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Respiratory Infections Flashcards

1
Q

What upper respiratory tract conditions can be caused by infection?

A 
URT = above vocal cords
common cold - coryza
sore throat - pharyngitis
sinusitis
epiglottitis
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2
Q

How can we get the common cold?

A

Cold viruses (rhinoviruses) proliferate best at about 32 degrees - in cold temperatures the air around our noses can drop to these temperatures making them suitable for rhinoviruses.

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3
Q

What lower respiratory tract conditions can be caused by infection?

A 
LRT = below vocal cords
acute bronchitis
acute exacerbation of COPD
pneumonia
influenza
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4
Q

What does acute sinusitis involve?

A

Preceded by common cold
Purulent nasal discharge
can be treated with antibiotics but no evidence

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5
Q

What are the clinical features of an acute exacerbation of COPD?

A

Usually preceded by upper respiratory tract infection
Increased sputum production which is now purulent
SOB
more wheezy
on examination: coarse crackles, may be cyanosed, ankle oedema in advanced disease.

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6
Q

How should you manage an acute exacerbation of chronic bronchitis?

A

Primary care: antibiotics eg clarithromycin, amoxicillin; bronchodilators; short course of steroids in some cases
Admit to hospital if: evidence of respiratory failure, not coping at home
Management in hospital: antibiotics eg clarithromycin, amoxicillin; inhaled bronchodilatrs; short course of steroids in some cases; measure ABGs; CXR to look for underlying respiratory disease; oxygen if in respiratory failure

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7
Q

If you suspect a pneumonia and on CXR there is opacification which obscures the right heart border, what is the most likely diagnosis?

A

Right middle lobe pneumonia

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8
Q

What is “red hepatisation”?

A

Consolidation of the lung lobe(s) as a result of pnemuonia which is red and resembles liver tissue, hence the name.

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9
Q

What might you see on a histological slide of a lungs biopsy from a patient with pneumonia?

A

Infiltration of inflammatory cells filling the alveoli - not leaving much room for gas exchange.

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10
Q

What are the symptoms and signs of pneumonia?

A

Symptoms: Malaise, anorexia, sweats, fever, rigors, myalgia, arthralgia, headache, confusion, cough, pleurisy, haemoptysis, dyspnoea, preceding URT infection, abdominal pain, diarrhoea.
Signs: fever, rigors, herpes labialis, tachypnoea, crackles, rub, cyanosis, hypotension

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11
Q

What investigations would you do for pneumonia?

A

CXR, blood culture, sputum culture, serology, FBC, ABG, LFTs, Urea, CRP, bronchoscopy/bronchoalveolar lavage

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12
Q

How do you assess the severity of a community acquired pneumonia?

A 
CURB65 score (only useful in community acquired, not hospital acquired)
C = confusion (new)
U = urea >7mmol/l
R = respiratory rate >30
B = Blood pressure < 90 systolic OR <61 diastolic
65 = aged 65 or over

Each one of these scores one point
0-1: mild, can treat at home
2: moderate - requires hospital treatment
3 or more: severe pneumonia

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13
Q

Other than CURB65 what are some other indicators of severity of pbeumonia?

A

Temperature 40
Cyanosis, PO2 30
multi-lobar involvement

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14
Q

What is the management of community acquired pneumonia?

A 
Antibiotics: amoxicillin and doxycycline
Oxygen - aim for sats of 94-98%
fluids
bed rest
no smoking
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15
Q

What are the complications of pneumonia?

A

Respiratory failure
Pleural effusion
Empyema
Death

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16
Q

What kind of antibiotic cover is required for hospital acquired pneumonia?

A

Gram negative

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17
Q

What kind of antibiotic cover is required for aspiration pneumonia?

A

Anaerobic

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18
Q

What is unusual about the clinical features of legionella pneumonia?

A

Chest signs may be absent

GI disturbance is common

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19
Q

What is the significance of sexual history in a patient presenting with a pneumonia?

A

Pneumonia can be a presenting feature of HIV.

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20
Q

When are the influenza and pneumococcal vaccines indicated?

A

Over 65
Chronic chest, heart, liver or renal disease
Diabetes
Immunocompromised eg splenectomy, AIDS, chemotherapy, steroids

influenza vaccine only: healthcare workers

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21
Q

What does acute bronchitis involve?

