Flashcards in Lower Respiratory Tract Infections And Pneumonia Deck (32)
What types of microorganisms are microbiome of the upper respiratory tract?
Describe some of the first defences of the respiratory tract
Cough and sneezing reflex
Mucosal immune system - lymphoid follicles of pharynx and tonsils, alveolar macrophages, secretory IgA and IgG
Name some general types of problems that can compromise respiratory defences
Abnormal ciliary function
Defects in host immunity
Name some common upper respiratory tract infections
What are the most common viruses of the respiratory system?
Respiratory syncytial virus (RSV)
Bacterial super-infections in the respiratory tract can lead to ...
Name some common lower respiratory tract infections
Describe acute bronchitis
Inflammation of the medium sized airways
Mainly in smokers
Cough, fever, increased sputum, shortness of breath
CXR = normal
What are the types of organisms causing acute bronchitis?
What is the treatment of acute bronchitis?
What is pneumonia and its presentation?
Inflammation of lung alveoli
Cough (+/- sputum)
Pleuritic chest pain
Shortness of breath
Often localising signs and abnormal CXR
What are the different ways of classification of pneumonia?
By clinical setting (CAQ, HAQ)
By presentation (acute, chronic)
By organism (bacterial, viral, fungal)
By lung pathology (lobar, broncho, interstitial)
What is pneumonitis?
Non-infective inflammatory disease
Describe the pathogenesis of pneumonia
Acute inflammatory response
Exudation of fibrin rich fluid
What underlying factors predispose to pneumonia?
Pre-existing lung disease
Geography, seasons, epidemics
Exposure to animals
What are the typical community causes of pneumonia?
What should you look for on examination of someone with pneumonia?
Dullness to percussion
Tactile vocal fremitus
What investigations should you do in someone with suspected pneumonia?
Urea and electrolytes
Arterial blood gases
What microbiological samples/investigations could you order in pneumonia?
Broncho-alveolar lovage fluid (BAL)
Nose and throat swabs
Serum (antibody test)
What does the CURB-65 score for pneumonia assess?
Urea > 7 mmol/L
Resp rate >30
BP <90 s / <60 d
> 65 years
(Score of 2+ means admit to hospital)
What is the antibiotic treatment for mild-moderate pneumonia?
What is the antibiotic treatment for moderate to severe pneumonia?
Co-amoxicillin and clarithromycin/doxycycline
What are the possible outcomes of acute bacterial pneumonia?
Resolution with some organisation (fibrous scarring)
Lung abscess (liquefactive necrosis)
Which organisms cause atypical pneumonia?
Organisms without a cell wall
Why do we need different treatments for atypical pneumonia?
Cell wall active antibiotics don't work eg. Penicillins
As the organisms don't have cell walls
What Abx do we use for atypical pneumonia?
Macrolides (eg. Erythromycin/clarithromycin)
Tetracyclines (eg. Doxycycline)
Describe viral pneumonia
Damage to cells lining the airways/alveoli by virus and immune cells
Fluid filled air spaces - interferes with gas exchange
Can get severe necrosis
Patchy or diffuse ground glass opacity of CXR
Which viruses can cause viral pneumonia?
Describe the causes the hospital acquired pneumonia