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WEEK 18:
Respiratory Tract Infections: bacterial infections
| Question | Answer |
|---|---|
| pneumonia classification (2) | community acquired or nosocomial (hospital acquired) |
| community acquired pneumonia divisions (2) | typical and atypical |
| community acquired pneumonia (CAP) cause | bacterial pathogens (streptococcus pneumoniae) |
| diagnosis | presence of new symptoms, signs of lower respiratory tract infection, and new pulmonary shadowing on CXR (sensitivity 50% to 85%) |
| pathogenesis of pneumonia (most common cause) | microaspiration of oropharyngeal contents during sleep |
| pathogenesis of pneumonia (2nd common cause) | inhalation of aerosol drops (0.5 to 1 micrometre) |
| pathogenesis of pneumonia (least common cause) | bloodstream infection |
| how does bronchopneumonia begin | begins as acute bronchitis then spreads locally into lungs (lower/ right middle lobe) with patchy areas of consolidation and microabscesses (pus filled cystic space) in areas of consolidation |
| lobar pneumonia | complete/ almost complete consolidation of lobe |
| complications of pneumonia (3) | lung abscesses, empyema (pus in pleural cavity), and sepsis |
| empyema | pus in pleural cavity |
| conventional bacteria cause how many causes of CAP | 60-80% |
| most common cause of URTI (upper respiratory tract infections)- common cold | rhinovirus |
| what is the best samples to obtain in infants and young children | nasal aspirates and swabs |
| what can be used to rule out bacterial pharyngitis | strep swabs |
| relevant clinical details for bacterial diagnosis (4) | sore throat (white pus trees image on tonsils), temp 38.2 degrees celsius, 48 hours since onset of pain, and no cough |
| relevant clinical details for viral diagnosis (4) | red sore throat, temp 37.8 degrees celsius, 5 days since onset of pain, and dry cough |
| clinical findings of LTRI (lower respiratory tract infection) (4) | high fever with productive cough, chest pain, tachycardia, and signs of consolidation |
| what type of consolidation would you find in LRTI | alveolar exudate (higher protein than transudate) |
| streptococcus pneumoniae | a gram positive diplococcus which is the most common cause of CAP |
| streptococcus pneumoniae structure | capsular polysaccharide for protection against phagocytosis |
| streptococcus pneumoniae relationship to penicillin | relative resistance to penicillin (becoming more common) |
| what does the urine test do for Streptococcus pneumoniae | detects capsular polysaccharide |
| haemophilus influenzae | gram negative rod with capsule which is the most common bacterial cause of acute exacerbation of COPD (makes COPD worse) |
| pseudomonas aeruginosa | gram negative rod with capsule that loves water (often transmitted by ventilators- hospital and ventilator acquired pneumonia) that produces green sputum (pyocyanin) |
| klebsiella pneumoniae | common gram negative fat rod causing lobar pneumonia and typical pneumonia in elderly patients in nursing homes and in alcoholics. Typical pneumonia associated with thick + blood-tinged sputum) |
| atypical features of pneumonia (5) | interstitial pneumonia (no signs of pneumonia), insidious onset + low grade fever, non productive cough, both URT/LRT symptoms, and flu symptoms |
| mycoplasma pneumoniae | no cell wall + most common cause of atypical pneumonia (20% CAP), common in adolescents + military, with an insidious onset and low grade fever. Treated with ribosomal antibiotics eg macrolides |
| legionella pneumophilia | cause of atypical pneumonia (more common in alcoholics, smokers and immunosupressed people) - gram negative rod which is poorly stained + loves water. Its antigens can be detected in urine and associated with high fever, dry cough, and flu like symptoms |
| nosocomial pneumonia occurrence | has to occur 48 hours after post admission |
| nosocomial pneumonia associated with (4) | ventilators (VAP) and intubation, opportunistic infection in parents with severe underlying disease, antibiotic therapy, and immunosuppression |
| CAP is managed where | GP |
| when is pneumonia most managed in GP(2) | symptoms + signs suggest more serious illness and symptoms are not improving with antibiotics as expected |
| severity of CAP is tested through | criteria CURB-65 in 65 year olds or more where if the answer to the measurement is yes then that is 1 point |
| C in criteria CURB-65 | confusion (mini mental test score of 8 or less)/ confused to time or place etc |
| U in criteria CURB-65 | urea >7mmol/l |
| R in criteria CURB-65 | respiratory rate >39bpm |
| B in criteria CURB-65 | blood pressure - systolic BP <90 mmHg or diastolic BP <60mmHg |
| score of 2 in criteria CURB-65 is classified as | moderate |
| score of 3+ in criteria CURB-65 is classified as | severe |
| microbiological investigations for moderate/ severe CAP ONLY | take blood + sputum cultures, AND, PCR/ immunofluorescence (for atypical organisms and viruses) |
| cystic fibrosis (and IV drug abusers) - staphylococcus aureus | gram positive cocci in clumps producing yellow sputum and is commonly causing secondary bacterial pneumonia after influenza or measles |
| empyema | pus in pleural cavity |
| atypical bacteria and viruses cause how many cases of CAP | 10-20% |
| empyema | pus in pleural cavity |
| atypical bacteria and viruses cause how many cases of CAP | 10-20% |
| how is the common cold diagnosed | clinical diagnosis not diagnostic testing (no tests) |
| symptoms of getting streptococcus pneumoniae (3) | rapid onset, productive cough, and signs of consolidation |
| bacteria causing nosocomial pneumonia (HAP) | pseudomonas, E.coli, gram positive bacteria eg S. aureus |
| how do you manage CAP (5) | confirm diagnosis + aetiological agent, CXR, culture and staining, assess severity of disease, and identify complications |
Created by:
kablooey
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