Cardio-Resp Infections Flashcards
(81 cards)
1
Q
Normal flora in URT
A
Viridans streptococci
2
Q
Temporary colonisers in URT
A
Staph aureus
Candida
3
Q
Pathogens in URT
A
Strep Pneumonia
Corynebacterium diptheria
Haemophilus Influenzae
Group A Strep
4
Q
Common URTI viruses
A
rhinovirus influenza coronavirus adenovirus RSV coxsackie enterovirus
5
Q
Common URTI bacteria
A
Strep pyogenes- group A
Strep pneumoniae
Haemophilus influenzae
6
Q
Influenza symptoms
A
Fever
Coryza
systemic symptoms- headache, malaise, myalgia, arthralgia
+/- GI symptoms
7
Q
Influenza investigation
A
Primary care- not needed
Secondary care- nasopharyngeal swab for flu PCR
8
Q
Influenza treatment
A
Within 48 hrs of start of symptoms
Oseltamivir 75mg bd oral/NG for 5 days
9
Q
Pharyngitis- viruses
A
7 common URTI viruses
EBV
CMV
HSV
10
Q
Pharyngitis- bacteria
A
Group A, B, C Streptococci
Mycoplasma pneumoniae
Neisseria gonorrhoea
Corynebacterium diptheriae
11
Q
Pharyngitis symptoms
A
Sore throat
Fever
Tonsillar exudate
Tender cervical nodes
12
Q
Pharyngitis centor criteria
A
Tonsillar exudate Tender cervical LN Absence of cough h/o fever --> if 3/4- 50% chance
13
Q
Pharyngitis antibiotic sensitivity
A
All are penicillin sensitive
Majority erythromycin sensitive (for penicillin allergic people)
14
Q
Pharyngitis Treatment
A
Penicillin V 500mg QDS or 1g BD for 5-10 days
OR clarithromycin 500mg BD for 5 days
15
Q
Pharyngitis complications
A
Rheumatic fever
Glomerulonephritis
16
Q
Amoxicillin + EBV
A
Often causes rashes
–> doesn’t mean they have allergy
17
Q
Amoxicillin and sore throat
A
DO NOT GIVE
18
Q
Acute Otitis media viruses
A
Common URTI viruses
19
Q
Acute Otitis media bacteria
A
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumoniae Streptococcus pyogenes
20
Q
Acute otitis media- children
A
No antibiotics unless:
- <2 years
- symptoms persist >48 hours
- high fevers
- bilateral
- otorrhea
21
Q
Acute otitis media antibiotics
A
Amoxicillin 5-7 days (or co-amoxiclav)
OR clarithromycin 5-7 days
22
Q
Acute otitis media complications
A
Decreased hearing
Mastoiditis
Brain abscess
23
Q
Sinusitis viral
A
Common URTI viruses
24
Q
Sinusitis bacterial
A
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
25
Sinusitis treatment
Treatment usually not necessary
Consider penicillin V or clarithromycin
Co-amoxiclav is systemically unwell
26
LRTI
Pneumonia - community acquired (typical or atypical), hospital acquired, aspiration
Exacerbations of chronic bronchitis
Bronchiectasis + cystic fibrosis
Empyema
27
Community Acquired Pneumonia- typical
Strep pneumoniae
Haemophilus influenzae
Staph aureus
M tuberculosis
28
Community Acquired Pneumonia- Atypical
Mycoplasma pneumoniae
Legionella
Chlamydia pneumoniae
Chlamydia psittaci
29
Pneumococcal pneumonia RFs
Influenza
Alcohol
Smoking/COPD
HIV
30
Pneumococcal pneumonia- resistance
Antibiotic resistance increasing
| Always take a travel history- lots of country have resistant strains against amoxicillin
31
Atypical pneumonia
Mycoplasma pneumoniae
| Legionella species
32
Mycoplasma
Smallest
No cell wall
Not affected by cell wall antibiotics
33
M pneumoniae
```
Autumn-winter
Epidemics
Dry cough
+/- pharyngitis, rhinorrhea, otalgia
+/- hepatitis, meningitis
```
34
M pneumoniae antibiotics
Macrolides (e.g. clarithromycin)
Quinolones (e.g. levofloxacin)
Tetracyclines (e.g. doxycycline)
35
Legionella spp microbiology
>50 species
Gram -ve rods
Slow growth (3-5 days)
36
Legionella spp antibiotics
Cell wall antibiotics not effective
| Quinolones>macrolides>tetracyclines effective
37
S aureus pneumonia with abscess RFs
Colonisation of URT
| Viral URTI
38
S aureus pneumonia with abscess- PVL toxin strains causes
Severe disease
| Necrotising/abscess formation
39
CURB-65
```
Confusion
Urea > 7mmol/l
Respiratory rate >30/min
BP (systolic <90 or diastolic< 60)
Age> or =65
```
40
CURB-65 Score 0-1
Low severity
Risk of death <3%
Outpatient
41
CURB-65 Score 2
```
Moderate severity
Risk of death 9%
Admit
Microbiological investigations
IV Rx
```
42
CURB-65 Score 3-5
High severity
Risk of death 15-40%
Urgent admission
43
CURB-65 0-1 treatment
Oral amoxicillin 500mg TDS OR doxycycline 100mg OD
44
CURB-65 2 treatment
IV benzylpenicillin 1.2g QDS & doxycycline 100mg BD
45
CURB-65 >2 treatment
IV co-amoxiclav 1.2g TDS & doxycycline 100mg BD
OR
IV ceftriaxone 2g OD & doxycycline 100mg BD
46
CAP Summary
Mild- po amoxicillin
Moderate- IV benzylpenicillin + doxycycline
Severe- IV co-amoxiclav + doxycycline
h/o travel- IV ceftriaxone & doxycycline
47
Hospital Acquired Pneumonia
>48 hrs after admission or within 2 weeks of admission
48
Hospital Acquired Pneumonia predisposing factors
Abnormal conscious state/intubation & ventilation
| Immunosuppression
49
HAP microbiology
