Chronic pulmonary Infection Flashcards Preview

Respiriatory: Airway Disease > Chronic pulmonary Infection > Flashcards

Flashcards in Chronic pulmonary Infection Deck (59)
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1

What are the possible diagnoses for a patient with the following symptoms:

* Shadow on CXR
* Weight loss
* Persistent sputum production
* Chest pain
* Increasing shortness of breath

* Lung Cancer
* Intrapulmonary abscess
* Empyema
* Bronchiectasis
* Cystic Fibrosis

2

What are risk factors for developing chronic pulmonary infection?

Abnormal host response
* Immunodeficiency (congenital, acquired)
* Immunosuppression (drugs, malignancy)
* Abnormal innate host defence (damaged bronchial mucosa, abnormal cillia, abnormal secretions)
* Repeated insult (aspiration, indwelling material)

3

What can cause immunodeficiency?

* Immunoglobulin deficiency
* Hypo-splenism
* Immune paresis
* HIV

4

What are different types of immunoglobulin deficiency?

* IgA Deficiency: common, increased risk of acute infections, rarely chronic infections
* Hypogammaglobulinaemia: rarer, increased risk of acute, and chronic infections
* CVID: commonest cause of immunodeficiency, recurrent infections
* Specific Polysaccharide Antibody Deficiency

5

How can smoking cause immunosuppression?

Abnormal cilia beat

6

What can causes aspiration?

NG tube down trachea rather than oesophagus

7

What is Specific Polysaccharide Antibody Deficiency (SPAD)?

Inability to develop antibodies against polysaccharide, so cannot resist certain bacteria

8

Why is hypo-splenism dangerous?

If no spleen, cannot produce polysaccharide antibodies

9

What is immune paresis?

Immune system goes into paretic state due to things like myeloma, lymphoma and metazoic malignancies

10

Why is immunosuppression common?

Due to increased use of immunosuppressant drugs

11

What are examples of immunosuppressant drugs?

* Steroids
* Azathioprine
* Methotrexate
* Cyclophosphamide
* Monoclonal antibodies (Infliximab, etanercept: TNFa, Rituximab: CD20, Leflunamide)
* Chemotherapy

12

What factors can damage bronchial mucosa?

* Smoking
* Recent pneumonia, or viral infection (‘Flu)
* Malignancy

13

What conditions can lead to abnormal cillia?

* Kartenager’s Syndrome
* Youngs Syndrome

14

What conditions cause abnormal secretions?

* Cystic fibrosis
* Channelopathies

15

What are causes of recurrent aspiration?

* NG feeding
* Poor swallow
* Pharyngeal pouch (collects food, etc)

16

What are causes of indwelling material?

* NG tube in the wrong place
* Chest drain
* Inhaled foreign body (peanut, chicken bone, piece of coal, etc)

17

What are forms of chronic respiratory infection?

* Intrapulmonary abscess
* Empyema
* Chronic Bronchial Sepsis
* Bronchiectasis
* Cystic Fibrosis and other oddities

18

What are clinical features of intrapulmonary abscesses?

* Indolent presentation (no pain)
* Weight loss common
* Lethargy, tiredness, weakness
* Cough
* Possible sputum

19

Why is treatment for intrapulmonary abscesses vital?

High mortality if not treated

20

What are causes of intrapulmonary abscesses?

Usually a preceding illness of some sort
* Pneumonic infection
* Post viral
* Foreign body

21

What are preceding illnesses of intrapulmonary abscesses?

Pneumonia
(Remember ‘Flu -> Staph Pneumonia -> Cavitating Pneumonia -> Abscess)
Aspiration pneumonia
* Vomiting
* Lowered conscious level
* Pharyngeal pouch
Poor host immune response
* Hypogammaglobulinaemia

22

What pathogens cause abscesses (stemming form pneumonia)?

Bacteria
* Streptococcus
* Staphylococcus (Particularly post ‘flu)
* E-Coli – normally in bowel but can present in chest to cause pneumonia
* Gram Negatives

Fungi
* Aspergillus

23

What can multiple abscesses on a CXR be indicative of?

Bacteraemia - bloot infection

24

What are causes of septic emboli?

* Right sided endocarditis
* Infected DVT – once infected travel to lungs
* Septicaemia
* Intravenous drug users

25

Why are intravenous drug users at risk of septic emboli and abscesses?

* Inject into groin – blood clot due to repeated trauma to the vien
* Leads to DVT
* Then Infection
* Then PE + Abscesses

26

Why are abscesses caused by PE's so dangerous?

* Very high mortality - 75%
* Abscesses sit close to pulmonary vessels – if abscess erodes into pulmonary artery, loss of blood (exsanguination)

27

What is empyema?

Pus in the pleural space

28

What are causes of empyema?

* 57 % of all patients with pneumonia develop empyema (commonest cause)
* Remainder are “Primary Empyema”, often iatrogenic, many idiopathic

29

What is the mortality of empyema?

* High mortality
* As high as severe pneumonia
* > 20 % of all patients with empyema die

30

What is the appearance of an empyema on a CT?

Looks like a banana - dark with lighter areas