Respiratory tract infection Flashcards
Give 4 conditions of the upper tact
Common cold - coryza
Sore throat - pharyngitis
Sinusitis
Epiglottitis
Give 4 conditions that can affect the lower respiratory tract
Acute bronchitis
Acute exacerbations of chronic bronchitis
Pneumonia
Influenza
What is the coryza
Common cold
Acute viral infection of the nasal passages
Spread by droplets and fomites
It is self-limiting
What is acute sinusitis?
Preceded by a common cold
Purulent nasal discharge
Usually self-limiting, some need antibiotics
What is acute bronchitis?
Cold ‘that goes to the chest’
Inflammation of mucus membrane of bronchial tubes
Preceeded by the common cold
What are clinical features of acute bronchitis?
Productive cough May have a fever (minority) Normal chest examination Normal CXR May have a transient wheeze
What is the treatment for acute bronchitis?
Usually self-limiting
Antibiotics only given if the patient has underlying lung disease
What are the clinical features of acute exacerbation of chronic bronchitis?
Follows upper respiratory tract infection
Worsening of sputum production which is now purulent
More wheezy
Breathless
What would be seen on examination of a patient with an acute exacerbation of chronic bronchitis?
Breathless Wheeze Coarse crackles May be cyanosed In advanced disease - ankle oedema
What management would a patient with an acute exacerbation of chronic bronchitis receive in primary care?
Antibiotic e.g. doxycycline or amoxicillin
Bronchodilator inhaler
In some cases, a short course of steroids
What additional management would a patient with an acute exacerbation of chronic bronchitis receive in hospital?
Measure arterial blood gases
CXR to check for additional diseases
Give oxygen if there is respiratory failure
What are the symptoms of pneumonia? (15)
Malaise, anorexia, sweats, rigors, arthralgia, headaches, confusion, cough, haemoptysis, dyspnoea, preceeding URT, abdominal pain and diarrhoea
What are the signs of pneumonia? (8)
Fever, rigors, herpes labialis, tachypnoea, crackles, rub, cyanosis and hypotension
What investigations would be carried out for pneumonia?
Blood culture, serology, arterial blood gases, full blood count, urea, liver function and CXR
What is the CURB 65 score for pneumonia?
C - new onset of confusion U - urea >7 R - respiratory rate >30/min B - blood pressure systolic <61 65 - age 65 or older Score 1 point for each of the above Mortality increases as CURB65 increases
What is the most common bacteria to cause pneumonia?
Streptococcus pneumoniae (pneumococcus)
What treatment would be given for community acquired pneumonia?
Antibiotics - doxycycline or amoxicillin Oxygen - SaO2 94-98% Fluids Bed rest No smoking
What are 3 special cases of pneumonia?
Hospital acquired
Aspiration pneumonia
Legionella
What can be done to prevent pneumonia?
Influenza and pneumococcal vaccinations
Who is entitled to influenza and pneumococcal vaccinations?
Over 65yo Chronic chest or cardiac disease Diabetes Immunocompromised Health care workers (just influenza)
What is the clinical presentation for influenza?
Fever - high and abrupt onset Malaise Myalgia Headache Cough Prostration (weak)
What is the cause of classical ‘flu?
Influenza A virus and influenza B virus
How is ‘flu transmitted?
Droplets or direct contact with respiratory secretions from an infected individual
What is an epidemic?
A widespread occurrence of an infectious disease in a community at a particular time
What is a pandemic?
A multi-continent epidemic
What is the therapy for ‘flu?
Symptomatic therapy - bed rest, fluids, paracetamol
Antivirals - Oseltamivir and Zanamivir - given uncer NICE guidelines
How do labs confirm influenza?
Direct detection of the virus using PCR
(virus from swabs of respiratory samples)
Or antibody detection
What types of vaccine are used to prevent ‘flu and who receives them?
Killed vaccine given annually to adults at risk of complications, healthcare workers and children between 6months - 2yrs at risk of complications
Or live attenuated vaccine given to children aged 2-17yrs, administered intra-nasally
What is mycoplasma pneumoniae a common cause of?
Community acquired pneumonia
What is the clinical presentation of bronchiolitis?
First or second year of life Fever Coryza Cough Wheeze Severe cases - grunting, decreases PaO2 an intercostal/sternal indrawing
What are 4 infections of the trachea and bronchi?
Acute epiglottitis
Acute exacerbations of COPD
Cystic fibrosis
Pertussis (whooping cough)
What virus causes acute epiglottitis?
Haemophilus influenzae
If there is an increase in sputum purulence what treatment would be given for an acute exacerbation of COPD?
1st line - amoxicillin 1g three times a day for 5 days
2nd line - doxycycline 200mg day 1 then 100mg daily for 4 days
What is cystic fibrosis?
Inherited defect
Leads to abnormally viscid mucus which blocks tubular structures in many different organs, including the lungs
What is the clinical presentation of pertussus?
Acute tracheobronchitis
Cold like symptoms for 2 weeks
Paroxysmal coughing
Residual cough for month or more
Name 6 infections of the lungs
Community acquired pneumonia Nosocomial pnuemonia (aka hospital acquired) Legionnaires disease Pneumocysitis carinii pneumonia (PCP) Fungal chest injection Tuberculosis
What percentage of community acquired pneumonia is accounted for by ‘atypical’ bacteria?
20%
Amoxicillin does not cover the atypical bacteria. What antibiotic is given to cover the atypicals?
Clarithromythen
What are 5 predisposing factors to nosocomial pneumonia?
Intubation Intensive Care Unit Antibiotics Immunosuppression Surgery
Are the majority of nosocomial pneumonia caused be gram positive or negative bacteria?
Gram negative
What is legionnaires disease?
Flu like illness
May progress to severe pneumonia, with mental confusion, acute renal failure and GI symptoms
Associated with travel and usually water
What is a cause of pneumonia in patients with AIDS
Pneumocysitis carinii pneumonia (PCP)
What causes TB?
Mycobacterium tuberculosis
What are the causative organisms in community acquired pneumonia?
Streptococcus pneumonia (70%) Atypicals/viruses (20%) Staphylococcus aureus (4%) Other bacteria (1%) Haemophilus influenzae (5%)
