respiratory infections Flashcards
TB, pneumonia, upper respiratory tract infections, influenza, and bronchiectasis.
how can someone catch bovine TB?
drinking unpasteurised milk from cows
risk factors for TB
diabetes mellitus immunocompromised (incl. HIV +ve) poor nutrition homelessness alcoholics viral hepatitis B/C pathophysiology born in high prevalence area
organisms responsible for TB
Mycobacterium tuberculosis
Mycobacterium bovis
Mycobacterium africanum
Mycobacterium microti
pathology of TB
TB survives inside phagolysosome –> macrophage recruits T cells –> granuloma
what is the time frame for primary TB?
within 2 years of infection
in what percentage of people will latent TB not do anything?
90%
signs of pulmonary TB
productive cough haemoptysis weight loss night sweats malaise fever anorexia
signs of lymph node TB
non-tender lymphadenopathy + systemically unwell
signs of CNS TB
symptoms of meningitis
raised intracranial pressure (and its associated symptoms)
systemically unwell
signs of bone TB
osteomyelitis + systemically unwell
signs of abdominal TB
ascites + systemically unwell
how many deaths per year worldwide are due to TB?
1.6 million
complications of TB
consolidation collapse pleural effusion pericardial effusion extra pulmonary TB
which part of the lung is TB most likely to affect?
the apex
diagnostic tests for TB
CXR
Ziehl-Neelson test with sputum
how to test for active TB
microbiology microscopy culture sputum urine CSF pleural fluid biopsy
how to test for latent TB
Mantoux test (type 4 hypersensitivity) interferon gamma release assay test for memory T cells
disadvantages of Mantoux test for latent TB
won’t distinguish infection from disease
false negative for immunocompromised and military TB
risk factors for pneumonia
immunocompromised elderly infants COPD nursing home impaired swallow diabetes congestive heart failure alcoholics IVDU
which organism is responsible for 40% of community acquired pneumonia?
S.pneumoniae
causes (organisms) of community acquired pneumonia
S.pnuemoniae
H.influenzae
S.aureus
atypical:
Legionella pneumophila
Chlamydia pneumoniae
most common cause (organism) of hospital acquired pneumonia
P.aeruginosa
organisms that are responsible for hospital acquired pneumonia
P.aeruginosa
S.aureus
K.pneumoniae
methods of spread of pneumonia
inhalation
aspiration of gastric contents
haematogenous spread
pathology of pneumonia
alveolar macrophages release cytokines –> attract neutrophils –> build up of pus, fluid, and cells
signs of pneumonia
pyrexia cyanosis dehydration confusion tachypnoea hypotension dull percussion note high respiratory rate tachycardia
symptoms of pneumonia
fever rigors anorexia dyspnoea sputum/cough pleuritic pain haemoptysis
signs of lung consolidation
dull percussion decreased air entry bronchial breath sounds crackles ± wheeze increased vocal resonance
how will inflammation lower lung manifest?
irritation in back of throat –> cough
mortality of pneumonia
CAP 1%
HAP 10%
ITU 30%
diagnostic tests for pneumonia
bloods - FBC, U&E, CRP endoscopy biopsy CXR O2 sats (<92%) urine, blood, and sputum culture ECG - tachycardia and arrhythmia
CURB65
what does it stand for?
when to admit someone to hospital?
Confusion Urea >7 mmol/L RR >30/min BP - systolic >90 or diastolic <60 65 or older
score of 3 or more is severe
score of 2 or more –> admit patient to hospital
score of 4 or 5 –> ITU admission
CURB65 and antibiotic treatments
0-1 –> amoxicillin
2 –> amoxicillin and clarithromycin
3-5 –> IV co-amoxiclav and clarithromycin
how to treat P.aeruginosa pneumonia in patients with CF?
ceftazidine
incubation period of Bordetella pertussis
5-21 days
what percentage of cases of pharyngitis are viral?
70-80%
sign of diphtheria
thick grey membrane on tonsils produced by WBCs
complications of sinusitis
brain abscess
sinus vein thrombosis
orbital cellulitis
complications of whopping cough
pneumonia
encephalopathy
subconjunctival haemorrhage
treatment of whooping cough
clarithromycin
proper name for croup
acute laryngo-tracheobronchitis
what causes epiglottitis?
Haemophilus influenzae type B (Hib)
signs of influenza
high fever runny nose sore throat muscle pains headache coughing fatigue weakness
complications of influenza
viral pneumonia
secondary bacterial pneumonia
sinus infection
how do neuraminidase inhibitors (oseltamivir) target the influenza virus?
inhibits virus from cutting loose from infected cells
inhibits virus’ ability to stop clumping together
bronchiectasis definition
permanent dilatation of bronchi and bronchioles, obstruction and severe inflammation usually of the lower lobes
destruction of bronchial and alveolar walls
main organisms responsible for bronchiectasis
H.influenzae
Strep. pneumoniae
S.aureus
P.aeruginosa
signs of bronchiectasis
reduced VC
chronic cough
foul smelling sputum
dyspnoea
complications of bronchiectasis
pneumonia lung abscess emphysema metastatic abscesses amyloid pulmonary fibrosis cor pulmonale chronic infection fungal colonisation septicaemia meningitis
diagnosis of bronchiectasis
sputum culture
cystic shadows on contrast XR
obstructive pattern on spirometry
bronchoscopy shows haemoptysis
treatment of bronchiectasis
antibiotics
physiotherapy
bronchodilators (ß2 agonists)
surgery if advanced
