Respiratory Infections Flashcards
How does pneumonia normally present?
SOB, productive cough, pleuritic chest pain, fevers, confusion, myalgia
Investigations of pneumonia?
Bloods (FBC etc + cultures)
Sputum culture and sensitivity
CXR (consolidation / effusion)
What is the CURB 65 score?
C (new confusion) U (urea > 7) R (RR > 30) B (Systolic <90, diastolic <60) 65 (age 65 +)
Curb 0-2 = amoxicillin
Curb 3+ = IV co-amiclav + clarithromycin
Hospital acquired pneumonia/aspiration = AMG
Follow up CXR in 6 weeks for those at risk of lung cancer.
Most common cause of pneumonia?
Strep pneumonia
Most common cause of pneumonia in COPD?
Haemophilus influenzae
Most common cause of pneumonia after the flu (Influenza A)
Staph aureus
Presentation of legionella pneumonia? Investigation and treatment
Travel/water Atypical pneumonia Hyponatraemia Diagnosis = urinary antigen Treatment = macrolide Abx
Who gets klebsiella pneumonia? Presentation
Alcoholics and diabetics
Red jelly sputum
Management = cefotaxime
Discuss pneumocytis pneumonia
- Caused by pneumocystis jiroveci
- Patients who have HIV / immunosuppressed CD4 < 200
- X ray will either be normal or show infiltrates
- Treatment is with co-trimoxazole
- Diagnosis is via bronchoalevolar lavage/
Mycoplasma pneumonia?
Affects older children/young adults
Atypical pneumonia
Haemolytic anaemia + erythema nodosum
Diagnosis is via serology and treatment is with a macrolide.
- Comes in waves every 4 years.
Who gets pseudomonas pneumonia?
Usually seen in those with bronchiectasis.
Treated with ciprofloxacin.
Pathology seen in Tuberculosis?
A macrophage and T cell immune response is activated which results in the formation of caseating granulomas.
The lesion is at the primary site of infection; GOHN focus.
How is TB spread?
Usually by inhalation of droplets containing the bacteria.
What is miliary TB?
When TB becomes disseminated following passage into the blood stream.
Assman focus is secondary pulmonary TB lesion caused by spread to the lungs from the initial site of infection.
Investigation of TB?
CXR: consolidation, cavitating upper lobe lesions, bilateral hilar lymphadenopathy.
- Latent on CXR = fibrosis and calcified lesions.
Sputum sample: PCE and Ziehl Neelson (acid fast bacilli) positive.
Tuberculin test:
- Mantoux test (skin prick)
- Tests for TB exposure and BCG injection. - Blood test (gamma release assay) - detects only exposure to TB.
