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Pulmo Infxs


Urine Ag test for: S pneumo or Legionella pneumophila PNA
PNA empiric tx resp FQs, macrolides, 2G or 3G cephs x5-21days = TxOC; kids HD amox or Aug
Nosocomial PNA tx Antipseudomonal PCNs + aminoglycosides or cephs ± vanc; Early onset: CTX or resp FQ (IV), Unasyn or ertapenem; Late onset (poss MDR): antipseudomonal ceph + antispeudo FQ; aminoglycoside + vanc
PNA Mgmt guides (acronyms) PORT, CURB-65 (consciousness impaired, urea>7, RR>30, SBP<90, >65yo
Nosocomial PNA bugs GN: E coli, PA, klebs, acinetobacter; SA, SP, H flu
Pos PPD tx INH 300mg daily for 6-12 months; monitor LFTs
Aspergillus tx itraconazole, voriconazole; resection
Flu incubation 1-4 days post-exposure
Flu presentation in kids croup, bronchiolitis, GI upset, conjunctivitis, OM; sore throat, nasal congestion, conjunctivitis, nonproductive cough
Flu: comps Pneumonia; Myositis; Myocarditis, pericarditis; Aseptic meningitis; Encephalitis; Reye syndrome; Guillain-Barre syndrome
Flu: dx Epidemiologic; Virus isolation or antigen detection; Serologic
Most common clinical manifestation of acute upper airway obstruction: croup
Croup presentation stridor, barking seal; worse at night; winter; 6 mos-3 yo; males; Parainfluenza; high RR, rales, rhonchi, retractions; steeple sx
Prolonged expiratory phase, hyper-resonance to percussion, & wheezing = bronchiolitis
Bronchiolitis presentation <2 yo (peak 6 mos); M>F; winter; if cardiopulmonary dz / immunodeficiency: more severe dz; concurrent URI; low fever
Bronchiolitis agent RSV or HMPV (also poss PIV, flu or adeno)
Premature infants w/bronchiolitis often have: apneic spells as presenting symptom
Bronchiolitis: X-ray may show: hyperinflation, atelectasis and infiltrates
Croup/bronchiolitis tx supportive; cool mist humidification; pulse ox, O2 if hypoxemia; poss bronchodilators
Pneumonia RFs CHD/ lung dz; CF; asthma; SCD; immunodeficiency syndromes
Pneumonia: viral causes more common in kids <5 yo; RSV, PIVs, Influenza, Adenovirus
Pneumonia: viral causes in neonates: consider CMV, Herpes, rubella
Pneumonia: bac causes if <1 month old GBS, SA, gram neg enteric bacilli; T. pallidum; Listeria
Pneumonia: bac causes for 1 month-5 yo SP (most common); H flu; GAS; SA (&MRSA); M. pneumo; C. pneumoniae
Pneumonia: bac causes for >5 yo M pneumo most common; SP, C pneumo; TB
Less common bac causes of pneumonia C trachomatis (afebrile pneumo in 2 wks-3 mos); pertussis, PCP
Pneumonia: dx CXR = segmental infiltrates, atelectasis, pleural effusions; poss empyema; blood cx pos in 10-30% of bac
Viral pneumonia s/s tachypnea, retractions, nasal flaring & use of accessory mx; diffuse rales, wheezing; CXR diffuse interstitial infiltrates & hyperinflation
M pneumo findings CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes; Fever, cough, HA, malaise; sore throat / OM
No. 1 cause of death from infectious disease in the US pneumonia
HAP = sx onset >___ hours after hospital admission 48
most common pneumonia bacterium worldwide Streptococcus pneumoniae
May have associated non-respiratory syndromes (CNS, immune hemolytic anemia) Mycoplasma pneumoniae
may cause necrotizing infiltrates or pneumatoceles Staphylococcal pneumonia; GN; aspiration pna
Inhalation of oropharyngeal or gastric contents (volume-dependent) aspiration pneumonia
RF for infection with drug resistant pneumococci recent beta lactam therapy (within 3 months); >65 yo
factor that increases the risk for gram negative infection nursing home; RF for enteric GN: underlying cardiopulmonary disease
RF for pseudomonas aeruginosa PNA Corticosteroid therapy (> 10 mg/d of prednisone); Structural lung disease (bronchiectasis); Broad-spectrum antibiotics (>7 d in past month)
Apical/posterior infiltrates of upper lobes, F, C, dry cough TB
Pediatric with barking cough, stridor viral croup (laryngotracheobronchitis); Tx w/ racemic epi and glucocorticosteroids if stridor at rest.
