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PathY5 > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What are the URTIs?

A

o Sinusitis

o Tonsillitis

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2
Q

What are the LRTIs?

A

Bronchitis
Pneumonia
Empyema
Bronchiectasis
Lung abscess

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3
Q

What effects on the body does respiratory defence compromise have?

A
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4
Q

· 18yo female; fever, cough and malaise

· Diagnosed with flu by GP (no ABx given)

· Attended A&E with…

o T 38C 87% sats on room air

o Chest clear, RR 24 Bloods (WCC 40.8, Neut 36.3, CRP 63)

What investigations wold you do?

A

o CXR double heart border (‘Sail’ sign)

o CT densely consolidated and collapsed lower lobe

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5
Q

o CXR double heart border (‘Sail’ sign)

o CT densely consolidated and collapsed lower lobe

Diagnosis?

A

LL pneumonia

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6
Q

What is streptococcus pneumonia?

A

o Alpha-haemolytic and optochin-sensitive

o Gram-positive cocci (chains and pairs)

o 30-50% of CAP

o Acute onset

§ Severe pneumonia Fever and rigors Lobar consolidation

o Almost always penicillin-sensitive

o Penicillin-resistance strains may be imported from Southern Europe

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7
Q

What is pneumonia?

A

inflammation of the lung alveoli

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8
Q

What is the presentation of pneumonia?

A

Fever

Cough

Abnormal CXR

Pleuritic chest pain

SoB

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9
Q

What are the types of pneumonia?

A

§ Community-acquired

§ Hospital-acquired/nosocomial (i.e. ventilator-associated)

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10
Q

What underlying factors contribute to pneumonia?

A

§ Pre-existing lung disease

Immunocompromise

§ Geography, seasons, epidemics

Travel, exposure to animals

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11
Q

What causes CAP?

A

· Streptococcus pneumoniae

· Haemophilus influenzae

· Moraxella catarrhalis

· Staphylococcus aureus

· Klebsiella pneumoniae

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12
Q

Which pathogens affect which agre group?

A
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13
Q

What are the cauess of CAP?

A

· TYPICAL (85%)

o Streptococcus pneumoniae

o Haemophilus influenzae

· ATYPICAL (15%)

o Legionella

o Mycoplasma

o Coxiella burnetii (Q fever) from exposure to farm animals

§ Hepatitis

o Chlamydia psittaci (Psittacosis) from exposure to birds

§ Splenomegaly, rash, haemolytic anaemia

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14
Q

What are the clinical features of CAP?

A

§ Symptoms:

· SoB Cough ± sputum Fever

· Rigors Pleuritic chest pain Malaise, N&V

§ Examination:

· Pyrexia Tachycardia Tachypnoea

· Cyanosis Bronchial breathing Crackles

· Dullness to percussion/tactile vocal fremitu

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15
Q

What Ix should you do for CAP?

A

· FBC, U&E, CRP BCs, Sputum MC&S

· ABGs CXR

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16
Q

What is the CURB 65?

A

· Confusion

· Urea > 7 mmol/L

· RR > 30

· BP < 90 systolic, < 60 diastolic

· 65+ years

2 = consider admitting

2-5 = manage as severe / consider ITU

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17
Q

What is bronchitis?

A

inflammation of medium-sized airways

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18
Q

What is the presentation of bronchitis?

A

§ Cough

§ Fever

§ Increased sputum production

§ Increased shortness of breath

CXR is usually NORMAL

19
Q

What organisms cause bronchitis?

A

§ Viruses

§ Streptococcus pneumoniae

§ Haemophilus influenzae

§ Moraxella catarrhalis

20
Q

What is the treatment of bronchitis?

A

§ Bronchodilation

§ Physiotherapy

§ Antibiotics

21
Q

· 56yo man; flu-like illness

· Presented with cough, fever, haemoptysis, pyrexia (but not severely unwell)

CXR shows cavitation

Differentials?

A

o Staphylococcus aureus

o Klebsiella pneumoniae

o Haemophilus influenzae

o TB

22
Q

What is H influenzae?

A

o Gram-negative cocco-bacilli (stain on chocolate agar)

o 15-35% of CAP

o More common with pre-existing lung disease

o May produce beta-lactamase

23
Q

· 62yo man; SOB

· Confusion, smoker, 91% saturation on room air, chest exam normal, hyponatraemia

· CXR showed bilateral interstitial change

Ddx?

A

§ Mycoplasma

Legionella

§ Chlamydia

Coxiella

24
Q

What is Legionella?

A

o Spread via inhalation of infected water droplets

o It is grown on a buffered charcoal yeast extract

o Can cause multi-organ failure

25
Q

Which antibioitcs are used for atypicals?

