What are the clinical features of TB?
Sub acute general onset
Weight loss, night sweats, malaise, headache, drowsy
Cough, haemoptysis
How is TB diagnosed?
ZN stain = pink
PCR = Look for resistance
Histology = Caseating granuloma
What is the common CXR finding for TB?
Upper lobe predominant
Cavities
Tissue deterioration
Scarring and shrinkage
What is the treatment for TB?
2 months = Rifampicin Isoniazid Pyrazinamide Ethambutol
4 months =
Rifampicin and Isoniazid
How is latent TB diagnosed?
Mantoux test
Interferon gamma testing
What should you ALWAYS test for in anyone with suspected TB?
HIV
What is pleural infection?
Active infection in the pleural space
What usually precedes a pleural infection?
Pneumonia
What is the progression of a pleural infection
Simple parapneumonic effusion
Complicated parapneumonic effusion
Empyema
What is a makes a simple parapneumonic effusion complicated?
+ve gram stain, acidic pH, low glucose, septations, locutions
What is an empyema?
Pus
What is the management for pleural infection?
Antibiotics for several weeks Drainage Early discussion with surgeons if persist sepsis Nutrition VTE prophylaxis CONSTANT REASSESMENT
What is coryza?
Common cold
What are the symptoms of coryza?
Acute viral infection of nasal passages
Sore throat
Mild fever
How is coryza spread?
Droplets and fomites
What usually precedes acute sinusitis?
Common cold
What are the symptoms of acute sinusitis?
Purulent nasal discharge
What is the management for acute sinusitis?
Usually self limiting
10 days
SOME need antibiotics
What are the features of diphtheria?
Pseudomembranes form at the back of the throat
Life threatening due to toxin production
Why is acute epiglottitis life threatening in children?
Swelling causes airway obstruction
Children have small airways, so even a small amount of swelling can cause obstruction
What is acute bronchitis?
Preceded by common cold
Inflammation spreads to the chest
What are the clinical features of acute bronchitis?
Productive cough Fever in minority of cases Normal chest exam Normal CXR Possible transient wheeze
What is the treatment of acute bronchitis?
Normal people = Usually self limiting, and antibiotics not indicated
Can lead to significant morbidity in patients with chronic lung disease
What are the risk factors for developing chronic pulmonary infection?
Immunodeficiency
Immunosuppression
Abnormal innate host defence
Repeated insult
Which immunodeficiency problems can increase risk of chronic pulmonary infection?
Immunoglobulin deficiency = IgA deficiency
Hypogammaglobulinaemia
CVID
Specific Polysaccharide Antibody Deficiency
Hypo-splenism
Immune paresis (usually caused by malignancy)
HIV
What kinds of immunosuppression can increase risk of chronic pulmonary infection?
Steroids Chemotherapy Monoclonal antibodies Methotrexate Azathioprine Cyclophosphamide
What defects to the innate host defence can increase risk of chronic pulmonary infection?
Damaged bronchial mucosa: smoking, pneumonia, malignancy
Abnormal cilia: Katenager’s, Youngs
Abnormal secretions: CF, channelopathies
What kinds of repeated insults can increase risk of chronic pulmonary infection?
Recurrent aspiration: NG feeding, poor swallow, pharyngeal pouch
Indwelling material: inhaled object, chest drain
What are the forms of chronic infection?
Intrapulmonary abscess Empyema Chronic bronchial sepsis Bronchiectasis CF
What pathogens can commonly cause an intrapulmonary abscess?
Streptococci, Staphylococci, E.Coli, Gram negatives
Aspergillus
What pathogens commonly cause empyema?
Strep Milleri, Staph Aureus
E.coli, Pseudomonas, Haemophilus Influenzae, Klebsiella
Which antibiotics are given to treat empyema?
IV amoxicillin and metronidazole initially
Oral specific to culture for 14 days