Flashcards in Week 5 Upper and lower Respiratory Tract Infection Deck (161)
What are the different normal flora in the URTI?
Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.
Give examples of infections that cause transient colonisation post antibiotics?
Coliforms, Pseudomonas, Candida
What respiratory pathogens are usually asymptomatic but can become symptomatic due to another infection?
Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes
Sit in your throat
How are Upper respiratory tract infections transmitted?
Coughs and sneezes spread diseases”
DROPLET spread. Hand washing and decontamination very important
What group of people are most likely to get URTI?
Most often v. young children/teenagers
Winter/viral. Bacterial and viral common in children.
Also immunocompromised people
What is the strategy used when GP are prescribing antibiotics? For kids and adults over the age of 3
Address concerns – have 1 of 3 strategies
Prescribe if risk of complications
What is the main disease that caues a cold?
What are less common causes of the cold?
What is symptoms of cold?
Nasal discharge, sneezing and sore throat
What is Coryza?
The common cold
What are the symptoms of Rhino-sinusitis?
Facial pain, nasal blockage, reduction smell
What is the aetiology of Rhino-sinusitis?
Post viral inflammation
What are the causes of Rhino-sinusitis?
Streptococcus milleri group,
What are the complications of Rhino-sinusitis?
What are less common causes of Rhino-sinusitis?
Allergic and non-infective causes
What are the investigations for Rhino-sinusitis?
When using imaging for a patient with Rhino-Sinusitis what are you investigating?
Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.
What is Sinus washouts ?
Diagnostic and therapeutic after referral to ENT.
Relieve some of the symptoms and so be able to get some sample to give to microbiologists
What are the treatment for Rhino-Sinusitis?
Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway.
Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
What is a uncommon cause of Rhino-Sinusitis?
What is the difference between pharyngitis and tonsillitis?
Pharyngitis and tonsillitis are infections in the throat that cause inflammation.
If the tonsils are primarily affected, it is called tonsillitis.
If the throat is primarily affected, it is called pharyngitis.
What are the viral causes of pharyngitis/tonsillitis?
Viral (RSV, Influenza, Adeno, Epstein barr virus, HSV1)
What is the main bacterial causes of pharyngitis/tonsillitis?
What are the rarer bacterial causes of pharyngitis/tonsillitis?
What investigation is done when a person is suspected of pharyngitis/tonsillitis?
Throat swabs and proper history
What are the signs and symptoms of pharyngitis/tonsillitis?
Sore throat , dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy
What does Group A Streptococcal Infection cause and in what group of people?
Pharyngitis/Tonsillitis in children
What complications can be caused when a child is infected with Group A Streptococcal Infection?
How do you prevent a child infected with Group A Streptococcal Infection getting scarlet fever?
Aim to prevent this rheumatic fever by giving penicilli
What other conditions do you try and prevent from occuring in a patient with Group A Streptococcal Infection?
Prevent suppurative complications too --> e.g. otitis media and quinsy (peritonsillar abscess))
What causes glandular fever?
Epstein-Barr virus (EBV
Who is at most risk of glandular fever?
Teenagers and older. Often asymptomatic.
What are the symptoms of glandular fever?
Sore throat, fever, cervical lymphadenopathy
What are the complications of glandular fever?
What should you avoid when a person has glandular fever?
Avoid ampicillin (mac-pap rash, not a true allergy)
Why should you not do contact sport for some weeks when you have glandular fever?
Cause your spleen to rupture
How do you test for glandular fever?
Serology – IgM/IgG, Paul Bunnell Test/PCR
What is Diptheria?
An acute and highly contagious bacterial disease causing inflammation of the mucous membranes in the throat
What causes diptheria?
What are the symptoms of diptheria?
Malaise, fatigue, fever +/- sore throat
What is the treatment of Diptheria?
Treatment is Erythromycin/ penicillin/antitoxin
What is the prevention steps for Diptheria?
Prevention is Immunisation
What caues Thrush?
Candida, usually after antibiotics or steroids
What happens in Epiglottitis?
Cellulitis of epiglottis (“cherry red”) – airway obstruction
What are symptoms of Epiglottitis?
Fever, irritable, difficulty speaking (“hot potato”) and swallowing.
Leans forward, drools.
How can you investigate a epiglottitis?
Lateral neck X-ray – enlarged epiglottis
Must send blood cultures
When a person has epiglottitis why do you send blood cultures and not a mouth swab?
You do not swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).
What is the treatment of epiglottitis ?
maintain airway, cefotaxime
What used to be a common cause of epiglottitis?
H. influenzae type B prior to immunization
What is laryngitis?
