Respiratory Infections Flashcards
Objectives
1
Q
Define acute bronchitis
A
- Inflammation of the bronchi due to upper airway infection
- Cough lasting > 5 days
- Usually 1-3 weeks
- Usually with sputum production
2
Q
Acute bronchitis eitology
A
- Typically viral
- 60-90% of patients who receive care for bronchitis are given antibiotics
3
Q
acute bronchitis incidence/risk factors
A
- 44 per 1000 adults per year (5% of adults)
- Winter/Fall higher incidence
- Chronic lung disease at greater risk
- Chronic illness at greater risk
4
Q
acute bronchitis Etiology/infectious agents
A
- Etiology: Viral
- Influenza A & B
- Parainfluenza
- Coronavirus
- Rhinovirus
- RSV
- Human metapneumovirus
- Difficult to establish exact agent (13-29%)
- Other pathogens:
- Mycoplasma Pneumoniae
- Severe URI symptoms for 4-6 weeks (cough, pharyngitis)
- Chlamydia Pneumoniae
- Pertusis
5
Q
acute bronchitis clinical presentation (signs and symptoms)
A
- URI type symptoms initially
- Congestion
- Nasal drip
- Facial pressure
- Develop a cough that persists > 5days
- Not critical to distinguish acute bronchitis from Viral URI
- It is critical to distinguish acute bronchitis from pneumonia
- Sputum Production: 50% of patients
- Bronchospasm
- Reduced FEV1
- Can occur for up to 5 weeks
- Cough for 10 to 20 days
- Fever unusual
6
Q
Acute bronchitis DX
A
- Diagnosis typically made during your H&P
- “Clinical Diagnosis”
- Labs
- CXR
- Sputum culture
7
Q
acute bronchitis dx labs
A
CBC results
- WBCs typically normal, occasionally slightly elevated
- Significant Leukocytosis
- Bandemia
- A large elevation in WBC’s or a “left shift/bandemia” should prompt CXR to rule out pneumonia
- Procalcitonin
- Cytokine stimulation by bacterial infections
- Helps distinguish bacterial vs viral
- Reduce Abx exposure in multiple settings
- Use if can be obtained in a timely manner - may not be possible in a lot of clinics
- Big idea: Not getting in the office only in hospital, mostly useful in bronchitis and pneumonia
8
Q
acute bronchitis Dx CXR
A
- Clear “no acute process” infiltrates or anything else on CXR should raise suspicion for PNA
- Should get a CXR when:
- Elevation of WBCs
- Abnormal vital signs
- Tachycardia OR bradycardia
- Tachypnea
- Fever
- Physical Exam suggestive of pneumonia
- AMS
9
Q
acute bronchitis dx sputum culture
A
- Takes time, bacterial typically not cause would see polymorphonuclear cells and/or bacterial pathogens if bacterial
10
Q
actue bronchitis management plan
A
- Symptom management
- Pain Relief: NSAID, ASA, Acetaminophen
- Cough suppressants: codeine, dextromethorphan
- Short Acting Beta Agonist – if bronchospastic
- Don’t give bronchitis abx – especially broad spectrum abx
- Antibiotics
- Large meta-analyses of 15+ RCT’s showed only a reduction of 0.6 days of cough.
- This is a marginal reduction considering the potential adverse effects and potential antibiotic resistance
- “Post infectious bronchospasm”
- Persistent dry cough for 4-6 weeks
- Treat with BD’s, sometimes corticosteroids
11
Q
acute bronchitis special considerations
A
- Chronic lung disease
- Episodes of acute bronchitis
12
Q
pertussis definition
A
- “Whopping cough”
13
Q
pertussis incidence/risk factors
A
- Primarily children pre-vaccine era
- Resurgence with anti-vaccine movement
- Highly contagious
14
Q
pertussis Etiology/infectious agents/basic pathophysiology
A
- Longer incubation period
- 1-3 weeks
- Catarrhal phase
- Early phase
- Malaise, rhinorrhea, mild cough
- Early phase
- Paroxsymal Phase
- 2nd week of illness
- Hallmark whooping cough
- Convalescent Phase
- Gradual reduction of cough
- Total Duration of Phases: up to 3 months
15
Q
pertussis Clinical presentation: signs and symptoms
A
- Hallmark:
- Inspiratory whoop
- Paroxysmal cough
- Posttussive emesis
16
Q
pertussis dx
A
- Clinical definition
- Cough lasting two weeks without cause + one of these:
- Paroxysmal coughing
- Inspiratory whoop
- Posttussive emesis
- Cough lasting two weeks without cause + one of these:
- Tests
- Nasopharyngeal Culture
- PCR
- Serology
- Antibody titers
17
Q
pertussis management plan
A
- Catarrhal phase antibiotics effective - decrease duration/severity of cough
- Antibiotics in later phases
- May not reduce duration or severity but may be useful in reducing spread of disease
- Use if < 2 weeks of symptoms
- Persistent symptoms at 4 weeks
- CDC: Empiric antibiotic therapy early
- Empiric antibiotic therapy early if suspicious for pertussis even while diagnostics are ongoing
- Antibiotics
- Macrolides
- Azithromycin 5 days
- Clarithromycin 500 mg PO BID x 7 days
- Bactrim DS alternative
- Macrolides
- Cough suppressants ineffective
18
Q
pertussis complications
A
- Pneumonia
- Otitis Media
- Cough complications
- Subconjunctival hemorrhage
- Hernia
- Rib fractures
- Lumbar strain
- Rare: Intracranial hemorrhage
- Time lost in school/work
19
Q
pertussis vaccination recommendation
A
- Postvaccine: adults 50% of the time
- DTaP: diptheria, tetanus, pertussis, acellular pertussis
- Tdap booster
20
Q
influenza definition
A
- On Boards the clinical scenario will have short period of time for illness with high fevers typically
