Respiratory Tract Infections Flashcards
(12 cards)
What is pneumonia? Describe its presentation and briefly describe its treatment.
It is inflammation of the lung alveoli which can be lobar or bronchopulmonary.
Presentation:
- Fever
- SOB
- Cough
- Sputum
- Localising signs and abnormal CXR
Treatment
- Antibiotics (depends on severity and type)
- Supportive (O2 and fluids)
What is bronchitis? Describe its presentation and briefly describe its treatment.
It is inflammation of the medium sized airways and occurs mainly in smokers.
Presentation:
- Fever
- Cough
- SOBOE
Treatment:
- Bronchodilation
- Physiotherapy
- +/- antibiotics
What are the most common causes of community acquired pneumonia? Give some distinguishing features of these infections
Streptococcus pneumoniae
- Gram +ve diplococci
- Rust coloured sputum
- Lobar distribution on CXR
Haemophilus influenzae
- Gram -ve cocco-bacilli
- Associated with lung disease
Moraxella catarrhalis
- gram -ve coccus
- Associated with smoking
Staphylococcus aureus
- Gram -ve cocci, clusters
- Recent viral infection
- Cavitation on CXR
Klebsiella pneumonia
- Gram -ve rod
- Associated with alcoholism or the elderly
What infections can cause a cavitating lesion?
- Staphylococcus aureus
- TB
- Klebsiella pneumoniae
What pathogens can cause an atypical pneumonia? Give some distinguishing features of these infections
Legionella pneumoniae
- Travel/air conditioner
- Droplet infection
- Hyponatraemia, abdominal pain, confusion
- Multi-organ failure
- Buffered charcoal yeast extract
- Has a urine antigen
Mycoplasma pneumoniae
- Occurs in epidemics
- Cold agglutinin test
- Erythema multiforme
Chlamydia (pneumonia or psittaci)
- Psittaci: bird owner/contact with birds
Coxiella (Q fever)
- Farm animals
Bordatella pertussis
- Whooping cough
- Unvaccinated children
TB
- No response to Abx
- Longer history
- Upper lobe cavitation
In immunocompromised patients, what pathogens are they more at risk to? Separate them according to the reason of their immunocompromise.
HIV
- PCP/PJP
- TB
- Cryptococcus
Neutropaenia
- Fungi (aspergillosis)
Bone marrow transplant
- Fungi (aspergillus)
- CMV
Splenectomy
- Encapsulated bacteria (H. influenzae, S. pneumoniae, N. meningitidis)
Cystic fibrosis
- Pseudomonas
- Bukholderia cepacia
What investigations should be ordered for a case of pneumonia?
- FBC, U&Es, CRP
- Blood culture, sputum MC&S
- ABGs
- CXR
- Urine antigens
- Antibody tests
- Immunofluorescence
Give some description of PJP
Pneumocystis jirovecii
- Protozoan
- Insidious onset (dry cough, weight loss, SOB)
- CXR: bat wing appearance/ground glass
- Diagnosed on immunofluorescence
- Walk test: walking and desaturating
- Treated with co-trimoxazole
What is the definition of a hospital acquired pneumonia?
Infection starting 48 hours after admission
What common organisms are the cause of hospital acquired pneumonias?
- Enterobacteriaceae
- Staphylococcus aureus
- Pseudomonas aeruginosa
What is the CURB-65 score?
It is useful to use in primary care.
C: confusion U: urea >7 R: respiratory rate >30 B: blood pressure <90/60 65: patient is >65 years old
A score of <2 is mild/moderate
A score of >2 required admission and is treated as severe
How is pneumonia treated?
Depending on type and severity: FOLLOW LOCAL GUIDELINES
Community acquired: classical
- Mild/moderate: amoxicillin/clarithromycin
- Moderate/severe: co-amoxiclav + clarithromycin
Community acquired: atypical
- Clarithromycin/doxycycline
Hospital acquired:
- First line: ciprofloxacin +/- vancomycin
- Second line: piptazobactam + vancomycin
- Add metronidazole if aspiration
Special therapies: CAP
- Legionella: clarithromycin + rifampicin
- S. aureus: flucloxacillin
Special therapies: HAP
- Pseudomonas: Tazocin/ciprofloxacin + gentamicin
- MRSA: vancomycin
