Respiratory infections Flashcards
What are the classic symptoms of respiratory tract infections?
Coryza, rhinorrhea – Sore throat, sneezing, cough
Define coryza.
Acute inflammation of the mucous membranes, marked by sneezing, lacrimation, and profuse secretion of watery mucus; usually associated with infection by one of the common cold viruses of acute allergic rhinitis.
What are the treatments of the common cold?
Self-limiting – No role for cough syrup – Avoid antibiotics – Avoid aspirin in children (Reye’s syndrome)
What are some key features of pharyngitis?
90% (A-G)
90% viral
A group strep
Beta heamolytic
CENTOR score
Diptheria
Exudate
FeverPain
Glomerularnephritis post-strep
What are the complications of group A strep?
How is group A strep tested for?
Lancefield classification for capsular antigen
Beads on a string
What % of sore throat/ pharyngitis is viral?
90%
What is the 4 Ts centor score and feverpain score testing?
For bacterial infection = 4Ts
Temperature
Tonsilar exudate
Tender lymph nodes
Time
How to manage a sore throat?
Gargle salty water
Drink plenty of water
Eat cool and soft foods
Take paracetemol and aspirin (unless under 16 - Reye’s)
Avoid smoking
Rest
How else can you disntinguish between sore throat being viral or baceterial?
The virus will cause coryza
The bacteria just stays in the throat
Yellow sputum
What other bacteria cause pharyngitis?
Corynebacterium diphtheria Group C & G strep Fusobacterium necrophorum
What is Lemierre’s syndrome?
Lemierre’s syndrome refers to infectious thrombophlebitis of the internal jugular vein.[2] It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.
Lemierre’s syndrome occurs most often when a bacterial (e.g., Fusobacterium necrophorum) throat infection progresses to the formation of a peritonsillar abscess.
What is a mneumonic for the FEVERpain score?
Tonsils purulent
Inflamed tonsils
Fever
In 3 days
No cough or coryza
What are the complications of strep throat?
PQRS. Post-streptococcal glomerulonephritis, quinsy, rheumatic fever, scarlet fever.
How can post-streptococcal glomerulonephritis be detected?
ASOtitre
What is ASOtitre?
anti-streptolysin O titre
Where is diptheria more common?
Eastern Europe and Bangladesh
What are some effects of diptheria?
Stridor
How might diptheria be managed?
Penicillin or erythromycin
Tracheostomy
What are some key features of infectious mononucleosis?
Caused by EBV
Lasts for + 1 month
No contact sports allowed for 6 months
Amoxicclin can cause rash
Malaise cough fever lymph nodes
EBV
Differentials for sore throat?
Laryngotracheitis/ croup
Influenza
Mononucleosis
Strep throat
Diptheria
Whooping cough
What causes croup?
RSV and parainfluenza
What are some breathing sounds linked to croup?
Stridor - windy sound
Croup cough - barking seal
How is croup treated?
Dexamethasone
What is shown here?
Steeple’s sign
What is bronchiolitis?
Inflammation of the bronchioles – Very common in childhood, mostly mild Organism: viruses – 70% RSV Epidemics in winter Highest cause of admission 2 have antibodies (ie. have been infected) Diagnosis – X-ray generally normal – Nasopharyngeal aspirate/swab PCR for viral RNA
What pathogens may cause exacerbation of COPD?
Organisms; – Viruses 20-40% Rhino/RSV/flu/adeno – Bacteria 30-50% Strep pneumo, haemophilus Moraxella catarrhalis Ecoli, klebsiella
How do you treat an exacerbation of COPD?
Management – Bronchodilators: salbutamol & ipratropium – Steroids: prednisolone 5 days – Consider antibiotics Amoxicillin, doxycycline Prevention – Regular inhalers Compliance and technique – Vaccines Influenza Pneumococcal – Smoking cessation Even once COPD established
What is bronchiolitis?
Inflammation of the bronchioles – Very common in childhood, mostly mild Organism: viruses – 70% RSV Epidemics in winter Highest cause of admission 2 have antibodies (ie. have been infected)
How is early HAP treated vs late HAP?
Early HAP: Co-amoxiclav Late HAP: Piperacillin-tazobactam
What are some causes of aspiration pneumonia?
Impaired swallow/gag reflex – Due to stroke, dementia, MND – Saliva, secretions, gastric contents – Chemical pneumonitis +/- infection – Recurrent: causes lobar bronchiectasis
Features of bronchiectasis?
Who is most at risk from bronchiectasis?
What are the stages of whooping cough?
What is pleural empyema?
Pleural empyema is a collection of pus in the pleural cavity caused by microorganisms, usually bacteria.[1] Often it happens in the context of a pneumonia, injury, or chest surgery.[1] It is one of the various kinds of pleural effusion. There are three stages: exudative, when there is an increase in pleural fluid with or without the presence of pus; fibrinopurulent, when fibrous septa form localized pus pockets; and the final organizing stage, Thoracentesis <7.2 USS gudance
What are the most common HAP infections?
Staph/ step/ stenotrophomonas
Pseudomonas
Acinetobacter
Carbamenemases producing enterobacter (CPE)
E.coli and klebsiella
What is the treatment for TB?
What pathogen is stained with an inidian ink stain?
What are the treatments for (i) strep a, (ii) HAP, (iii) fungal infections and (iv) TB?
Strep - phenoxymethylpenicillin or clarithrumycin
HAP - Co-amxoclav or later tazozam and pioercillin
Fungal infections - co-trimexazole
TB - 2 months RIPE, 4 months RI
