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Lower Respiratory Tract Infections Notes

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This is an extract of our Lower Respiratory Tract Infections document, which we sell as part of our Respiratory Notes collection written by the top tier of University Of Leicester students.

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Lower Respiratory Tract Infections Pneumonia Infective respiratory tract infection causing radiological shadowing Classified according to setting in which it is acquired as this influences the likely pathogens and therefore determines best empirical treatment

Community-acquired pneumonia Pathophysiology
- Droplet spread
- Organisms multiply rapidly in lung
- Local defense mechanisms overcome
- = Pneumonia Clinical features
- Fever
- Cough
- Sputum production (yello/green)
- Chest pain
- Dyspnoea
- Systemic features (malaise, anorexia, fatigue) Likely organisms
- Strep. Pneumonia
- H. Influenzae Investigations Microbial
- Sputum MC+S
- Blood culture
- Urine (legionella antigen)
- Microscopy (gram, acid fast stain for TB)
- PCR - viral replication
- Nose and throat swabs
- NPAs (nasopharyngeal aspirates
- viral)

Defense mechanisms
- Muco-cilary escalator
- Cough reflex Tobacco suppresses ciliary function = impaired defense Signs
- Tachypnoea
- Hypotension Severe disease
- Cyanosis
- Confusion
- Crackles, bronchial breathing

Differential diagnosis
- Pulmonary infarction (but no fever)
- Pulmonary oedema (no fever, 3rd heart sound)
- Inflammatory diseases o Vasculitis, acute allergic alveolitis
- TB (cavitation on CXR, night sweats) Non-Microbial Imaging
- CXR Bloods
- Blood gas (saturation)
- FBC (WCC, platelets)
- U+E (Urea + hydration status)

Management Assess severity
- CURB 65 General supportive measures
- Analgesia, O2, IV fluids Antibiotic therapy
- Mild cases (amoxicillin)
- Severe cases (IV macrolide - erythromycin) Treat complications
- Effusion, empyema, lobar collapse

CURB 65 Confusion Urea >7mmol/L Respiratory rate > 30/min Blood pressure <60mmHg diastolic Age > 65 2 = severe pneumonia (admit) No criteria = non-severe pneumonia 1 criteria = use clinical judgment and age to decide whether to admit

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