Bronchiectasis and Chronic Lung Infection

Question 1

Shadow on x-ray, weight loss, persistent sputum production, chest pain, increasing dyspnoea

Answer 1

Lung cancer (not very likely), empyema, intrapulmonary abscess, bronchiectasis, cystic fibrosis

Question 2

Risk factors for developing chronic pulmonary infection

Answer 2

Abnormal host response - Immunosuppressed or immunodeficient
Abnormal innate host defence
Repeat insult

Question 3

What can cause a damaged bronchial membrane

Answer 3

Smoking, recent pneumonia, malignancy

Question 4

Abnormal ciliary function diseases

Answer 4

Kartenager’s syndrome -
Impaired ciliary function leading to absent or reduced mucus clearance.
Young’s syndrome -
Lungs have normal function but mucous is abnormally viscous

Question 5

How can pneumonia cause intrapulmonary abscess

Answer 5

Staphylococcus pneumonia can cause cavitating pneumonia that leads to formation of abscess

Question 6

How can IV drug users get septic emboli

Answer 6

IV drug users inject drugs into their groin or veins. A formed DVT may be infected causing pneumonia. This can lead to an abscess or septic emboli

Question 7

What is primary empyema

Answer 7

Empyema which may be iatrogenic or idiopathic

Question 8

Major cause of empyema

Answer 8

Pneumonia

Question 9

Progression of effusion to empyema

Answer 9

Simple paraneumonic effusion - 
Clear fluid, pH > 7.2, LDH < 1000, Glucose > 2.2
Complicated paraeumonic effusion -
pH < 7.2, LDH > 1000, Glucose < 2.2
Empyema - Pus

Question 10

Aerobes or anaerobes in pneumonia

Answer 10

Aerobes are more common, anaerobes usually if poor dental hygiene or severe pneumonia

Question 11

Most common organism of pneumonia post-operative or nosocomial

Answer 11

Staphylococcus aureus

Question 12

Diagnosing empyema

Answer 12

Clinical - Slow to resolve pneumonia
CXR - Lateral and AP, persisting effusion especially with loculations
Ultrasound testing - Simple, bedside testing
CT - Differiate from abscess

Question 13

Preferred diagnostic tool for empyema

Answer 13

Ultrasound testing

Question 14

Antibiotics for empyema

Answer 14

Yes, broad spectrum IV such as Amoxicillin and Metronidazole initially. Oral antibiotics directed towards cultured bacteria for 14 days

Question 15

Uncomplicated vs complicated paraneumonic effusion

Answer 15

Uncomplicated - Mainly exudative with predominant neutrophilic effusions reflecting increasing passage of interstitial fluid due to inflammation. No infection yet
Complicated - Bacterial infection of pleural space resulting in a cloudy fluid. Requires drainage for resolution

Question 16

What are paraneumonic effusions

Answer 16

Pleural effusions due to pneumonia, lung abscess or bronchiectasis

Question 17

Does uncomplicated pneumonia need draining

Answer 17

No but complicated does

Question 18

What is bronchiectasis

Answer 18

Localist, irreversible dilation of bronchial tree due to inflammation. Obstructs airway and impairs clearance of secretions

Question 19

How does bronchiectasis present

Answer 19

Recurrent chest infection, short lived response to antibiotics and persistent sputum production

Question 20

Chronic bronchial sepsis vs bronchiectasis

Answer 20

Same symptoms as bronchiectasis but chronic bronchial sepsis doesn’t show up on high resolution CT

Question 21

Treatment for chronic bronchial sepsis or bronchiectasis

Answer 21

Stop smoking
Flu or pneumococcal vaccine
Reactive antibiotics specific to most recent culture
Prophylactic broad spectrum antibiotics such as nebulised Gentamicin or Colomycin. Can also pulsed IV or alternating oral