Week 5 Upper and lower Respiratory Tract Infection Flashcards
(161 cards)
1
Q
What are the different normal flora in the URTI?
A
Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.
2
Q
Give examples of infections that cause transient colonisation post antibiotics?
A
Coliforms, Pseudomonas, Candida
3
Q
What respiratory pathogens are usually asymptomatic but can become symptomatic due to another infection?
A
Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes
Sit in your throat
4
Q
How are Upper respiratory tract infections transmitted?
A
Coughs and sneezes spread diseases”
DROPLET spread. Hand washing and decontamination very important
5
Q
What group of people are most likely to get URTI?
A
Most often v. young children/teenagers
Winter/viral. Bacterial and viral common in children.
Also immunocompromised people
6
Q
What is the strategy used when GP are prescribing antibiotics? For kids and adults over the age of 3
A
Address concerns – have 1 of 3 strategies
No prescribing
Delayed prescribing
Prescribe if risk of complications
7
Q
What is the main disease that caues a cold?
A
Rhinovirus
8
Q
What are less common causes of the cold?
A
Coronoviruses RSV, Parainfluenza viruses Enteroviruses Adenovirus
9
Q
What is symptoms of cold?
A
Nasal discharge, sneezing and sore throat
10
Q
What is Coryza?
A
The common cold
11
Q
What are the symptoms of Rhino-sinusitis?
A
Facial pain, nasal blockage, reduction smell
12
Q
What is the aetiology of Rhino-sinusitis?
A
Post viral inflammation
13
Q
What are the causes of Rhino-sinusitis?
A
Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus milleri group, anaerobes, fungal
14
Q
What are the complications of Rhino-sinusitis?
A
chronic sinusitis,
Osteomyelitis,
meningitis,
cerebral abscess
15
Q
What are less common causes of Rhino-sinusitis?
A
Allergic and non-infective causes
16
Q
What are the investigations for Rhino-sinusitis?
A
Imaging
Sinus washouts
17
Q
When using imaging for a patient with Rhino-Sinusitis what are you investigating?
A
Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.
18
Q
What is Sinus washouts ?
A
Diagnostic and therapeutic after referral to ENT.
Relieve some of the symptoms and so be able to get some sample to give to microbiologists
19
Q
What are the treatment for Rhino-Sinusitis?
A
Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway.
Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
20
Q
What is a uncommon cause of Rhino-Sinusitis?
A
Dental problem
21
Q
What is the difference between pharyngitis and tonsillitis?
A
Pharyngitis and tonsillitis are infections in the throat that cause inflammation.
If the tonsils are primarily affected, it is called tonsillitis.
If the throat is primarily affected, it is called pharyngitis.
22
Q
What are the viral causes of pharyngitis/tonsillitis?
A
Viral (RSV, Influenza, Adeno, Epstein barr virus, HSV1)
23
Q
What is the main bacterial causes of pharyngitis/tonsillitis?
A
Streptococcus pyogenes,
24
Q
What are the rarer bacterial causes of pharyngitis/tonsillitis?
A
Neisseria gonorrhoeae
Corynebacterium diphtheria
Mycoplasma pneumoniae
Chlamydophila pneumoniae
25
What investigation is done when a person is suspected of pharyngitis/tonsillitis?
Throat swabs and proper history
26
What are the signs and symptoms of pharyngitis/tonsillitis?
Sore throat , dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy
27
What does Group A Streptococcal Infection cause and in what group of people?
Pharyngitis/Tonsillitis in children
28
What complications can be caused when a child is infected with Group A Streptococcal Infection?
acute glomerulonephritis
rheumatic fever
scarlet fever
29
How do you prevent a child infected with Group A Streptococcal Infection getting scarlet fever?
Aim to prevent this rheumatic fever by giving penicilli
30
What other conditions do you try and prevent from occuring in a patient with Group A Streptococcal Infection?
Prevent suppurative complications too --> e.g. otitis media and quinsy (peritonsillar abscess))
31
What causes glandular fever?
Epstein-Barr virus (EBV
32
Who is at most risk of glandular fever?
Teenagers and older. Often asymptomatic.
33
What are the symptoms of glandular fever?
Sore throat, fever, cervical lymphadenopathy
34
What are the complications of glandular fever?
splenic rupture
35
What should you avoid when a person has glandular fever?
