CBL4 Bronchiectasis and Pneumonia Flashcards
(61 cards)
What’s bronchiectasis?
(in terms of simple pathology)
Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.
Causes of bronchiectasis
Causes
- post-infective: tuberculosis, measles, pertussis, pneumonia
- cystic fibrosis
- bronchial obstruction e.g. lung cancer/foreign body
- immune deficiency: selective IgA, hypogammaglobulinaemia
- allergic bronchopulmonary aspergillosis (ABPA)
- ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
- yellow nail syndrome
What characteristic features can be seen on that X-ray?
What’s the diagnosis?
- Chest x-ray showing tramlines, most prominent in the left lower zone
- Diagnosis: bronchiectasis
- What can be seen on that X ray? (characteristic feature) (2)
- What’s the diagnosis?
- CT chest showing widespread tram-track and signet ring signs
- diagnosis: bronchiectasis
Differential diagnosis for bronchiectasis
Symptoms of bronchiectasis
Characteristics of the cough in bronchiectasis
- productive
- worse in the morning
- large volume
- daily purulent sputum
Investigations in bronchiectasis (just in general)
- spirometry
- CXR
- CT
- sputum culture
What pattern of spirometry may be seen in bronchiectasis?
Obstructive or normal
Characteristic features of CXR in bronchiectasis
- May be normal
- Ring opacities, tram-tracks
- Fluid-filled cysts or bronchocoeles
Characteristic features of CT in bronchiectasis
- Signet ring sign and tram-tracks
- Lack of tapering of airways - thickness is NOT reduced towards the end
- Mucus impaction
- Mosaicism (vessels of different size in different regions of the lungs - smaller where less perfused)
Management of bronchiectasis
- physiotherapy (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
- postural drainage (airway clearance)
- antibiotics for exacerbations + long-term rotating antibiotics in severe cases
- bronchodilators in selected cases
- immunisations (influenza and bronchodilators)
- surgery in selected cases (e.g. Localised disease)
Most common organisms isolated from patients with bronchiectasis (4)
Most common organisms isolated from patients with bronchiectasis:
- Haemophilus influenzae (most common)
- Pseudomonas aeruginosa
- Klebsiella spp.
- Streptococcus pneumoniae
Management of infective exacerbations in bronchiectasis (what to do in general)
- Review previous sputum culture results & most recent course of antibiotics given
- Send more sputum for culture
- Choose antibiotic (in line with local guidance):
–amoxicillin/clarithromycin/doxycycline oral
–ciprofloxacin if Pseudomonas aeruginosa
–Tazocin/3rd generation cephalosporin IV
*Total course 10-14 days
*May need to consider outpatient IV antibiotics
•Chest physiotherapy
Antibiotics used in infective exacerbations of bronchiectasis
- what oral antibiotics
- what for Pseudomona aeurginosa
- what IV antibiotic
- how long for
* Choose antibiotic (in line with local guidance):
–amoxicillin/clarithromycin/doxycycline oral
–ciprofloxacin if Pseudomonas aeruginosa
–Tazocin/3rd generation cephalosporin IV
- Total course 10-14 days
- May need to consider outpatient IV antibiotics
Management of Pseudomonas Aeurginosa infection
- oral
- IV
- nebulised
•can colonise abnormal lungs
- also be associated with active infection
- Only orally active antimicrobial is Ciprofloxacin (fluoroquinolone antibiotic)
- IV: Tazocin (Piperacillin and Tazobactam), Ceftazidime (cephalosporin)
- Nebulised: colomycin (polymyxin antibiotic) can be used to suppress Pseudomonas in the case of colonisation with frequent exacerbations
Azithromycin
- class
- use
- usual dose
Azithromycin
Class: macrolide antibiotic
Antimicrobial and immuno-modulatory actions
Dose (usual):250mg three times a week
Use: aim of reducing exacerbation frequency
Side effects of Azithromycin
Key Side Effects:
–Prolonged QT and cardiac dysrhythmia
–Hearing loss (usually reversible)
–Hepatic dysfunction
Presenting symptoms of pneumonia
- cough
- sputum
- dyspnoea
- chest pain: may be pleuritic
- fever
What is pneumonia? (in general)
What is the most common cause?
Any inflammatory condition affecting the alveoli of the lungs, but in the vast majority of patients this is secondary to a bacterial infection
What is the likely organism causing pneumonia in the following presentation?
- Accounts for 80% of cases
Particularly associated with high fever, rapid onset
- A vaccine to pneumococcus is available
Streptococcus pneumoniae (pneumococcus)
What is the likely organism causing pneumonia in the following presentation?
Particularly common in patients with COPD
Haemophilus Influenzae
What is the likely organism causing pneumonia in the following presentation?
Often occurs in patient following influenza infection
Staphylococcus aureus
What is the likely organism causing pneumonia in the following presentation?
- One of the atypical pneumonias
- often present a dry cough
- atypical chest signs/x-ray findings
- Autoimmune haemolytic anaemia and erythema multiforme may be seen
Mycoplasma pneumoniae
