Respiratory tract infections Flashcards
1
Q
What are the 3 main routes of transmission for respiratory tract infections ?
A
- Contact (touch)
- Airborne
- Droplet
2
Q
Define what acute cough/ acute bronchitis is
A
It is an infection of the the bronchi - the large airways.
3
Q
What is acute bronchitis caused by ?
A
- It is usually due to viral infection
- Less commonly it may be caused by bacterial infection
4
Q
What are the main causative organisms of bacterial acute bronchitis ?
A
H.influenzae, S.pneumoniae, M.catarrhalis.
5
Q
What are the main clinical features of acute bronchitis ?
A
- The key symptom is a productive cough
- May have a transient wheeze
- You may also develop a fever, headache, cold symptoms and aches and pains.
- Symptoms typically peak after 2-3 days and then gradually clear. However, it commonly takes 2-3 weeks for the cough to go completely after the other symptoms have gone.
6
Q
In someone with acute bronchitis would you expect their chest exammination and CXR to be normal ?
A
Yes
7
Q
What is the mainstay of the treatment of acute bronchitis ?
A
It is usually self-limiting in the average joe so treatment is supportive:
- Analgesia – paracetamol and ibuprofen
- Hydration.
- Time.
8
Q
When may antibiotics be used in the treatment of acute bronchitis ?
A
- When the patient is systemically very unwell
- When the patient has symptoms and signs of serious complications
- When the patient is at high risk of serious complications due to serious co-morbidity
- When the patient is aged 65 or older
- Where community acquired pneumonia is suspected, antibiotic treatment should be commenced without delay, and assessment of the CRB-65 score is essential
9
Q
When antibiotics are indicated for treatment of acute bronchitis what should be given?
A
- 1st line = Amoxicillin
- 2nd line = Doxycyline if penicillin allergy
10
Q
Define what bronchiolitis is
A
Bronchiolitis is an acute viral infection of the lower respiratory tract that occurs primarily in the very young.
11
Q
Who is most commonly affected by bronchiolitis ?
A
Most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months)
12
Q
During what part of the year do most cases of bronchiolitis occur ?
A
Winter
13
Q
What are the causes of bronchiolitis ?
A
- Respiratory syncytial virus (RSV) is the principle cause
- Others include; Mycoplasma, parainfluenza and adenoviruses
14
Q
What are the typical clinical features of bronchiolitis ?
A
Coryzal symptoms (including mild fever) precede:
- Dry cough
- Increasing breathlessness
- Wheezing & fine inspiratory crackles (not always present)
- Intercostal recession
- Cyanosis
- Feeding difficulties
15
Q
What are the main reasons for admitting someone with bronchiolitis ?
A
- Poor feeding
- RR > 50
- Apnoea
- Central cyanosis
- Persistent O2 sats < 92%
- Dehydration
- Severe respiratory distress, for example grunting, marked chest recession
- Patient or parental exhuastion
16
Q
How is bronchiolitis diagnosed ?
A
By PCR on throat or pernasal swabs
17
Q
What is the treatment of bronchiolitis ?
A
Supportive - give O2
18
Q
Define what bronchiectasis is
A
This is where there is permanent fixed dilatation of the bronchi & bronchioles secondary to chronic infection or inflammation
19
Q
List the causes of bronchiectasis
A
- Post-infective: tuberculosis, measles, pertussis, pneumonia
- Cystic fibrosis
- Bronchial obstruction e.g. lung cancer/foreign body
- Immune deficiency: selective IgA, hypogammaglobulinaemia
- Allergic bronchopulmonary aspergillosis (ABPA)
- Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
- Yellow nail syndrome
20
Q
What are the signs/symptoms of bronchiectasis ?
A
- Persistent cough - with copious amounts of purulent sputum & intermittent haemoptysis
- SOB
- Finger clubbing
- Coarse inspiratory crackles
- Wheeze
- Chest pain, usually non-pleuritic
- Large airway rhonchi (low-pitched snore-like sounds)
21
Q
What additional parts to a history might make you think more of bronchiectasis ?
A
- Young age at presentation.
- History of symptoms over many years.
- Recurrent “chest infections” and Abx prescriptions but with no response or short lived to the antibiotics
- Absence of smoking history.
22
Q
What initial investigations should be done in someone with suspected bronchiectasis ?
A
- Sputum culture — to identify colonizing pathogens
- Chest X-ray — to exclude other pathology and to help confirm the diagnosis where disease is severe.