Avoid ampicillin (mac-pap rash, not a true allergy)
36
Why should you not do contact sport for some weeks when you have glandular fever?
Cause your spleen to rupture
37
How do you test for glandular fever?
Serology – IgM/IgG, Paul Bunnell Test/PCR
38
What is Diptheria?
An acute and highly contagious bacterial disease causing inflammation of the mucous membranes in the throat
39
What causes diptheria?
Corynebacterium diphtheriae
40
What are the symptoms of diptheria?
Malaise, fatigue, fever +/- sore throat
41
What is the treatment of Diptheria?
Treatment is Erythromycin/ penicillin/antitoxin
42
What is the prevention steps for Diptheria?
Prevention is Immunisation
travel history
Notifiable disease
43
What caues Thrush?
Candida, usually after antibiotics or steroids
44
What happens in Epiglottitis?
MEDICAL EMERGENCY
| Cellulitis of epiglottis (“cherry red”) – airway obstruction
45
What are symptoms of Epiglottitis?
Fever, irritable, difficulty speaking (“hot potato”) and swallowing.
Leans forward, drools.
Stridor, hoarse.
46
How can you investigate a epiglottitis?
Lateral neck X-ray – enlarged epiglottis
Must send blood cultures
47
When a person has epiglottitis why do you send blood cultures and not a mouth swab?
You do not swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).
48
What is the treatment of epiglottitis ?
maintain airway, cefotaxime
49
What used to be a common cause of epiglottitis?
H. influenzae type B prior to immunization
50
What is laryngitis?
Inflammation of the larynx
51
What is the symptoms of acute laryngitis?
Hoarse/husky voice, globus pharyngeus (lump in throat), fever, myalgia, dysphagia
52
Cause of acute laryngitis?
Usually viral and self-limiting, occasionally it is bacterial
53
Is antibiotics given to a person with acute laryngitis?
No unless if the patient has a severe disease
54
What are non infection causes of acute laryngitis?
voice abuse, malignancy
55
What is Croup/Acute laryngotracheobronchitis?
Inflammation of larynx and trachea after infection of upper airways
Common in children
56
What is the cause of Croup/Acute laryngotracheobronchitis?
Viral esp. parainfluenza type 2 therefore NO antibiotics also Respiratory Syncytial Virus
57
What is the treatment for Croup/Acute laryngotracheobronchitis?
Symptomatic treatment only
58
What is the cause of Whooping cough?
Bordetella pertussis - Gram negative coccobacillus
59
Does whooping cough just happen in children?
No happens in adults as well as the immunization can wear off.
Very contagious
60
How do you test fr whooping cough?
Pernasal swab and PCR
61
How long is the incubation period for whooping cough?
1-3 wks
62
What are the initial symptoms of whooping cough?
Initially catarrhal phase – runny nose, fever, malaise
63
What is catarrhal?
is a disorder of inflammation of the mucous membranes in one of the airways or cavities of the body
64
What is the symptoms of whooping cough after few weeks?
Dry non productive cough. This becomes whooping/paroxysms. (short bursts on exhalation, then inspiratory gasp which is the whoop.
65
What is the treatment of whooping cough?
Supportive and erythromycin
| May be prolonged convalescence - weeks
66
What is the complications of whooping cough?
otitis media,
pneumonia Often secondary infection or aspiration
Convulsions.
Subconjunctival haemorrhages
67
How is whooping cough prevented?
Immunisation very important. Erythromycin to household contacts/Notifiable disease
68
What is Otitis externa?
Infection of the external auditory canal
69
What is the symtpoms of Otitis externa?
Pain, itch, swelling and erythema, otorrhoea
70
What are the 3 different types of Otitis externa?
Acute OE, chronic OE and malignant OE.
71
What are the caues of acute Otitis externa?
S. aureus and Pseudomonas spp.(esp. after swimming)
72
How do you test for acute OE?
Swab ear canal and give to microbiology
73
What is the treatment for acute OE?
Toilet with saline and/or alcohol and acetic acid. Wick insertion. Topical drops
74
What is the cause of Otitis externa - chronic?
Irritation from drainage from perforated tympanic membrane.
75
What is the symptoms and treatment of chronic OE?
