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Respiratory Tract Infection Flashcards

1
Q

What are common upper respiratory tract infections?

A
  1. rhinitis
  2. sinusitis
  3. otitis
  4. pharyngitis
  5. laryngotracheitis
  6. epiglottitis
  7. bronchitis
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2
Q

Rhinitis is caused by what?

A
  1. rhinovirus (30%)
  2. coronavirus (10%)
  3. parainfluenza
  4. influenza
  5. RSV
  6. adenovirus
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3
Q

What causes sinusitis?

A

many viral, some bacterial (strep pneumo, H flu, moraxella, and oral anaerobes)
-treat with ampicillin, amoxicillin, tmp-sulfa, amox-clav

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4
Q

What causes pharyngitis?

A

viral 70%

strep throat

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5
Q

What causes epiglottis?

A 
H flu
group A strep
H parainfluenzae
Emergency ENT consultation 
-Amox-clav, amp-sulbactam, 3rd generation cephalosporin
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6
Q

What causes acute bronchitis?

A

self limited infection/inflammation of large airways
cough> 5days, purulent sputum

Etiology: majority viral 
1. influenza
2. parainfluenza
3. RSV
4. coronavirus
5. adenovirus
6. rhinovirus 
(same as sinusitis)

Bacterial

  • mycoplasma
  • strep pneumo
  • H flu
  • Chlamydophila
  • B pertussis

treatment is symptomatic, routine antibiotics are not suggested, antitussives and mucolytics usually aren’t helpful

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7
Q

What are the signs and symptoms of pneumonia?

A

cough, sputum, fever, shortness of breath

signs of consolidation on exam, elevated wbc

Risk factors: old age, pulmonary disease, smoking, recent viral illness, diabetes, chronic renal disease, immunodeficiency

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8
Q

What are the diagnostic tests for CAP?

A
  1. CXR
  2. if there is a pleural effusion it should be sampled
  3. flu test
  4. yield on blood sputum cultures is low
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9
Q

What are the signs of typical of community acquired pneumonia?

A
  1. Acute onset of symptoms (cough, sputum, fever, shaking chills)
  2. Lobar infiltrate
  3. gram stain with PMNs and organisms
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10
Q

What are common bugs of typical CAP?

A
  1. Strep pneumo
  2. H flu
  3. moraxella catarrhalis
  4. staph aureus
    no organisms found in 30-50%
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11
Q

What is the most common cause of typical CAP?

A

strep pneumo

  • acute onset fever, shaking chill, SOB, pleuritic chest pain
  • rusty sputum, lancet shaped diplococcus
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12
Q

What are the symptoms of atypical CAP?

A
  • subacute onset of symptoms
  • milder symptoms
  • prodrome
  • negative gram stain
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13
Q

What are the most common bugs of atypical CAP?

A
  1. Mycoplasma
  2. Chlamydia
  3. Legionella
  4. viruses
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14
Q

What are symptoms of legionella pneumophila?

A

headache, myalgias, high fever, fatigue, cough, sputum

  • can progress to multi-organ system failure
  • flourishes in artificial aquatic environments
  • infection with inhalation or drinking contaminated water
  • diagnosis by urinary legionella antigen
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15
Q

What are the most common etiologic agents causing viral atypical CAP?

A
  1. influenza
  2. RSV
  3. adenovirus
  4. parainfluenza
    - can develop secondary bacterial infections
    - seasonal
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16
Q

What are typical symptoms of influenza?

A

fever, cough, headache, sore throat, myalgias
can cause pneumonia, respiratory failure, death

-in flu season can, test, isolate and start therapy if within 48 hours of start of symptoms

Therapy: Oseltamivir or zanamivir

Best prevention: yearly flu vaccine

17
Q

What are the symptoms of CAP in pediatrics?

A

tachypnea, fever, cough dyspnea

18
Q

What are the most common bugs in CAP pediatrics?

A

Under 2: viral (RSV, rhinovirus)
5-10 yrs old: mycoplasma
10-16: s pneumo, chlamydophila

Emerging pathogens:
Human metapneumovirus
Human Bocavirus
Simkania Negevensis

19
Q

What is the therapy for CAP?

A

Outpatient:

  • Macrolide or doxycycline
  • If co-morbid illness or recent antibiotics, a respiratory fluoroquinolone

Inpatient, non ICU

  • respiratory fluoroquinolone
  • B lactam + macrolide

Inpatient ICU:
-B lactam + macrolide or fluoroquinolone

If pseudomonas is a concern:

  • Anti-pseudomonal B lactam + respiratory fluoroquinolone
  • Anti-Antipseudomonal b lactam + macrolide + aminoglycoside
20
Q

How long do you give antibiotics?

A

at least 5 days, longer if the patient is sick or the initial empiric choices were wrong

21
Q

What are diagnostic criteria for HAP?

A

-fever, new infiltrate, leukocytosis, and change in sputum

22
Q

What are the bugs that cause HAP?

A

become colonized with gram negative rods:

  1. klebsiella
  2. e. coli
  3. enterobacter
  4. proteus
  5. serratia
  6. pseudomonas
  7. acinetobacter

organisms are aspirated
host defenses are lowered by coexisting illness

23
Q

What are risk factors for HAP?

A
  1. mechanical ventilation
  2. chronic lung disease
  3. CHF
  4. > 60
  5. Head trauma
  6. shcock
  7. decreased mental status/coma
24
Q

What are risk factors for HAP that is multidrug resistant?

A
  1. antibiotics within 90 days
  2. inpatient for >5 days
  3. residence in NH
  4. dialysis
  5. immunosuppression
25
What is the therapy for HAP?
``` Early, broad empiric therapy Narrow by culture results or lack there of 1. antipseudomonal cephalosporin 2. antipseudomonal carbapenem 3. b lactam/ b lactamase 4. vancomycin if worried about MRSA ```
26
What is chronic pneumonia?
subacute onset of symptoms -typically >6 weeks | caused by slow growing organisms
27
What are common bugs with chronic pneumonia?
1. mycobacterium (tb or atypical) 2. nocardia 3. actinomyces 4. endemic fungi 5. coxiella 6. tularemia 7. anatomic problem
28
What does lung abscess lead to? What bugs cause lung abscesses?
-leads to tissue destruction and necrosis, suppuration, cavitation anaerobic mouth organisms (bacteroides, fusobacterium, peptostreptococcus), aerobic and anaerobic streptococcus, GNR caused by : aspiration, post-pneumonic, septic emboli
29
What is empyema?
infection spreading to the pleural space
30
What causes neutrophil dysfunction or deficiency, what organisms cause pneumonia with this deficiency?
Causes: chemo, leukemia, chronic granulomatous disease organisms: 1. gram negative rods (pseudo, Hflu) 2. staph 3. aspergillus 4. candida
31
What can cause T cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?
Causes: AIDS, T cell lymphoma, Transplant, DiGeorge's syndrome Organisms: Fungi (candida, aspergillus, cryptococcus) Viral (CMV, HSV) -Pneumocystis, mycobacteria, listeria
32
CMV Pneumonia
rare in the immunocompetent but common in T cell def (BMT and lung transplants, less common in AIDs but can co-infect with pneumocystis) generalized infection (multiple organisms) Diagnosis-pathology, immunofluorescence, PCR on blood Therapy: ganciclovir, valganciclovir
33
What can cause B cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?
causes: splenectomy, chronic lymphocytic lymphoma, NHL, Myeloma, gamma globulin deficiencies Organisms: 1. strep pneumo 2. H flu 3. Neisseria 4. Klebsiella 5. E. coli 6. Giardia

MHD (81 decks)

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