- Post-bronchodilator spirometry — to assess the severity of airflow obstruction.
23
Q
What CXR features are suggestive of bronchiectasis?
A
Signet rings & tramlines
24
Q
What is the gold standard test done to diagnose bronchiectasis ?
A
High-resolution computed tomography (HRCT)
25
What additional investigations are done to determine the cause of bronchiectasis following definitive diagnosis with HRCT ?
* Testing for cystic fibrosis (such as sweat chloride or gene testing)
* Screening for gross antibody deficiency (serum immunoglobulin G [IgG], IgA, IgM and serum electrophoresis)
* Serum total immunoglobulin IgE and specific IgE or skin prick test to Aspergillus – to exclude allergic bronchopulmonary aspergillosis
* Specific antibody levels against capsular polysaccharides of Streptococcus pneumoniae
* Tests of ciliary function — for children where no other cause for bronchiectasis is identified and if there is a history of continuous rhinitis, neonatal respiratory distress, and/or dextrocardia; and for adults if there is a history of upper respiratory tract problems or otitis media.
* Bronchoscopy — for children with suspected foreign body aspiration or to exclude an endobronchial lesion in adults.
* Gastrointestinal investigations (such as 24-hour pH monitoring) — for adults and children suspected of having bronchiectasis secondary to gastro-oesophageal reflux and aspiration.
26
What is the general management of bronchiectasis ?
* Physical training e.g. inspiratory muscle training
* Postural drainage (x2 daily) - chest physio may aid sputum expectoration & mucous drainage
* Antibiotics for exacerbations
* Bronchodilators may be useful in patients with asthma, COPD, CF & ABPA
* Corticosteroids for ABPA
* Stop smoking
* Vaccinations - influenza & pneumococcal
* Surgery may be indicated for localised disease or to control severe haemoptysis
27
Describe what an acute exacerbation of bronchiectasis is
An acute exacerbation of bronchiectasis is a sustained worsening of symptoms from a person's stable state.People with bronchiectasis should be educated so they know how to recognise an acute exacerbation. Signs to look out for include:
* Acute deterioration over a few days.
* Worsening cough.
* Increased sputum volume, viscosity or purulence.
* Increased wheeze, breathlessness or haemoptysis.
* Feeling systemically unwell.
28
What organism commonly causes chest infections/pneumonia in young patients bronchiectasis ?
Haemophilus influenzae
29
Describe what chronic bronchial sepsis is
This is when there are all the hallmarks of bronchiectasis but with no evidence of it on HRCT
30
What is the management of an acute exacerbation of bronchiectasis ?
* Send a sputum sample for culture and susceptibility testing.
* Offer an initial antibiotic based on the severity of symptoms, previous exacerbation and hospital admissions, the risk of developing complications, and previous sputum culture and susceptibility results.
* First-choice oral antibiotics for empirical treatment are clarithromycin or azithromycin
31
Define what influenza 'flu' is
* Flu (influenza) is caused by the influenza virus. However, many other viruses can cause an illness similar to flu.
* It is often difficult to say exactly which virus is causing the illness, so doctors often diagnose a flu-like illness.
32
What are the causes of influenza 'flu'?
There are three types of influenza virus - A, B and C. Influenza A and B cause most of the cases of flu. Each winter a different type of influenza virus causes an outbreak of flu which affects many people. This is called seasonal flu. If you get a flu-like illness during an outbreak of seasonal flu, it is likely to be caused by the prevailing influenza virus.
33
When do most cases of infleuza 'flu' occur?
In a period of six to eight weeks during the winter.
34
What is the cause of the winter epidemics of influenza?
Minor mutations in the surface proteins of the virus - antigenic drift
35
What are some of the causes of flu-like illnesses?
Parainfluenza viruses & many others
36
What is swine flu?
Swine flu is caused by a particular strain of influenza A virus which is called H1N1v. It seems to affect children and young adults more commonly than those over the age of 60 years. Most people with this type of flu have a mild flu-like illness. You are more likely to have sickness and/or diarrhoea with this type of flu.
37
How is influenza transmitted ?
By droplets when someone coughs or sneezes, or through direct contact with respiratory secretions of someone with the infection
38
What are the symptoms of influenza 'flu'?
* Fever (upto 40 degrees) & sweats
* Headache
* Malaise
* Myalgia (muscle ache quite marked) & arthralgia
* Prostration (state of being exstremly weak)
* Dry cough
* Sneezing
* Sore throat
39
Appreciate this:
The illness caused by the influenza virus tends to be worse than illnesses caused by other viruses which cause a flu-like illness. Even if you are young and fit, flu can make you ill enough to need to go to bed.
