Respiratory Infections

Question 1

What are respiratory tract infections split into?

Answer 1

• Upper Respiratory Tract Infections (URTIs)
• Lower Respiratory Tract Infections (LRTIs)

Question 2

What are examples of URTIs?

Answer 2

• Acute rhinitis - runny nose
• Pharyngitis - sore throat
• Laryngitis - inflam of larynx/ voice box
• Sinusitis - inflammation of sinuses
• Tonsillitis - inflammation of tonsels
• Tracheitis - infammation of trachea
• Otitis Media - inflammatory diseases of miffle ear

Question 3

What are URTIs usually casued by and what can be used to treat them?

Answer 3

Viruses

Symptomatic treament - Rest, hydration, analgesics, antipyretics e.g. paracetamol and ibuprofen (bring temp down)

Question 4

In community pharmacies, pharmacists can test patients to determine potential cause.

What is measured?

How is this helpful?

Answer 4

Specific role of pharmacist in point of care (POC) testing in the community pharmacy:

• Use of CRP
• Provides reassurance to patient
• Avoids unnecessary use of antibiotics
• Avoids unnecessary appointments at GP

Question 5

What are assessment scores of CRP that indicate bacterial/viral infections.

What is the action to be taken for each?

Answer 5

At second stage patient should be adviced of red flag symptoms e.g. persistnat sore throat, cough lasting more than 3 weeks, unilateral enlarged tonisils

Question 6

What other POCT can be done to determine cause of URTIs?

Answer 6

Other POCT involving nasal swabs for respiratory viral testing

Patients testing negative for viruses, and having normal CRP and Chest X-ray are unlikely to have a bacterial infection

“Test-and-threat” sore throat service – an on the spot throat swab aimed to diagnose whether an infection is viral or bacterial and carried out in pharmacies

Question 7

What are symptoms of Lower RTIs?

Answer 7

Describes a range of symptoms and signs varying in severity

most common = cough (which is new/changed)

• Other symptoms include - sputum production
• breathlessness
• wheeze
• chest pain
• fever
• sore throat
• corza(common cold)

Question 8

What are examples of LRTIs?

Answer 8

• Acute bronchitis
• Infective exacerbations of chronic bronchitis/COPD
• Pneumonia (Hospital/community acquired)
  
  • hosp/comm - important to help guide the empirical treatment of pneumonia

Question 9

What is phenummonia?

Answer 9

It is inflammation of the lung parenchymal. So it involves the alevoli rather than the bronchi due to infection

Question 10

How can CAP be diagnosed?

Answer 10

Presence of abnormalities on physical examination of chest - good indicator:

Characterised by consolidation – pathological process alveoli are filled with inflammatory exudate, bacteria & WBC. On a chest X-ray this will show as an opaque area in normally clear lung fields

Question 11

Who should therapy for CAP be considered in?

Answer 11

Consider therapy in all patients with coexisting illness like COPD, asthma, heart failure, alcoholism, history of previous productive cough or in those who don’t improve spontaneously

Question 12

How is CAP diagnosed - all features present?

Answer 12

• Cough with one other respiratory symptom (wheeze, dyspnoea, sputum production etc)
• at least 1 systemic feature - fever, shiver etc
• no other explanation of illness
• Severity – CRB-65 (community) or CURB-65 scores (hospital)
• (BTS CAP guidelines 2009 update)

Question 13

Describe CRB measurement in community

Answer 13

Question 14

Describe CURB measurement in hospitals

Answer 14

Question 15

What are examples of CAP causative organisms?

Why is it important to know these?

Answer 15

• Streptococcus pneumoniae
• Hemophilus influenzae
• Atypical organisms e.g. Mycoplasma pneumoniae
• Staphylococcus aureus (post influenza)
• MRSA pneumonia - consideration in NH patients

To allow approproate AB treatment

Question 16

Signs and symptoms of CAP

Answer 16

• Some or all symptoms of infection (lecture 1)
• Cough
  
  • Dry then productive – purulent or bloodstained rust coloured sputum
• Dyspnoea
• Pleuritic chest pain
  
  • Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. It is exacerbated by deep breathing, coughing, sneezing, or laughing
• Markedly ↑WCC
• May be bacteraemia
• Consolidation on CXR

Question 17

SIRS criteria of penumonia?

Answer 17

• Temperature >38°C or <36°C
• Tachycardia >90 beats per minute
• Respiratory rate >20 per minutes
• WCC - >12 or < 4

Question 18

What is the treatment for CAP?

Answer 18

• Empirical therapy (No culture report. Trying to cover wide spectrum)
  
  • macrolide + penicillin
    
    • Macrolide doesnt act on cell wall (atypical organisms dont have cell wall) and penicillin acts on cell wall
    • Cover S.pneumonia, H.influenzae & M.pneumoniae (atypical)
• Tetracyclines and Macrolides (both dont act on cell wall) will cover against other atypical organisms (e.g. C.psittaci) WHY?
• Flucloxacillin + rifampicin, fusidic acid or gentamicin (S.aureus)
• Vancomycin or linezolid (MRSA)

Question 19

1. What are other names for healthcare accquired pneummonia?
2. When does it typicall develop?
3. Why is it harder to treat?
4. Treatment?

Answer 19

1. Also called hospital acquired, nosocomial infection
2. Infection which develops 48 hours after admission into a healthcare institution
3. May be more difficult to treat than CAP – WHY?
   
   • More resistant to treatmnet
4. Antibiotics required based on local guidelines

Question 20

Who are most at risk of bacterial pneummonia?

Answer 20

• Infants and childrens
• On long term immunosupressant
• over 65
• smokers

Question 21

In addition to an AB what may also be prescribe?

Answer 21

• A cough medication to help calm the cough and help cough up mucus
• An antipyrogenic to reduce fever and temp