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Yr 3 - January lectures 19 > Respiratory tract infections > Flashcards

Respiratory tract infections Flashcards

1
Q

In a healthy “normal” state which part of the respiratory tract is sterile?

A

lower resp tract is normally sterile but upper resp tract is not - some organisms are present in healthy individuals (normal flora)

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2
Q

What defence mechanisms does the respiratory system have?

A

cilia
mucus production
cough and swallow mechanism and immunoglobulins (IgA)

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3
Q

What are some of the key elements of a respiratory history?

A

symptoms: cough, nature of sputum, haemoptysis, pleuritic pain, fever, night sweats, coryzal symptoms (nasal discharge, facial pain, muscle aches and pains, lethargy)
History of travel
employment - exposure to animals, air conditioning, student, occupational exposures
does pt keep birds
underlying/predisposing illness
unwell contacts

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4
Q

What are the key factors of an URTI?

A 
common 
short-lived, rarely serious 
usually viral aetiology 
only require abx if:
- bacterial aetiology known or suspected
- systemically unwell 
- features or high risk of complications
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5
Q

What tend to be the classic URTI symptoms?

A

acute coryza - nasal discharge, sneezing, cough
pharyngeal involvement = sore throat
laryngeal involvement = hoarse or lost voice
can be complicated by tracheitis/bronchitis = wheeze
nasal congestion, facial pain/pressure should raise possibility of sinusitis

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6
Q

What are the causative agents of URTI in the nasopharynx?

A

rhinovirus, coronavirus, S. aureus

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7
Q

What are the causative agents of URTI in the oropharynx?

A

group A streptococcus, cornyebacterium diphtheriae, epstein-barr virus, adenovirus

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8
Q

What are the causative agents of URTI in the epiglottis?

A

H. influenzae

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9
Q

What are the causative agents of URTI in the larynx-trachea?

A

Parainfluenza, S. aureus

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10
Q

What are the symptoms of epiglottitis and what organisms normally cause it?

A

haemophilus influenzae type B - nearly completely disappeared due to vaccine

  • acute onset fever, sore throat, respiratory distress
  • must avoid manipulation of the throat - need help call ENT
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11
Q

What are the symptoms of sinusitis and what are the common organisms that cause?

A

inflammation of the lining of the sinuses

s.aureus, H.influenzae, and anaerobes

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12
Q

What are the characteristics of pharnygitis (sore throat/tonsilitis)?

A

inflammation, exudate, fever, tender cervical lymph nodes

difficult to differentiate between viral and bacterial pharyngitis on basis of clinical findings

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13
Q

What are common organisms that cause pharyngitis, and its complications?

A

streptococcus pyogenes - group A streptococcal most common bacterial cause = about 30%

Complications:

  • scarlet fever (characteristic red rash all over body)
  • rheumatic fever
  • post-strep glomerulonephritis
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14
Q

What are the symptoms of whooping cough and how is it transmitted ?

A

bordetella pertussis bacteria

  • mild, cold like symptoms
  • develop into coughing fits (characteristic barking cough), can persist for weeks to months

person to person, coughing and sneezing

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15
Q

When are the vaccinations for whooping cough?

A

2, 3 and 4 months booster pre-school

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16
Q

What are the important viruses in RTI?

A

influenza/parainfluenza
RSV
novel coronavirus

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17
Q

What are the 3 main types of influenza?

A

A, B and C

- A and B = most of disease burden

18
Q

What is meant by influenza virus is antigenically unstable?

A

constantly changing

  • antigenic DRIFT = minor changes to the amino acid sequence of the haemagglutinin
  • antigenic SHIFT = major changes in HA

Seasonal epidemics and pandemics

  • H1N1
  • HSN1 avian influenza
19
Q

Which groups are offered influenza vaccination and how is it diagnosed?

A

risk groups are offered it each year
components of vaccine aim to cover circulating strains

throat swab detection by PCR

20
Q

How is RSV transmitted and what are the symptoms?

A

transmitted by large droplets and secretions
- occurs regularly each year

generally mild but children (<6 months) develop most severe disease (bronchiolitis and pneumonia)
60% will have been infected prior to 1st birthday
disease in childhood doesn’t give lifelong protection

21
Q

What can novel coronoaviruses cause?

A

respiratory infections of varying severity in humans and animals
Severe acute respiratory syndrome (SARS)

Middle east respiratory syndrome coronoavirus (MERS-CoV)
- camels are suspected primary source of infection

22
Q

What are the common LRTI?

