Upper and lower respiratory tract infections Flashcards
What are the common viral infective agents?
Adenovirus, paraflu I and III, influenza A and B, rhinovirus
What are the common bacterial infective agents?
Streptococci, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis , Mycoplasma
What are the common symptoms?
Sore throat, fever
What are the common symptoms?
lymphadenopathy, decreased appetite, dysphagia (trouble swallowing), redness and sings of inflammation
What investigations should be carried out?
Nose or throat swab, full blood count (raised white blood cells and C reactive protein)
What is the treatment?
If not serious just rest, fluids and paracetamol or aspirin, most of them are self-limiting
What are the infections of upper respiratory tract?
Rhinitis, otitis media, tonsillitis, epiglottitis, laryngitis, pharyngitis, laryngotracheal
What is rhinitis or coryza?
irritation and inflammation of the mucous membrane in the nose
What are the symptoms of rhinitis?
stuffy and runny nose, sneezing, post-nasal drip
What are other possible complications?
pneumonia, bronchiolitis, septicaemia
What is otitis media?
Inflammation of the middle ear, red and bulging drum
What are the common causes of otitis media?
Usually viral,secondary pneumococcal/ heamophilar infection
What are the possible complications of otitis media?
rupture of ear drum
What is the most important treatment in otitis media?
Analgesia
What is tonsillitis?
inflammation of tonsils
What is pharyngitis ?
Inflammation of pharynx
What are the common causes of tonsillitis and pharyngitis?
Can be both viral and bacterial, difficult to distinguish, need to do throat swab
What is the treatment for tonsillitis and pharyngitis?
Nothing or 10 days of penicillin
What is croup?
Laryngotracheocronchitis in children
What is the common cause of croup?
viruses especially paraflu I
What are the signs of croup?
Coryza, stridor, hoarse voice and barking cough
What is the treatment for croup?
Dexamethasone
What is epiglottitis?
inflammation of epiglottis
What is the common cause of epiglittitis?
Usually bacterial, H. influenza, possibly by haemolytic streptococci
What are the signs of epiglottis?
Stridor, very unwell patients, sat forward, drooling, difficulty swallowing
What is the treatment for epiglottitis?
intubation and antibiotics
What are the main lower respiratory tract infections?
bronchitis, bronchiolitis, pneumonia, acute exacerbation of COPD, empyema, lung abscess, bronchiectasis
What is acute bronchitis?
Inflammation of bronchi
What is pneumonia?
Inflammation of lungs (alveoli)
What are the symptoms of pneumonia?
Malaise, fever, chest pain pleuritic on inspiration, purulent sputum that is rusty colour, headache, dyspnoea
What are the signs of pneumonia?
Pyrexia, tachypnea, central cyanosis, bronchial breath sounds, dullness on percussion, inspiratory crackles, increased vocal resonance
What investigations should be performed to diagnose pneumonia?
Full blood count and serum biochemistry, sputum cultures, throat swab, urinary legionella antigen test, chest X ray
What does the chest X ray show?
white consolidation as alveoli are filled with inflammatory cells, fluid and bacteria
What can be observed on CT?
Air bronchogram, the bronchi filled with air can be observed as the alveoli are opacified (filled with fluid)
What are the common causes of pneumonia?
Most commonly streptococcus pneumonia, H. influenazae, Legionella, Staph aureus, Mycoplasma pneumoniae, Chlamydia psittaci, all viruses
How can be the severity of pneumonia be assessed?
Using the CURB 65 score
What is CURB 65 score?
C confusion, U blood urea >7, respiratory rate > 30, diastolic pressure < 60 age > 65, each has one point
Where is pneumonia treated?
0 is community treatment, 1-2 hospital, 3-5 ITU and high risk of death
How is pneumonia treated?
0-1 Amoxicillin or clarithomycin/ doxycicline
1-2 amoxicilin and clarithomycin or levofloxacin
3-5 co-amoxiclav and clarithomycin or levofloxacin
What are the supportive treatments for pneumonia?
