Resp tract infection Flashcards
conditions affecting upper resp tract
common cold - coryza
sore throat - pharyngitis
sinusitis
epiglottis
conditions affecting lower resp tract
acute bronchitis
acute exacerbations of chronic bronchitis
pneumonia
influenza
coryza
common cold
acute viral infection of nasal passages
symptoms can include
sore throat
mild fever
spread
droplets + fomites
complications
sinusitis
acute bronchitis
self limiting
acute sinusitis
after common cold
purulent nasal discharge
treatment
viral aetiology
self limited
10 days = better
some
antibiotics
diptheria
life threatening
toxin production
characteristic pseudo-membrane
not UK = vaccination
acute epiglottitis in children
life threatening due to obstruction
acute bronchitis
cold then to chest
clinical features productive cough fever normal chest exam normal chest X ray transient wheeze
acute bronchitis treatment
self limiting = normally
antibiotics = not indicated
sign morbidity = patients with chronic lung disease
URTI incubation times
rhiovirus 1-5 days group A streptococci 1-5 days influenza + parainfluenza viruses 1-4 days RSV 7 days Pertussi 7-21 days Diptheroa 1-10 days Eptsein Barr virus 4-6 days
acute COPD exacerbation
chronic sputum production
bronchoconstriction
airway inflammation
acute COPD clinical features
preceded by upper resp tract infection increased sputum production increased sputum purulence more wheezy breathless
acute COPD on examinations
resp distress wheeze coarse crackles may be cyanosed advanced disease = ankle oedema
acute COPD exacerbations primary care managemnent
antibiotic e.g. doxycylcline/ amoxicillin
bronchodilator inhalers
short course of steroids
acute COPD exacerbations refer to hospital
resp failure evidence
acopia
acute COPD exacerbations hospital management
arterial blood gases
CXR - find other diseases
O2 - resp failure
pneumonia symptoms
malaise anorexia sweats rigors myalgia arthralgia headache confusion cough pleurisy haemoptysis dyspnoea preceding URTI abdominal pain diarrhoea
pneumonia signs
rigors fever herpes labialis tachypnoea crackles rub cyanosis hypitension
pneumonia investigation
blood culture serology arterial gases full blood count urea liver function chest X ray
what is CURB65
severity score for community acquired pneumonia
1 point given for each
what does CURB65 stand for
C new onset confusion U urea>7 R resp rate >30/min B B.P. systolic <90 Diastolic <61 65 age 65 years or older
Other pneumonia severity markers - not CURB65
temp <35 or >40
cyanosis PaO2 <8 kPa
WBC < 4 or > 30
multi lobar involvement
Most common pneumonia
strep pneumonia
pets link to pneumonia
chlamydia psitacci
pneumonia that peaks every 4 years
mycoplasma
adult smokers + chicken pox
death from chicken pox pneumonia
varicella pneumonia
community acquired pneumonia: management
antibiotics
- amoxicillin
- doxycycline
oxygen
-maintain SaO2 94-98% or 88-92%
fluids
bed rest
no smoking
pneumonia complications
resp failure
pleural effusion
emphema
death
pneumonia special cases
hospital acquired
-need extended gram negative cover
aspiration pneumonia
-need anaerobic cover
legionella
- chest symptoms
- may be minimal
- GI disturbance = common
- confusion = common
Pneumonia Prevention
influenza + pneumococcal vaccines
- over 65
- chronic chest or cardiac disease
- diabetes
- immunocompromised e.g. splenectomy
influenza vaccine
-healthcare workers
influenza clinical presentation
fever - high, abrupt onset malaise myalgia headache cough prostration
flu aetiology
classical flu
influenza A
influenza B
flu aetiology
flu like illness
parainfluenza virus
haemophilus influenza
bacterium
haemophilus influenza not a primary cause of flu rather a
secondary invade
flu trasmission
droplets/ direct contact resp secretions of someone with infection
high risk flu transmission
intubation cardiopulmonary resuscitation bronchoscopy suregry + post mortem = high speed devices dental procedures non invasive ventilation high frequency oscillatory ventilation sputum induction
flu complication
primary influenzal pneumonia (young adults)
secondary bacterial pneumonia (infants/elderly)
bronchitis
otitis media
influenza during pregnancy = perinatal mortality, prematurity, smaller neonatal size, lower birth weight
fly therapy
symptomatic
-bed rest, fluids, paracetamol
antivirals
- oesltamivir
- xamivir
NICE guidelines
flu epidemics
winter epidemics
minor mutation in surface proteins - antigenic drift
flu pandemics
rare unpredictable influenza A only -antigenic shift -segmented genome -animal reservoir/ mixing vessel
lab confirmation of influenza
direct detection of virus
PCR
- nasopharyngeal swabs in virus transport medium
- throat swabs in virus transport medium
flu prevention
killed vaccine
-adults, health care workers, 6 months - 2 yrs
live attenuated vaccine
-2yrs - 17 - intra nassally
anti virals after flu contact
rarely used
most prevalent flu in winter
influenza
most prevalent flu in summer
rhinovirus species A
community acquired pneumonia causes
microbiological causes
- mycoplasma pneumoniae
- coxiella burnetii
- chlamydia
mycoplasma, coxiella + chlamydophilia psittaci cna be referred to as
atypical pneumonia
mycoplasma, coxiella + chlamydophilia psittaci therapy
tetracycline + macrolides
mycoplasma, coxiella + chlamydophilia psittaci mortality
normally lower than classical bacterial pneumonia
mycoplasma, coxiella + chlamydophilia psittaci lab confirmation
serology
- acute + convalescent bodies to lab
- gold top vacutainer
virus detection
- PCR on resp swabs/ secretions
- gradually increasing
- mycoplasma only in Tayside
mycoplasma pneumoniae
community acquired = commonly
children + young adults
person to person
only uncommon pneumonia in UK
coxiella burnetti (Q fever)
pneumonia
pyrexia of unknown origin
uncommon, sporadic zoonosis
sheep + goats
complications - culture negative endocarditis
chlamydia + resp disease
chlamydia psittaci –> psittacosis
uncommon, sporadic zoonosis
usually presents as pneumonia
bronchiolitis clinical presentation
one or two yrs fever coryza cough wheeze
bronchiolitis clinical presentation severe cases
grunting
low PaO2
intercostal/ sternal indrawing
bronchiolitis
swelling in the smallest airways in the lungs, known as Bronchioles, obstructing them and making it more difficult for breathing
bronchiolitis complications
resp + cardiac failure
- prematurity
- pre-exisiting resp or cardiac disease
bronchiolitis cause
resp syncytial virus
bronchiolitus lab confirmation
PCR on throat or pernsaal swabs
bronchiolitis therapy
supportive
bronchiolitis epidemiology
every winter very common no vaccine spread in hospitals -cohort nursing -handwashing, gowns, gloves passive immunisation -poor efficacy
metapneumovirus
respiratory virus that causes an upper respiratory infection
metapneumovirus epidemiology
antibody positive by 5 2001 discovered not new world-wide highest = winter
metapneumovirus lab confirmation
PCR
chlamydia trachomatis
STI which can cause infantile pneumonia
chlamydia trachomatis diagnosed by
PCR on mothers urine or pernasal
child throat swab
chlamydophila pneumoniae
person to person
mid resp infection
may be picked up by Psitacossis test
