infectious diseases Flashcards
Acute bronchitis: what is it, syx, ix, mx
LRTI, not pneumonia.
- Acute = common in <5y, in winter
- Chronic = productive cough >3m of year and going on for at least 2y. Type of COPD. RF = >40y, smoking.
Syx Peaks after 2-3d. - Cough +/- clear, yellow/green phlegm - Fever - Coryzal syx - R/O: pneumonia, asthma, postnasal drip
Ix
Dx based on clinical picture
- Obs + resp ex
- Consider: PFT, CXR, CRP
Mx
- Self-limiting
- Self-care: fluids + rest, simple analgesias
- OTC cough medicines
- Abx if systemically unwell or hi risk of complications
- safetynet
Acute bronchiolitis: what is it, syx, ix
Bronchiole infection causes by RSV.
Common in winter, <2y.
Lasts 7-10d, syx peak at 3-4d.
Syx dx if <2y, coryzal syx past 1-3d and worsening (1.) coryzal syx (2.) dyspnoea (3.) tacypnoea (4.) poor feeding (5.) mild fever (6.) apnoea (7.) signs or resp distress: hi RR, inc WOB (accessory muscles, tracheal tugging, recession, nasal flaring, head bobbing), cyanosis, wheeze/grunting /stridor.
Ix
- Obs: SATs, RR, HR, BP
- Hydration status: CRT, skin tugor, dryness of mucous mb, U/O
- Chest auscultation
Acute bronchiolitis mx - mild, severe, prophylaxis
(1. ) Advise self-limiting illness and syx peak at day3/5 + pcm + fluids + safetynet
(2. ) Palivizumab - target RSV, given to hi risk pt (ex-prem, congenital heart disease, complications)
(3. ) Urgent admission if apnoea, severe resp distress
(4. ) Refer if:
- RR >60, Sats <92%
- 50-75% reduced milk intake
- Clinical dehydrated
- <3m or pre-existing conditions e.g. prem, down syndrome or cystic fibrosis
- Parent not confident to manage at home
Secondary care
(1. ) Oxygen if <92%
(2. ) Saline nasal drops or suction
(3. ) Adequate intake (oral/NG/IV) ensuring not to overfeed as full stomach will restrict breathing.
(4. ) Cap BGL
Croup: what is it, causes, syx, classification, mx
- Laryngotracheobronchitis infection, usually self-limiting. Caused by parainfluenza 1 + 3 (75%), influenza A +B, adenovirus, RSV
- Common in 6m-2y
Syx
(1. ) Coryzal syx
(2. ) Barking, seal-like cough - worse at night
(3. ) Hoarseness
(4. ) Inspiratory stridor
(5. ) Impending resp failure red flags: drowsy, agitated, cyanosis, tachypnoea, recession
Classification
- Mild = seal-like barking cough
- Moderate = PLUS stridor and sternal recession
- Severe = PLUS agitation or lethargy
Mx
(1. ) mild:
- PO Dexamethasone STAT + pcm, fluids, check child, safetynet
(2. ) Admit if: mod-servere, RR>60, hi fever, <3months, pre-existing conditions, reduced fluid intake, no wet nappies for 12hrs
- Oxygen
- Dexamethasone PO or budesonide neb
- Adrenaline neb
Influenza: virus type, vaccines, dx/ix, mx.
(1.) It is a RNA virus with three pathogenic serotypes: A, B, C
(2. ) Vaccines given to:
- >65y
- chronic conditions e.g. asthma, COPD, HF, DM
- HCP + nursing home residents.
(3. ) Dx made clinically but ix may be used if ‘complicated influenza’
- Nasopharyngeal swabs + culture
- PCR
Mx
(1. ) Supportive: analgesia, antipyretics, fluids, oxygen
(2. ) Antiviral (oseltamivir) if at risk of serious complications or in an ‘at risk group’:
- >65y, <6y, pregnant
- spleen dysfunction e.g. sickle cell anaemia or coeliac
- chronic resp, heart, kidney, liver, neuro disease. DM, obese, imc.
Acute Epiglottis: what is it, causes, syx, mx , dx
Paed emergency
Infection + inflamm of the epiglottis which may lead to abrupt blockage of upper airway and death.
Caused by Hib. Cases less common due to vaccines.
