Lecture 3 - Clinical Infections Flashcards Preview

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Flashcards in Lecture 3 - Clinical Infections Deck (39):
1

What causes an acute sore throat?

Describe each condition?

Pharyngitis - inflammation of back of throat

Acute Toinsilar Pharyngitis - symmetrically inflamed tonsils

Infectious Mononucleosis (EBV) - symmetrically inflamed tonsils + soft palate inflammation

Epiglottitis - sudden onset of severe sore throat. No inflammation

2

PHARYNGITIS + TONSILAR PHARYNGITIS

What are the common causes?

What are the rare causes?

Symptoms?

o Virus – rhinovirus, coronavirus, parainfluenza, infuelza, adenovirus. Common
o Bacteria – Group A strep

o Neisseria Gonorrhoea
o HIV-1
o Corynebacterium diptheriae

Symptoms - tonsils exudate, lymphadenopathy, fever. No cough

3

PHARYNGITIS + TONSILAR PHARYNGITIS

Investigtations

Treatment?

Outpatients - nothing

Inpatients -
o Throat swabs
o Blood cultures
o Blood tests: FBC, U&E, LFTs
o For suspected mononucleosis – blood sample

Treating - analgesics. Only give antibiotics if they have infection symptoms

4

INFECTIOUS MONONUCLEOSIS
Caused by?

Symptoms?

Complcations?

Test?

• Caused by EBV (Epstein Barr virus)
Symptoms:
o Fever
o Pharyngitis
o Cervical lymphadenopathy

Complications = splenic rupture
AVOID AMPICILLIN

• Test bloods for monospot +/- EBV serology

5

EPIGLOTTITIS
Caused by?

Investigations?

Management?

Caused by bacterial infection
o Haemophillus influenza, Strep Pneumoniae, Group A Strep

Investigations
o Blood cultures
o Epiglottic swabs

Management
o Epiglottits can cause airway obstruction – need to secure airway + oxygenation
o IV antibiotics
o Analgesia

Need to inform Public Health

6

What infections can affect the ear?

Otitis Externa (acute/ chronic/ malignant)
Otitis Media

7

Otitis Externa
What is it?

Symptoms?

Risk factors

Inflammation of outer ear.

Symptoms: itching, pain, non-mucoid damage.

Risk factors - swimming, trauma, ear device

8

What causes Acute Otitis Externa?

How to investigate?

How to manage?

Bacteria - Staph Aureus, Pseudomonas

Investigate - ear swab, pus sample. Do a CT to make sure it hasn't spread to skull.

Management
o Remove precipitating factors e.g. pus + debris
o Analgesia
o Topical antimicrobials for mild OE
o Topical + antibiotics (fluclox) if severe

9

MALIGNANT OTITIS EXTERNA
What is it?
Symptoms?
Treat?

When bacteria spread to temporal bone, eats it's way through

Symptoms:
o Severe pain
o Otorrhoea
o Granulation tissue in canal floor
o Cranial nerve palsies

Treat - ceftazidime (cephalosporin) or pro-ciprofloxacin for 6 weeks

10

What is Chronic Otitis Externa?

Causes?

Treat?

Ear canal has no wax, allows build up on white keratin, which blocks the ear duct.

Causes: allergic dermatitis (shampoo) OR underlying condition e.g. psoriasis

Treat - underlying cause

11

What is otitis media?

What are the 2 different types?

What are the causes?

Symptoms

Treat?

Fluid in the middle ear.

o Uncomplicated acute OM – no ear discharge/ fever. Low temp. Mild pain <72h

o Complicated acute OM – severe pain, perforated eardrum, discharge, infection signs

Caused by:
o Viruses
o Strep Pneumoniae
o Haem Influenza
o Morazella catarrhalis

Treat - symptoms. If serious give amoxicillin.

12

What is mastoiditis?

What are the causes?

Symptoms?

What is the treatment?

Bacteria eating away at mastoid bone

Causes - acute OE

Symptoms: pain, fever, oedema of the pinna, displaced pinna, erythema

Treat - painkillers, IV antibiotics

13

What is pinna cellulitis?

