RTIs and Pneumonia

Question 1

What are the types of upper and lower respiratory tract infection?

Answer 1

upper
- common cold, acute rhinitis, pharyngitis/tonsillitis, laryngitis, epiglottitis

lower
- bronchiolitis, pneumonia

Question 2

What is pneumonia? What are the different types?

Answer 2

pneumonia
- infection of the lung tissues causing inflammation of the lung tissue and sputum filling of the alveoli and airways

community acquired pneumonia
hospital acquired pneumonia
atypical pneumonia
aspiration pneumonia
ventilation associated pneumonia

Question 3

What is community acquired pneumonia (CAP) caused by?

Answer 3

streptococcus pneumoniae (gram +)
haemophilus influenzae (gram -)
covid-19 (SARS)

moraxella catarrhalis (gram -)
pseudomonas aeruginosa (gram -)
staphylococcus aureus (gram +)

Question 4

What is atypical pneumonia? What is it caused by?

Answer 4

atypical pneumonia is caused by an organism that cannot be cultured in the normal way or detected using gram stain

• mycoplasma pneumoniae
• chlamoydophila pneumonia and psittaci
• legionella pneumphilia

don’t respond to penicillins
can be treated with macrolides (clarithromycin), fluoroquinolone (levofloxacin) or tetracyclines (doxycycline)

Question 5

How should upper respiratory tract infections be treated?

Answer 5

management is symptomatic
- can be a viral or bacterial infection

antibiotics if an infection is
- severe, persistent or in an immunocompromised patient

Question 6

What are the different symptoms of a viral and bacterial infection?

Answer 6

viral
- low grade fever, cough, sneezing, stuffy/runny nose, sore throat, headache, muscle aches

bacterial
- high grade fever, reduced appetite, focal evidence of infection, cough, headache

Question 7

What is the CENTOR criteria? What does it entail?

Answer 7

CENTOR criteria is used to give an indication of the likelihood of a sore throat being due to a bacterial infection (Group A Strep)

1 - tonsillar exudate
2 - tender anterior cervical lymphadenopathy or lymphadenitis (inflamed or abnormally large lymph nodes)
3 - history of fever (>38)
4 - absence of cough

a score of greater than 3 needs antibiotics

Question 8

What are the symptoms of a lower respiratory tract infection?

Answer 8

tachypnoea
tachycardia
hypoxia
hypotension (shock)
fever
confusion
chest dullness to percussion (not resonant if infected)
coase crackles (due to air/fluid filled lungs)

cough
mucopurulent sputum
haemoptysis
dyspnoea
pleuritic chest pain
myalgia. (muscle pain)
arthralgia (joint pain)
back/abdominal pain
non-pulmonary clinical features

Question 9

What are the investigations for respiratory tract infection?

Answer 9

vitals
- oxygen saturation
chest X-ray
arterial blood gases
sputum/urine tests
- to find causative agent

Question 10

What are the types of respiratory failure? How do pH, oxygen and carbon dioxide levels differ?

Answer 10

type I respiratory failure
- normal/high pH
- low oxygen
- normal/low carbon dioxide

acute type II respiratory failure
- normal/low pH
- low oxygen
- high carbon dioxide
= is worse clinical

Question 11

What does a focal area of consolidation mean in a chest X-ray

Answer 11

indicates filling of the alveoli and bronchioles in the lungs

pus/mucus - pneumonia
fluid - pulmonary oedema
blood - pulmonary haemorrhage
cells - cancer

Question 12

What is the CURB65 score?

Answer 12

predicts mortality associated with community acquired pneumonia

confusion - mental test score or 8 or less
raised blood urea nitrogen - >7mmol/l
raised respiratory rate - > 30 breaths per minute
low blood pressure - diastolic 60mmHg or less, systolic less than 90 mmHg
aged 65 years or more

Question 13

How should community acquired pneumonia be managed?

Answer 13

oxygen
IV fluids
chest physiotherapy
analgesia
respiratory support
antibiotics

Question 14

What are potential complications of pneumonia?

Answer 14

general
- respiratory failure
- sepsis

local
- empyema/parapneumonic effusion
- lung abscess
- acute respiratory distress syndrome
- sepsis
- respiratory failure

Question 15

What is aspiration pneumonia? What are the risk factors?

Answer 15

results from inhalation of oropharyngeal contents into the lower airways that leads to pneumonitis and resultant bacterial infection

risk factors/history
- swelling issues, vomiting episode, choking episode

the right lung is the most common site of infiltrate formation due to the large calibre and more vertical orientation of the right mainstream bronchus

Question 16

What is hospital acquire pneumonia caused by?

Answer 16

pseudomonas aeruginosa
streptococcus pneumoniae
MRSA

Question 17

What are the risk factors for pneumonia?

Answer 17

smoking
increasing age
heart conditions
lung conditions
alcohol
diabetes mellitus

Question 18

How should community acquired pneumonia be treated with antibiotics? What are lines of treatment depending on their CURB65 score?

Answer 18

antibiotics

• CURB 0-1
  = doxycycline 200mg PO then 100mg 24 hourly or erythromycin 500mg 6 hourly if pregnant
• CURB 2-5
  = benzylpenicillin 2g IV 4 hourly + doxycycline 200mg PO then 100mg 24 hourly

allergic to penicillin + CURB 2-5
- levofloxacin 500mg PO/IV 12 hourly