Resp Infection Flashcards
In CF Organisms which may colonise Pts (4)
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Burkholderia cepacia*
- Aspergillus
Pancreatic & Liver sx of CF
- pancreatic insufficiency- preventing digestive reaching the gut = fat isn’t absorbed, causing steatorrhea & vitamin A, D, E, and K, deficiencies
-
avitaminosis A= pancreatitis= insulin-dependent DM.
biliary cirrhosis
Genes effected in CF
Pathology of CF
AR Chrom 7 , ∆F508
resulting
CFTR mutation –> misfolded protiens –> Chloride channel dysfuntion in the mucus and sweat-producing cells= increased viscosity of secretions= Blockage
bilateral absence of vas deferens & infertile occurs in what disease
CF
Labs in CF (2)
- HYPOkalemia
- contraction ALKalosis in those with symptoms suggestive of hypovolemia.
DX of CF
pilocarpine sweat test
Respiratory sx in CF (4)
-
Bronchiectasis- obstructive pattern
2.Pneumonias : Stap. A or MRSA; Pseudomonas aeruginosa
3.Allergic bronchopulmonary aspergillosis, or ABPA (Hypersensitivity to Aspergillus fumigatus that can live in the sinus or lung cavity)
4 Nasal polyps
FEV1 in CF
decrease
Rx CF (6)
- Chest physio
- Mucolytic
- Bronchodilators
- Anti-inflammatory
- abx azithromycin
-
CFTR modulators- ivacaftor, tezacaftor
and lumacaftor,
Explain action of CFTR modulators ivacaftor, and lumacaftor
Lumacaftor-can correct the misfolded protein & bring it to the cell membrane,
Ivacaftor-which opens the chloride channels & improves the ion’s transport.
Allergic Bronchopulmonary Aspergillosis (ABPA)
Labs
RAST
Ig
- eosinophilia
- flitting CXR changes
- positive radioallergosorbent (RAST) test to Aspergillus
- +ve IgG precipitins (not as positive as in aspergilloma)
- raised IgE
Rx Allergic Bronchopulmonary Aspergillosis (ABPA)
- oral glucocorticoids
- itraconazole is sometimes introduced as a second-line agent
Ix Aspergilloma
Investigations
1. Chest x-ray containing a rounded opacity. A crescent sign may be present
2. high titres Aspergillus precipitins
Bronchiectasis on imaging & PFTS
tram-track and signet ring signs
Obstructive picture
Pneumonia, particularly following influenza or Ass. w/
IV drug
Staphylococcus aureus
Pneumonia ass w/ cold sores
Cold sores
Most common cause of CAP
Pneumonia ass. w/ bronchiectasis exacerbations
Haemophilus influenzae
Most common organisms isolated from patients with bronchiectasis:
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
Pneumonia ass. w/ Aspiration, Alcoholic and Diabetics
Outcomes
Klebsiella pneumoniae
* commonly causes lung abscess formation and empyema & lung necrosis
What are Atypicals of lung infection
- Mycoplasma pneumoniae
2.Legionella pneumophilia
3.Chlamydia psittaci
4.
Chlamydia psittaci rx
doxycycline or erythromycin
Pneumonia ass. w/ deranged LFT & HYPONa
RX
Legionella
erythromycin/clarithromycin
Pneumonia ass w/
bullous myringitis
cold agglutins (IgM)
ITP
& RX
Mycoplasma pneumoniae
doxycycline or a macrolide
Pneumocystis jiroveci/ Pneumocystis pneumonia rx & Prophylaxis
have few chest signs and develop exertional dyspnoea
trimethoprim/sulfamethoxazole is usually used for treatment and dapsone as a prophylaxis for HIV+ people with a CD4+ count under 200 cells per microliter
common infective causes of COPD exacerbations
- Haemophilus influenzae (most common cause)
- Streptococcus pneumoniae
- Moraxella catarrhalis
Ventilator-associated pneumonia,
Pseudomonas aeruginosa and Staph. aureus
Pneumonia : Cavitation develop in (5)
- S. aureus
- Klebsiella
- Legionella
- Pseudomonas aeruginosa
- Mycrobactum tuberculosis
Primary tuberculosis vs secondary TB (reactivation )
Primary TB - Ghon focus is composed of tubercle-laden macrophages. The combination of a Ghon focus and hilar lymph nodes is known as a Ghon complex. Type 4 hypersensitivy
Secondary TB is usually found where in the lung
upper lobes
How does rifampin work
preventing transcription
Not being able to generating mRNA, the bacteria will die.
SE isoniazid (6) & what should it be prescribed with
- Hepatotoxicity,
- P- 450 inhibition,
- drug-induced lupus,
- anion gap metabolic acidosis,
- seizures that are refractory to benzodiazepines.
- vitamin B6 deficiency= peripheral neuropathy and sideroblastic anemia. Thus administered w/ pyridoxine which is B6 vitamin.
SE of Pyrazinamide (2)
can cause
1. hyperuricemia and
2. hepatotoxicity.
ethambutol SE
optic neuritis,
Ix aspergillosis
Fungal infection
Galactomannan
Halo sign on HR CT
BAL = fungal hyphea
A cause of massive hemoptysis
Aspergilloma
may require bronchial art embolism
people where a tuberculin test may be falsely negative :
*
miliary TB
* sarcoidosis
* HIV
* lymphoma
* very young age (e.g. < 6 months)
causes of bilateral hilar lymphadenopathy
Sarcoidosis and tuberculosis.
Other causes include:
lymphoma/other malignancy
pneumoconiosis e.g. berylliosis
fungi e.g. histoplasmosis, coccidioidomycosis
what is Kartagener’s syndrome/ primary ciliary dyskinesia sx (4)
Features
1. dextrocardia or complete situs inversus
2. bronchiectasis
3. recurrent sinusitis
4. subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