What bacteria causes it?

How to test?

What's the treatment?

Infection of already damaged area e.g. trauma, surgery, burns.

Caused: Pseudomonas, Staph aureus.

Test - swab, blood cultures

Treat - ciprofloxacin, fluclox

14

What is pneumonia?

Which 2 areas of the rest system do they affect?

Consolidation in lungs. Bacterial infection.

o Broncopneumonia – patchy distribution. Starts with inflamed bronchioles, spread to alveoli
o Lobar Pneumonia – affects lobe of lung

15

What are the different ways of acquiring pneumonia?

What are the bacteria associated with each way?

Community acquired
o Caused by typical + atypical bacteria - don't respond to penicillin

Hospital acquired
o Pneumonia develops >48 hours post hospital admission
o Risk of enterobacteriaceae

Ventilator acquired
o Develops >28 hours after ET intubation and ventilation
o Psudomonas spp.

Aspiration
o Caused by abnormal entry of fluids – e.g. food, drinks, e.g. into lower respiratory tract bc patient can’t swallow
o Anaerobes

16

What the signs and symptoms of bacterial pneumonia?

SYMPTOMS
o Rapid onset
o Fever/chills
o Productive cough – sputum
o Pleuritic chest pain
o Fatigue + anorexia

SIGNS
o Tachypnoae
o Tachycardia
o Hypotension

Examination dull to percuss, decr air entry = bronchial breathing

17

There are 4 types of atypical bacteria that can cause community acquired pneumonia?

o MYCOPLASMA PNEUMONIAE
What's the main symptom?
How to diagnose?
Complications?

o CHLAMYGOPHILA PNEUMONIA
What does it cause?
In which population does it occur mostly?

o LEGIONELLA PNEUMOPHILIA
Symptoms? Progresses to other systems
What will a blood test show?

o CHLAMYDOPHILA PSITTACI
What do you need to be exposed to?
Associated conditions?

MYCOPLASMA PNEUMONIAE
o Main symptom = cough
o Diagnosis - serology
o Rare complications:
♣ Pericarditis
♣ Arthritis
♣ Gullain-Barre = Peripheral neuropathy

CHLAMYGOPHILA PNEUMONIA
o Causes mild pneumonia/ bronchitis
o Old people

LEGIONELLA PNEUMOPHILIA
o High fever, rigor, cough (dry to productive)
o Dyspnoea, Vomiting, diarrhoea, confusion

oBloods--> abnormal LFT, low sodium

CHLAMYDOPHILA PSITTACI
o Bird exposure
o Rash, hepatitis, haemolytic anaemia, reactive arthritis

18

What investigations are needed for community acquired pneumonia

o CXR
o Sputum + blood culture
o Look for Pneumococcal urinary antigen
legionella urinary antigen

o PCR for viral pathogens/ mycoplasma pneumonia/ chlamydophillia (blood)

19

What are the complications of pneumonia?

o Pleural effusion
o Empyema (pus in pleural space)
o Lung abscess – destruction of lung tissue
o Single abscess anaerobes/ pseudomonas
o Multiple staph aureus

20

What is the name of the fungus that can cause pneumonia?

Why is this fungus so resistant to treatment?

What are the symptoms?

How to treat?

Pneumocystis Jiroveci pneumonia

o lacks ergosterol, so is resistant to most antifungals

o fever, dyspnoea, non-productive cough, decr exercise tolerance

o Found in sputum

o Treat = co-trimoxazole + steroids

21

Viral causes of pneumonia

Which viruses affect adults?

Which affect children?

Which viruses can affect both?

oAdults = influenza, adenovirus, varicella zoster

o Children = RSV, parainfluenza

o ALSO measles, herpes simplex, cytomegalovirus, HHV-6

22

How does pneumonia caused by influenza present?

o Fever, headache, myalgia, sore throat, dry cough

o Lasts 2-3 weeks

23

Pneumonia caused by influenza:

What is primary viral pneumonia? 3 main symptoms?

