Pulmonary Infectious Disease

What is pneumonia?

inflammation of the lungs where the air sacs are filled with pus and may become solid

What are the types of pneumonia?

community acquired, hospital acquired, ventilator associated

What is community acquired pneumonia?

acquired outside the hospital setting or develops in the hospital within 48 hours of admission

What is Nosocomial pneumonia?

Development of pneumonia > 48 hours after admission

What are the most common pathogens in nosocomial pneumonia?

Pseudomonas or MRSA

What is ventilator acquired pneumonia?

Pneumonia that develops more than 48 hours after endotracheal intubation (ET tube)

What pathogens are responsible for bacterial pneumonia?

Strep pneumonia, H.flu, Klebsiella, and Staph aureus

Pulmonary exam findings of typical bacterial pneumonia

Dullness to percussion, increased tactile remits, ego phony, and crackles.

Workup of pneumonia

CBC w/diff, CMP, Sputum gram stain, sepsis workup, possibly bronchoscopy

What is the GOLD standard for diagnosing pneumonia?

Infiltrates on CXR

Klebsiella pneumonia is most common in

alcoholics and patients with chronic disease (DM)

what will the sputum in Klebsiella pneumonia look like?

purple colored

What is the CURB-65 score?

estimates mortality of CAP to determine appropriate disposition (discharge or admit)

0-1 CURB-65 score OR 0-2 expanded CURB-65

Outpatient

2 CURB-65 score OR 3-4 expanded CURB-65

Inpatient

3+ CURB-65 score OR 5-8 expanded CURB-65

ICU

Aspiration pneumonia is most common in the

right lower lobe

Which type of pneumonia has foul smelling sputum?

aspiration pneumonia

Wheezing heard in the lungs is described as

whistling

Rhonchi heard in the lungs is described as

rattling typically deeper than wheezing

Crackles heard in the lungs is described as

bubbly, caused by fluid buildup

who has a high risk for viral pneumonia

pregnant women, elderly, young children, and immunocompromised

What is the most common cause of viral pneumonia?

influenza virus

What is the most common cause of viral pneumonia in infants and children?

RSV

Physical exam findings of viral pneumonia?

Tachypnea, crackles, intercostal retractions, dullness to percussion, and pleural friction rub.

workup for viral pneumonia

CBC, CMP, PCR viral panel, cytology, respiratory bio fire panel

what is the most common type of atypical pneumonia

mycoplasma pneumonia "walking pneumonia"

Mycoplasma pneumonia most often affects

young, healthy people

Physical exam findings of Mycoplasma pneumonia

Conjunctivitis, oropharyngeal inflammation, and bulbous myringitis (in the eardrum but rare)

What is the most common CXR finding in mycoplasma pneumonia

reticulonodular patterns

What causes Legionella pneumonia?

contaminated water or air conditioner units.

Who is at the greatest risk for Legionella pneumonia?

immunocompromised, smokers, elderly, and chronic lung disease

Physical exam findings of Legionella pneumonia

AMS, fever >102, water non-bloody diarrhea, localized crackles.

Nosocomial legionella has up to ___% mortality

50%

What causes histoplasmosis pneumonia?

contamination from soil containing bird or bat droppings

Physical exam findings of histoplasmosis pneumonia

blood diarrhea, fever, ulcers, adrenal insufficiency

What is influenza?

Flu

This is a virus that invades the airway and respiratory tract

what is acute bronchitis

inflammation of bronchi due to upper airway infection

"common cold"

what is the most common cause of acute bronchitis?

Influenza A/B and rhinovirus

A patient comes in with a cough that has lasted more than 5 days. Chest wall tenderness. Sore throat. Congestion. What do you suspect the patient has?

Acute bronchitis

True or false?

Fever is an unusual sign in acute bronchitis.

True

What would be the significance of order a CXR when you suspect acute bronchitis

Used to exclude pneumonia

What are the types of acute respiratory failure (ARF)

hypoxemic, hypercapnic, and mixed

What is acute respiratory distress syndrome (ARDS)

Acute, diffuse inflammatory form of lung injury and respiratory failure. Onset within hrs to a few days

ARDS is most common in

critically ill patients

What is the most common causes of ARDS

sepsis*, pneumonia, and aspiration of gastric contents.

