Flashcards in Chronic Pulmonary Infection Deck (33):
What's the diff. diagnosis of:
Shadow on CXR
Persistent sputum production
What are the risk factors for developing chronic pulmonary infection?
Abnormal host response- immunodeficiency/ immunosuppression
Abnormal innate host defence- Damaged bronchial mucosa/ abnormal cillia/ abnormal secreation
Repeated insult- aspiration/ indwelling material (eg NG or ET tube)
What immunoglobulin deficiencies are associated with chronic pulmonary infection?
IgA deficiency- more accute
CVID- common cause, recurrent infections
Specific Polysaccharide Antibody Deficiency
What are other causes of immunodeficiency?
Immune paresis- myeloma, lymphoma, metastatic malignancy
What are some common causes of immunosuppression?
Monoclonal antibodies (Infliximab, etanercept, TNFa/ rituximab/ leflunamide)
What causes defective innate host defence?
Damaged bronchial mucosa
Abnormal cillia ( Kartenager's syndrome, Young's syndrome
Abnormal secretions (CF, channelopathies)
What causes repeated insult?
Recurrent aspiration (NG feeding, poor swallow, pharyngeal pouch)
Indwelling material (NG tube, chest drain, inhaled foreign body?
What's an intrapulmonary abscess?
Indolent presentation (quietly growing)
Lethargy, tiredness, weakness
Cough sometimes sputum
high mortality if untreated
usually a preceding illness of some sort (pneumonic, post viral, foreign body)
what bacteria is very good at causing abscesses?
What can cause aspiration pneumonia?
Lowered conscious level
what poor immune response is associated with pulmonary abscess?
What pathogens are common of lung abscess?
What are three main causes of septic emboli?
Right sided endocarditis
How does IV drug use lead to septic emboli?
Inject into groin,
PE + abscesses
What is empyema?
Pus in pleural space- infected pleural effusion
What is pleural effusion?
fluid in pleural space
what does empyema look like on a CT scan?
like a banana
What are signs of simple parapneumonic effusion?
pH > 7.2
LDH < 1000
Glucose > 2.2
what are signs of complicated parapneumonic effusion/
pH < 7.2
Glucose < 2.2
NEEDS CHEST TUBE DRAINING
what are signs of empyema?
How would you diagnose empyema?
What does a D shape on CXR indicate?
Empyema treatments other than chest drain?
- broad spectrum
- amoxicillin and metronidazole initially
How should you tap an empyema?
with a USS
What is bronchiectasis?
Localises, irreversible dilation of bronchial tree
What is the presentation of bronchiectasis?
Recurrent "chest infections"
Recurrent antibiotic prescriptions
No response to antibiotics
Short lived response to antibiotics
Persistent sputum production
How to diagnose bronchiectasis?
Cough productive of sputum
What would be characteristic on a brochiectasis CT?
What causes bronchiectasis?
Young's and Kartanager's syndrome
Monier-Khum syndrom (lack of tracheal cartillage)
Yellow Nail syndrome
ABOUT 50% IDIOPATHIC
What is chronic bronchial sepsis?
hallmarks of bronchiectasis but no radiological signs
Who are likely to get chronic bronchial sepsis?
Young women working with children
Older people with COPD or airways disease
How to treat chronic bronchial sepsis?
reactive antibiotics: sputum sample, antibiotics appropriate to most recent positive culture