Itchy
| Treat underlying cause
76
Why should aminoglycosides be avoided by a person with chronic OE?
Avoid aminoglycosides if perforation. Resistance may form and sensitisation occurs with prolonged courses
77
What happens in Otitis externa - malignant?
Severe, necrotizing. Spreads from local area more deeply. May invade bone, cartilage and blood vessels.
78
When is Otitis externa - malignant life threatening?
Spread to temporal bone, base of skull, meninges and brain.
79
What is the cause of malignant OE?
Often Caused by Pseudomonas aeruginosa
80
What is the symptoms of malignant OE?
pain, drainage of pus from canal
81
Who is likely to have malignant OE?
Elderly, diabetics, immunosuppressed
82
What is the treatment for malignant OE?
Treat 4-6 weeks altogether e.g. with iv ceftazidime then ciprofloxacin
83
What is Otitis media (OM)?
Middle ear inflammation. Fluid present in the middle ear.
| V. common in children
84
What is the symptoms of OM?
Fever, pain, impaired hearing. Red bulging tympanic membrane
85
What is the cause of OM?
VIRAL. H influenzae, S. pneumoniae, M. catarrhalis
86
What test do you do for OM?
Swab any pus discharging
87
What is the treatment of Otitis media?
Treatment, if not unwell WATCH and treat symptomatically (decongestant etc) and review early. If unwell give amoxicillin.
88
What is Mastoiditis?
Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone
89
It mastoiditis common?
Much lower incidence after introduction of antibiotics.
90
What are the signs of Mastoiditis?
Signs as Acute Otitis Media, but pain/swelling over mastoid too
91
What sample do you need to confirm the infection of mastoiditis?
Need bacteriology samples
| Imaging – CT helps to assess extent
92
What is the treatment of Mastoiditis?
Similar treatment to acute OM unless Gram negatives are suspected and then need broader spectrum cover as per organism isolated
1st line treatment is co-amoxiclav (amoxicillin-clavulanate)
93
What are Ludwig’s angina, Lemierre’s Syndrome?
Deep fascial space infections of head and neck
94
What are gingivitis/peridontal infection?
Infection of the gums
95
What are the different ways of diagnosing a infection? 6 answers
```
Send pus/throat swab/blood cultures
Gram stain
Culture
Sensitivity testing
Reference laboratory work (typing, toxin detection)
Serology and antibody detection
```
96
When is Erythromycin mainly used?
If pencillin allergic and Whooping cough/diphtheria
97
What is classed as lower respiratory tract?
Below the larynx
98
Give examples of LRTI and what part of the LRT they affect?
Tracheitis --> affecting the trachea
Bronchitis affecting the bronchus and bronchioles
Pneumonia --> lung
Abscesses --> lung
99
What are the different types of Bronchitis?
Acute
Chronic but can have acute exacerbations
100
What are the different types of Pneumonia?
Community acquired
Hospital acquired
Ventilator acquired
Aspiration
101
What are the Predisposing factors to LRTI?
Loss or suppression of cough reflex / swallow
e.g. stroke, coma, ventilation
Ciliary defects e.g. PCD similar to CF
Mucus disorders e.g. CF
Pulmonary oedema – fluid flooding alveoli ( warm and moist harbour organisms)
Immunodeficiency: congenital or acquired (Multiple examples!)
Macrophage function inhibition e.g. smoking
102
What viruses cause LRTI's?
- Influenza
- Parainfluenza
- Respiratory syncytial virus
- Adenovirus
103
When do fungus cause LRTI?
When the person is immunosuppressed most of the time
104
Examples of fungi that cause LRTI?
Aspergillus sp.
- Candida sp.
- Pneumocystitis jiroveci
105
Examples of baceteria that cause LRTI?
Streptococcus pneumoniae
- Haemophilus influenzae
- Staphylococcus aureus
- Klebsiella pneumonia
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella pneumophila
- Mycobacterium tuberculosis
106
What happens to the bronchi in Acute bronchitis?
Inflammation & oedema of trachea and bronchi
107
What are the symptoms of acute bronchitis?
Cough (typically dry), dyspnoea & tachypnoea
Cough may be associated with retrosternal pain
108
What is the Epidemiology of acute bronchitis?
Most frequent in winter, in children
109
What are the Causative viruses for acute bronchitis?
