Chest infections

Question 1

How do chest infections present?

Answer 1

Chest infections typically present with a cough and sputum production, shortness of breath, fever, lethargy and crackles on the chest. Remember that viral bronchitis is very common, will also present with a productive cough and does not require antibiotics.

Question 2

Common causes of chest infections

Answer 2

Streptococcus pneumoniae (50%)
Haemophilus influenzae (20%)

Question 3

Other causes of chest infections

Answer 3

• Moraxella catarrhalis in immunocompromised patients or those with chronic pulmonary disease
• Pseudomonas aeruginosa in patients with cystic fibrosis or bronchiectasis
• Staphylococcus aureus in patients with cystic fibrosis

Question 4

Atypical bacteria

Answer 4

You can remember the 5 causes of atypical pneumonia with the mnemonic “legions of psittaci MCQs”:

Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydydophila pneumoniae
Qs – Q fever (coxiella burnetii)

Question 5

Abx treatment in chest infections

Answer 5

An appropriate initial antibiotic in the community would be

Amoxicillin

Alternatives:
Erythromycin / clarithromycin
Doxycycline
To treat atypical bacteria:

• Macrolides such as clarithromycin
• Quinolones such as levofloxacin
• Tetracyclines such as doxycycline