Inflammation of the larynx
What is the symptoms of acute laryngitis?
Hoarse/husky voice, globus pharyngeus (lump in throat), fever, myalgia, dysphagia
Cause of acute laryngitis?
Usually viral and self-limiting, occasionally it is bacterial
Is antibiotics given to a person with acute laryngitis?
No unless if the patient has a severe disease
What are non infection causes of acute laryngitis?
voice abuse, malignancy
What is Croup/Acute laryngotracheobronchitis?
Inflammation of larynx and trachea after infection of upper airways
Common in children
What is the cause of Croup/Acute laryngotracheobronchitis?
Viral esp. parainfluenza type 2 therefore NO antibiotics also Respiratory Syncytial Virus
What is the treatment for Croup/Acute laryngotracheobronchitis?
Symptomatic treatment only
What is the cause of Whooping cough?
Bordetella pertussis - Gram negative coccobacillus
Does whooping cough just happen in children?
No happens in adults as well as the immunization can wear off.
How do you test fr whooping cough?
Pernasal swab and PCR
How long is the incubation period for whooping cough?
What are the initial symptoms of whooping cough?
Initially catarrhal phase – runny nose, fever, malaise
What is catarrhal?
is a disorder of inflammation of the mucous membranes in one of the airways or cavities of the body
What is the symptoms of whooping cough after few weeks?
Dry non productive cough. This becomes whooping/paroxysms. (short bursts on exhalation, then inspiratory gasp which is the whoop.
What is the treatment of whooping cough?
Supportive and erythromycin
May be prolonged convalescence - weeks
What is the complications of whooping cough?
pneumonia Often secondary infection or aspiration
How is whooping cough prevented?
Immunisation very important. Erythromycin to household contacts/Notifiable disease
What is Otitis externa?
Infection of the external auditory canal
What is the symtpoms of Otitis externa?
Pain, itch, swelling and erythema, otorrhoea
What are the 3 different types of Otitis externa?
Acute OE, chronic OE and malignant OE.
What are the caues of acute Otitis externa?
S. aureus and Pseudomonas spp.(esp. after swimming)
How do you test for acute OE?
Swab ear canal and give to microbiology
What is the treatment for acute OE?
Toilet with saline and/or alcohol and acetic acid. Wick insertion. Topical drops
What is the cause of Otitis externa - chronic?
Irritation from drainage from perforated tympanic membrane.
What is the symptoms and treatment of chronic OE?
Treat underlying cause
Why should aminoglycosides be avoided by a person with chronic OE?
Avoid aminoglycosides if perforation. Resistance may form and sensitisation occurs with prolonged courses
What happens in Otitis externa - malignant?
Severe, necrotizing. Spreads from local area more deeply. May invade bone, cartilage and blood vessels.
When is Otitis externa - malignant life threatening?
Spread to temporal bone, base of skull, meninges and brain.
What is the cause of malignant OE?
Often Caused by Pseudomonas aeruginosa
What is the symptoms of malignant OE?
pain, drainage of pus from canal
Who is likely to have malignant OE?
Elderly, diabetics, immunosuppressed
What is the treatment for malignant OE?
Treat 4-6 weeks altogether e.g. with iv ceftazidime then ciprofloxacin
What is Otitis media (OM)?
Middle ear inflammation. Fluid present in the middle ear.
V. common in children
What is the symptoms of OM?
Fever, pain, impaired hearing. Red bulging tympanic membrane
What is the cause of OM?
VIRAL. H influenzae, S. pneumoniae, M. catarrhalis
What test do you do for OM?
Swab any pus discharging
What is the treatment of Otitis media?
Treatment, if not unwell WATCH and treat symptomatically (decongestant etc) and review early. If unwell give amoxicillin.
What is Mastoiditis?
Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone
It mastoiditis common?
Much lower incidence after introduction of antibiotics.
What are the signs of Mastoiditis?
Signs as Acute Otitis Media, but pain/swelling over mastoid too
What sample do you need to confirm the infection of mastoiditis?
Need bacteriology samples
Imaging – CT helps to assess extent
What is the treatment of Mastoiditis?
Similar treatment to acute OM unless Gram negatives are suspected and then need broader spectrum cover as per organism isolated
1st line treatment is co-amoxiclav (amoxicillin-clavulanate)
What are Ludwig’s angina, Lemierre’s Syndrome?
Deep fascial space infections of head and neck
What are gingivitis/peridontal infection?
Infection of the gums
What are the different ways of diagnosing a infection? 6 answers
Send pus/throat swab/blood cultures
Reference laboratory work (typing, toxin detection)
Serology and antibody detection
When is Erythromycin mainly used?
