOB/skin or bone lesions
lobar consolidation, diffuse or nodular infiltrates
2) desert, sand storms, construction, military exercise
cough/SOB/fever/fatigue
eosinophilia, lobar consolidation, focal or diffuse infiltrates, cavities, effusion
3) America (ohio river), bat/rodent droppings (often in soil)
cough/SOB/fever/arthalgia
focal, diffuse or cavitatory infiltrates, lymphadenopathy
4) Immunocompromised
Fever/cough/chest pain/SOB
Solitary nodule/lobar consolidation/cavitatory lesion or disseminated forms
5) South America
Acute: Fever/wt loss/hepatosplenomegaly/lymphadenopathy
Chronic: cough/SOB/haemoptysis/wt loss
Diffuse/nodular infiltrates
What classifies someone as having severe covid?
One of:
- RR >30
- severe resp distress
- SATS <90%
When should CPAP be offered in COVID?
Needing 40% oxygen or more
Nb. Target sats >=94%
What are indications for Tociluzumab?
CRP>75 when commenced on CPAP
What are indications for Remdesevir?
Low flow oxygen NOT HFNO, CPAP, invasive
What are indications for Nirmatrelvir/Ritonavir? (Paxlovid)
Not on oxygen
High risk of progression to severe COVID
When can oseltamivir be used?
Influenza and known influenza A or B circulating
<48hrs symptom onset
High risk patient - includes diabetes, chronic resp/heart/liver/renal/neuro - nb includes asthma
Farmer presents with 24hr hx of fever, myalgia, cough and large volume haemoptysis. He has jaundice and conjunctival haemorrhages. He has coagulopathy, thrombocytopaenia, acute renal and liver dysfunction. Autoimmune screen negative. What is most likely diagnosis?
Leptospira (Weil’s disease)