A

preceded by common cold, not life-threatening
virus/inflammatory cells go down airways into LRT
Get productive cough, fever (minority of cases), normal chest exam, normal chest xray, may have transient wheeze (common in children)
Do NOT give antibiotics (unless there is underlying chronic lung disease)

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22
Q

What does the common cold involve?

A

Acute viral infection of nasal passages, often accompanied by a sore throat and sometimes a mild fever
spreads by droplets and fomites
complications include sinusitis and acute bronchitis

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23
Q

What are the clinical features of influenza?

A

Incubation period = 1-4 days
symptoms include: fever (up to 40 degrees), chills, headache, sore throat, myalgia, malaise, anorexia, dry cough, prostration
clear nasal discharge
evidence of complications
bed bound for 3-4 days, recovery of about 5-6 days

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24
Q

What are complications of influenza?

A

death
primary viral pneumonia - cough, bloody sputum and respiratory failure within 24 hours of initial onset of fever
secondary bacterial pneumonia - new fever on day 7
myositis (skeletal or cardiac)
encephalitis
depression

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25
Give examples of anti-viral drugs and why they are used.
``` Neuramidase inhibitors: -Zanamavir - inhaler -Osletamavir (tamiflu) - oral Benefits of oseltamavir: - reduce duration of symptoms by one day - reduce antibiotic use - may reduce infectivity ```
26
How can presence of influenza virus be detected?
PCR - from nasopharyngeal or throat swab
27
How can influenza be prevented?
Killed vaccine: contains 2 influenza A viruses and one influenza B virus; given to adults at risk of complications and healthcare workers Live attenuated vaccine: attenuated by cold virus; contains 2 influenza A viruses and one influenza B virus; given intra-nasally to children anti-virals can be given as prophylaxis after contact with virus but this is not done very often
28
How can infection with an atypical be confirmed?
Serology
29
What are the characteristics of a mycoplasma pneumoniae infection?
Atypical Common in older children and young adults person to person spread
30
What are the characteristics of coxiella burnetti?
Causes pneumonia and pyrexia of unexplained origin (Q fever) Uncommon, sporadic Sheep and goats complications include culture negative endocarditis
31
What are the characteristics of chlamydophila psittaci?
Causes psittacosis which usually presents as pneumonia uncommon, sporadic usually caught from pet birds
32
What is the clinical presentation of bronchiolitis?
Usually first or second year of life fever coryza cough wheeze in severe cases: grunting on expiration, reduced PO2, sternal/intercostal indrawing (the intercostal muscles can't cope with the negative pressure caused by inflation of the chest but impaired air inflow) complications include respiratory and cardiac failure
33
What are the causative organisms and how are they classed?
``` Streptococcus pneumoniae haemophilus influenzae influenza atypicals: - mycoplasma pneumonia - legionella - coxiella burnetti - chlamydophila psittaci ```
34
What is the aetiology of bronchiolitis?
90% cases caused RSV (respiratory syncytial virus) very common -epidemics every winter no vaccine immunity is short lived so can be infected more than once
35
What does metapneumovirus cause?
acute respiratory tract infection (ARTI) in children most children are antibody positive by age 5 may be the sole pathogen or may be secondary to RSV (respiratoy syncytial virus) causes the same symptoms as RSV
36
What is chlamydia trachomatis and what does it cause?
STI that can cause infantile pneumonia | diagnoses by PCR on urine of mother or pernasal/thraot swab of child
37
What is chlamydophila pneumoniae and what does it cause?
Mostly causes mild respiratory infections spread from person to person may be picked up by test for psittacosis
38
What are the infections of the trachea and bronchi?
acute epiglottitis acute exacerbations of COPD cystic fibrosis pertussis (whooping cough)
39
What is acute epiglottitis and what causes it?
``` Haemophylis influenza (small gram negative bacillus) severe case of croup in children aged 2-7 may progress to respiratory obstruction and death Don't do bronchoscopy! ```
40
How is acute epiglottitis diagnosed?
Blood culture from throat swab (H.influenzae grows in white colonies on chocolate agar)
41
How is acute epiglottitis treated?
ITU | Ceftriaxone (third generation cephalosporin)
42
Describe an acute exacerbation of COPD.