Viruses are the usual cause (rhinovirus, coronavirus, adenovirus, influenza)
110
What are bacterial causes of acute bronchitis?
Bacterial causes less common (H.influenzae, M.pneumoniae, B.pertussis)
111
Is it more common for a bacteria or a virus to cause acute bronchitis?
Virus more common than bacteria
112
How is diagnosis of acute bronchitis made?
Usually there is no diagnostic test for mild presentation.
| Might look at vaccination & previous exposure history e.g. influenza, B. pertussis to exclude some organisms
113
When is culture of respiratory secretion done in case of acute bronchitis?
If looking for a specific cause e.g B pertussis and the person is very unwell but not routine
114
What is the treatment for acute bronchitis?
Supportive treatment for healthy patients
Those with severe disease or co-morbidities may require oxygen therapy or respiratory support
Antibiotics only if bacterial cause is suspected or found
115
What is the definition of chronic bronchitis?
Cough productive of sputum on most days during at least 3 months of 2 successive years (which cannot be attributed to an alternative cause)
116
Chronic bronchitis is common in what type of people and what is assoicated with it?
Most common in men and >40yrs
| Associated with smoking, pollution, allergens
117
What is the main difference apart from duration of symptoms between acute and Chronic bronchitis?
In Chronic the inflammation and oedema of airways is mediated by exogenous irritants rather than infective agents seen in acute bronchitis.
118
Is chronic bronchitis caused by different infective agents to acute bronchitis?
Patients have chronic exacerbations mediated by same infective pathogens as acute bronchitis
119
What is the presentation of bronchiolitis?
Inflammation and oedema of bronchioles
120
What is the symptoms of bronchiolitis?
: Acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, nasal flaring)
121
What is the epidemiology of bronhciolitis?
Peaks in winter and early spring, in infants 2-10 months.
Primarily paediatrics
122
What is the main cause of Bronchiolitis?
Most commonly caused by Respiratory syncytial virus (RSV)--> 75% of cases
123
What percentage of children by age of 2 have been infected by RSV?
80%
124
What are less common causes of bronchiolitis?
Also caused by parainfluenza, adenovirus, influenza
125
What is the diagnosis of bronchiolitis?
Chest x-ray
Full blood count
Microbiological diagnosis: usually nasopharyngeal aspirate of respiratory secretions sent for viral PCR
126
What is the treatment for bronchiolitis?
Supportive: oxygen, feeding assistance ( due to problems of eating due to irritants)
No clear evidence to support steroids, bronchodilators, ribavirin
Antibiotics only if complicated by bacterial infection
127
What is pneumonia?
Infection affecting the most distal airways and alveoli
Formation of inflammatory exudate
128
What are the two anatomical patterns of pneumonia? Give a description for both
Bronchopneumonia
Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli
```
Lobar pneumonia
Affects a large part, or the entirety of a lobe
90% due to S.pneumoniae
Solid consolidation
Demarcated by the lob of the lug
```
129
Which type of pneumonia is the most common?
Community acquired pneumonia
130
When do you get hospital acquired pneumonia?
Pneumonia developing >48hrs after hospital admission
131
What are the causative orgaisms of hospital acquired pneuomina?
Different causative organisms to CAP, especially if >5days after admission: enterobacteriaceae & Pseudomonas sp.
132
What sub group is Ventilator acquired pneumonia (VAP) in?
Subgroup of HAP
133
What is the cause of Ventilator acquired pneumonia?
Pneumonia developing >48hrs after ET intubation & ventilation
Et > preaching there natural defence and causing impairment of swallowing and coughing > increase risk of infection
134
What is the cause of Aspiration pneumonia?
Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract
Patient usually has impaired swallow mechanism
135
When is CAP mostly seen and by what group of the population?
Peak age 50-70 years
| Peak onset midwinter to early spring
136
What are the different acquisition of CAP? GIve example of organims
Person-to-person or from a person’s existing commensals (S.pneumoniae, H.influenzae)
From the environment (L. pneumophilia)
From animals (C.psittaci)
137
Bacterial cause of CAP can be divided into what two groups?
Typical and Atypical bacteria cause
138
What is meant by Atypical pneumonia?
Traditionally described cases which failed to respond to penicillin or sulpha drugs and no organism could be identified
Now recognised as atypical organisms due to different clinical presentation and treatment is slightly different
139
Name 5 typical organisms of CAP?