40
Typically how long does symptoms of influneza last?
* Typically, symptoms are at their worst after 1-2 days. Then they usually gradually ease over several days.
* Most people completely recover within 2-7 days
41
How is influenza 'flu' usually diagnosed ?
Diagnosis is usually made using clinical features alone when it is known to be circulating in the community
42
When a definitive diagnosis of influenza is required what is done ?
PCR of nasopharyngeal swabs, throat swabs or of other respiratory samples
43
What may indicate that someone has developed complications of influenza?
* Signs and symptoms that require hospital admission.
* Symptoms of LRTI (hypoxaemia, dyspnoea, lung infiltrate).
* Central nervous system involvement.
* Significant exacerbation of an underlying medical condition.
44
What are some of the complications which can develop as a result of influenza?
* Bronchitis
* Penumonia - most commonly this is a secondary pneumonia caused by bacterial infection with H. influenza. Or this may be a primary influenzal pneumonia
* Sinusitis
* Ottitis media
* Encephalitis
* Pericarditis
* Reyes syndrome (coma, Increased LFTs)
* Influenza during pregnancy - associated with perinatal mortality, prematurity, smaller neonatal size & LBW
45
List the people who are considered at risk groups for suffering a worse prognosis from influenza
'At risk group' includes people aged over 65 years, children aged under 6 months, pregnant women (at any stage of pregnancy, or women up to two weeks post partum), and people with any of the following conditions:
* Asplenia or dysfunction of the spleen
* Chronic respiratory disease
* Chronic heart disease
* Chronic kidney disease
* Chronic liver disease
* Chronic neurological conditions
* Diabetes mellitus
* Immunosuppression - people undergoing chemo or radiotherapy, bone marrow transplants, HIV, treated with systemic steroids for \> 1 month, multiple myeolma & genetic disorders affecting the immune system
* Morbid obesity (body mass index of 40 or more).
46
What is the treatment of inflenza 'flu'?
For uncomplicated influenza in previously healthy people tx = supportive (no antivirals needed) with hydration, paracetamol & ibuprofen)
For complicated influenza or uncomplicated in at risk groups (including pregnant women):
* 1st line = oseltamivir
* 2nd line = zanamivir
47
When is post-exposure prophylaxis for influenza done ?
Prescribe either oseltamivir (upto 48hrs after exposure) or zanamivir (upto 36hrs after exposure) if all the following apply:
1. The national surveillance scheme indicates that influenza is circulating.
2. The person has been exposed to a person (in the same household) with an influenza-like illness
3. The person is either immunocomprimised or in an at risk group of having a worse prognosis of influenza
Note - this is not done in at-risk groups who have been vaccinated against seasonal influenza at least 14 days before exposure.
48
Who is influenza vaccines recommended for ?
* All people older than 65 years, and those older than 6 months if they at in an at risk group (mentioned in previous flashcard)
* health and social care staff directly involved in patient care (e.g. NHS staff)
* * carers of the elderly or disabled person whose welfare may be at risk if the carer becomes ill (at the GP's discretion)
* All children aged two-five years (not yet at school)
* All primary school aged children (primary one to primary seven) at school.
49
What is the difference between the adult and childrens influenza vaccine and therefore what children are contraindicated from recieving it and hence require the adult vaccine ?
The childrens vaccine is a live vaccine rather than an inactivated one
Contraindications to the live vaccine:
* immunocompromised
* aged \< 2 years
* current febrile illness or blocked nose/rhinorrhoea
* current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4)
* egg allergy
* pregnancy/breastfeeding
* if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye's syndrome
50
What is MERS?
* Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath.
* Mortlaity rate roughly 35%
51
What are the symptoms of MERS?
Most people confirmed to have MERS-CoV infection have had severe respiratory illness with symptoms of:
* fever
* cough
* shortness of breath
52
What animal is an important resevoir for MERS?
Cammels
53
Where is MERS most prevelent ?
Saudi arabia
54
What is avian influenza ?
* This is different from regular infleunza and is caused by H5N1 strain of influenza A.
* It results in rapidly progressive pneumonia with \>= 50% mortality rate
55
How is avain influenza transmitted?
Avian-to-human transmission
56
When should you suspect avian influenza?