A patient has new onset respiratory failure, new radiographic pulmonary opacities, and impaired oxygenation (PaO2 >80mmHg). What do you suspect the patient has?

Acute Respiratory Distress Syndrome

Symptoms of ARDS

Acute dyspnea, hypoxemia, and multiorgan failure

Workup of ARDS

CXR or CT, CBC, CMP, BNP, EKG, ABG

(Patient is very sick, so lots for labs will need to be done).

Diagnostic criteria for ARDS

- hypoxemia that does not improve with supplemental O2

- infiltrates on CXR

- PF ratio <300

What is prone position

lying on stomach

what are the most specific labs/tests for Histoplasmosis?

Sputum or blood cultures

Who has an increased risk for severe cases of Influenza virus?

Pregnant women in 2nd and 3rd trimester

Clinical history of influenza

Abrupt onset of nausea, high fever/chills, body aches, HA, and worsening cough

Why do we avoid the use of aspirin to treat symptoms in children?

Reye syndrome, which can lead to hepatorenal failure and brain swelling

Rales indicate disease beyond

bronchi

What are potential cough suppressants that can be used in the treatment of acute bronchitis?

- Dextromethorphan (Robitussin)

- Guaifenesin (Mucinex)

True or False?

Patients with acute bronchitis do not experience benefit from ABX treatment

True

What is hypoxemia respiratory failure

Failure of the lungs and heart to provide adequate O2 to meet metabolic needs

what is hypercapnia respiratory failure

failure of the lungs to eliminate adequate CO2

Describe the process of ARDS

Damage to alveoli and their capillaries, leading to impaired O2 and CO2 exchange

What would you find on a CXR that will differentiate ARDS from heart failure?

In ARDS, the costophrenic angles are spared from the collecting edema.

The lower the PF ratio in ARDS, the _____ the mortality rate

higher

What intervention should be used in patients with ARDS to prevent atelectasis?

Prone position

When is it appropriate to use ECMO in a patient with ARDS?

This is saved for the most severe patients who do not improve with traditional ventilation.

"salvage option"

What does SARS-CoV-2 stand for?

severe acute respiratory syndrome coronavirus 2

What are risk factors of SARS-CoV-2?

- close contact with confirmed cases

- traveling in ares with incidence

- comorbidities

- immunocompromised

Incubation period of SARS-CoV-2

2-14 days

What are the variants of SARS-CoV-2

alpha, delta, omicron

How would you describe a mild case of COVID-19?

no dyspnea, sore throat, fatigue

How would you describe a severe case of COVID-19?

dyspnea, RR >30/min, hypoxia

How would you describe a critical case of COVID-19?

respiratory failure, shock, and multiorgan dysfunction

What is Long COVID?

Sx persisting > 4 weeks PLUS evolving sx

What are COVID toes?

thought to be an immune response to COVID, where the toes swell, become red, and the skin blisters possibly turning purple

When would it be indicated for a patient with COVID to be admitted to the hospital?

- Hypoxia, SaO2 <94%

- If they need O2 ventilatory support.

Which variant of SARS-CoV-2 has the highest mortality rate?

Alpha variant

What is Tuberculosis?

Pulmonary infection caused by mycobacterium tuberculosis

If a patient has tuberculosis, who do you report that information to?

The health department

What is a characteristic finding of TB on imaging?

tiny tubercles/nodules

What is latent TB?

The patient is asx, cannot spread TB, and if it is not treated it can turn into active TB.

What is active TB?

The patient can spread the disease, they feel very ill, and can be treated.

What are symptoms of tuberculosis?

Unexplained weight loss, night sweats, and hemoptysis.

Why is it important to obtain a pregnancy test in female patients you suspect have TB?

B/c the drugs used to treat TB are NOT safe for fetus

What is the workup for tuberculosis?

Sputum AFB culture

What reading of a PPD/TB skin test is suggestive that the patient may be positive for TB?

10-14mm

What reading of a PPD/TB skin test is a for sure positive TB?

>15mm

What do you need to monitor during tuberculosis treatment?

Renal function, liver enzymes, vision changes, hearing changes.