Lower Respiratory Tract Infection Flashcards
(23 cards)
what are the clinical signs of organ dysfunction?
brain = confusion
lungs = increased resp rate and hypoxia
heart = icreased heart rate and low BP
kidneys = oliguria and high creatinine
skin = prolonged central capillary refill
what is the sepsis 6?
give 3 and take 3 - within the first hour of presentation
Give: oxygen, broad spec. antibiotics, fluids
take: blood cultures, FBC, urinary output
what type of epithelium do we find in the lower resp. tract?
ciliated collumnar epithelium with mucous producing goblet cells
what immune cells exist at the level of the alveoli?
alveolar macrophages
what is the definition of pneumonia?
acute lower respiratory tract infection involving the lung parenchyma
what categories do we seperate pneumonia into? Why is that relevant?
community acquired pneumonia
hospital acquired pneumonia
It’s important to distinguish as different causative organisims
How do patients with pneumonia present?
systemic: fever, rigors, malaise, myalgia, anorexia
cough: often productive of purulent sputum
dyspnoea
tachypnoea
haemoptysis
pleuritic chest pain
what sort of investigations should we order in a suspected case of penumonia?
- blood culture
- sputum
- FBC
- urinary antigen for legionella/pneumococcus
- nose/throat swab for influenza
- WCC/inflammatory markers
- CXR
what is the difference between community acquired pneumonia and hospital acquired pneumonia?
community = pneumonia is acquired thorugh the community
hospital= pneumonia that occurs 48 hours or more after a hospital admition= “nosocomial” pneumonia
HAP is different to CAP b/c of additional patient risk factors, and different infectious diseases invovled so different antimicrobials are required
is healthcare associated pneumonia the same thing as hospital acquired pneumonia?
No.
In fact, healthcare associated pneumonia is more similar to community acquired pneumonia than hospital acquired pneumonia
what is the most common bacterial cause of community acquired pneumonia?
streptococcus pneumoniae - 60%
mycoplasma pneumoniae= 10-20%
describe strep. pneumonia laboratory characteristics
gram - positive
optochin sensitivie
alpha haemolytic
catalase negative
what should be your treatment to strep. pneumonia assuming no allergies?
Amoxicillin for oral switch
if there is a penicillin allergy = cefotaxime IV
what does H. Influenzae cause?
it is a bacteria which causes pneumonia, NOT the flu- the flu is a result of the influenza virus
what sort of atypical pnuemonias might we see?
- mycoplasma s
- legionella s
- chlamydias
- coxiellas
what pneumonia do we see in people who are exposed to birds?
chlamydia psittaci
- contraction via inhalation of dried, infected bird droppings
what pneumonia might we see with farmers, veterinarians, abattoir workers etc.
coxiella burnetii (Qfever)
- it is a zoonosis from sheep/cattle/goats
what pneumonia is associated with an abscess formation - and is notable for it’s severe infection of previously healthy young people?
staph aureus
what sort of viral causes of pneumonia might we see?
Influenza A&B
RSV
chickenpox in immunosuppressed
measles
CMV
what sort of bugs do we see in hospital acquired pneumonia?
gram negative bacilli: E.coli, klebsiella spp, enterobactor spp, pseudomas spp,
Staph Aureus
Legionella Pneumophila
Viruses
what pneumonias would we consider in immunocompromised patients?
fungi = aspergillus fumigatus and cryptococcus neoformans
viruses = herpes simplex, cytomegalovirus
mycobacteria= non-tuberculous mycobacteria and M tuberculosois
why do CF patients get infections?
- defects in microbial clearance
- altered salt content in airway surface - liquid inactivates antimicrobial defensins and impairs neutrophila killing
- receptor for P. aeruginosa
- decreased NO antibacterial predisposes to lung infection
- airways hyperinflammatory
what pathogens are most likely to infect CF patents?
P. Aeruginosa
and S. Aureus
