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Pulm IV: Infectious Cheat Sheet by

Pulmonology
medical     medicine     lung     pathophysiology     disease

Acute Bronchitis

Definition
Inflam­mation of the airways (trachea, bronchi, bronch­ioles) charac­terized by cough
Etiology
>90% viral (rhino­virus, corona­virus, RSV)
CXR will be ____ in acute bronchitis
Negative
Treatment for acute bacterial bronchitis
Second­-ge­ner­ation cephal­osporin (ie Ceftin)
When are antibi­otics indicated in acute bronchitis
Elderly, underlying cardio­pul­monary disease, cough >7-10 days, immuno­com­pro­mised state

Acute epiglo­ttitis

Definition
A severe, life-t­hre­atening infection of the epiglo­ttis*
Most common ages
2-7 yo
What has decreased the incidence in children
Wide-s­pread admini­str­ation of H. flu vaccine
Clinical findings
Patients sit upright with necks extended, higher fever, reap. distress, drooling
Lateral neck radiograph finding
Thumbprint sign
Treatment
Secure airway + broads­pectrum 2nd or 3rd generation cephal­osporin (cefot­axime or ceftri­axone) x 7-10 days
Buzzwords: Drooling, sniffing position, tripod, toxic, thumbprint sign
 

Croup

Definition
Viral laryng­otr­ach­eo-­bro­nch­itis, affects kids 6mo-5yo
Most common cause
Parain­fluenza virus types 1 & 2
Clinical findings
Harsh, barking, seal-like cough
PA neck film radiograph
Steeple sign
Treatment
Mild croup doesn't need treatment
Buzzwords: pediatric with barking cough, steeple sign, inspir­atory stridor

Tuberc­ulosis

Organism
Mycoplasma tuberc­ulo­sis­-ac­quired by inhaling organisms within aerosol droplets expelled from coughing
Inactive TB most commonly found in
Apices of lungs
Most common symptom
Cough
Histologic hallmark
Bx showing caveating granulomas
Tx for LTBI
INH x 9 months
Tx for active TB
INH/RI­F/P­ZA/EMB x 2 months then INH/RIF x 4 months
Indura­tions greater than ___ should be treated aggres­ively
5mm
Buzzwords: Apical infilt­rates, fever, chills, dry cough

Acute bronch­iolitis

Definition
Inflam­mation of the bronch­ioles (<2mm diameter), primarily in kids/i­nfants
Most common organism
RSV
Treatment
Hospit­ali­zation + ribavirin + supportive measures
 

Pneumonia

Definition
Inflam­mation in the alveoli of the lung caused by microo­rga­nisms
Most common cause of CAP
Strep pneumo.
Clinical Features
cough, sputum, SOB, pleuritic chest pain, sweats, rigors
Treatm­ent­-un­com­pli­cat­ed/­out­patient
Doxycy­cline, erythr­omycin, macrolides (azith­rom­ycin), fluoro­qui­nolones
Treatm­ent­-in­patient (want to cover Legion­ella)
Ceftri­axo­ne/­cef­otaxime + azithr­omy­cin/or fluoro­qui­nolone
Most common cause of atypical CAP
Mycoplasma pneumo.
Treatm­ent­-at­ypical CAP
erythr­omycin (Mycop­lasma pneumo.) or tetrac­ycline (Chlam­ydia)
Who is at highest risk for HAP?
ICU patients on mechanical ventil­ation
Organism in ICU with worst prognosis
Pseudo­monas auroginosa
Most common opport­unistic infection in patients with HIV
Pneumo­cystis jiroveci
Treatm­ent­-HI­V-r­elated pneumonia
Bactrim (trime­thr­opr­im/­sulfa.)
When is prophy­laxis recomm­ended for HIV-pn­eumonia
CD4<200
Clinical Scenario: >35yo with PNA. Rusty colored or yellow­-green sputum. Acute onset F/C
Strep. pneumonia
Clinical Scenario: <35 yo, college students. Fever, cough, +/- sputum, chills, muscle aches, Bullous myringitis
Mycoplasma pneumonia
Clinical Scenario: PNA w/ Smokers, COPD
H. influenza
Clinical Scenario: PNA w/ DM, immuno­com­pro­mised, EtOH. Currant color sputum.
Klebsiella
Clinical Scenario: PNA w/ Water, late summer, constr­uction site. Diarrhea. Toxic looking
Legionella
Clinical Scenario: PNA from Nursing homes, chronic care facility. Purulent sputum
Staphy­loc­occus aureus
Clinical Scenario: PNA & HIV+, AIDS, Immuno­com­pro­mised. Sx out of proportion to exam. Diffuse inters­titial & alveolar infilt­rates
Pneumo­cystis jerovecii; TMP-SMX = Drug of choice
Clinical Scenario: PNA & decreased mental status, poor dental hygiene, dentures, foul smelling sputum, bronch­iec­tasis. Patchy infilt­rates in dependant lung zones
Aspiration pneumonia
Buzzwords: Fever, cough, sputum. Crackles, decreased breath sounds, dullness to percus­sion, +egophony, pector­iloquy. CXR – infilt­rates or consol­idation

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