respiratory infection Flashcards
where does the respiratory tract start and end?
wha are the different types of pathogen?
nose to alveolus
pathogen:
- virus
- bacteria
- other (other bacteria, mycobacterium, fungus, parasite
differential
Interstitial pneumonia ‘ia’, inhalation, allergy
what are different types of respiratory infection:
URTI?
LRTI?
what are 4 other types?
URTI= rhinitis, pharyngitis, tonsilitis, laryngitis
LRTI= laryngo-tracheo bronchitis (LTB), bronchiolitis, pneumonitis
- pneumonia/bronchopneumonia
- empyema (not emphysema)
- bronchiectasis
- lung access
what 3 things can respiratory infections be exacerbations be of?
- COPD, asthma
- bronchiectasis
- fibrotic lung disease
what are the principals of treatment?
what is infection outcome?
- source control
- consider the pathogen
- consider the host
- consider the severity
infection = pathogen x host
what is the basic practise of respiratory infections?
- basic microbiology
- respiratory microbiology
(commensal organisms vs respiratory pathogens, the lung microbiome, why do we get pneumonia)
what is the 2nd basic practise of respiratory infection?
basic antibiotic biology.
- respiratory antibiotics:
(soldier the spectrum, route of administration, bioavailability, duration)
( consider goal of treatment- cure, control, maintenance= immune modulation)
what is the 3rd basic practise of respiratory infections?
basic immunology
what is sepsis?
what is septic shock?
a life threatening organ dysfunction caused by a dysregulated host response to infection.
septic shock = a subset of patients with profound circulatory, cellular and metabolic abnormalities.
MAP <65 mmHg, lactate >2mmol/l
hypotensions despite fluid resuscitation, requiring vasopressors.
what are the different organisations of standards of care?
BTS (guidelines of practise)
NICE (pneumonia guidelines)
British infection association (BIA) guidelines.
what are the international guidelines in the standard of care?
- European respiratory society
- ATS/IDSA guidlines
treatment for URTI?
- supportive, not antibiotics
- special diagnosis - stridor, croup, quinsy
consider the underlying diagnosis -allergy, polyps, immunity
consider ENT review and direct nasendoscopy
treatment of LRTI?
- (supportive)
- maybe antibiotics
- consider related mobility - URT, LRT asthma, chronic cough
- make a back up plan (consider CXR, antibiotics, referral)
treatment of pneumonia?
- (supportive)
- antibiotics
- choose spectrum antibiotics over 5/7/10 days
- consider underlying diagnosis- allergy, polyps, immunity, co-morbidities =, bronchiectasis, COPD
- admission into hispotal
treatment for empyema?
- antibiotics
- drain
- supportive (any cormorbidities, psycho-social, pain, oxygen)
- consider the underlying diagnosis- pathogen, immunity?
- surgery, thoracoscopy?
treatment of bronchiectasis?
- antibiotics
- clearance
long term chronic disease = management plan, specialist nurse, GP’s, motivated patient, preventative therapies, rescue therapies
consider exacerbation of be vs pneumonia vs progression
treatment of lung abscess and cavitation?
- antibiotics
- treatment will be defined by cause
identify the pathogen
- surgery?
pneumonia- community acquired:
definition
incidence
aetiology
sex
geography
pathology
symptoms and signs
prognosis
defincition= clinical features + radiology
incidence = 1% adults; 5-10% of GP presentation with LRTI
aetiology = virus, bacteria, co-infection
sex= same in the incidence, possibly slightly worse outcomes F>M
geography= relevant in aetiology and outcomes
pathology = consolidation, pus, necrosis (neutrophils, lymphocytes, eosinophils)
symptoms and signs = cough with phlegm, SOB, fever
prognosis = consider CURB65: <1% -> 50%; consider CAP/HAP
what is curb65?
are blood test required?
to predict mortality secondary to community acquired pneumonia
- blood tests are not required
This is a test to establish the the severity of pneumonia
C= confusion
U= urea >7
R= respiratory >30
B= blood pressure systolic <90
>65
how do you work out how long someone should be on antibiotics?
- it depends!
- depends on the pathogen (consider sensitive streptococcus pneumonia vs staphylococcus aureus pneumonia)
it depends on the disease - consider pneumonia + vanity + bacteraemia + signal change in bone
- depends on the host response!
how long do you give antibiotics for:
pneumonia?
deep seated infection?
empyema?
cavitation?
what is emphyma?
pockets of pus in the lung
what is bronchiectasis?
permanent dilation of the bronchi and bronchioles following damage to the airway and infection.
it will lead to mucus plugging.
what is pneumonia?
an infection causing inflammation of the alveoli and terminal bronchioles.
This will lead to consolidation of the bronchopulmonary segment or lobe.
symptoms of pneumonia?
high fever
sputum
sore body
tests for pneumonia
blood test
sputum culture
CXR
what is a lung abscess
liquidative necrosis of lung parenchyma due to infection. the will lead to creation of a cavity filled with fluid and debris.