Respiratory Tract Infection Flashcards
Give four upper respiratory tract infections
- Coryza
- Pharyngitis
- Sinusitis
- Epiglottits
What is the term for the common cold?
Coryza
Give four lower respiratory tract infections
- Acute bronchitis
- Acute exacerbation of of chronic bronchitis
- Pneumonia
- Influenza
Give three viruses that cause the common cold
- Adenovirus
- Rhinovirus
- Respiratory syncytial virus
How is infection from the common cold physically spread?
- Droplets - small moisture particles
- Formites - objects or materials that can carry infection (hospital blanket)
Complications of coryza may include what?
- Sinusitis
- Acute bronchitis
What does acute sinusitus entail?
- Nasal discharge
- Usually infection into the ethmopid sinuses which can spread to the eyes or brain
What is diptheria?
Usually caused by Corynebacterium diphtheriae
This bacterium can be stread via droplets or physical contact
Some strains can release toxin which can cause obstruction of the airways
The condition is vaccinated against in the UK
In which age demographic is acute epiglottitis most dangerous?
Young children
The key symptom is drooling - the child cannot swallow properly
What are the main clinical features of acute bronchitis?
- Productive cough - mucous build-up in bronchi
- Fever
- Normal chest Xray
- Normal chest exam
- Transient wheeze
What are the three main symptoms of COPD?
- Chronic sputum production
- Bronchoconstriction
- Inflammation of airways
Give four clinical features of COPD
- Increased sputum production
- Increased sputum purulence (contains pus)
- More wheezy
- Breathless
What may be found on on a COPD physical examination?
- Wheeze
- Coarse crackles
- Potential cyanosis
- Ankle oedema
How can COPD be managed in primary care?
- Antibiotics (doxycycline or amoxicillin)
- Bronchodilator inhalers
- Short course of steroids to reduce inflammation
In which two instances would a COPD patient be referred to hospital?
- Evidence of respiratory failure
- Acopia - unable to cope at home alone
How is management of COPD different in hospital versus primary care?
- Arterial blood gases are taken
- CXR
- Oxygen is given in the instance of respiratory failure
Give 6 symptoms of pneumonia
- Malaise
- Anorexia
- Sweats
- Rigors - cold/shivering despite temperature rise
- Myalgia - muscle pain
- Arthralgia - joint pain
- Headache
- Confusion - determine with CURB65
- Cough
- Pleurisy
- Haemoptysis
- Dyspnoea
- Preceding URTI
- Abdominal pain
- Diarrhoea
What are some signs of pneumonia?
- Fever
- Rigors
- Herpes labialis
- Tachypnoea
- Crackles
- Rub
- Cyanosis
- Hypotension
How can pneumonia be investigated?
- Blood culture
- Serology (blood and sputum)
- Arterial gases
- Full blood count
- Urea
- Liver function
- CXR
Describe the CURB65 severity score
Each of the criteria below account for one point
As the score increases, mortality increases
If COPD is also present, mortality is increased by 10%
- C - new onset of confusion
- U - urea > 7mmol/l
- R - respiratory rate > 30/min
- B - blood pressure systolic < 90 or diastolic <61
- 65 - aged 65+
Score: 0 (0.6%), 1 (2.7%), 2 (6.8%), 3 (14.0%), 4 (27.8%), 5 (27.8%)
What is likely to cause death in a patient with pneumonia?
Bacteraemia and sepsis
What are severity markers for pneumonia besides the CURB65 score?
Temperature <35 or >40
Cyanosis PaO2 < 8kPa
WBC <4 or >30
Multi-lobar involvement
Whcih pathogens may be involved in pneumonia?
- Streptococcus pneumonia
- Haemophilus influenzae
- Staph aureus
- Legionella pneumophilia
- Gram negative bacteria
- Mycoplasma pneumonia
What are some complications of pneumonia?
- Respiratory failure
- Pleural effusion
- Empyema
- Death
If pneumonia is classified based on location of infection, what are the three categories?
- Community acquired
- Hospital acquired
- Aspiration
What is the most common bacterial pneumonia?
Pneumococcal pneumonia
Caused by streptococcus pneumoniae
How is pneumococcal pneumonia treated?
- Amoxicillin
- Benzylpenicillin
- Cephalosporin
What will a chest X-ray likely show for pneumococcal pneumonia?
Lobar consolidation
What is staphylococcal pneumonia?
Caused by staph aureus
Affects young, old, IV drug users or patients with an underlying condition most
How is staphylococcal pneumonia treated?
Flucloxacillin and potentiall rifampicin
If MRSA is present consider vancomycin
How will staphylococcal pneumonia present on a chest X-ray?
Bilateral cavitating bronchopneumonia
Klebsiella pneumonia will likely affect which types of people?
- Alcoholics
- Elderly
- Diabetics
Which patients are vaccinated againstinfluenza and pneumococcal pneuonias?
- Over 65
- Chronic chest or cardio disease
- Immunocompromised
- Influenza vaccine is given to healthcare workers
Pseudomonas pneumonia is caused by which pathogen?
Pseudomonas aeruginosa
(gram negative)
Commonly hospital acquired
How is pseudomonas pneumonia treated?