O2, IV fluids, intubation or ventilation, continuous positive airways pressure
What are the possible complications of pneumonia?
septicaemia, acute kidney failure, empyema, lung abscess, haemolytic anaemia, actor respiratory distress syndrome
What is empyema?
Accumulation of pus in pleural space
What are the common bacteria associated with empyema?
Anaerobic organisms, staph aureus, streptococci
What are the signs of empyema?
Prominent chest pain, absence of cough, often high swinging fever
How can empyema be diagnosed?
Chest X ray, CT thorax and pleural ultrasound, diagnosed by aspiration , pH < 7.2 and fluid looks cloudy
What is the treatment for empyema?
Chest drain, IV antibiotics, prolonged treatment, Intrapleural t-PA / DNase might be required, if not improved surgery might be required
What is lung abscess?
Thin wall, filled with pus cavity
What are the organisms associated with the abscess?
anaerobes, Staph aureus, pseudomonas
What are the signs of lung abscess ?
Non-specific, weight loss, swinging fever, lethargy
What is the treatment for lung abscess?
Prolonged antibiotics, occasionally percutaneous drainage
What is bronchiectasis?
Chronic thickened airways walls, dilated and filled with mucus
What are the causes of bronchiectasis?
idiopathic, immotile cillia syndrome, cystic fibrosis, childhood infections, allergic bronchopulmoanry aspergillosis, hypogammaglobulinaemia
What are the essential investigations for bronchiectasis?
high resolution CT, sputum culture, serum immunoglobulins, IgE levels, CF genotyping
What is the treatment for bronchiectasis?
chest physiotherapy, treatment of any infection with higher dose and longer duration, may need beta 2 agonist and bronchodilators
What are the types of pulmonary infections?
primary, facultative, opportunistic
What is primary pulmonary infection?
Caused by very infective organisms, can infect healthy people
What is facultative pulmonary infection?
Infection in patients with predisposing lung pathology, common in clinical practise
What is opportunistic pulmonary infection?
Caused by normally non-pathogenic or low pathogenic organisms, in immuno-compormised patients
What features of upper respiratory tract help to prevent infection?
Spacial shape of nose cavity that enables turbulent air flow, nasal hair act as filter, epithelium that is most and warms up the air, cilia that moves up mucus with the trapped pathogens
Describe the air flow in respiratory tract
Turbulent in nose, laminar in trachea, turbulent again in acinus
What are the mechanisms that prevent infection in lower respiratory tract?
Macrophages in alveoli, muco-ciliary escalator that moves the mucus, cough reflex
What is the common pathology of pulmonary infections?
Viral infections that disturb the muco-ciliary escalator, secondary bacterial infection
What are the different possible types of pneumonia?
anatomica, aetiological, microbiological
What are the different classes of pneumonia based on the aetiology?
community acquired, hospital acquired, in immunocompromised patients, atypical, aspiration, recurrent,
What are the possible causes in pneumonia in immunocompromised patients?
Cytomegalovirus, fungi or yeast such as pneumocystis jirovecii
Describe aspiration pneumonia
In apical right segment, in unconscious, vomiting, sedation, oesophageal lesions, neuromuscular disorders,
What are the types of pneumonia based on anatomy?
broncho (very diffuse), lobar or segmental
What is hypostatic pneumonia?
Occurs in patients who are in supine position for very long time, bed bound patients, poor drainage of the lungs and accumulation of mucus in the dorsal regions of the lungs
What is endogenous lipid pneumonia?
Inflammation that results when lipids enter bronchial tree (due to accumulation of cellular debris such as cholesterol)
Describe bronchopneumonia
Patchy consolidation, usually hypostatic, common in patents with cardiac arrest and chronic bronchitis, filled with pus in terminal and respiratory bronchioles ( where the air sits and accumulates), usually confined, lower of the lungs due to gravity, commonly bilateral
Describe lobar pneumonia
Affect the whole lobe of the lungs, more aggressive microorganisms, spread, the pathogens are washed around, reaches the pleura
What are the possible complications of pneumonia?
Pleurisy, pleural effusion, empyema, lung abscesses, bronchiectasis
