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Flashcards in Respiratory Tract Infection Deck (33)

What are common upper respiratory tract infections?

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


Rhinitis is caused by what?

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


What causes sinusitis?

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


What causes pharyngitis?

viral 70%
strep throat


What causes epiglottis?

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


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)

-strep pneumo
-H flu
-B pertussis

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


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


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


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


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%


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


What are the symptoms of atypical CAP?

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


What are the most common bugs of atypical CAP?

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


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


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

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


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


What are the symptoms of CAP in pediatrics?

tachypnea, fever, cough dyspnea


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


What is the therapy for CAP?

-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


How long do you give antibiotics?

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


What are diagnostic criteria for HAP?

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


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


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


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


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


What is chronic pneumonia?

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


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


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


What is empyema?

infection spreading to the pleural space


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

Causes: chemo, leukemia, chronic granulomatous disease

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


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


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


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

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

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