Unusual infections, Bonchiectasis, CF Flashcards
Romanowsky staining positive for what infection?
Nocardia
Buzz word: “sulfur granule”
Actinomyces
Buzz word” Gram positive and weakly AFB positive
Nocardia
Treatment for nocardia?
Bactrim. If severe, add second agent
Treatment for actinomyces?
PCN
Biggest risk factor for actinomyces infection?
aspiration
Nocardia on CT has cavitation + what?
nodules
Actinomyces on CT has cavitation + what?
bronchiectasis, LAD, pleural disease, local invasion
Etiology of focal bronchiectasis?
- Necrotizing pneumonia
- Bronchial atresia
- Mechanical obstruction (FB, external compression, stenosis)
Etiology of central bronchectiasis?
ABPA, cartilage syndromes
Etiology of upper lobe bronchiectasis?
CF, sarcoid, post-radiation
Etiology of middle lobe bronchiectasis?
Immotile cilia syndrome, NTM/MAC
Etiology of lower lobe bronchiectasis?
Post-infection, chronic aspiration, fibrotic lung disease, post-transplant, HIV
Class I-V of CF mutations?
- I: no functional CFTR made
- II: misfolded CFTR doesn’t get to surface
- III: CFTR on surface doesn’t work.
- IV: Ion channel in CFTR is faulty
- V: Insufficient CFTR quantity
Sweat chloride level to diagnose CF?
- Cl > 60
- Cl 40-59 with 1 CFTR mutation and strong suspicion / FHx
- 2 CFTR mutations
- If Cl < 30, very unlikely
Three pulmonary infections in CF associated with worse prognosis?
- MRSA
- Psuedomonas
- Burkholderia
All CF patients should get what therapies?
- Dornase alfa
- Inhaled 3% saline
- Inhaled mannitol as second line if failed above
When should CF patients get antibiotics?
- If known colonizer, give suppressive chronic ppx
- Treat pseudomonas, maybe MRSA
Avoid which therapies for CF?
Chronic steroids, ICS, leukotrine inhibitors
Prognosis for transplanted lungs in CF?
Good. Transplant does not develop CF. Must have bilateral.
Treatment for non-CF bronchiectasis to reduce exacerbations?
macrolides
