Chronic Pulmonary Infection Flashcards
What is the diagnosis of a chronic pulmonary infection?
Shadow on a CXR Weight loss Persistent sputum production Chest pain Increasing shortness of breath.
What are the different diagnosis of chronic pulmonary infection?
Lung cancer Intrapulmonary Abscess Empyema Bronchiectasis Cystic Fibrosis
What are the risk factors for developing chronic pulmonary infection?
Abnormal host response e.g. immunodeficiency/suppression
Abnormal innate host defence e.g. bronchial mucosa, abnormal cillia, abnormal secretions
Repeated insult e.g. aspiration
What conditions can cause immunodeficiency?
Immunoglobulin Deficiency
Hypo-splenism
Immune paresis
HIV
What are drugs that can cause immunosuppression?
Steroids Azathioprine Methotrexate Cyclophosphoamide Monoclonal antibodies Chemotherapy
What can cause defective innate host defence?
- Smoking, malignancy
- Kartenager’s Syndrome, Youngs Syndrome
- Cystic fibrosis, channelopathies.
What is indwelling material and how can it contribute to chronic infection?
Something in the wrong place e.g. NG tube down the trachea or an inhaled foreign body.
What are FORMS of chronic infection?
Intrapulmonary abscess Empyema Chronic Bronchial Sepsis Bronchiectasis CF
What usually causes an abscess?
A preceding illness of pneumonia, aspiration pneumonia and poor host immune response.
How can septic emboli arise?
From right sided endocarditis
Infected DVT
Septicaemia
IV drug users.
What is a complicated Parapneumonic Effusion?
The step before empyema.
Has a pH of lower than normal
LDH is high (byproduct of bacteria)
Glucose is low
What test do you do to differentiate between an empyema and an abscess?
CT scan
What is the sign on the CT scan that shows bronchiectasis?
Thickened walls of the airways and dilated, appear as a signet ring with their pulmonary vessel right next to it.
What is Chronic Bronchial Sepsis?
Has all the hallmarks of bronchiectasis but none on a HRCT
If a patient is colonised with persistent bacteria, what drugs will be prescribed?
Prophylactic antibiotics
Nebulised gentamicin
Alternating oral antibiotics and pulsed IV abx