If pencillin allergic and Whooping cough/diphtheria
What is classed as lower respiratory tract?
Below the larynx
Give examples of LRTI and what part of the LRT they affect?
Tracheitis --> affecting the trachea
Bronchitis affecting the bronchus and bronchioles
Pneumonia --> lung
Abscesses --> lung
What are the different types of Bronchitis?
Chronic but can have acute exacerbations
What are the different types of Pneumonia?
What are the Predisposing factors to LRTI?
Loss or suppression of cough reflex / swallow
e.g. stroke, coma, ventilation
Ciliary defects e.g. PCD similar to CF
Mucus disorders e.g. CF
Pulmonary oedema – fluid flooding alveoli ( warm and moist harbour organisms)
Immunodeficiency: congenital or acquired (Multiple examples!)
Macrophage function inhibition e.g. smoking
What viruses cause LRTI's?
- Respiratory syncytial virus
When do fungus cause LRTI?
When the person is immunosuppressed most of the time
Examples of fungi that cause LRTI?
- Candida sp.
- Pneumocystitis jiroveci
Examples of baceteria that cause LRTI?
- Haemophilus influenzae
- Staphylococcus aureus
- Klebsiella pneumonia
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella pneumophila
- Mycobacterium tuberculosis
What happens to the bronchi in Acute bronchitis?
Inflammation & oedema of trachea and bronchi
What are the symptoms of acute bronchitis?
Cough (typically dry), dyspnoea & tachypnoea
Cough may be associated with retrosternal pain
What is the Epidemiology of acute bronchitis?
Most frequent in winter, in children
What are the Causative viruses for acute bronchitis?
Viruses are the usual cause (rhinovirus, coronavirus, adenovirus, influenza)
What are bacterial causes of acute bronchitis?
Bacterial causes less common (H.influenzae, M.pneumoniae, B.pertussis)
Is it more common for a bacteria or a virus to cause acute bronchitis?
Virus more common than bacteria
How is diagnosis of acute bronchitis made?
Usually there is no diagnostic test for mild presentation.
Might look at vaccination & previous exposure history e.g. influenza, B. pertussis to exclude some organisms
When is culture of respiratory secretion done in case of acute bronchitis?
If looking for a specific cause e.g B pertussis and the person is very unwell but not routine
What is the treatment for acute bronchitis?
Supportive treatment for healthy patients
Those with severe disease or co-morbidities may require oxygen therapy or respiratory support
Antibiotics only if bacterial cause is suspected or found
What is the definition of chronic bronchitis?
Cough productive of sputum on most days during at least 3 months of 2 successive years (which cannot be attributed to an alternative cause)
Chronic bronchitis is common in what type of people and what is assoicated with it?
Most common in men and >40yrs
Associated with smoking, pollution, allergens
What is the main difference apart from duration of symptoms between acute and Chronic bronchitis?
In Chronic the inflammation and oedema of airways is mediated by exogenous irritants rather than infective agents seen in acute bronchitis.
Is chronic bronchitis caused by different infective agents to acute bronchitis?
Patients have chronic exacerbations mediated by same infective pathogens as acute bronchitis
What is the presentation of bronchiolitis?
Inflammation and oedema of bronchioles
What is the symptoms of bronchiolitis?
: Acute onset wheeze, cough, nasal discharge, respiratory distress (grunting, retractions, nasal flaring)
What is the epidemiology of bronhciolitis?
Peaks in winter and early spring, in infants 2-10 months.
What is the main cause of Bronchiolitis?
Most commonly caused by Respiratory syncytial virus (RSV)--> 75% of cases
What percentage of children by age of 2 have been infected by RSV?
What are less common causes of bronchiolitis?
Also caused by parainfluenza, adenovirus, influenza
What is the diagnosis of bronchiolitis?
Full blood count
Microbiological diagnosis: usually nasopharyngeal aspirate of respiratory secretions sent for viral PCR
What is the treatment for bronchiolitis?
Supportive: oxygen, feeding assistance ( due to problems of eating due to irritants)
No clear evidence to support steroids, bronchodilators, ribavirin
Antibiotics only if complicated by bacterial infection
What is pneumonia?
Infection affecting the most distal airways and alveoli
Formation of inflammatory exudate
What are the two anatomical patterns of pneumonia? Give a description for both
Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli
Affects a large part, or the entirety of a lobe
90% due to S.pneumoniae
Demarcated by the lob of the lug
Which type of pneumonia is the most common?
Community acquired pneumonia
When do you get hospital acquired pneumonia?