This puts you at risk of developing secondary bacterial pneumonia. Which bacteria will cause this infection? (PIA)

How to diagnose the virus?

Primary - pneumonia in patients with pre-existing cardiac/ lung conditions.

3 main symptoms: cough, breathless, cyanosis

S. Pneumoniae
H. Influenza
S. Aureus

Viral antigen detected in resp sample

24

CMV and VSV both can cause pneumonia

What is VSV?
Who is at incr risk?
When does it start?
How does it progress?
Investigations + treatment?

o Complication of chicken pox infection

o Incr risk in immunocompromised/ adults with chronic lung disease/ smokers/ pregnant women

o Sudden onset 1-6 days after rash
o Progressive tachypnoae
o Dyspnoae
o Drug cough

o CXR diffuse bilateral infiltrates

o Treatment IV acyclovir

25

CMV and VSV both can cause pneumonia

With CMV, who is at incr risk?
Tests?
Treatment?

o Immunocompromised

CXR
Bronchi-alveolar lavage Viral load PCR

oTreatment:
Supportive
Ganciclovir,
Decr
immunosuppression

26

What are the 2 types of LRTI

Which virus is most associated with LRTI?

o LRTI with bronchiectasis

o LRTI with CF

RHINOVIRUS

27

LRTI with Bronchiectasis

What is bronchiectasis?

What are the symptoms?

What are the tests?

Bronchiectasis - abnormal dilation of airways.

Symptoms:
Breathless
Chronic cough
Sputum production
Recurrent infection

Tests
o SpO2, CXR, FBC, U&E, LFT

28

LRTI with Bronchiectasis
What bacteria are you at risk of getting recurrent infections from?

What is the treatment?

o Staph aureus, Infleunza, Pseudomonas, viruses

Treat:
o Non-microbial – physio, postural drainage
o Nutritional support
o Treat underlyring cause
o Influenza vaccination

29

LRTI with CF

What is CF
What organisms colonise the resp tract?

o abnormal CTFR, viscous secretions

Colonising organisms
o S aureus
o Pseudomonas
o Burkholderia cepacia complex – hella resistant
o Non-TB mycobacterium + fungi

30

What are the 2 ways of preventing LRTI's

1. Pneumococal vaccination against S Pneumoniae – for patients with chronic disease. Every 5 years

2. Influenza vaccination for vulnerable groups annually.

31

What is aspergillosis?
What are the 2 types?

Mould in lungs

Allergic Bronchopulmonary Aspergillosis

Aspergilloma

32

Allergic Bronchopulmonary Aspergillosis

Who is at high risk?

How to diagnose?

What will a CT scan show?

How to treat?

Someone with asthma/ CF

High IgE and IgG specific to aspergillus

CT shows bronchiectasis

Treating - corticosteroids + anti fungal therapy

33

Aspergilloma
What causes it?

What are the symptoms?

Complcations?

Having TB previously or sarcoidosis leaves abscesses in the lungs. Can be filled with mould

Symptoms:
Cougj
haemoptysis
Weight loss
Wheeza
Clubbing

Complications - massive haemoptysis

34

How to treat Aspergilloma?

Antifungals

Surgical resection

Can be self limiting

35

What is Nocardia asteroids?

How to test?

How to treat

bacteria that causes nocardiasis (lung abscesses

Test - sputum

Treat cotrimoxazole

36

How can you develop TB?

Inhaling infected resp droplets. Bacilli lodge in alveoli + multiply.

Can remain dormant in macrophages. granulomas develop, but the TB inside isn't killed, so can be reactivated

37

What are the symptoms of TB?

Chronic productive cough

haemoptysi

weight loss

fever

NIGHT SWEATS

38

How to diagnose TB?

How to treat?

How to prevent?

o Radiology
o Detection of acid fact bacilli
o Culture of M. TB from sputum

Chemo

Give BCG to children in high prevalence areas

39

What does 4am cough mean?

Asthma (caused by low steroid levels, diurnal variation)