Respiratory Tract Infections Flashcards
(41 cards)
what are URT infections
primarily viral, everything above vocal chords to mouth and nose
- common cold, sinusitis, pharyngitis, laryngitis
- do not require antibiotics
what are the LRT infections
acute bronchitis, pneumonias, TB, influenza,
overview of acute bronchitis
50% viral, 25% bacterial, 25% mixed
- treat with antibiotics, measure PCT and CRP
- treat inflammatory component with ICS
- treat repiratory failure
- symptoms include cough with yellow-green phlegm
what is pneumonia?
a LRTI causing inflammation of lung tissue and sputum filling airways and alveoli
- when presenting say: signs of a LRTI (fever/cough or bronchial breathing) and CXR changes
how do you classify pneumonia?
community acquired = gram positive
hospital acquired = gram negative neg or staph aureus
fungi
unusual organisms / fungi
aspiration pneumonia
what is aspiration pneumonia?
from upper respiratory or GI tract
involves right lower lobe
what is hospital acquired pneumonia?
new onset of symptoms more than 48 hours after patients admission to hospital
what is ventilator acquired pneumonia
HAP in patients on mechanical ventilation
within 4-5 days of admission
how does pneumonia present?
SOB cough - sputum fever haemoptysis pleuritic chest pain delirium abdominal pain sepsis
what are the clinical signs of pneumonia
tachypnea tachycardia hypoxia fever confusion
how does pneumonia present on a chest x-ray
alveoli filled with neutrophils = consolidation
what can you hear in a patient with pneumonia?
bronchial breath sounds - harsh breath sounds loud on inspiration and expiration
focal coarse crackles
dullness to percussion bc consolidation
how do you assess the severity of pneumonia?
CURB-65
predicts mortality and score 1 = treat at home, score >1 hospital admissions
score >2 ICU
c- confusion
u-urea >7
R - resp rate >30
b - blood pressure
65 - age 65 and >
what are the common microbes causing pneumonia
strep pneumonia
haemophilius influenzae
moraxella catarrhalis: in immunocompromised patients
PA in CF patients and staph A as well
what is atypical pneumonia
organism that cannot be cultured and doesn’t respond to gram staining or penicillins
treated with macrolides or tetracyclines eg doxy
what are the organisms causing atypical pneumonia?
legionella pneumophila; can cause SIADH hyponatremia
in infected waters
mycoplasma pneumoniae (rashes)
chlamydia psitacci from infected birds
chlamyodphila pneumoniae: school aged with wheeze
coxiella burnetti: exposure to animals, have a flu
what is fungal pneumonia?
pneumocystis jivorecci
immunocompromised
dry cough, SOB on exertion, night sweats
co-trimoxazoles/ trimethoprim
what are the investigations for pneumonia?
CURB 0-1 = none
- CXR
- o2 sats, ABG
- FBC: WCC, Hb, platelets for inflammation
- viral swab!! and blood cultures
- urinary pneumococcal antigen
- CRP
- U&E’s
- LFT’s = sepsis
- lactate for sepsis
what is the treatment for CAP pneumonia
local guidelines
moderate, severe or septic: IV antibiotics then switch to oral
5 day (mild: amoxicillin or clarithryomycin) or 7 day course of dual amoxicillin AND macrolide
what is the treatment for HAP?
- broad spectrum b lactamase stable antibiotics such as co-amoxiclav together with a macrolide
what do you do if pneumonia is very hard to treat/not responding?
piperacillin-tazobactam
then change to narrow spec like benzylpenicillin
also continue clarithromycin to cover for atypical causes
what are the complications of pneumonia?
sepsis
pleural effusion = fluid in pleural cavity
empyema - pus in pleural space (drain and antibiotic)
lung abscess - pus in non pre-formed space
VTE
death
what causes pneumonia in children?
neonates: e coli, strep b and listeria
1-6 months: chlamydia trachomatis, staph a and RSV
6m-5 years is RSV and para-influenzae
what do CXR look like in diff conditions?
LOOK AT IMAGES
COVID: may be normal, peripheral bilateral consolidation
CAP - shadowing and consolidation
COPD: hyperexpansion an and reduced air markings
Lung cancer: pneumonia or recurrent infections