* If fever \>38 plus lower resp track signs or consolidation on CXR, or life threatening infection
* AND they have had contact with poultry or others with similar symptoms
57
Define what pneumonia is
Strictly speaking it describes any inflammatory condition affecting the alveoli of the lungs, in the vast majority of patients this is secondary to a bacterial infection.
58
List in general the different causes of pneumonia
1. Viruses - influenza, parainfluenza, measles, VZV, RSV, COIVD-n19 (these are common but usually self-limiting, but can be complicated)
2. Bacteria - by far the most common type of pneumonia
3. Atypical bacterial - Mycoplasma pnuemoniae, Coxiella, Chlamydiophila psittaci & Legionella
4. Fungi e.g. Pneumocytis jiroveci
59
What are the different ways in which a pneumonia can be classified?
1. By clinical setting e.g. CAP vs HAP, aspiration pneumonia or pneumonia in an immunocompromised patient
2. By organism (refer to causes of pnuemonia flashcard)
3. By morphology e.g. lobar pneumonia or bronchopnuemonia
60
Define what is meant by a lobar pneumonia
This is a pnuemonia involving one or more lobes of the lung
61
Define what is meant by describing a pneumonia as 'bronchopneumonia'
This is a type of pneumonia in which the infection starts in the airways and spreads to adjacent alveolar lung
62
Describe the pathology of penumonia
1. Organism reaches lungs
2. Causing acute inflammatory/immune response with exudation of fibrin-rich fluid, followed by neutrophil infiltration and then macrophage infiltration and then resolution
3. During this response there is fluid & cellular build-up in the alveoli leading to impairment of gas exchange
Note red hepatisation is seen
63
What is the prognosis of pnuemonia ?
* 5-10% mortality from pneumococcal pnuemonia
* But can be as high as 30% if patient is bacteraemic
64
What are the potential risk factors for penumonia development ?
* Increased age
* Smoking
* Low BMI
* Chronic illnesses - Heart failure, Diabetes, Chronic liver disease, HIV
* Respiratory diseases - COPD, Asthma
* Influenza & other resp tract infections
* Risks for aspiration - Epilepsy, Stroke, Chronic neurological diseases e.g MS, Alcohol abuse
* Ventilation
* Steroids & PPIs
65
List the causes of community-aquired pneumonia (CAP)
* Streptococcus pnuemoniae
* Haemophilus influenzae
* Staph. Aureus
* Klebsiella pneumonia
* Atypical pneumonia (refer to general causes flashcard)
* Viruses e.g. influenza
Think KASSH + viruses
66
List the causes of hospital-aquired pneumonia ?
* Gram -ve enterobacteria (including E. coli, Klebsiella spp. Pseudomonas spp)
* Staph. aureus more common than in CAP
* H.influenza
* Legionella
* Mycoplasma pneumonia more common than in CAP
* Viruses e.g. influenza
Super heavy LMG
67
What is the most common cause of CAP ?
Streptoccocus pneumoniae (accounts for 80% of cases) (pneumococcus)
68
Who does pnuemoccocal pneumonia affect?
All ages, but is commoner in the elderly, alcoholics, post-splenectomy, immunosuppressed, chronic HF or pre-exisiting lung disease
69
Who is classically affected by staphylococcal pnuemonia ?
* **Often following influenza infection**
* or Haematogeneous spread of staphylococcus aureus e.g. from cardiovascular infections
others include the young, elderly, IVDU & those with underlying conditions
70
Who is classically affected by Haemophilus influenzae pneumonia ?
It is particularly common in COPD patients
71
What is the colour of sputum of the following causes of pneumonia:
* Red jelly suptum
* Mucoid suputum
* Rusty coloured sputum
* Red jelly suptum - Klebseilla pneumonia
* Mucoid suputum - Clamidya psittaci
* Rusty coloured sputum - Streptococcus pneumonia
72
Who is classically affected by Klebsiella pneumonia ?
* **Alcoholics**
* Also occurs in elderly & diabetics
Due to aspiration - these people are risk factors for aspiration
73
What is legionella pnuemonia classically caused by ?
Colonised hotel air conditioning & hot water tanks - results in outbreaks of it
74
What is the classical description of someone with legionella pneumonia in an exam question?
Classical presentation of pneumonia, confusion, diarrhoea in a returning traveller
75
What is the classical cause of hlamydophila psittaci pnuemonia ?
Typically aquired from birds (in particular parrots)
76
What is the commonest cause of viral pneumonia ?
