*Resp. Infections 1 (lecture 1) Flashcards by Sophia White

What infections tend to affect the upper respiratory tract?

Common cold (coryza)
Pharyngitis
Sinusitis
Epiglottitis

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What infections tend to affect the lower respiratory tract? (4)

Acute bronchitis
Acute exacerbation of chronic bronchitis
Pneumonia
Influenza

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What is coryza?

The common cold - acute viral infection of nasal passages

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How is the common cold spread/

Droplets and fomites

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Complications of the common cold? (2)

Sinusitis

Acute bronchitis

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What 3 organisms tend to cause your common cold?

Adenovirus
Rhinovirus
Respiratory syncytial virus

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Treatment of acute sinusitis?

Most are viral and therefore self limiting resolving in about 10 days but some need antibiotics

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What is a quinsy?

Abscess between tonsil and wall of throat (complication of tonsillitis)

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What is diphtheria?

Diphtheria is a potentially fatal contagious bacterial infection that mainly affects the nose and throat, and sometimes the skin -causes a pseudo-membrane to form over the thought and is life threatening due to toxin production - not seen in Uk due to vaccination

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What is epiglottitis?

A life threatening inflammation of the epiglottis that can cause obstruction

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What is acute bronchitis?

also known as a chest cold, is short-term inflammation of the bronchi (large and medium-sized airways) of the lungs

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Clinical features of acute bronchitis?

Preceded by a common cold
Productive cough
Fever in the minority of cases
Normal chest examination
Normal chest x-ray
May have a transient wheeze

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Treatment of acute bronchitis?

Self limiting in normal meaning antibiotics are not required

Can lead to significant morbidity in patients with chronic lung disease

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Incubation period for rhinovirus?

1-5 days

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Incubation time for group A streptococci?

1-5 days

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Incubation time for influenza and parainfluenza viruses?

1-4 days

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Incubation time for RSV?

7 days

Incubation time for pertussis?

7 -21 days

What is pertussis?

Whooping cough

Incubation time for diphtheria?

1-10 days

Incubation time for EBV?

4-6 weeks

Types of pathogens that tend to cause URTI?

Rhinovirus
Adenovirys
Group A strep
Influenza and parainfluenza
RSV
Pertussis
Diptheria
EBV

Clinical features of an acute exacerbation of COPD?

Usually preceded by an upper respiratory tract infection
Increased sputum production
Increased sputum purulence
More wheezy
Breathless
On examination:
Respriatory distress
Wheeze
Coarse crackles
May be cyanosed
In advance disease - ankle oedema

What are acute exacerbations of COPD?

a sustained worsening of the patient’s symptoms from his or her usual stable state, which is beyond normal day-to-day variations and is acute in onset

Management of acute exacerbation of COPD?

Manage in primary care with antibiotics (amoxicillin or doxycline), bronchodilator inhalers, short course of steroids in some cases Refer to hospital if evidence of respiratory failure, not coping at home Management in hospital = same as before + measure arterial blood gases, CXR to look for other disease, oxygen if respiratory failure

What is pneumonia?

acute inflammation with an intense infiltration of neutrophils in and around the alveoli and the terminal bronchioles.

What is the difference between pneumonia and pneumonitis?

Pneumonia is inflammation of the lung tissue due to infection where as pneumonitis is inflammation of the lungs general (usually used to describe non-infectious causes)

What is it called when the lungs become engorged with blood cells (usually due to pneumonia) and resemble liver tissue?

Red hepatisation

What is pleurisy?

inflammation of the pleurae, which impairs their lubricating function and causes pain when breathing. It is caused by pneumonia and other diseases of the chest or abdomen.

What are the symptoms of pneumonia?

``` General symptoms e.g. sweats, rigors, malaise, myalgia Cough Confusion Pleurisy Haemoptysis Dyspnoea Preceding URTI Abdo pain Diarrhoea ```

Signs of pneumonia?

``` Fevers Rigors Herpes labialis (cold sores due to reactivation of herpes simplex virus due to alteration in the immune system) Tachypnoea Crackles Rub Cyanosis Hypotension ```

Do the lips show central or peripheral cyanosis?

Central

Investigations for pneumonia? (7)

``` Blood culture Serology Arterial gases FBC Urea Liver function Chest x-ray ```

What scoring system is used to determine the severity of CAP?

CURB65

What each part of the CURB65 stand for?

``` C = new onset confusion U = urea greater than 7 R = respiratory rate greater than 30/min B = blood pressure systolic less than 90 or diastolic less than 61 65 = age 65 years or older ```

How much greater is the mortality for a patient with COPD compared to a patient without with CAP?

10% increased mortality

Apart from CURB65, what are the other severity marker of pneumonia? (4)

Temperature less than 35 or greater than 40 Cyanosis PaO2 less than 8kPa WBC less than 4 or greater than 30 Muti-lobar involvement

What are the pathogens which cause CAP?

Commonest cause = streptococcus pneumoniae (pneumococcal) Haemophillus pneumoniae and mycoplasma pneumoniae are the next most common causes Staph. aureus, moraxella catarrhalis, legionella sp, and chlamydia account for most of the rest Gram negative bacilli, coxiella burnetti and anaerobes are rarer Viruses account for up to 15%

What is a cause of pneumonia in patients with parrots?

Chlamydia psitacci

Treatment of CAP? (5)

``` Antibiotics (amoxicillin if mild/ moderate, co-amoxiclav and clarithromycin if severe) Oxygen Fluids Bed rest No smoking ```

Complications of pneumonia?

Respiratory failure Pleural effusion Empyema (gets drained) Death

How is pneumonia prevented?

Influenza and pneumococcal vaccines for over 65s, chronic chest or cardiac disease, diabetes, immunocompromised Influenza vaccine for health care workers