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Flashcards in Respiratory Tract Infection Deck (33):
1

What are common upper respiratory tract infections?

1. rhinitis
2. sinusitis
3. otitis
4. pharyngitis
5. laryngotracheitis
6. epiglottitis
7. bronchitis

2

Rhinitis is caused by what?

1. rhinovirus (30%)
2. coronavirus (10%)
3. parainfluenza
4. influenza
5. RSV
6. adenovirus

3

What causes sinusitis?

many viral, some bacterial (strep pneumo, H flu, moraxella, and oral anaerobes)
-treat with ampicillin, amoxicillin, tmp-sulfa, amox-clav

4

What causes pharyngitis?

viral 70%
strep throat

5

What causes epiglottis?

H flu
group A strep
H parainfluenzae
Emergency ENT consultation
-Amox-clav, amp-sulbactam, 3rd generation cephalosporin

6

What causes acute bronchitis?

self limited infection/inflammation of large airways
cough> 5days, purulent sputum

Etiology: majority viral
1. influenza
2. parainfluenza
3. RSV
4. coronavirus
5. adenovirus
6. rhinovirus
(same as sinusitis)

Bacterial
-mycoplasma
-strep pneumo
-H flu
-Chlamydophila
-B pertussis

treatment is symptomatic, routine antibiotics are not suggested, antitussives and mucolytics usually aren't helpful

7

What are the signs and symptoms of pneumonia?

cough, sputum, fever, shortness of breath

signs of consolidation on exam, elevated wbc

Risk factors: old age, pulmonary disease, smoking, recent viral illness, diabetes, chronic renal disease, immunodeficiency

8

What are the diagnostic tests for CAP?

1. CXR
2. if there is a pleural effusion it should be sampled
3. flu test
4. yield on blood sputum cultures is low

9

What are the signs of typical of community acquired pneumonia?

1. Acute onset of symptoms (cough, sputum, fever, shaking chills)
2. Lobar infiltrate
3. gram stain with PMNs and organisms

10

What are common bugs of typical CAP?

1. Strep pneumo
2. H flu
3. moraxella catarrhalis
4. staph aureus
no organisms found in 30-50%

11

What is the most common cause of typical CAP?

strep pneumo
-acute onset fever, shaking chill, SOB, pleuritic chest pain
-rusty sputum, lancet shaped diplococcus

12

What are the symptoms of atypical CAP?

-subacute onset of symptoms
-milder symptoms
-prodrome
-negative gram stain

13

What are the most common bugs of atypical CAP?

1. Mycoplasma
2. Chlamydia
3. Legionella
4. viruses

14

What are symptoms of legionella pneumophila?

headache, myalgias, high fever, fatigue, cough, sputum
-can progress to multi-organ system failure
-flourishes in artificial aquatic environments
-infection with inhalation or drinking contaminated water
-diagnosis by urinary legionella antigen

15

What are the most common etiologic agents causing viral atypical CAP?

1. influenza
2. RSV
3. adenovirus
4. parainfluenza
-can develop secondary bacterial infections
-seasonal

16

What are typical symptoms of influenza?

fever, cough, headache, sore throat, myalgias
can cause pneumonia, respiratory failure, death

-in flu season can, test, isolate and start therapy if within 48 hours of start of symptoms

Therapy: Oseltamivir or zanamivir

Best prevention: yearly flu vaccine

17

What are the symptoms of CAP in pediatrics?

tachypnea, fever, cough dyspnea

18

What are the most common bugs in CAP pediatrics?

Under 2: viral (RSV, rhinovirus)
5-10 yrs old: mycoplasma
10-16: s pneumo, chlamydophila

Emerging pathogens:
Human metapneumovirus
Human Bocavirus
Simkania Negevensis

19

What is the therapy for CAP?

Outpatient:
-Macrolide or doxycycline
-If co-morbid illness or recent antibiotics, a respiratory fluoroquinolone

Inpatient, non ICU
-respiratory fluoroquinolone
-B lactam + macrolide

Inpatient ICU:
-B lactam + macrolide or fluoroquinolone

If pseudomonas is a concern:
-Anti-pseudomonal B lactam + respiratory fluoroquinolone
-Anti-Antipseudomonal b lactam + macrolide + aminoglycoside

20

How long do you give antibiotics?

at least 5 days, longer if the patient is sick or the initial empiric choices were wrong

21

What are diagnostic criteria for HAP?

-fever, new infiltrate, leukocytosis, and change in sputum

22

What are the bugs that cause HAP?

become colonized with gram negative rods:
1. klebsiella
2. e. coli
3. enterobacter
4. proteus
5. serratia
6. pseudomonas
7. acinetobacter

organisms are aspirated
host defenses are lowered by coexisting illness

23

What are risk factors for HAP?

1. mechanical ventilation
2. chronic lung disease
3. CHF
4. >60
5. Head trauma
6. shcock
7. decreased mental status/coma

24

What are risk factors for HAP that is multidrug resistant?

1. antibiotics within 90 days
2. inpatient for >5 days
3. residence in NH
4. dialysis
5. immunosuppression

25

What is the therapy for HAP?

Early, broad empiric therapy
Narrow by culture results or lack there of
1. antipseudomonal cephalosporin
2. antipseudomonal carbapenem
3. b lactam/ b lactamase
4. vancomycin if worried about MRSA

26

What is chronic pneumonia?

subacute onset of symptoms -typically >6 weeks
caused by slow growing organisms

27

What are common bugs with chronic pneumonia?

1. mycobacterium (tb or atypical)
2. nocardia
3. actinomyces
4. endemic fungi
5. coxiella
6. tularemia
7. anatomic problem

28

What does lung abscess lead to? What bugs cause lung abscesses?

-leads to tissue destruction and necrosis, suppuration, cavitation

anaerobic mouth organisms (bacteroides, fusobacterium, peptostreptococcus), aerobic and anaerobic streptococcus, GNR

caused by : aspiration, post-pneumonic, septic emboli

29

What is empyema?

infection spreading to the pleural space

30

What causes neutrophil dysfunction or deficiency, what organisms cause pneumonia with this deficiency?

Causes: chemo, leukemia, chronic granulomatous disease

organisms:
1. gram negative rods (pseudo, Hflu)
2. staph
3. aspergillus
4. candida

31

What can cause T cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?

Causes: AIDS, T cell lymphoma, Transplant, DiGeorge's syndrome
Organisms: Fungi (candida, aspergillus, cryptococcus)
Viral (CMV, HSV)
-Pneumocystis, mycobacteria, listeria

32

CMV Pneumonia

rare in the immunocompetent but common in T cell def (BMT and lung transplants, less common in AIDs but can co-infect with pneumocystis)

generalized infection (multiple organisms)

Diagnosis-pathology, immunofluorescence, PCR on blood

Therapy: ganciclovir, valganciclovir

33

What can cause B cell dysfunction or deficiency? What organisms cause pneumonia in this deficiency?

causes: splenectomy, chronic lymphocytic lymphoma, NHL, Myeloma, gamma globulin deficiencies

Organisms:
1. strep pneumo
2. H flu
3. Neisseria
4. Klebsiella
5. E. coli
6. Giardia