Chest infection

Question 1

What are the principles of treatment?

Answer 1

Consider pathogen, host (immune system) and severity

Question 2

What are the two bacterias most associated with pneumonia?

Answer 2

Haemophilus influenza

Streptococcus pneumoniae

Question 3

What is septic shock?

Answer 3

Subset of patients with profound circulatory, cellular and metabolic abnormalities
MAP <65mmHg, lactate >2mmol/l
Hypotension despite fluid resuscitation, requiring vasopressors
Consider sepsis alongside consideration of pneumonia and antibiotics

Question 4

URTI tx

Answer 4

Supportive, not antibiotics
Special diagnoses - stridor, croup, quinsy
Consider underlying diagnosis - allergy, polyps, immunity
Consider ENT review and direct nasendoscopy

Question 5

LRTI tx

Answer 5

Supportive, aybe antibiotics
Consider related morbidity - asthma, chronic cough
Make a back-up plan - consider CXR, antibiotics, referral

Question 6

Pneumonia tx

Answer 6

Consolidation on chest imaging
Supportive and antibiotics (normally even if viral cause)
Decisions on AB choice (spectrum) and duration (5-7-10 days)

Consider underlying diagnoses - allergy, polyps, immunity, co-morbities, bronchiectasis, COPD
Consider admission

Question 7

Empyema

Answer 7

Collection of fluid in pleural cavity caused by MO’s
Definitely antibiotics and definitely drain
Supportive - co-morbidities, pyscho-social, pin, oxygen

Consider underlying diagnosis - pathogen, immunity, surgery

Question 8

Bronchiectasis

Answer 8

Widening of the airways, causing more mucous build up, more likely to have infection - common symptom is a persistent cough with phlegm
Airway clearance and antibiotics
Long term chronic lung disease, management plan, specialist nurses, rescue therapies etc

Question 9

Lung abscess, cavitation

Answer 9

Definitely antibiotics, tx defined by cause

Identify pathogen, surgery, antibiotics

Question 10

Pneumonia (pathology, symptoms and signs, prognosis)

Answer 10

Pathology - consolidation, pus/necrosis
S and S - cough and phlegm, SOB, fever
Prognosis - consider CRB65, consider CAP/HAP

Question 11

HAP

Answer 11

Included more than 48h after admission or within 10-30 days of discharge
Radiographic change - pneumonia, effusion, empyema
ALtered microbiological context - gram -ve, anaerobes, MRSA (C.difficile)

Question 12

Follow-up goals

Answer 12

Consider exclusion of other diagnoses, exclusion of residual infection, complications of infection
Consider pneumonia vs bronchiectasis vs pleural infection control

Post pneumonia CXR - cancer, residual infection or complication

Question 13

Future directions

Answer 13

rapid diagnostics
rapid drug sensitivities
improved community support
Immunomodulatory therapy
Biomarkers to assess response (7 day course)

Question 14

Sequencing

Answer 14

Whole genome sequencing
Cost, speed, logistics
Bioinformatics
Clinical utility