as for CAP + gram negative organisms (e. coli, klebsiella, pseudomonas)
50
HAP mild/moderate
doxycycline
51
HAP severe
```
early onset (<5 days)- co-amoxiclav)
late onset (>5 days)- piperacillin-tazobactam
```
52
Aspiration pneumonia aetiology
Bacteria from URT/stomach
Low virulence
Polymicrobial (aerobic streptococci + anaerobes)
53
Aspiration pneumonia treatment options
Amoxicillin + metronidazole
Levofloxacin + metronidazole
Co-amoxiclav
Piperacillin-tazobactam
54
Exacerbation of COPD
Acute- due to inflammation in airways
| Worsening of symptoms- SOB, Cough, Sputum
55
Possible triggers for ECOPD
```
Viruses
COPD
Bacteria
Pollution
CCF
VTE
Aspiration
```
56
Infective ECOPD- bacteria
Haemophilus influenzae Moraxella catarrhalis Streptococcus pneumoniae
Pseudomonas aeruginosa Chlamydia pneumoniae
57
Infective ECOPD- viral
```
Rhinovirus
Influenza/parainfluenza
Adenovirus
RSV
Metapneumovirus
Coronavirus
```
58
IECOPD Antibiotics
Effective if h/o >2 of:
- increased dyspnoea
- increased sputum purulence
- increased sputum volume
59
IECOPD Empirical treatment
Doxycycline or clarithromycin
60
IECOPD Specific treatment
Duration- 5 days
If relapse within 3 months, alternative agent
If consolidation on CXR then treat as CAP/HAP
61
Bronchiectasis
Abnormal dilatation of major bronchi + bronchioles
Chronic daily cough with viscid sputum production
CT- bronchial wall thickening + luminal dilatation
62
Cystic fibrosis
Congenital
| Abnormal secretions resulting in chronic infections + bronchiectasis
63
Bronchiectasis + CF Treatment
Guided by sputum culture
If no pseudomonas- clarithromycin of doxycycline or co-amoxiclav
If pseudomonas- po ciprofloxacin or IV pip-taz
64
Bronchiectasis + CF prophylaxis
```
Chest physio/postural drainage
Oral azithromycin (for recurrent only)
Inhaled abx (nebulised gentamicin, tobramycin, colistin
```
65
Empyema
Complicated parapneumonic effusion (effusion into pleural space adjacent to bacterial pneumonia)
Usually small
Usually resolve with pneumonia treatment
66
Complicated parapneumonic effusion
Bacteria involve pleural space
| Empyema develops
67
Empyema treatment
Drainage
| Antibiotics until XR resolution (2-4 weeks)
68
Prevention of Resp Infections
VACCINATIONS
Influenza
Pneumococcal Haemophilus influenzae Pertussis
Diptheria
69
Infective Endocarditis RF
Iatrogenic- infected cannula
| IVDA (often leads to right side endocarditis)
70
Infective endocarditis pathogens
High pathogenicity organisms
Staphylococcus aureus Strep pneumoniae
yeast
71
Infective endocarditis- abnormal native valve
rheumatic fever
degenerative (calcific) disease
congenital defects (especially turbulent flow)
mitral valve prolapse (5-10 x risk)
72
Infective endocarditis- abnormal valve bacteria
Often low virulence
oral (viridans) streptococci Enterococcus spp.
HACEK group of organisms
Occasionally …Coxiella burnetii, Chlamydia spp, Mycoplasma spp., Bartonella spp.
73
Infective endocarditis- prosthetic valve
1st year after surgery- risk approx. 1-2%
Commonly- staph aureus, coagulase negative staph
After 1 year post-surgery- risk <0.5%
Commonly- oral streptococci, enterococcus spp.
74
Infective Endocarditis treatment principles
```
Vegetation impenetrable by phagocytes
Surgical backup essential
Synergistic combination often required
Intravenous therapy essential – duration?
Duration?
- 4 weeks native valve IE
- 6 weeks prosthetic valve IE
Need to know aetiology of infection
- MIC of organism guides therapy
```
75
Infective endocarditis antibiotic sensitivity testing
```
Disc diffusion tests
MIC tests (E test)
```
76
Infective endocarditis antibiotic sensitivity testing- MIC
Minimum inhibitory concentration = lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation
77
Infective endocarditis antibiotic sensitivity testing- MBC
minimum bactericidal concentration = lowest concentration of antimicrobial that will prevent the growth of an organism after subculture on to antibiotic-free media.
78
Empirical therapy for endocarditis
Only if severe endocarditis
Native valve- vancomycin + gentamicin OR vancomycin + meropenem
Prosthetic valve- Vancomycin + gentamicin + rifampicin
79
IE directed therapy
Staphylococcus- flucloxacillin 4 hourly (MRSA- vancomycin)
Streptococci- benzyl penicillin 4 hourly (penicillin resistance- vancomycin + gentamycin)
Enterococci- amoxicillin 4 hourly + gentamicin
80
Prosthetic valve IE course
6 weeks
Poor prognosis
Add oral rifampicin to treat biofilm
81
Endocarditis summary
uncommon but may high morbidity & mortality
difficult to diagnose
4-6 weeks of IV antibiotic therapy
surgery occasionally needed
valve replacement carries risks of new infection
Antimicrobial prophylaxis is generally no longer indicated but this is controversial
