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adult resp infxs

definition of acute bronchitis inflammation of the tracheo-bronchial tree from an infectious (viral or bacterial) process
what is acute bronchitis characterized by? productive cough that persists longer than the common cold
Acute bronchitis is usually self-limiting? True
_____% of acute bronchitis is viral 90%
viral pathogens for AB RSV, adenovirus, Influenza A/B, Parainfluenza, Rhinovirus, Coronavirus, Coxsackievirus
Nonviral pathogens of AB mycplasma, chlamydia, bodatella pertussis
AB: recent _____, tobacco use, ___ to _____ cough, ___ grade fever, fatigue, dyspnea, pleuritic chest pain, mild tachy, tachypnea URI, dry to productive, low grade
auscultation of AB: clear or scattered rhonchi that ________ clear with coughing
percussion of AB? negative egophony, bronchophony, tactile fremitus
when do you do labs for AB? ONLY IF dx is not clear.
CBC: if elevated WBC w/ "left shift" think ___ ____ bacterial pneumonia
tx for AB? tx symptoms, smoking cessation, good hydration, NSAIDs, pt edu, f/u
GOLD standard for dx of pneumo? CXR
pneumonia presents when? aspiration of contaminated secretions, inhalation of microorganisms, hematogenous spread
pneumo: the inflammatory exudate fills _______ and causes decrease in ventilation causing ________ alveoli, hypoxemia
difference between CAP and nosocomial pneumo CAP: outpt, or w/in 48hrs of hospital admission NP: >48hrs post-hospital admission, nursing home, long-term care facilities
CAP: bacterial accounts for ___% 90
bacterial agents in CAP strep pneumo (#1), mycoplasma, chlamydia,
CAP RFs >65yo, alcoholism, tobacco use
co-morbid medical conditions of CAP Asthma, COPD, cerebrovascular dz, chronic renal failure, DM, liver dz, CA, immunosuppression
PE of CAP dull percussion, increased tactile fremitus, egophony suggest consolidation. crackles (rales) suggest interstitial infiltrates
what does the urinary antigen test test for? S pneumo, Legionella,
when would you order a urinary antigen test for S. pneumo? leukopenia, asplenia, active alcohol use, chronic severe liver dz, pleural effusion, and those requiring ICU admission
when would you order a urinary antigen test for Legionella? active alcohol use, travel w/in 2wks, pleural effusion, ICU admission
CAP Tx: CURB65 confusion, uremia, respiratory rate, BP, age. (1&2: outpt, 3: middle, 4&5: hospital)
tx of OUTPT CAP for previously healthy pt w/ no recent abx (90d) macrolide (azithro, clarithro) OR doxycycline (weaker evidence)
tx of OUTPT CAP for pt at risk for drug resistance (>65yo, comorbid illness, exposure to child in daycare, immunosuppression, abx use in last 90d) resp. fluoroquinolone (moxifloxacin, levofloxacin, gemifloxacin) OR macrolide PLUS B-lactam (amoxicillin or amoxicillin-clavulanate)
tx of INPT CAP (non-intensive care unit) resp. fluoroquinolone or macrolide + B-lactam
tx of INPT CAP (intensive care) azithro OR resp fluoroquinolone PLUS antipneumococcal B-lactam
indications for Polyvalent pneumococcal vaccine >65yo, presence of any chronic illness that increases risk of dz
dosage of polyvalent pneumococcal vaccine immunocompromised pts: revaccinate 6yrs after 1st vaccination immunocompetent: 2nd dose if 1st dose >6yrs previously & was under 65yrs at that time
fungal pneumonias? pneumocystosis, histoplasmosis, cryptococcosis, coccidioidomycosis
endemic pathogens? where found? histoplasmosis (mississippi river valley and ohio river valley) and coccidioidomycosis (southwest US)
opportunistic pathogen? cryptococcus
possible extrapulmonary findings of fungal pneumo? meningitis (stiff neck, HA, mental status change), skin lesions, rhematologic and allergic findings
CXR of fungal pneumo? patchy infiltrate, nodules, consolidation, cavitation or pleural effusion. possibly, mediastinal adenopathy (unilateral or bilateral)
Pneumocystos: sxs? lab? CXR? dx? tx? sxs: fever, SOB, dry cough, fatigue, tachypnea Lab: LDH elevated CXR: diffuse interstitial and alveolar infiltrates dx: fiberoptic bronchoalveolar lavage is definitive tx: po Bactrim (3wks)
mycotic infx caused by inhaling fungus found in soil contaminated w/ bird or bat droppings histoplasmosis
sxs of histoplasmosis? asymptomatic!
