Respiratory tract infections Flashcards
baby?
:)
what bacteria are normally colonised in the upper respiratory tract
staphylococcus streptococcus pneumoniae viridans steptococcus haemophilus . anearobes the alveoli also contains a microbiome of normal microbes
Causes of rhinosinusitis
viral mostly - rhinovirus, influenza and para-influenza bacterial is less often streptococcus pneumoniae haemophilus influenzae moraxella catarrhalis
bacterial rhinosinusitis
bi-phasic illness
lasts more than 10 days
secondary to infection to allergic/ viral rhinitis
red flags of rhinosinusitis
severe/ persistent headache periorbital oedema visual changes opthalmoplegia cranial nerve palsy altered mental state neck stiffness papilloedema
complications of rhinosinusitis
pre-orbital/ orbital cellulitis subperiosteal abcess osteomyelitis meningitis intracranial abcess septic cavernous sinus thrombosis
treatment for viral rhinosinusitis
will self-resolve
supportive therapy - analgesics, intranasal steroids if it lasts longer than 10 days
decongestants
treatment for bacterial rhinosinusitis
will self resolve
supportive therapy - can give back up antibiotics to be take if not resolving in 5-7 days
evidence is poor
symptoms of rhinosinusitis
nasal congestion
green nasal discharge
headache - frontal, constant and worse on leaning forward
common cold
benign self-limiting syndrome
causes of the common cold
rhinovirus coronavirus influenza parainfluenza respiratory syncytial virus
how is the common cold transmitted?
direct transmission
hand contact - up to 2 hours on skin
sneezing or coughing - tissues do not support virus transmission
large droplets from close contact or 8 hours on external surfaces
how much does the common cold cost per year?
$40 billion due to time off work
effective treatments for common cold
supportive
nasal decongestants
antihistamines combination
analgesics
Ineffective treatments for common cold
antibiotics antivirals vitamin C echinacea - herb codeine intranasal glucocorticoid
symptoms of common cold
dry cough
sore throat
tiredness - malaise
runny nose - rhinorrhea
symptoms of acute pharyngitis
sore throat
difficulty swallowing
swollen tonsils
swollen lymph nodes
acute pharyngitis
tonsilitis
causes of viral tonsilitis
adenovirus
rhinovirus
coronavirus
adenovirus
fatigue
rhinovirus
nasal congestion
coronavirus
cough
bacterial tonsilitis
group A, C and G
streptococcus
what are the symptoms of bacterial tonsilitis
acute onset sore throat fever patchy tonsilar exudate pharyngeal edema tender anterior cervical lymphdenopathy scarlatiniform rash
less common causes of tonsilitis
infectious mononucleosis (mono) Epstein-Barr Virus - EBV
symptoms of infectious mononucleosis
high fever
prominent posterior cervical lymphdenopathy
symptoms of EBV
splenomegaly and atypical lymphocytosis
what is splenomegaly
abnormal enlargement of the spleen
what tonsilitis needs antibiotics?
GBS
prescribing antibiotics for acute sore throat
scoring systems depending on score of fever and pain
back up antibiotics
not needed immediately
for use if no improvement of symptoms in 3-5 days or if the symptoms worsen .
symptoms of bronchiolitis
fever cough wheezing increased respiratory rate poor feeding
bronchiolitis
viral infection of the small airways
prodromal upper respiratory tract infection followed by secondary inflammation of bronchi/ bronchioles
caused by respiratory syncytial virus
seasonal outbreaks in autumn and winter
leading cause of admission for 0-5 year olds
peak incidence at 2 years old .
clinical course of bronchiolitis
day 0 - upper respiratory symptoms day 2 - lower respiratory symptoms day 3-5 - peak illness day 15 - cough resolves 90% fully resolved within 3 weeks
risk factors for severe disease from bronchiolitis
apnoea respiratory failure prematurity low birth weight age - less than 12 weeks]chronic lung disease anatomical defects congenital heart disease immunodeficiency neurological disease
treatment for bronchiolitis
NICE guidance promotes supportive care and non-invasive ventilation in acute respiratory failure .
when to discharge someone with bronchiolitis?
clinically stable
taking oral fluids
oxygen sats greater than 92%
what treatments should not be used?
antibiotics hypertonic saline adrenaline salbutamol montelukast ipratropium bromide systemic or inhaled corticosteroids
symptoms of pneumonia
worsening cough with green sputum lower right sided chest pain with inhalation fatigue confusion high fever chills clamminess blueness skin SOB pleuritic chest pain hemoptysis - coughing up blood aches headaches loss of appetite mood swings low BP nausea vomiting pain in joints
what is used to measure the severity of pneumonia?
CURB 65
CURB 65
confusion urea - >7mmol respiratory rate over 30 blood pressure less than 90/60 older than 65
classification of CURB 65 scores
less than 1 = <3% risk of death - ambulatory
1-2 = 9% risk of death - admit
more than 3 = 40% risk of death - HDU/ITU
Causes of community acquired pneumonia
typical - viewed on a gram stain and sensitive to beta-lactams
atypical - cannot be viewed on gram stain, require other antibiotics
other causes
typical causes of CAP
streptococcus pneumoniae haemophilus influenzae moraxella catarrhalis staphylococcus aureus group A strep aerobic gram -ve anearobes - associated with aspiration
Atypical causes of CAP
legionella spp mycoplasma pneumoniae chlamydia pneumoniae chlamydia psittaci coxiella burnetii
other causes of CAP
viral funcgal TB influenza A and B rhinovirus parainfluenza RSV
Hospital acquired pneumonia
occurs more than 48hrs after admission to hospital . Increased risk by mechanical ventilation as the tube provides a surface for bacteria to live/ reproduce
pathogens that cause HAP
Staphylococcus aureus pseudomonus aeruginosa klebsiella enterobacter acinetobacter E coli
Treatment of pneumonia
antibiotic therapy based on local guidance
treatment for CAP
penicillin
tetracyclines
macrolides
e.g. clarithromycin
treatment for HAP
broad spectrum penicillin or Carbopenum e.g. co-amoxiclav
Aminoglycosides - gentamicin
complications of pneumonia
pleural effusion empyema respiratory failure acute respiratory distress syndrome cavitating disease abscess
what is epyema?
collection of pus in the pleural cavity