Influenza
77
What organisms can classically cause pneumonia in the immuno-suppressed e.g. HIV?
* **Pneumocystis jiroveci**
* Also aspergillus & TB
78
Who is pseudomonas causing pneumonia classically seen in ?
* Bronchiectasis or CF patients
* Also particularly in ITU patients or after surgery
79
What is unusual about the prevelence of mycoplasma pneumonia ?
It occurs in epidermics every 4 years
80
What additional signs/complications are associated with pneumonia caused by mycoplasma pneumoniae?
* Autoimmune haemolytic anaemia
* Erythema multiforme
* Hepatitis
* Immune thrombocytopenic purpura
* Arthritis
81
What is typical of the presentation of mycoplasma pneumoniae?
It presents insidiously (slowly) with flu-like symptoms (headache, myalgia, arthralgia) followed by a dry cough
82
Who is pnuemonia caused by Coxiella burnetii classically seen in ?
People who have had contact with Sheep and goats
83
What are the signs/symptoms of pnuemonia ?
Symptoms:
* Cough
* Purulent suptum +/- haemoptysis
* Dysponea/SOB
* Chest pain (pleuritic)
* Fever
Signs:
* Fever, rigors, sweats
* Tachypnoea & tachycardia
* Decreased O2 sats, cyanosis
* Signs of consolidation = dullness to percussion, decreased chest expansion, decreased breath sounds, bronchial breathing
* Confusion
* Pleural rub
* Crackles
* Herpes labialis reactivation of HSV due to aleration of immune system)
84
Appreicate this
Shows the severity of pneumonia based on sputum colour
85
What is the initial management and assessment of someone with pneumonia ?
86
What further assessment should be done in someone with pneumonia ?
87
How is pnuemonia diagnosed ?
* Initially measure FBC, Us & Es & CRP - this allows you to calculate severity based on CURB65
* Take blood & suptum cultures + viral PCR & pneumococcal & legionella antigen tests (legionella one can now be done with the viral PCR of sputum)
* Atypical serology - Mycoplasma IgM, ( already done Legionella urinary antigen), Respiratory Viruses, Chylamidia serology, Other specific tests
* Also do ABG's if low O2 sats or patient has pre-exisiting resp disease e.g. COPD
(basically do the initial ones and if severity worse enough do the diagnostic tests for the organisms)
88
What should be done to assess the severity of a pneumonia and ==\> decide the treatment ?
CURB65 score:
* Confusion (AMTS \< 8)
* Urea \> or equal to 7 mmol/l
* RR \> or equal to 30
* BP: SBP \< 90 or DBP \< 60
* Age \> or equal to 65
89
Where should patients with a CURB65 score of 0 be managed ?
In the community
90
The presence of what additional factors may increase the severity of someones presentation of potential pnuemonia and therefore must be taken into account ?
* Co-exisiting illness
* O2 sats \< 92% or PaO2 \< 8kPa or requiring O2
* BIlateral or multilobar changes on CXR or changes suggestive of empyema or cavitation
* Acidosis (pH\<7.35)
91
Patients with a CURB-65 score of 1 should have what assessed to be sure they can be managed in the community?
Sa02 assessed which should be \>92% to be safely managed in the community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.
92
Patients with a CURB-65 score of 2 or more should be managed where?
In hospital
93
What is the treatment of a mild/moderate community acquired pneumonia (CAP) and what CURB65 score classifys it as one ?
* Score of 0-2
* Amoxicillin IV/PO (If penicillin allergic: Doxycycline PO or IV Clarithromycin if NBM - nil by mouth)
94
What is the standard treatment of a severe CAP and what CURB65 score classifys it as one ?
* Score of 3-5
* Co-amoxiclav IV + Doxycycline PO (If penicillin allergic: IV Levofloxacin monotherapy)
95
What is the standard treatment of a severe CAP in ICU/HDU or one who is NBM ?
Co-amoxiclav IV + Clarithromycin IV (If penicillin allergic: IV Levofloxacin)
96
What is the stepdown treatment for ALL patients with severe CAP?
Doxycycline IV/PO
97
What is the treatment of a non-severe hospital acquired pneumonia (HAP)?
PO Amoxicillin (If penicillin allergic: Doxycycline)
98
What is the treatment of a severe HAP ?
IV Amoxicillin + Gentamicin (If penicillin allergic:IV Co-trimoxazole + Gentamicin)
99
What is the step down treatment of a severe HAP ?