```
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae
```
140
Name 5 atypical organisms of CAP?
```
Mycoplasma pneumoniae
Legionella pneumophilia
Chlamydophila pneumoniae
Chlamydophila psittaci
Coxiella burnetii
```
141
What are the symptoms of bacterial CAP?
```
Usually rapid onset
Fever / chills
Productive cough
Mucopurulent sputum
Pleuritic chest pain
General malaise: fatigue, anorexia
```
142
What are the signs of bacterial CAP?
Tachypnoea
Tachycardia
Hypotension
```
Examination findings consistent with consolidation:
Dull to percuss
Reduced air entry, bronchial breathing
Can hear crakles
Alveoli trying to work against the fluid
```
143
Atypical Mycoplasma pneumonia is commonest at what time of year and by who?
Autumn epidemics every 4-8 years
| Commonest in children & young adults
144
What is the diagnosis of Mycoplasma pneumonia, common symptoms and possible complications?
Diagnosis: serology (difficult to culture)
Main symptom is cough
Rare complications: pericarditis, arthritis, Guillain-Barre, peripheral neuropathy
145
Outbreak of Legionella pneumophilia is assoicated with what?
Colonises water piping systems
| Outbreaks associated with showers, air conditioning units, humidifiers
146
What are the symptoms of Legionella pneumophilia, how is it diagnosed?
High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion
Bloods: deranged LFTs, SIADH (low sodium
147
What percentage of people who have CAP in adults are affected by Chlamydophila pneumoniae?
3-10% of CAP cases in adults
Highest incidence in elderly
148
What are the symptoms of Chlamydophila pneumoniae
| and do they vary by age?
Causes mild pneumonia or bronchitis in adolescents & young adults
Incidence highest in the elderly – may experience more severe disease
149
What is Chlamydophila psittaci
| assoicated with?
Associated with exposure to birds
150
What 3 factors would make you consider pneumonia caused by Chlamydophila psittaci?
Consider in those with pneumonia, splenomegaly & history of bird exposure
151
What is Splenomegaly?
Abnormally enlarged spleen
152
What are the symptoms would a person infected with Chlamydophila psittaci
may show?
Rash
hepatitis
Haemolytic anaemia
Reactive arthritis
153
Is influenza a complicated disease? What are the symptoms and recovery time?
IT is a uncomplicated disease.
Fever, headache, myalgia, dry cough, sore throat
Convalescence takes 2-3 weeks
154
What type of patients does primary viral pneumonia commonly occur in? What are the symptoms associated?
Occurs more commonly in patients with pre-existing cardiac & lung disorders
Cough, breathlessness, cyanosis
155
How would priamry viral pneumonia develop into secondary bacterial pneumonia?
It could develop after initial preiod of imporvement but follows infection caused by:
S.pneumoniae, H.influenzae, S.aureus
156
How do you diagnose viral pneumonia?
Viral antigen detection in respiratory samples using PCR
157
What are the 3 non- microbiological investigations for CAP?
Routine observations: BP / pulse / oximetry
Bloods: including FBC / U&E / CRP / LFTs
Chest X-ray
158
What are 5 microbiological investiations recommended by BTS for all moderate- severe cases of CAP?
```
Sputum Gram stain & culture
Blood culture
Pneumococcal urinary antigen
Legionella urinary antigen
PCR or serology for:
Viral pathogens
Mycoplasma pneumoniae
Chlamydophila so
```
159
Why should we bother establishing a diagnosis?
Optimise antibiotic selection
Limit the use of broad spectrum agents
Identify organisms of epidemiological significance
Identify antibiotic resistance and monitor trends
Identify new or emerging pathogens
160
What is CURB test based on and what does it tell you?
Confusion
Urea >7mmol/l
REspiratory rate >30
Blood pressure
You get 1 point on each point--> tell you how severe the CAP is and where should treatment happen
161
What are the prevention methods of LRTIs?
Pneumococcal vaccination (S. pneumoniae)
Patients with chronic heart, lung and kidney disease
Patients with splenectomy
May repeat after 5 years in certain populations
Influenza vaccination for vulnerable groups (annually)
Over 65s
Chronic disease, multiple co-morbidities