prevention/treatment of histoplasmosis? prevention: itraconazole daily in AIDS-related tx: mild: itraconazole orally up to several months severe: amphoterecin B
most common cause of fungal meningitis? cryptococcosis
dx and tx of coccidioidomycosis? dx: presence of anticoccidioidal antibody in serum tx: mild: fluconazole or itraconazole for 3-6mo
acute onset, high fever, chills, purulent or blood-tinged sputum, productive cough, pleuritic chest pain streptococcus pneumoniae
PE/Labs/Tx of strep pneumoniae? PE: signs of lobar consolidation; bronchial breath sounds Lab: often leukocytosis; rapid urinary antigen=pneumococcal tx: uncomplicated: amoxicillin 750mg BID x 7-10d
usually in school age children; slow onset, persistent dry cough, low fever, HA, pharyngitis, myalgia Mycoplasma pneumonia
diffuse crackles, mild leukocytosis, possible patchy diffuse infiltrates, atelectasis Mycoplasma pneumonia
tx of mycoplasma? macrolide, floroquinolones, or tetracyclines
adolescents, college students, military; mild sore throat, hoarseness, little or no fever, scant sputum, persistent cough chlamydia pneumonia
single segmental infiltrate in lower lobes chlamydia pneumonia
tx of chlamydia pneumonia doxycycline
older adults; smokers, chronic lung dz, immunocompromised, exposure to water source, age >50yo Legionella pneumonia
HA, myalgias, malaise, mental status changes, high fever legionella pneumonia
Lab/Tx of legionella? lab: special sputum stain, Legionella urinary antigen tx: doxycycline
post-influenza, ETOH, MD, high fever, chest pain, purulent sputum, hemoptysis CA staph aureus
Lab/CXR/Tx of CA staph aureus Lab: blood & sputum cultures CXR: bilateral patchy infiltrates w/ pleural effusion Tx: anti-staph pcn (zithromax, azithromycin)
leading cause of death d/t infection nosocomial pneumo
most common organisms in NP P.aeruginosa, S. aureus, g - rods (enterobactor, K. pneumoniae, E. coli)
how to handle nosocomial pneumo? get a sputum culture. tx w/ broad-spectrum abx first, then switch to sensitive abx after culture is back
NP should have 2 of 3 of these sxs? PLUS....? fever, leukocytosis, purulent sputum PLUS chest radiograph abnormality (new or progressive pulmonary opacity)
Tx of NP first: broad-spectrum: 2nd gen ceph (if no unusual RFs) if high risk: antipseudomonal, 2nd antipsudomonal, MRSA coverage (if indicated)
pulmonary suppuration w/ parenchymal necrosis caused by bacterial infx pulmonary abscess
pulm abscess is primarily caused by what? aspiration (80%)
anaerobic bacteria (comes from mouth) prevotella, bacteroides, anaerobic strep, fusobacterium
aerobic bacteria (pulm abscess) staph aureus, Klebsiella
pulm abscess: aspiration RFs depressed LOC, impaired deglutition, mechanical disruption
fever, malaise, weight loss, cough, pleuritic pain & hemoptysis, PURULENT and PUTRID sputum pulm abscess
pulm abscess tx clindamycin IV OR augmentin OR penicillin IV PLUS metronidazole IV. tx for at least 6wks and f/u w/ CXR until clear
Created by: rjerome09