A

Protein synthesis inhibitors:

§ Macrolides (clarithromycin/erythromycin)

§ Tetracyclines (doxycycline)

26
Q

o Extra-pulmonary features (e.g. hepatitis, hyponatraemia) – characteristic of atypical pneumonias

o Account for 20% of CAP

o Often have a flu-like prodrome before fever and pneumonia

A

o Extra-pulmonary features (e.g. hepatitis, hyponatraemia) – characteristic of atypical pneumonias

o Account for 20% of CAP

o Often have a flu-like prodrome before fever and pneumonia

27
Q

What is legionella?

A

o Aerosol spread and associated with environmental outbreaks

o Associated with:

§ Confusion Abdominal pain Diarrhoea

§ Lymphopaenia Hyponatraemia

o Investigation: urinary antigens

o Sensitive to macrolides

28
Q

What is coxiella?

A

o Common in domesticated farm animals

o Transmitted by aerosol or milk

o Investigation: serology

o Sensitive to macrolides

29
Q

What is Chlamydia?

A

o Spread from birds by inhalation

o Investigation: serology

o Sensitive to macrolides

30
Q

Why might empyema not improve?

A

Failure to improve on treatment:

o Empyema/abscess Proximal obstruction (tumour)

o Resistant organisms (travel hx) Not receiving/absorbing antibiotics

o Immunosuppression Other diagnosis (lung cancer, cryptogenic organising pneumonia

31
Q

How is TB diagnosed?

A

o Clues -> Ethnicity, Prolonged prodrome, Fevers, Weight loss, Haemoptysis

o CXR -> classically upper lobe cavitation (but can vary)

o Staining:

§ An auramine stain and a Ziehl-Neelsen stain will be done

§ Red rods are the acid-fast bacilli

32
Q

What is HAP?

A

o A pneumonia onset >48 hours in hospital

o Patients have often had previous antibiotics and maybe even ventilation

o Bronchial lavage is desirable (differentiate upper respiratory from lower respiratory flora)

o Aetiology of HAP

§ Enterobacteriaciae (e.g. E. coli, K. pneumoniae) – 31% Staphylococcus aureus – 19%

§ Pseudomonas spp – 17% Haemophilus influenzae – 5%

§ Acinetobacter baumanii – 4% Fungi (Candida spp) – 7%

33
Q

What would pneumocystis pneumonia cause on CXR?

A

bilateral ground-glass shadowing (“bat’s wing”)

34
Q

What is Pneumocystic Jirovecii?

A

o Protozoan

o Ubiquitous in the environment

o Insidious onset

§ Dry cough Weight loss

§ SOB Malaise

35
Q

How do you manage Pneumocystis pneumonia?

A

· Investigations: bronchoalveolar lavage

· Treatment: co-trimoxazole (septrin)

· Prophylaxis: co-trimoxazol

36
Q

What can aspergillus cause?

A

o Allergic bronchopulmonary aspergillosis

§ Chronic wheeze

§ Eosinophilia

§ Bronchiectasis

o Aspergilloma

§ Fungal ball, often in pre-existing cavity

§ May cause haemoptysis

o Invasive aspergillosis

§ Immunocompromised

§ Treatment: amphotericin B

37
Q

What LRTIs can different immnosuppressed groups get?

A
38
Q

How do you diagnose LRTIs?

A

o Sputum/induced sputum Blood cultures BAL

o Pleural fluid Antigen tests Antibody tests

o Immunofluorescence PCR

o Antigen Tests

§ Limited urine antigen tests available for: Legionella pneumophila Streptococcus pneumoniae

§ Send in severe CAP

39
Q

What are antibody tests?

A

§ Only useful on paired serum samples (one acutely unwell and another when getting better)

· Usually collected on presentation and 10-14 days later

§ Looks for a rise in antibody level over time

§ Most useful organisms to send antibody tests for because they are difficult to culture:

· Chlamydia Legionella

40
Q

What is immunofluorescence?

A

§ Antibody is labelled with fluorescent dye

§ Often used in virology

§ PCP immunofluorescence is the most commonly used one in microbiology labs

§ PCP may also be detected by Silver stain in cytology labs

41
Q

How do you treat CAPs?

A

§ Mild-Moderate: Amoxicillin [OR erythromycin/clarithromycin]

§ Moderate-Severe

· Needing hospital admission: Co-amoxiclav (augmentin) AND clarithromycin

· Allergic: Cefuroxime AND clarithromycin

42
Q

How do you treat HAPs?

A

§ 1st Line -> Ciprofloxacin ± vancomycin

§ 2nd Line/ITU -> Piptazobactam AND vancomycin

§ Specific Therapy:

· MRSA: Vancomycin

· Pseudomonas: Piptazobactam OR ciprofloxacin ± gentamicin

43
Q

What is the treatment of general pneumonia?

A

o Cefuroxime and clarithromycin (hypotensive -> query allergic)

o Fluid resuscitation

o Supplemental O2

o Senior support requested

44
Q

How can you prevent pneumonia?

A

o Smoking cessation

o Vaccination:

§ Childhood immunisation schedule

§ Adults -> influenza annually, pnemovax every 5 years

PathY5 (98 decks)

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