Y3 LRTI Flashcards
HIV can pre-dispose you to what specific respiratory infection?
Pneumocystis pneumonia (pneumocystis jirovecii)
Describe what is shown on the chest x-ray:
Consolidation within the middle lobe of the right lung.
- classic presentation of community acquired pneumonia.
Describe what is shown on the chest x-ray:
Apical cavity in the apex of the right lung.
- classic appearance of pulmonary mycobacterium tuberculosis.
Describe what is shown on the chest x-ray:
Large area of increased opacification in the right hemithorax - very dense - lens shaped pattern.
- suggestive of a pleural lesion - likely patient would have a fever, weight loss, cough, chest pain.
- Empyema
Describe what is shown on the chest x-ray:
Consolidation in the midzone with sparing of peripheries - bats wing presentation.
Pneumocystis pneumonia (pneumocystis jirovecii)
- commonly present in people whom are immunocompromised.
Describe what is shown on the chest x-ray:
COVID pneumonia
Presents with a wide spread ground glass appearance consolidation worst at the peripheries.
What does this chest CT suggest?
Bacterial pneumonia - focal consolidation.
What does this chest CT show?
Multi-focal ground glass appearance classic of COVID pneumonia and other viral pneumonia’s.
What tests should be ordered in cases of RTI?
FBC - white count raised/low.
- abnormal neutrophils suggest bacterial.
- abnormal lymphocytes suggest viral.
- High platelet count or low Hb (normocytic anaemia) can present in chronic infections.
CRP - high CRP is non-specific but can indicate bacterial infection.
U&E - indicate AKI.
Albumin - low albumin may suggest chronic infection - poor prognostic feature.
HIV - screening.
How are pathogens detected in RTI?
Blood culture is important as bacteria that cause LRTI can often lead to sepsis.
What are the three categories of pneumonia?
Community acquired pneumonia
Hospital acquired pneumonia
Ventilator acquired pneumonia
How is severity of community acquired pneumonia assessed?
CURB65 score - determines whether patient can be safely discharged and treated at home or needs to stay in hospital.
Note: Any patient with a CURB65 score above 2 should have a blood culture.
Note: Any patient with a CURB65 score above 3 should have a legionella antigen test.
What is the therapeutic approach to CAP?
Support treatment with O2 and fluids.
Legionella antigen test
The most commonly used laboratory test for diagnosis of Legionnaires’ disease is the urinary antigen test, which detects a molecule of the Legionella bacterium in urine. If the patient has pneumonia and the test is positive, then you should consider the patient to have Legionnaires’ disease.
Legionnaires’ disease
Legionnaires’ disease is a severe form of pneumonia (lung inflammation) usually caused by infection. It’s caused by a bacterium known as legionella. Most people catch Legionnaires’ disease by inhaling the bacteria from water or soil.
What is the treatment for pulmonary TB?
Be aware of liver toxicity as a side effect from taking these drugs.
Contact tracing is provided to anyone with confirmed TB.
Non-TB Mycobacterium
Non-TB mycobacterium is only a problem for people with underlying lung disease.