can be viral or bacterial often follow a viral infection or a drop in atmospheric temperature patients tend to present with increased breathlessness and increased production and purulence of sputum.
43
What are the most common bacterial causes of acute exacerbations of COPD
Haemophilus influenza streptococcus pneumoniae moraxella catarrhalis all of these organisms are part of the normal URT flora.
44
How do you treat acute exacerbations of COPD?
If there is increased sputum purulence - antibiotics If there is no increased sputum purulence then don't give antibiotics unless there is consolidation on the CXR or signs of pneumonia first line: amoxicillin 500mg 3x daily for 5 days second line: doxycycline 200mg on day 1 then 100mg daily for 4 days
45
What causes exacerbations of CF?
Genetic disease that causes secretion of abnormally viscid mucous in many tubular structures including bronchioles in the lungs leads to recurrent chronic respiratory infection causative organsims include: -haemophilus influenzae -pseudomonas aeurginosa -burkholdereria cepacia
46
What organism causes pertussis?
bordetella pertussis
47
What are the clinical characteristics of pertussis?
acute tracheobronchitis cold-like symptoms for 2 weeks paroxysmal cough for 2 weeks - repeated violent exhalations followed by severe inspiratory whoop, vomiting common residual cough for a month or more can affect teenagers and adults as well as children
48
How is the diagnosis of pertussis made?
Pernasal swab - blood agar culture | serology
49
How is pertussis treated?
Macrolides - treatment most effective in the first 10 days of the illness vaccination
50
What are the infections of the lungs?
``` community acquired pneumonia nosocomial pneumonia Legionaire's disease pneumocyistis carinii pneumonia (PCP) fungal chest infections TB ```
51
What are the characteristics of community acquired pneumonia?
symptoms: dsypnoea, cough sputum production fever CXR has infiltrates acquired in the community
52
What is the microscopy of streptococcus pneumoniae?
Gram positive cocci (pairs or short chains)
53
What is characteristic of streptococcus pneumoniae culture on blood agar?
Alpha haemolytic colonies (partial haemolysis - appears green).
54
How do you treat a strep. pneumonia community acquired pneumonia?
usually penicillin
55
What is another term used to describe nosocomial pneumonia?
hospital acquired pneumonia
56
What are the predisposing factors to hospital acquired pneumonia?
``` intubation intensive care unit antibiotics surgery immunosuppression ```
57
What are the most common causative organisms of hospital acquired pneumonia and how do you treat them?
Most are gram negative organisms such as pseudomonas aeruginosa and coliforms (eg klebsiella) Can also be caused by anaerobes if it is an aspiration pneumonia - metranidazole is used to treat anaerobes treatment: - if severe: amoxacillin + metranidazole + gentamicin then step down to co-amoxiclav. 7-10 days total - if non-severe: amoxacillin + metranidazole for 7 days
58
What is the causative organism of Legionnaire's disease?
Legionella pneumophila
59
What are the clinical characteristics of Legionnaire's disease?
Flu-like illness which progresses to severe pneumonia with mental confusion with acute renal failure and GI symptoms
60
What is the epidemiology of Legionnaire's disease?
often associated with travel and usually associated with water.
61
How is Legionnaire's disease investigated/diagnosed?
Legionella urinary sample serology (because it is an atypical) PCR of sputum sample
62
How do you treat Legionnaire's disease?
Macrolides - erythromycin or clarithromycin | Fluoroquinolones - levofloxacin
63
What is the main feature of pneumocystis carinii pneumonia (PCP)?
Cause of pneumonia in HIV patients
64
How is pneumocystis carinii pneumonia diagnosed and treated?
Broncho-alveolar lavage induced sputum and identification of cysts treatment: cotrimoxazole and pentamidine
65
What is the cause of fungal chest infection?
aspergillus fumigatus
66
What kind of patients get aspergillus fumigatus pneumonia?
severely immunocompromised patients
67
How is aspergillus infection diagnosed and treated?
sputum culture and do CXR to look for cavity | treatment: amphotereicin B
68
What is aspergilloma?
Mushroom-like growth of aspergillus in a pre-existing cavity in the lung (eg caused by TB, sarcoidosis)
69
What can aspergillus fungus cause?
sever pneumonia or systemic infection in severely immunocompromised patients Aspergilloma if fungus gets into pre-existing cavity in the lung
70
Can atypical pneumonias be treated with penicillin? Why?
no - penicillins act on bacterial cell wall but atypicals don't have normal cell walls.

Respiratory (5 decks)

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