Flashcards in Chronic Pulmonary Infection Deck (38):
What does a shadow on a CXR indicate?
Cancer or infection
Clinical signs of lung infection (5)
Shadow on CXR
persistent sputum production
What are some risk factors for developing chronic pulmonary infection (4)
Abnormal innate host defence (mucosa, cilia and secretions damaged)
How can immunodeficiency occur?
How can immunosuppression occur? (4)
Immunosuppressor drugs (Azathioprine, Methotrexate, Cyclophosphamide)
Monoclonal antibodies (infliximab, rituximab)
How can the bronchial mucosa be damaged? (4)
From smoking, recent pneumonia, viral infection or malignancy
How can cilia be damaged? (3)
Smoking, Kartenager's syndrome, Young's syndrome
How can secretions become abnormal? (2)
Why does damaging the bronchial mucosa cause problems?
It damages the wall, letting bacteria in as the 2nd infection can now get through the wall
e/g/ staphylococcal empyema
How can Aspiration occur (3)
- Nasogastric tube feeding
- Poor swallowing
- Pharyngeal pouch
Name the 5 forms of chronic infection
- intrapulmonary access
- chronic bronchial sepsis
- cystic fibrosis
What is the clinical presentation of an intrapulmonary abscess?
It has an indolent presentation - isn't obvious, doesn't cause any pain
however, weight loss, lethargy, tiredness, cough with/out sputum can be common
often preceding an illness e.g. post viral, post having pneumonia
What bacteria can cause chronic pulmonary infections? (4)
what fungi can cause chronic pulmonary lung infections?
What kinds of people tend to become affected by Aspergillus?
immunosuppressed e.g. on high doses of Chemo or have HIV
What could be a cause of multiple abscesses?
Bacteraemia (bacteria in bloodstream)
What 4 ways can septic emboli occur
1. Right sided endocarditis
2. Infected DVT
4. Intravenous drug users
What is Empyema?
Pus in the pleural space (infected fluid)
If fluid in the pleural space is not infected, what is it called?
What pH is a Simple Parapneumonic Effusion?
Over 7.2; alkali
What pH is Complicated Parapneumonic Effusion?
Under 7.2; acidic
What kind of bacteria cause Empyema; anaerobic or aerobic?
Name 2 Gram +ve organisms that can cause Empyema
Strep milleri and Staph aureus
Name 4 Gram -ve organisms that can cause Empyema
In what cases can anaerobic bacteria cause Empyema
in severe pneumonia or poor dental hygiene
What does Empyema appear like clinically?
As a 'slow to resolve' pneumonia
What does Empyema look like on a CXR
persisting effusion, look for a 'D' sign as empyema is sticky so sticks to side of chest wall
What is the best investigation for Empyema
USS (ultrasound) (blackness on ultrasound is fluid = empyema)
How can Empyema be treated
IV or Oral antibiotics
Name 2 IV antibiotics for Empyema
Amoxicillin and Metronidazole
What is Bronchiectasis?
Localized, irreversible dilation of the bronchial tree
What does Bronchiectasis result in for the patient?
Impaired clearance of secretions
How does Bronchiectasis present clinically?
Recurrent chest infections, persistent sputum and no response/short lived response to antibiotics
What are the clinical signs of Chronic Bronchial Sepsis?
Has all the hallmarks of bronchiectasis but none shown on HRCT
Treatment for Bronchiectasis
Name 2 antibiotics used for bronchiectasis
Clarithromycin and Azithromycin
What is the mortality from abscess?