Respiratory Tract Infections Flashcards
What are the common upper respiratory tract infections?
- Rhinitis
- Sinusitis
- Pharyngitis
- Epiglottitis
What is the cause of most rhinitis?
Viral
What are the causes of sinusitis?
Many are viral, some bacterial (S pneumonia, H flu, moraxella and oral anaerobes)
Why is pharyngitis often treated?
Treatment prevents complications (rheumatic fever, post strep GN)
What are the signs of epiglottitis?
– High fever, systemic toxicity, drooling, blood cultures positive in 65% of kids, 30% adults
What are the causes of epiglottitis?
H flu, group A strep, H parainfluenza
What are the cause of acute bronchitis?
- Majority are viral (influenza, parainfluenza, RSV, coronavirus, adenovirus, rhinovirus)
- Bacteria include mycoplasma, strep pneumoniae, H flu, chlamydophila, B pertussis
What are some risk factors for pneumonia?
- Old age
- Pulmonary disease
- Smoking
- Recent viral illness
- Diabetes
- Chronic renal disease
- Immunodeficiency
What are some signs of pneumonia?
- Cough, sputum, fever, shortness of breath
* Signs of consolidation
What is seen in typical CAP?
Acute onset of symptoms (cough, sputum, fever, shaking chills), lobar infiltrate, gram stain with PMNs and organisms
What is the most common cause of typical CAP?
Streptococcus pneumoniae
What is seen in atypical CAP?
Subacute onset of symptoms, prodrome, milder symptoms (“walking pneumonia”), negative gram stain
What are the common causes of atypical CAP?
Mycoplasma, Chlamydia, Legionella, viruses
What are the typical signs of influenza?
Fever, cough, headache, sore throat, myalgias.
What are the signs of CAP in pediatric patients?
• Tachypnea, fever, cough, dyspnea
What are the major organisms causing CAP in the 3 pediatric age ranges (under 2/5-10/10-16)?
- Under 2: Viral (RSV, rhinovirus)
- 5‐10 years old: Mycoplasma
- 10‐16: S. pneumoniae, Chlamydophila
What is the outpatient treatment for CAP?
Macrolide or doxycycline
What is the in-patient treatment for CAP?
– Respiratory fluoroquinolone
– Lactam + macrolide
What are the possibilities if CAP is not responding to therapy?
‐ Inadequate dosing
‐ Host factors (slower response in elderly, patients with other chronic illnesses, alcoholics)
What are the typical organisms of HAP?
Klebsiella, E coli, Enterobacter, Proteus, Serratia, Pseudomonas, Acinetobacter
What is the treatment for HAP?
Early, broad empiric therapy that is narrowed down with the culture results
What are some organisms involved in chronic pneumonia?
- Mycobacterium (TB or atypical)
- Nocardia
- Actinomyces
- Endemic fungi (histo, blasto, cocci)
- Coxiella
- Tularemia
- Anatomic problem
What are organisms commonly involved in lung abscess?
Commonly isolated organisms include anaerobic mouth organisms (bacteroides, fusobacterium, peptostreptococcus), aerobic and anaerobic streptococcus, GNRs
What organisms is someone with neutrophil deficiency susceptible to?
Gram negative rods (Pseudomonas and H flu), Staph, Aspergillus, Candida
What organisms is someone with T cell deficiency susceptible to?
– Fungi (candida, aspergillus, cryptococcus)
– Viral (CMV, HSV)
– Pneumocystis, Mycobacteria, Listeria
What organisms is someone with B cell deficiency susceptible to?
Encapsulated organisms: S pneumoniae, H flu, Neisseria, Klebsiella, E coli, Giardia
What is CMV pneumonia?
Rare in immunocompetent but is seen in those with T cell deficiency and involves multiple organ systems
What can cause neutrophil deficiency?
Chemotherapy, leukemia, chronic granulomatous disease
What can cause T cell deficiency?
AIDS, T cell lymphoma, Transplant, DiGeorge’s syndrome
What can cause B cell deficiency?
Splenectomy, chronic lymphocytic lymphoma, Non Hodgkin’s Lymphoma, Myeloma, gamma globulin deficiencies