Fever (80%), cough, rusty sputum. RR often >24. Crackles/rales, decreased breath sounds, dullness to percussion, +egophony, pectoriloquy. CXR infiltrates/ consolidation Pneumonia
Pt >35 yo with PNA. Rusty colored or yellow-green sputum. Acute onset, F/C. Bug = Strep pneumoniae
Pt <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches. PNA bug = Mycoplasma pneumonia
PNA w/ Smokers, COPD: bugs = H. influenza; M cat (COPD)
PNA w/ DM, immunocompromised, EtOH. Currant color sputum. Bug = Klebsiella
PNA w/ Water, late summer, construction site. Diarrhea, toxic looking; males, high fevers, multilobar dz Legionella
PNA from Nursing homes, chronic care facility. Purulent sputum. Bug = Staphylococcus aureus
PNA & HIV+, AIDS, Immunocompromised, sxs out of proportion to exam; diffuse interstitial/alveolar infiltrates. Bug = Pneumocystis jerovecii (tx of choice: TMP-SMX)
PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronchiectasis. Patchy infiltrates in dependant lung zones Aspiration PNA
Cystic fibrosis w/ PNA. Bug = Pseudomonas aeruginosa
PNA: lancet-shaped gram-positive diplococci Strep pneumo
PNA: patchy lower lung consolidations. Bug = Pseudo aeruginosa
Gram negative PNA organisms (2) seen in EtOH/COPD: Klebsiella, Legionella
Lancet shaped gram positive cocci in pairs = Streptococcus pneumoniae
TB infection is spread person to person via: respiratory droplets in air (cough)
Positive PPD Zone Size >= __ mm if no risk factors: 15
Positive PPD Zone Size >= __ mm if co-morbid RFs: DM, CKD, ca, IVDA, congregate setting, foreign born/immigrant <5yrs from endemic area (Asia, Africa, Latin America), Mycobacteriology lab tech, gastrectomy 10
Positive PPD Zone Size >= __ mm if HIV+, contact of TB+ person, organ transplant / immuno-suppression, fibrotic CXR, on 15 mg prednison/day, or TNF alpha inhibitor 5
Positive PPD Zone Size >10 if comorbid RFs = DM, CKD, ca, IVDA, congregate setting, foreign born/immigrant <5yrs from endemic area (Asia, Africa, Latin America), Mycobacteriology lab tech, gastrectomy
Positive PPD Zone Size >5 if: HIV+, contact of TB+ person, organ transplant / immunosuppression, fibrotic CXR, on 15 mg prednisone/day, or TNF alpha inhibitor
Substance used for control in PPD test: Candida albicans antigen
The inability to react to TB skin tests because of a weakened immune system = anergy
More specific test for LTBI & can help exclude BCG or Mycobacterium (non-TB) reactions = Interferon Gamma Release Assay
Macrophages: Activated phagocytic cells are common in: fungal, acid-fast & some atypical bacterial infections
Influenza has an incubation period of ___ days 1-4
Fever, myalgia, headache, malaise, nonproductive cough, sore throat, rhinitis = influenza
Flu resolves in ___ days; cough/ malaise can persist for 2 weeks 3-7
Children with influenza may present with: otitis media, nausea, vomiting
Viral cultures are optimal from ______ specimens and require specific viral culture media nasopharyngeal
Only _______ are effective against both Influenza A and B ostelmavir and zanamivir
Who needs annual influenza vaccinations? LT aspirin tx; PG; Chronic medical conditions; SNF residents; 6 mos-18 yrs or >50 yo
Who needs annual influenza vaccinations? Chronic medical conditions (pulmonary, cardiac, metabolic, renal, neurologic, immunodeficiency, hemoglobinopathy)
Cough, weight loss, fever, night sweats, hemoptysis, fatigue, decreased appetite, chest pain can be: reactivated TB
In bacterial pneumonia, blood cx is positive how often: in 10-30%
frank pus located in pleural space = empyema
Pulmonary defense mechanisms = mucociliary lining of lung, phagocytes (alveolar macrophages, neutrophils), surfactant, IgG, chemotactic agents (C5a, IL-8)
Serum antibody titer (IgG, IgM, Legionella) can be helpful to dx: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella
Respiratory anthrax tx Cipro or doxy
Respiratory (pneumonic) plague tx streptomycin or doxy
Respiratory tularemia (F tularensis) tx streptomycin
Created by: Adam Barnard Adam Barnard