Syx - do NOT ex child
(1. ) sudden hi fever
(2. ) severe throat pain - hoarse, drooling, stridor, pain on swallowing
(3. ) tripod position due to breathing difficulty
(4. ) Minimal cough
Mx:
(1. ) ABCDE + senior help, ENT, ITU alert
(2. ) Cultures + examine throat - once airway secure
(3. ) IV abx - cefuroxime
(4. ) laryngoscopy GOLD for dx epiglottis
(5. ) CXR if concern for foreign body
what does Bordetella pertussis cause?, syx? ix? mx?
Gram -ve bacteria which causes URTI. It is high contagious. Children + preg women are vaccinated against it.
Syx
(1. ) Early phase: coryzal syx + mild fever
(2. ) Spasmodic phase
- Dry hacking/violent cough worse at night
- Whooping cough
- Child vomits/faints/ cyanosed after coughing fits
(3. ) Convalescent phase
- Cough last 2-3m after infection has cleared
Ix
NPA + PCR/culture - confirms dx h/e takes 2-3w
Anti-pertussis toxin IgG if syx >2w
Mx
(1. ) Notify PH
(2. ) Admit if <6months
(3. ) PO clari or azithromycin
(4. ) Prophylaxis abx for close contacts
TB: syx, Ix, mx, SE of abx
Mycobacterium tuberculosis
- Chronic cough + purulent sputum +/- haemoptysis
- Night sweat
- Fever
- Wt loss
- Lethargy
Ix X3 Sputum culture (1.) sputum smear for Ziehl-Neelsen stain (2.) sputum culture (GOLD) (3.) NAAT for rapid dx (4.) CXR - upper lobe cavitation - b/l hilar lymphadenopathy - pleural effusion - ‘millet seeds’ in disseminated TB (5.) Mantoux test or IGRAs for latent TB
Management
(1. ) Notify PH
(2. ) 2-6m Abx: Isoniazid, rifampicin, ethambutol, pyrazinamide for 2m
- Isoniazid + rifampicin for a further 4m, extended duration in TB meningitis, pericarditis, and spinal TB.
SE of Abx
- Isoniazid: liver toxicity, peripheral neuropathy (“I’m-so-numb-azid”)
- Rifampicin: liver toxicity, red/orange urine + tears (“red-an-orange-pissin’)
- Ethambutol: visual disturbances (“eye-thambutol”)
- Pyrazinamide: liver toxicity, gout
Pneumonia: typical + atypical causes. Features of atypical pneumonia.
(1. ) Bacteria:
- Strept.pneumoniae (50%)
- H.influenzae (20%)
- Moraxella catarrhalis in IMC or chronic disease
- P.aeruginosa in cystic fibrosis or bronchiectasis
(2. ) Atypical
- Legionella pneumophilla caused by infected water supplies or air con, causes hyponatremia.
- Mycoplasma pneumoniae causes erythema multiforme/target lesions + neuro syx
- Chlamydia psittaci from infected birds/parrot owner
- Klebsiella pneumonia ‘red currant sputum’ seen in alcoholics
(3. ) Fungal
- Pneumocystis jiroveci (PCP) pneumonia in IMC/HIV
- Candidiasis
(4. ) Aspiration - where it is unsafe to swallow, usually right lung is affected. RF: stroke, myasthenia gravis, bulbar palsy, alcoholism, achalasia
(5. ) Viral - influenza, swine flu, coronavirus
Pneumonia: syx, curb, ix, mx
Syx
- Productive cough +/- blood
- CP
- SoB
- Fever
- Signs: hi rr, hi hr, hypotension, crackles, dull percussion
CURB65: predicts mortality, guides whether to admit
- Confusion
- Urea > 7
- RR ≥ 30
- < 90 systolic or ≤ 60 diastolic.
- Age ≥ 65
If CRB65 used: - 0: home - 1 or 2: consider admission - 3 or 4: urgent admission If CURB65 used: - Score 0/1: home PO - Score ≥ 2: admission PO - Score ≥ 3: itu IV
Ix
- Bloods: FBC, UE, CRP
- ABG
- Blood culture
- Sputum culture
- CXR: consolidation
- Urine sample: antigen testing for legionella + pneumococcal
Mx
(1. ) Oxygen, IV fluids, Analgesia
(2. ) Abx:
- Mild: 5d PO amoxicillin
- Moderate-severe: 7-10d co-amoxiclav
(3. ) Fungal - IV co-trimoxazole for 21d
