Respiratory Tract Infections Flashcards
A hot feverish drooling child is a medical emergency because they may have?
Epiglottitis
Symptoms of sinusitis is?
- Frontal headache
- Retro-orbital pain
- Maxillary sinus pain
- Tooth ache
- Discharge
Characteristic sign of diphtheria?
Pseudo-membrane at back of throat
In what people can acute bronchitis cause problems
Those already with lung diseases for example it can cause an exacerbation of COPD
Management of an exacerbation of COPD?
Ipatropium Salbutamol Oxygen Amoxicillin Prednisolone
List some symptoms and signs of pneumonia?
- Cough (usually productive but can be dry)
- Breathlessness
- Fever
- Chest Pain
- Myalgia, arthralgia and malaise
- Headache
- Abdo pain, diarrhea and vomiting (ATYPICAL SIGNS)
- Can get herpes simplex reactivation in Strep Pneumonia
- Skin rashes in Mycoplasma
- In elderly may become confused
Explain CURB65
C New onset of confusion U Urea >7 R Respiratory rate >30/min B Blood pressure Systolic <90 OR Diastolic <61 65 age 65 years or older
Management of CURB65 0-2 Pneumonia?
Amoxicillin orally
In hospital acquired pneumonia what bacteria are you more likely to get?
Gram negative
Two antivirals given for the flu?
Oseltamivir and zanamivir
Pneumonia is….
a lower respiratory tract infection with new consolidation on X-ray
Lobar pneumonia is ____ and is usually caused by _______
• Confluent consolidation involving a complete lung lobe
Streptococcus pneumoniae
Bronchopneumonia is ____ and is most often seen as _____
Infection starting in airways and spreading to adjacent alveolar lung
Complication of pre-existing lung or cardiac disease
A lung abscess is _____, it leads to _______ and is difficult to treat because ______
Localised collection of pus, tumour like
Chronic malaise and fever
Antibiotics don’t penetrate very well
Bronchiectasis is _____ usually due to ____ and can cause __________
Abnormal fixed dilatation of the bronchi
Fibrous scarring following infection
Chronic Infections and pus
What type of bacteria causes TB?
Mycobacteria Tuberculosis
Primary TB occurs in?
Patients, usually children who have not been previously exposed to TB or vaccinated against it.
Tissue changes in primary TB include?
Small focus (Ghon focus) in periphery of mid zone of lung and large hilar nodes (granulomatous)
Secondary TB is ____ and results in ____
This is a recurrence of TB in later life- either reactivation or reinfection.
The patients have immunity to TB and develop a cellular response leading to caseation.
Typical pneumonia is caused by ____ this bacteria is ______ its key virulence factor is its ___
Strep pneumoniae
Alpha haemolytic, gram positive cocci
Capsule
CURB65 score 3-5 treatment?
Co-amoxiclav + doxycycline orally
One of the very few times you can use a quinolone (ends in floxacin) is? Two other antibiotics used are?
Legionella infection
Clarithromycin and erythromycin
Walking pneumonia is caused by _____ and _____ is not used as the bacteria don’t have cell walls
Mycoplasma pneumoniae
Amoxicillin
Although less common than strep pneumoniae the bacteria _____ can also occur post influenza and is treated with _______
Staph pneumoniae
flucloxacillin
HAP pneumonia non severe treatment?
Amoxicillin orally
MTB are ….
rod shaped gram positive bacilli
Describe Primary TB infection
- Primary infection occurs in those who have not been previously exposed to TB or vaccinated against it
- A small Ghon focus at the periphery of the lung is the site of infection and there is lymphatic spread to the hilar lymph nodes, some caseous masses may form
- In most patients the lesions undergo fibrosis or calcification and heal
- Spread however can occur
Risk factors for TB?
- Babies, young adults, old people.
- Immigrants
- People who live in deprivation
- Immuno-supressed people
Lymph node TB is _____ controlled and on scan you will see ____ Miliary TB is _____ controlled and on scan you will see ____
well
enlarged lymph nodes
poorly
little dots all over lungs
Name two stains that can be used in the identification of mycobacteria
Auramine
Zhiel Neelson will turn acid fast bacilli red
Treatment of active TB?
- 4 drugs for 2 months: Rifampicin, Isoniazid Pyrazinamide, ethambutol
- 2 drugs for a further 4 months: rifampicin, isoniazid.
