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Flashcards in Lower RTI Deck (31):
1

Acute bronchitis
-etiology

***bronchitis without pneumonia is ALWAYS viral***

90% viral

- influenza viruses
-RSV
-other respiratory viruses

10% bacterial

-mycoplasma pneumoniae
-chlamydophila pneumoniae
-bordetella pertussis

2

The Flu
-epidemiology (what time of year, who gets it, how many of us get it)
-major epidemics result of...

-winter months
-everyone gets it, but death highest among elderly and infants
-10-20% attack rate

-Major epidemics are the result of rearrangement of the segmented genome (antigenic shift)

3

The Flu
-etiology
-H and N significance

-Influenza virus
-Hemagglutinin binds sialic acid on cell surface
-Neuraminidase cleaves new virions from cell surface

4

The Flu
-course of infection

- shedding 24-48h before symptoms
-sudden onset symptoms: fever, headache, myalgias, malaise, cough, rhinnorhea (like the cold, but worse)
-2-7 days of symptoms
-viral shedding stops 6-7 days after symptom onset

5

The Flu
-Management

- supportive therapy
- antiviral therapy (oseltamivir) for high risk

6

The Flu
-Prevention

- Immunisation
- Chemoprophylaxis in nursing homes (oseltamivir)
-Droplet precautions

7

COPD
-general definition

- irreversible air flow limitation, usually associated with an inflammatory response
-chronic bronchitis +/- emphysema

8

Acute exacerbations of chronic bronchitis
-define chronic bronchitis, and an acute exacerbation

-Chronic bronchitis: productive cough for at least 3/12 for 2yrs
-Acute exacerbations: increased sputum volume, purulence +/- dyspnea

9

Acute exacerbation of chronic bronchitis
-prevention

COPD patients should receive the flu vaccine each year and pneumococcal vaccine (q6 yrs)

10

Acutre exacerbation of chronic bronchitis
-etiology

50% viral

Mild:
Haemophilus spp.
S. pneumoniae
M. cattarhalis

Moderate:
above + enterobacteriaciae

Severe:

above + P. aeruginosa

11

Acute exacerbation of chronic bronchitis
-management

- If antibiotics are given, amoxicillin for mild, amoxil-clav for moderate and levofloxacin for severe

12

Bronchiolitis
-epidemiology (who gets it? when?

-Infants and children
-fall--->spring

13

Bronchiolitis
-etiology

-RSV (50-80%)
-Influenza (6-25%)
-Rhinovirus (16-25%)
-Parainfluenza (7-18%)

14

Bronchiolitis
-S/S
-Diagnosis

-prominent cough, lethargy, inc. RR, signs of respiratory distress
-Can be seen on CXR unlike bronchitis

Diagnosis is clinical, but can do a viral nasopharyngeal swab

15

Bronchiolitis
-Management

-supportive care

16

Pneumonia
-definition
-CAP vs. HAP vs. HCAP vs. VAP

-inflammation of the alveoli, usually caused by viruses or bacteria
-Communit-acquired pneumonia
-Hospital acquired pneumonia
-Health-care associated pneumonia: non-hospital health care source
-Ventilator pneumonia

17

Pneumonia
-etiology in children and adults
-atypical pathogens

Children: RSV, Influenza, S. pneumoniae, H. influenzae, S. aureus

Adults: more often bacterial--> S. pneumoniae most common (others exist)

Typical:
S. pneumoniae
H. influenza

Atypical:
Mycoplasma penumoniae
Chlamydophila pneumoniae
Legionella pneumophila

Viral:
Influenza

Oppotunistic:
PJP
TB
fungal

18

Pneumonia
-predisposing conditions

-alcoholism
-diabetes
-CHF
-COPD
-smokers
-aspiration prone
-post-influenza
-cystic fibrosis (pseudomonas esp

19

Pneumonia
-diagnosis

Treatment depends on the ability to identify the pathogen!!

-Physical
-History
-Sputum smear and culture
-CXR
-CT

20

Pneumonia
-empiric therapy for outpatient CAP, inpatient CAP, nursing home CAP, HAP, VAP


Outpatient

- must use Ab that covers S. pneumoniae
-Amoxicillin
-If concerned about atypical pathogens add doxy or clarithromycin
-NOT macrolides (resistance of S. pneumo)

Inpatient
- use ceftriaxone

Nursing home patient
-Amoxil-clavulanate

HAP
-ceftriaxone

VAP
-pipercillin-tazobactam (want to cover P. aeruginosa)

21

Atypical pneumonia
-mycoplasma pneumoniae diagnosis and treatment

Diagnosis: serology and CXR
Treatment: erythromycin (macrolide)

22

Atypical pneumonia
-legionella pneumophila diagnosis

Diagnosis: consider in patients not responding to B-lactams and possible exposure (A/C, hot tubs, resp equipment). Urine antigen test

Treatment: quinolones or macrolides

23

Empyema
-definition

- collection of pus in the pleural space

24

Empyema
-etiology

- S. pneumoniae/pyogenes/aureus
-Anaerobes

25

Empyema
-management

-drain pleural space, gram stain and C&S this fluid
-empiric therapy: ceftriaxone +metronidazole

26

Lung abscess
-definition

-a cavity in the lung when microbial infection leads to necrosis of lung tissue

27

Lung abscess
-etiology

-usually mouth flora (oral anaerobes e.g. streptococci)
-TB
-fungi
-malignancy

28

Lung abscess
-treatment

-clindmycin
OR
-penicillin +metronidazole

29

Chronic pneumonia
-general causative agents

Bacteria
Mycobacteria
Fungi
Parasites

**rarely seen**

30

TB natural history
-S/S

-inhalation of TB
-Primary active disease OR
-Latent infection --> reactivation

Most TB is pulmonary:
-cough
-hemoptysis
-weight loss
-night sweats
-low grade fever
-dypnea

Can also have:
-pericarditis
-meningitis
-SSTI
-Bone and joint infection

31

TB
-diagnosis

-Ziehl-Neelson stain of sputum
-Fluorescent stain (bacilli, bright, beaded)