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Lecture 11 Microbiology of Lower Respiratory Tract Infections
Definition of LRTI o Any infection of respiratory tract from vocal cords downwards o Includes bronchi, bronchioles, alveoli, parenchyma, pleura & pleural cavities Normal flora of LRT o Normal LRT is bacteriologically sterile o Inhaled particles including microorganisms are trapped by mucus & moved to URT by epithelial cilia Abnormal flora of LRT o Paralysis of cilia o Excessive volume &/or viscosity of mucus o Paralysis, ventilation, failure to protect LRT o Failure to cough up debris from larger airways o Loss of swallowing reflex o "Colonisers" of LRT often from URT (such as Haemophilus influenza and Streptococcus pneumoniae) o Antibiotic therapy WILL affect URT colonisation Types of LRTI o Acute cough (<3w) o Bronchiolitis o Bronchitis (acute exacerbation in COPD) o Bronchiectasis
? Abnormality of anatomy of respiratory tract
? Dysfunctional bag full of pus that becomes infected o Non-pneumonic LRTI o Pneumonia (community-acquired, hospital-acquired) o Lung abscess/Emphysema Infective exacerbation of chronic bronchitis (aka. COPD) o Antibiotic therapy indicated if two of
? Increased breathlessness, increased sputum volume, increased purulence o Patients with COPD may have colonisation of LRT with organisms normally found in URT such as H. influenza (50%), M. catarrhalis and to less extent S. pneumoniae o Give amoxicillin, tetracycline or macrolide Pneumonia o Types
? Community acquired pneumonia
* General o Symptoms of acute LRTI (cough and one other) o New focal chest signs on examination o One systemic feature (fever, shivers etc./raised temp) o No other explanation for illness, treated with CAP antibiotics
* Bacteria o Streptococcus pneumoniae
? Gpos laceolate diplococcus, 83 capsular serogroups
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