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MHD > Respiratory Tract Infection > Flashcards

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
Q

What is the therapy for HAP?

A 
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
Q

What is chronic pneumonia?

A

subacute onset of symptoms -typically >6 weeks

caused by slow growing organisms

27
Q

What are common bugs with chronic pneumonia?

A
  1. mycobacterium (tb or atypical)
  2. nocardia
  3. actinomyces
  4. endemic fungi
  5. coxiella
  6. tularemia
  7. anatomic problem
28
Q

What does lung abscess lead to? What bugs cause lung abscesses?

A

-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
Q

What is empyema?

A

infection spreading to the pleural space

30
Q

What causes neutrophil dysfunction or deficiency, what organisms cause pneumonia with this deficiency?

A

Causes: chemo, leukemia, chronic granulomatous disease

organisms:

  1. gram negative rods (pseudo, Hflu)
  2. staph
  3. aspergillus
  4. candida
31
Q

What can cause T cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?

A

Causes: AIDS, T cell lymphoma, Transplant, DiGeorge’s syndrome
Organisms: Fungi (candida, aspergillus, cryptococcus)
Viral (CMV, HSV)
-Pneumocystis, mycobacteria, listeria

32
Q

CMV Pneumonia

A

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
Q

What can cause B cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?

A

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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