- All these drugs have side effects so need good reason to give out these drugs.
Treatment of latent TB?
- 2 drugs for 3 months: rifampicin, isoniazid
- For further 3 months: isoniazid
- Problem with convincing people to take these drugs as they have no symptoms and can’t take the pill etc.
Every time you see someone with chronic infections you should check for?
HIV
What does intrapulmonary abscess usually precede?
Illness of some sort such as pneumonic infection, post viral infection, inhaled a foreign body
Empyema is…
pus in the pleural space
How do you detect empyema?
Patients will have a slow to resolve pneumonia
Then need CXR
USS- preferred investigation but not always needed
CT to differentiate between empyema and abscess
Detection of complicated pleural effusion requires sampling
Treatment of empyema?
- IV antibiotics, broad spectrum- amoxicillin and metronidazole
- Oral antibiotics directed towards cultured bacteria 5 weeks usually co-amoxiclav (here you can give it!!!)
Bronchiectasis is and can lead to?
- Localised irreversible dilation of the bronchial tree
- Involved bronchi are dilated, inflamed and easily collapsible
- Can lead to airflow obstruction and impaired clearance of secretions
How will patients with bronchiectasis present?
- Recurrent chest infections
- Recurrent antibiotic prescriptions
- Short lived response to antibiotics
- Persistent sputum
Explain chronic bronchial sepsis?
There are recurrent infections but no bronchiectasis. Often younger patients, mainly women, often involved in childcare. Others are older with COPD, or airways disease
Same work up as bronchiecstasis
Treatment options for bronchiectasis?
- Stop smoking
- Flu vaccine
- Pneumococcal vaccine
- Reactive antibiotics
- When colonised with persistent bacteria- most successful seems to be low dose macrolides clarithromycin, azithromycin.
Systemic signs of CF?
- Salty Sweat
- Intestinal Blockage
- Fibrotic Pancreas
- Failure to Thrive
- Recurrent Bacterial Lung Infections
- Congenital Bilateral Absence of Vas Deferens (male infertility)
- Filled Sinuses
- Gallbladder and Liver disease
What is the most common mutation in CF patients?
delta F508
Treatment of severe HAP?
IV Amoxicillin + Gentamicin
5 categories you test for CF?
- Anyone who has bronchiecstasis and under the age of 40
- Anyone presenting with upper lobe bronchiecstasis
- Colonisation with staph
- Infertility
- Low weight
What is a potential drug treatment for Cf that is very expensive?
Ivacaftor
Is it okay to prescribe broad spectrum antibiotics to those with CF?
Yes!
Right sided endocarditis is associated with?
Drug users
Coxiella burnetti causes….
pneumonia and pyrexia of unknown origin
Mycoplasma pneumonia is….
community acquired and seen in older children and young adults
Haemophilus influenzae…
causes pneumonia, acute epiglottis, exacerbations of COPD and is gram neg and cultured on chocolate agar.
Infects children, with peak incidence in winter. May be secondary to another infection, and can cause mild to severe illness, which may be flu-like. Diagnosis is confirmed by PCR.
Metapneumovirus
Fungal lung infections are …
Often opportunistic, these organisms tend to affect immunocompromised patients and are usually caused by inhaled spores or reactivation of latent disease.
Tuberculosis drug side effects
Rifampicin stains body secretions pink-orange
Pyranzamide- joint pain
Isonnizaid- peripheral neuropathy
Ethambutol- problems with eyesight
All four can have bad effect on the liver
Describe secondary TB infection?
- This is a recurrence of TB in later life due to reactivation or reinfection
- Reactivation can occur due to subtle immunosuppression such as old age, or other health conditions or due to immunosuppressive medication or HIV
- Patients with secondary infection already have immunity to TB and develop and cellular response and caseation
What is aspiration pneumonia? Why does it occur?
- This occurs due to inhalation of food or infected material from the mouth or oropharynx
- May be a complication of anaesthesia, coma or occur in conditions where there is frequent reflux e.g. oesophageal obstruction or poor swallowing due to motor neurone disease or stroke
Treatment of non severe aspiration pneumonia?
Amoxicillin and Metranidazole orally
Treatment of severe aspiration pneumonia?
IV Amoxicillin, Gentamicin and Metranidazole
