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