PO Co-trimoxazole
100
What is the treatment of non-severe and severe aspiration pneumonia ?
* Non severe 1st line = PO Amoxicillin + Metronidazole (If penicillin allergy use doxycyline)
* Severe 1st line = IV Amoxicillin + Metronidazole + Gentamicin (If penicillin allergy use PO Doxycycline or IV Clarithromycin\*)
101
What additional tx do patients alongside Abx's for pneumonia recieve ?
102
What review do patients how have had pneumonia require?
103
Who is the pnuemoccocal vaccine (main cause of pneumonia) offered to ?
To all adults over the age of 65 years and those with:
* Asplenia or splenic dysfunction
* Chronic respiratory disease (asthma only included if it requries oral steroids at sufficient dose to immunosuppress)
* Chronic heart disease
* CKD (at stages 4 and 5, nephrotic syndrome, kidney transplantation)
* Chronic liver disease
* Diabetes requiring medication
* Immunosuppression
* Patients with cochlear implants
104
List the potential complications of pneumonia
* Respiratory failure
* Hypotension
* Atrial fibrillation
* Pleural effusion
* Empyema
* Lung abscess
* Septicaemia
* Pericarditis & myocarditis
* Jaundice
105
What is a lung abscess ?
This is a cavitating area of localised, supprative infection within the lung
106
List the causes of lung abscesses
* Pnuemonia
* Bronchial obstruction
* Pulmonary infarction
* Septic emobli (from R-sided endocarditis, infected DVT, septicaemia, or IDVU's e.g. from injecting intp groin ==\> causing infection ==\> then PE + abscess fro septic emboli)
* Suphrenic or hepatic abscess
107
What organism is commonly associated with causing septic emboli ?
Staph.aureus
108
What are the clinical features suggestive of a lung abscess ?
Usually a preceding illness of some sort e.g. Pneumonic infection, Post viral, foreign body
* Swining fever
* Cough
* purulent, foul-smelling sputum
* Pleuritic chest pain
* Haemoptysis
* Malaise
* Weight loss
109
What bedside test needs to be done before aspiration of pus from the chesr in someone with a lung abscess is done ?
USS
110
What is the treatment of a lung abscess ?
* Antibiotics as per sensitivities
* Repeated aspiration, antibiotic instillation, or surgical excision may be required
111
What is the treatment of legionella pnuemonia ?
* SEVERE (CURB65 SCORE \>3) = See Management of Community Acquired Pneumonia and seek advice from ID/microbiology
* MILD OR MODERATE (CURB65 SCORE \<2) = Levofloxacin OR Clarithromycin + rifampicin
112
What viruses are tested for in Tayside when nasopharyngeal or throat swabs in viral transport medium, bronchoalveolar lavage (BAL), endotracheal aspirate etc are sent for viral PCR?
Current panel of viruses tested for in Tayside: Flu A, Flu B, parainfluenza 1-4, coronaviruses (4 species), metapneumovirus, adenovirus, RSV, rhinovirus, enterovirus, Mycoplasma pneumoniae (itself is not a virus so unsure why)
113
What is whooping cough (pertussis) and what is it caused by ?
It is an infectious disease resulting in acute trachea-bronchitis caused by the Gram-negative bacterium Bordetella pertussis.
114
What features usually preceed the characteristic features of whooping cough?
2-3 days of coryzal symptoms
115
What is the diagnostic criteria for whooping cough?
Suspect if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
1. Paroxysmal cough - worse at night
2. Inspiratory whoop.
3. Post-tussive vomiting - coughing bout ending in vomiting
4. Undiagnosed apnoeic attacks in young infants.
116
How is whooping cough diagnosed?
Via pernasal swab and then either bacterial culture or PCR (PCR preferred as think quicker)
117
What is the treatment of whooping cough?
* If \< 1/12 months old tx = clarithromycin
* If \> 1/12 months old tx = clarithromycin or azithromycin
* If pregnant tx = erythromycin
118
What complications can develop due to whooping cough?
* Subconjunctival haemorrhage - due to persistent coughing
* Pneumonia
* Bronchiectasis
* Seizures - due to persistent coughing
119
When are people offered the vaccination against whooping cough?
* Infants are routinely immunised at 2, 3, 4 months and 3-5 years.
* AND Women who are between 20-32 weeks pregnant
120
adolescents and adults may develop whooping cough despite having had their routine immunisations - T or F?
True - neither infection nor immunisation results in lifelong protection
