Resp Infections Flashcards
CURB65 and criteria for each?
What scores mean?
Confusion (<=8/10 on MSQ) Urea (>7) Resp rate (>=30) BP (<=90/60) 65 (age >=)
0-2 = mild-mod 3-5 = severe
Treatment of mild/mod CAP?
Amoxicillin 5 days
(Doxycycline or Clarithromycin if allergic)
Usually treat at home
Treatment of severe CAP?
Co-amoxiclav + doxycycline
(Levofloxacin monotherapy if pen allergic)
Usually transfer to hospital
Treatment of severe CAP requiring ICU admittance?
Co-amoxiclav + clarithromycin
Levofloxacin monotherapy if pen allergic
Step down for all patients with severe CAP?
Doxycycline IV/PO 5 days
Treatment of non-severe HAP?
Amoxicillin 5 days
Doxy if pen allergic
Treatment of severe HAP?
Step down?
Amoxicillin + gentamicin
(Co-trimoxazole + gentamicin if pen allergic)
Step down: Co-trimoxazole IV/PO 7 days
Treatment of severe HAP with previous ICU admission or Hx of MRSA?
Contact microbiology
Treatment of non-severe aspiration pneumonia?
Amoxicillin + metronidazole 5 days
Doxy + metronidazole if pen allergic
Treatment of severe aspiration pneumonia?
Step down?
Amoxicillin + metronidazole + gentamicin
(replace amoxicillin with doxy or clarithromycin if pen allergic)
Step down: amoxicillin + metronidazole 7 days
Antibiotic treatment of acute exacerbation of COPD?
No antibiotics unless purulent sputum, consolidation on CXR or other signs of pneumonia
1st line - amoxicillin
2nd line - doxycycline
(5 days)
Antibiotic treatment of acute bronchitis?
Antibiotics give no significant clinical benefit - only consider in frail or elderly
1st line - amoxicillin
2nd line - doxycycline
(5 days)
What must you consider when prescribing clarithromycin?
QTc prolongation
Name 5 atypical pneumonias?
Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella pneumophila Coxiella burnetti Viral pneumonia
Most common cause of pneumonia?
Specific signs/associations? (4)
CXR?
Strep pneumoniae (pneumococcus)
High fever, rapid onset, herpes labialis precedes, rusty sputum
Lobar consolidation
Who is staph aureus pneumonia common in? (2)
CXR?
Rx for MRSA?
MRSA toxin?
IVDU, recent influenza infection
Bilateral cavitating bronchopneumonia
Vancomycin
PVL - panton valentine leukocidin
Who does Klebsiella pneumonia typically affect? (3)
CXR?
Alcoholics, diabetics, elderly
Cavitating pneumonia - often R upper lobe (most common for aspiration when recumbent)
Who does pseudomonas pneumonia typically affect?
Bronchiectasis and CF patients
Pattern of Mycoplasma Pneumoniae infection? Symptoms? CXR? Diagnosis? Complications?
Occurs in epidemics (roughly every 4 years)
Flu-like Sx with dry cough, headache, myalgia
No typical CXR pattern, may show reticulo-nodular shadowing
Diagnosis by serology
Complications: haemolytic anaemia, erythema multiforme, guillain-barre syndrome, myelitis
Who does legionella pneumonia typically affect? Symptoms? CXR? What may be seen on blood tests? Diagnosis?
Recently been abroad to warm location, it typically colonises water tanks and air conditioning units
Non-specific symptoms sometimes, with cough, D&V, hepatitis, AKI, haematuria
CXR = bi-basal consolidation
Bloods = lymphopaenia, hyponatraemia, deranged LFT
Diagnosis = urine antigen, blood serology, or PCR from BAL
What is the commonest chlamydia infection?
How does it spread?
Illness pattern?
Diagnosis?
Chlamydophila pneumonia (tends to cause mild pneumonia in younger patients, similar to mycoplasma) Person-to-person
Biphasic illness:
1 - pharyngitis, hoarseness, otitis
2 - pneumonia
Diagnosis = complement fixation test, or IgM serology
Who does chlamydia psitacci typically affect? Symptoms? Extra-pulmonary features? CXR? Diagnosis?
Those with birds (parrots, pigeons, cockatiels etc)
Symptoms = headache, fever, dry cough, lethargy, anorexia
Extra-pul = D&V, meningo-encephalitis, hepatitis, endocarditis, nephritis etc
CXR = patchy consolidation
Diagnosis = chlamydia serology
Who does pneumocystis pneumonia typically affect? Symptoms/signs? CXR? Diagnosis? Treatment?
Immunocompromised - part of normal lung flora (e.g. HIV)
Dry cough, SOB, typically absence of chest signs - exercise-induced desaturations
CXR may be normal or show bilateral hilar shadowing
Diagnosis = can be from sputum induction and expectoration (induce by nebulising hypertonic saline)
OR PCR from BAL
Rx: Co-trimoxazole and Pentamidine
Who does coxiella brunetti (Q Fever) usually affect?
Symptom onset?
Diagnosis?
Sheep farmers
2-4 weeks after infection, insidious flu-like symptoms like fever, headache and myalgia
Pneumonia and hepatitis can then develop
Diagnosis by serology
2 commonest causes of acute exacerbation of COPD?
Pneumococcus
H Influenzae
3 commonest causes of HAP?
Pneumococcus
H Influenzae
Coliforms
Legionella can also cause HAP
Name 4 coliforms?
What covers them?
What else does this drug give good coverage of?
(Gram negative)
E coli
Klebsiella
Enterobacter
Proteus
Gentamicin
Pseudomonas (also gram neg)
What drugs have anaerobic cover?
Metronidazole Co-amoxiclav Clindamycin Pipperacillin-Tazobactam Meropenem
What are EBSL’s?
What are they resistant to?
What should be used for them?
Extended spectrum beta-lactamases
Resistant to all penicillins, including co-amox, pipperacillin-tazobactam and aztreonam
Rx: Temocillin, Pivmecillonam or Meropenem
Do temocillin and aztreonam have anaerobic cover?
No
When is staph aureus pneumonia particularly bad?
Following influenza infection
If PVL-producing staph
What are CRE’s?
What are they resistant to?
Carbapenem- resistant enterobacterales
Virtually everything - pretty much untreatable
What is VRE?
What are they resistant to?
Vancomycin-resistant enterococcus
Vancomycin and meropenem
What is MRSA?
What is it resistant to?
How should it be treated?
Meticillin-resistant Staph Aureus
All beta-lactams (penicillins, fluclox, cephalosporins, tazocin & meropenem)
Vancomycin
What is invasive aspergillosis?
3 types of aspergillus?
CXR?
How can it be diagnosed?
When aspergillus which normally colonises the lung as flora invades throughout the lung in immunocompromised patients - this can spread to disseminated infection and is a leading cause of death in the immunocompromised
A. flavus, A. fumigatus, A. terreus
CXR may show widespread infection
Diagosis by bronchoscopy and BAL
What is allergic bronchopulmonary aspergillosis? Symptoms? CXR? Other Ix? Rx?
Allergy to aspergillus spores in the lung
Symptoms similar to asthma - productive cough, wheeze, dyspnoea for months, but not very responsive to treatment
Proximal bronchiectasis
Raised eosinophils, raised IgE, positive RAST for aspergillus, raised aspergillus IgM, positive skin prick test for aspergillus
Rx: mainstay = oral prednisolone
Oral itraconazole sometimes used as 2nd line or steroid sparing agent