A

pneumonia - infection of lung tissues

Acute bronchitis/bronchiolitis - inflammation of the bronchi

primary difference is pneumonia has radiological changes

23
Q

What are some pre-disposing conditions for LRTIs?

A

alcoholic - S. pneumonia, h. influenzae, K pneumonias

COPD - H influenzae, S pneumoniae

Cystic fibrosis - pseudomonas, staphylococci

Post influenza - staphylococci , H influenzae, s pneumoniae

Mechnical ventilation - klebsiella, MRSA, p.auruginosa, enterobacter

24
Q

What are the signs and symptoms of community acquired pneumonia?

A

typical: fever, chest pain and purulent sputum

Atypical: dyspnoea and cough, minimal sputum production, more systemic upset

25
Q

What does a chest radiograph?

A
  • lobar / multilobar / segmental => one or more lobes affected
  • bronchopneumonia - diffuse/patchy, bilateral, asymmetric usually effects both lower lobes
26
Q

Where is streptococcus pneumoniae a normal inhabitant?

A

upper respiratory tract

  • it is the most common cause of CAP
  • gram +ve cocci in pairs
27
Q

How can pneumonia be prevented?

A 
polyvalent pneumococcal vaccine 
offered to:
- elderly >65
- splenectomised pts 
- alcoholics 
- COPD
28
Q

What are the symptoms of an acute infective exacerbation of COPD?

A 
Change in colour of sputum 
fever
increased sputum production 
caused by:
- h influenzae
- streptococcus pneumoniae
- moraxella catarrhalis

exacerbations are not always due to infection

29
Q

What organisms cause atypical pneumonias?

A 
legionella pneumophila
mycoplasma pneumoniae 
chlamydia psittaci 
chlamydia pneumoniae 
coxiella burnetti
30
Q

Where is legionella pneumophila usually acquired from and what are the symptoms and diagnosis?

A

gram -ve rod
responsible for large outbreaks
associated with environmental water sources (taps in hospitals, water systems (air conditioning))

symptoms = mild flu like symptoms to severe pneumonia

diagnose with URINE legionella antigen test

31
Q

What is chlamydia psittaci and how is it transmitted and prevented?

A

obligate intracellular bacteria

  • usually causes infections in birds
  • tranmission to humans is by inhalation of dried birds faeces

symptoms= flu like illness, pneumonia

treat infected birds

32
Q

What is mycoplasma pneumoniae?

A

small gram -ve organism - transmitted by resp droplets
infections most commonly in children (5-14) and adults (30-39)
epidemics every 4 years

ranges from mild respiratory illness to pneumonia

33
Q

What is HAP and what common organisms cause it?

A

hospital acquired pneumonia

  • pneumonia presenting 2 or more days after hospital admission
  • patient from nursing home or long term care facility/having haemodialysis spent >2 days in hosp in the last 90 days = healthcare associated pneumonia (HCAP)

gram -ve organisms = e. coli, klebsiella, serratia, pseudomonas, staph aureus, MRSA, s. pneumoniae

34
Q

What are the risk factors for HAP?

A

Endotracheal intubation, ventilation, immunocompromised patients, post surgery

35
Q 
Case 1:
18 M 
sore throat and fever 
- amoxicillin 
rash over body 
mild splenomegaly 
lymphopaenia

What could be the diagnosis be?

A

EBV - glandular fever
amino-penicillins can cause rash (not allergic reaction)

for pharyngitis presentations should consider HIV testing

36
Q

Case 2
36 M
previously well and fit
3 day hx cough productive green sputum, fever, pleuritic chest pain
starts temp => still spiking temperature and his inflammatory markers stop improving

What should you be thinking if the infection you are treating isn’t improving?

A

wrong bug
wrong drug
complication

37
Q

What diagnostic approaches are important in RTI?

A 
Hx and exam 
Blood cultures
Sputum cultures and throat swab if appropriate send urine 
CXR
routine bloods 
pleural aspiration if evidence of fluid
38
Q

What score is used to assess severity of CAP?

A

CURB 65

  • confusion of new onset
  • Urea greater than 7
  • RR >30
  • bP <90 systolic or <60 diastolic
  • age 65 or older
39
Q

What is the treatment approach for RTI?

A

SSTF = start smart, then focus

  • give broad, empirical abx
  • narrow spec when further microbiological/clinical evidence emerges
40
Q

When should you review abx prescription?

A

48 hour review

  • continue
  • cancel
  • convert to oral

Yr 3 - January lectures 19 (30 decks)

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