Flashcards in Chronic Lung Sepsis. Deck (45):
What are the risk factors for developing chronic lung sepsis?
Congenital or acquired immunodeficiency. Immunosuppression, abnormal innate host defence e.g. Abnormal cilia and repeated insult e.g. Foreign object or aspiration.
What is the most common cause of immunodeficiency in adults? what does it cause?
CVID- common variant immunodeficiency.
How common is IgA deficiency and what does it cause?
Common. Causes increased risk of acute infections but rarely chronic ones.
What is hypogammaglobinaemia?
What does it cause?
It is a decreased level of gamma globulin in the blood. This consists mainly of antibodies.
Causes increased risk of both acute and chronic infections.
It is rare than IgA deficiency.
What are some other causes of immunodeficiency?
Specific polysaccharide antibody syndrome.
Immune paresis caused by myeloma, lymphoma and metastatic malignancy.
What kinds of drugs cause immunosuppression?
Steroids, apathioprine, methotrexate, cyclophosamide.
Monoclonal antibodies: infliximab, TNFa, rituximab and leflunamide.
What can cause damaged bronchial mucosa?
Smoking, recent pneumonia, viral infections and malignancy.
What can cause abnormal cilia?
Youngs syndrome - normal lung function but abnormally thick mucus.
What different froms of chronic lung infection do we get?
Intrapulmonary abscess, empyema, chronic bronchial sepsis, bronchiectasis and cystic fibrosis.
What signs and symptoms do we get of pulmonary abcesses?
Indolent (failing to heal) presentation.
Weight loss common, lethargy, tiredness, weakness, cough +/- sputum.
What types of illnesses can precede chronic lung abscesses?
Pneumonia, aspiration and hypogammaglobinaemia.
How do get from flu to an abscess?
Flu ==> staph pneumonia ==> cavitation pneumonia ==> abscess.
What can increases the chances of aspiration?
NG feeding, lowered consciousness, pharyngeal pouch, alcoholism, neurological issues. Vomiting.
What is immune paresis?
Muscular weakness caused by a disease of the neuro system.
What pathogens can cause a chronic lung abscess?
Streptococcus, staphylococcus, E. coli, gram negatives and fungi like aspergillus.
What can cause septic emboli?
Right sided endocarditis, infected DVT, septicaemia and IVDU causing infected DVT.
What is empyema?
What commonly causes it?
Pus in the pleural space.
Pneumonia but the rest are primary form idiopathic or iatrogenic causes.
How deadly in empyema?
20 % of all people that have it die.
How does pleural effusion progress to empyema?
Simple parapneumonic effusion to complicated to empyema.
What are the features of a simple parapneumonic effusion?
Ph > 7.2
What are the features of a complicated parapneumonic effusion?
What is LDH and when is it released?
Lactate dehydrogenase enzyme. Released during tissue damage.
What will empyema look like on aspiration?
What do we see on CXR for empyema?
What type of organisms most commonly cause empyema?
What gram positive organisms cause empyema?
Strep milleri and staph aureus.
What gram negative organisms cause empyema?
E.coli, haemophilus influenzae and Klebsiella.
What patients should we be suspicious may have developed empyema?
Slow to resolve pneumonia.
What test should we do for empyema?
Front and lateral CXR.
When is a lateral CXR particularly useful in empyema?
When there are small retro diaphragmatic collections.
What IV antibiotics do we use for empyema?
Amoxicillin and metronidazole.
What oral antibiotics do we use for empyema? When do we give them?
Given after broad spectrum IV antibiotics for 14 days.
Dictated by culture of aspirate.
How do we avoid empyema?
By detecting and sampling complicated effusion.
What is bronchiectasis? What can it cause?
Localised irreversible dilation of the bronchial tree. Involved bronchi can easily collapse, which can cause airflow obstruction and decreased clearance of secretions. The dilated airways usually accumulate purulent secretions.
What is the presentation of the type of patient that gets bronchiectasis?
Recurrent chest infections, with recurrent antibiotics. No or short lived response to antibiotics. Persistent sputum production.
What are the signs and symptoms of bronchiectasis?
Cough productive of sputum, chest pain, recurrent LRTI.
What tests do we do to look for bronchiectasis?
Radiography and high resolution commuted tomography.
What usually cause bronchiectasis?
Usually due to fibrous scarring following infection e.g. Pneumonia or TB.
Also seen in chronic obstructions like a tumour.
What is bilateral pulmonary oedema usually always caused by?
What are the three main causes of pleural effusion?
Malignancy, heart failure and infection.
What is bronchial sepsis?
All the hallmarks of bronchiectasis but none seen on HRCT.
Who does chronic bronchial sepsis commonly affect?
Often younger women involved in childcare.
Or older people with COPD or other airway diseases.
What is the treatment for bronchiectasis and chronic bronchial sepsis?
When colonised with persistent bacteria give prophylactic antibiotics.
Nebuliser gentamicin or colomycin.
Alternating oral antibiotics.
Anti inflammatory treatment: low dose macrolides have been shown to reduce exacerbations.
Clarithromycin 250mg once a day.
Azithromycin 250mg three times a week.
What is the prognosis for bronchiectasis and bronchial sepsis?
Recurrent infection, colonisation, abscesses and empyema.