Anti-pseudomonal penicillin, cerftazidime, meropenum, or ciprofloxacin + aminoglycoside
How is klebsiella pneumonia treated?
Cefotaxime or Imipenem
Mycoplasma pneumonia occurs in epidemics every _____ years and presents with ___-____ symptoms
Four
Flu-like
How is mycoplasma pneumoniae treated?
Clarithromycin or Tetracycline or Fluroquinolone (e.g. ciprofloxacin or norfloxacin)
How is Legionella pneumonia commonly caught?
Stagnant water reserves e.g. hotel water tanks
Causes flu-like symptoms are dry cough with dyspnonea
What is chlamydophilia pneumonia?
The most common chlamydial infection
It is person to person spread
How is chlamydophilia pneumonia treated?
Tetracycline or Clarithromycin
What is chlamydiophilia psittaci?
A bacterial infection that causes psittacosis (commonly from infected birds)
How is Chlamydophila psittaci treated?
Tetracycline or Clarithromycin
What is the most common cause of viral pneumonia?
Influenza
Other viruses include:
Measles, CMV and varicella zoster
How is viral pneumonia treated?
Ciprofloxacin and Co-Amoxiclav.
Prophylactically oseltamivir is given
How can viral pneumonia be diagnosed?
PCR
Viral culture
Pneumocystis pneumonia commonly causes pneumonia in which type of patients?
Immunosuppressed
What is the organism responsible for pneumocystis pneumonia?
Pneumocystis jiroveci
How can pneumocystis pneumonia be diagnosed?
- Visualisation in sputum
- Bronchoalveolar lavage
- Lung biopsy
How is pneumocystis pneumonia treated?
High dose co-trimoxazole or pentamidine.
Steroids are beneficial if severe hypoxaemia. Prophylaxis often used.
What is CVID?
Common variable immune deficiency
The most common cause of immunodeficiency characterised by a lack of immunoglobulins
What is an intrapulmonary abscess?
It is a type of liquefactive necrosis
Which symptoms will normally accompany an intrapulmonary abscess?
- Weight loss
- Productive cough
- Lethargy
What will often precede an intrapulmonary abscess?
- Pneumonia, flu can preceed this
- Aspirating pneumonia - vomiting or pharyngeal pouch use
- Poor host immune response
Which types of pathogens will cause intrapulmonary abscesses?
- Streptococcus
- Staphylococcus - especially post flu, leads to cavitating pneumonia and abscess formation
- E.coli
- Gram negatives
- Aspergillus
Septic emboli can cause conditions such as what?
- Right sided endocarditis
- Infected DVT
- Septicaemia
What is empyema?
Pus in the pleural space
(associated with pneumonia)
How do empyemas differ to abscesses on a CXR?
Empyema - banana shaped
Abscess - orange shaped
If a pulmonary effusion is the initial cause of an empyema what is the stepwise progression to an empyema?
- Simple parapneumonic effusion
- Complicated parapneumonic effusion
- Empyema
When a simple parapneumonic effusion becomes an empyema what changes happen?
- Fluid thickens to puss
- pH drops
- Lactate dehydrogenase enzyme increases
- Glucose levels decrease (lactate dehydrogenase breaks it down)
In terms of oxygen requirement, which type of organisms are most likely to cause empyema?
Aerobic
Which gram postitive bacteria are likely to cause empyema?
Strep milleri
Staph aureus (usually post op)
Which gram negatives are likely to cause empyema?
- E-coli
- Pseudomonas
- Haemophilus influenzae
- Klebsiella
If anaerobes cause empyema, this is usually under which circumstances?
- Severe pneumonia
- Poor dental hygiene
How many an empyema be diagnosed?
CXR - looks D shaped, lateral can show fluid build up
Ultrasound
CT - can differentiate between abscess and empyema
How is an empyema treated?
IV antibiotics
Amoxicillin and metronidazole
Oral antibiotics can be given to bacteria that are cultured
These are given for at least 14 days
What is bronchiectasis?
Localised irreversible dilation of bronchial tree
Can easily collapse leading to airflow obstruction and clearance of secretions becomes difficult
What can bronchiectasis commonly be condused with on a CT?
Abscesses
This is due to the extreme dilation
What are some common symtoms of bronchiestasis?
- Breathlessness
- Increased sputum production
- Chest pain
- Lower respiratory tract infections
What may cause bronchiectasis?
- Rheumatoid arthritis
- Immunodeficiency
- Cystic fibrosis
- Bronchial obstruction
- Idiopathic
How can bronchiectasis and chronic bronchial sepsis be differentiated?
Serological tests
Which patients are suceptible to chronic bronchial sepsis?
- Younger patients
- Generally female
- Involved in childcare
- Older patients suffering from COPD
How can bronchiectasis be treated?
- Smoking cessation
- Influenza vaccine
- Pneumococcal vaccine
- Reactive antibiotic (from sputum sample)
In bronchiectasis, what is the treatment for a patient colonised with a persistant bacteria?
- Prophylactic antibiotics
- Nebulised gentamicin or colomycin - ensures local delivery
- Alternating oral antibiotics
- IV antibiotics
- Anti-inflammatory treatment
- Macrolide antibiotics (clarithromycin, azithromycin - effective against bacteria pseudomonas)