Pneumonia developing >48hrs after hospital admission
What are the causative orgaisms of hospital acquired pneuomina?
Different causative organisms to CAP, especially if >5days after admission: enterobacteriaceae & Pseudomonas sp.
What sub group is Ventilator acquired pneumonia (VAP) in?
Subgroup of HAP
What is the cause of Ventilator acquired pneumonia?
Pneumonia developing >48hrs after ET intubation & ventilation
Et > preaching there natural defence and causing impairment of swallowing and coughing > increase risk of infection
What is the cause of Aspiration pneumonia?
Pneumonia resulting for the abnormal entry of fluids e.g. food, drinks, stomach contents, etc. into the lower respiratory tract
Patient usually has impaired swallow mechanism
When is CAP mostly seen and by what group of the population?
Peak age 50-70 years
Peak onset midwinter to early spring
What are the different acquisition of CAP? GIve example of organims
Person-to-person or from a person’s existing commensals (S.pneumoniae, H.influenzae)
From the environment (L. pneumophilia)
From animals (C.psittaci)
Bacterial cause of CAP can be divided into what two groups?
Typical and Atypical bacteria cause
What is meant by Atypical pneumonia?
Traditionally described cases which failed to respond to penicillin or sulpha drugs and no organism could be identified
Now recognised as atypical organisms due to different clinical presentation and treatment is slightly different
Name 5 typical organisms of CAP?
Name 5 atypical organisms of CAP?
What are the symptoms of bacterial CAP?
Usually rapid onset
Fever / chills
Pleuritic chest pain
General malaise: fatigue, anorexia
What are the signs of bacterial CAP?
Examination findings consistent with consolidation:
Dull to percuss
Reduced air entry, bronchial breathing
Can hear crakles
Alveoli trying to work against the fluid
Atypical Mycoplasma pneumonia is commonest at what time of year and by who?
Autumn epidemics every 4-8 years
Commonest in children & young adults
What is the diagnosis of Mycoplasma pneumonia, common symptoms and possible complications?
Diagnosis: serology (difficult to culture)
Main symptom is cough
Rare complications: pericarditis, arthritis, Guillain-Barre, peripheral neuropathy
Outbreak of Legionella pneumophilia is assoicated with what?
Colonises water piping systems
Outbreaks associated with showers, air conditioning units, humidifiers
What are the symptoms of Legionella pneumophilia, how is it diagnosed?
High fevers, rigors, cough: dry initially becoming productive, dyspnoea, vomiting, diarrhoea, confusion
Bloods: deranged LFTs, SIADH (low sodium
What percentage of people who have CAP in adults are affected by Chlamydophila pneumoniae?
3-10% of CAP cases in adults
Highest incidence in elderly
What are the symptoms of Chlamydophila pneumoniae
and do they vary by age?
Causes mild pneumonia or bronchitis in adolescents & young adults
Incidence highest in the elderly – may experience more severe disease
What is Chlamydophila psittaci
Associated with exposure to birds
What 3 factors would make you consider pneumonia caused by Chlamydophila psittaci?
Consider in those with pneumonia, splenomegaly & history of bird exposure
What is Splenomegaly?
Abnormally enlarged spleen
What are the symptoms would a person infected with Chlamydophila psittaci
Is influenza a complicated disease? What are the symptoms and recovery time?
IT is a uncomplicated disease.
Fever, headache, myalgia, dry cough, sore throat
Convalescence takes 2-3 weeks
What type of patients does primary viral pneumonia commonly occur in? What are the symptoms associated?
Occurs more commonly in patients with pre-existing cardiac & lung disorders
Cough, breathlessness, cyanosis
How would priamry viral pneumonia develop into secondary bacterial pneumonia?
It could develop after initial preiod of imporvement but follows infection caused by:
S.pneumoniae, H.influenzae, S.aureus
How do you diagnose viral pneumonia?
Viral antigen detection in respiratory samples using PCR
What are the 3 non- microbiological investigations for CAP?
Routine observations: BP / pulse / oximetry
Bloods: including FBC / U&E / CRP / LFTs
What are 5 microbiological investiations recommended by BTS for all moderate- severe cases of CAP?
Sputum Gram stain & culture
Pneumococcal urinary antigen
Legionella urinary antigen
PCR or serology for:
Why should we bother establishing a diagnosis?
Optimise antibiotic selection
Limit the use of broad spectrum agents
Identify organisms of epidemiological significance
Identify antibiotic resistance and monitor trends
Identify new or emerging pathogens
What is CURB test based on and what does it tell you?
REspiratory rate >30
You get 1 point on each point--> tell you how severe the CAP is and where should treatment happen