Respiratory Tract Infections Flashcards
What is pneumonia? Describe its presentation and briefly describe its treatment.
It is inflammation of the lung alveoli which can be lobar or bronchopulmonary.
Presentation:
- Fever
- SOB
- Cough
- Sputum
- Localising signs and abnormal CXR
Treatment
- Antibiotics (depends on severity and type)
- Supportive (O2 and fluids)
What is bronchitis? Describe its presentation and briefly describe its treatment.
It is inflammation of the medium sized airways and occurs mainly in smokers.
Presentation:
- Fever
- Cough
- SOBOE
Treatment:
- Bronchodilation
- Physiotherapy
- +/- antibiotics
What are the most common causes of community acquired pneumonia? Give some distinguishing features of these infections
Streptococcus pneumoniae
- Gram +ve diplococci
- Rust coloured sputum
- Lobar distribution on CXR
Haemophilus influenzae
- Gram -ve cocco-bacilli
- Associated with lung disease
Moraxella catarrhalis
- gram -ve coccus
- Associated with smoking
Staphylococcus aureus
- Gram -ve cocci, clusters
- Recent viral infection
- Cavitation on CXR
Klebsiella pneumonia
- Gram -ve rod
- Associated with alcoholism or the elderly
What infections can cause a cavitating lesion?
- Staphylococcus aureus
- TB
- Klebsiella pneumoniae
What pathogens can cause an atypical pneumonia? Give some distinguishing features of these infections
Legionella pneumoniae
- Travel/air conditioner
- Droplet infection
- Hyponatraemia, abdominal pain, confusion
- Multi-organ failure
- Buffered charcoal yeast extract
- Has a urine antigen
Mycoplasma pneumoniae
- Occurs in epidemics
- Cold agglutinin test
- Erythema multiforme
Chlamydia (pneumonia or psittaci)
- Psittaci: bird owner/contact with birds
Coxiella (Q fever)
- Farm animals
Bordatella pertussis
- Whooping cough
- Unvaccinated children
TB
- No response to Abx
- Longer history
- Upper lobe cavitation
In immunocompromised patients, what pathogens are they more at risk to? Separate them according to the reason of their immunocompromise.
HIV
- PCP/PJP
- TB
- Cryptococcus
Neutropaenia
- Fungi (aspergillosis)
Bone marrow transplant
- Fungi (aspergillus)
- CMV
Splenectomy
- Encapsulated bacteria (H. influenzae, S. pneumoniae, N. meningitidis)
Cystic fibrosis
- Pseudomonas
- Bukholderia cepacia
What investigations should be ordered for a case of pneumonia?
- FBC, U&Es, CRP
- Blood culture, sputum MC&S
- ABGs
- CXR
- Urine antigens
- Antibody tests
- Immunofluorescence
Give some description of PJP
Pneumocystis jirovecii
- Protozoan
- Insidious onset (dry cough, weight loss, SOB)
- CXR: bat wing appearance/ground glass
- Diagnosed on immunofluorescence
- Walk test: walking and desaturating
- Treated with co-trimoxazole
What is the definition of a hospital acquired pneumonia?
Infection starting 48 hours after admission
What common organisms are the cause of hospital acquired pneumonias?
- Enterobacteriaceae
- Staphylococcus aureus
- Pseudomonas aeruginosa
What is the CURB-65 score?
It is useful to use in primary care.
C: confusion U: urea >7 R: respiratory rate >30 B: blood pressure <90/60 65: patient is >65 years old
A score of <2 is mild/moderate
A score of >2 required admission and is treated as severe
How is pneumonia treated?
Depending on type and severity: FOLLOW LOCAL GUIDELINES
Community acquired: classical
- Mild/moderate: amoxicillin/clarithromycin
- Moderate/severe: co-amoxiclav + clarithromycin
Community acquired: atypical
- Clarithromycin/doxycycline
Hospital acquired:
- First line: ciprofloxacin +/- vancomycin
- Second line: piptazobactam + vancomycin
- Add metronidazole if aspiration
Special therapies: CAP
- Legionella: clarithromycin + rifampicin
- S. aureus: flucloxacillin
Special therapies: HAP
- Pseudomonas: Tazocin/ciprofloxacin + gentamicin
- MRSA: vancomycin
