Lower Respiratory Tract Infections

10 Questions

What is the primary goal of non-pharmacological therapy in pneumonia treatment?

Provide supplemental oxygen

What is the primary factor in selecting antibiotic therapy for pneumonia?

All of the above

What is the expected timeframe for full recovery from pneumonia?

10-14 days

What is the purpose of chest physiotherapy in pneumonia treatment?

To aid in postural drainage

What is the goal of achieving antibiotic concentrations in respiratory secretions?

To achieve concentrations in excess of pathogen MIC

What is the purpose of monitoring WBC count in pneumonia treatment?

To monitor for improvements in laboratory parameters

What is the primary method of preventing VAP?

Minimizing the risk of developing VAP

What is the purpose of administering bronchodilators in pneumonia treatment?

To manage bronchospasm

What is the expected timeframe for symptoms to begin resolving after initiation of appropriate antibiotics?

Within 2 days

What is the purpose of fluid resuscitation in non-pharmacological therapy?

To maintain hydration and prevent organ dysfunction

Study Notes

Lower Respiratory Tract Infections (LRTIs)

LRTIs, including COPD, are the 3rd and 4th leading causes of death worldwide.
LRTIs include acute bronchitis, pneumonia, and acute exacerbation of chronic lung diseases such as COPD and bronchiectasis.
Causative agents are viral or bacterial.
Annual incidence of pneumonia is 24.8 per 10,000 adults, with a higher incidence in patients >65 years of age.

Pneumonia

Pneumonia is a bacterial or viral infection of the lungs, causing inflammation, increased mucus secretion, and impaired mucociliary function.
Pathogens can enter the lungs through inhalation, bloodstream, or aspiration of oropharyngeal contents.
Impairments in normal defense mechanisms, such as mucociliary transport, can increase the risk of developing pneumonia.

Pneumonia Classification

Community-Acquired Pneumonia (CAP): caused by Streptococcus pneumonia, Moraxella Catarrhalis, Haemophilus influenzae, and respiratory viruses.
Hospital-Acquired Pneumonia (HAP): caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Enteric gram-negative bacilli.
Ventilator-Associated Pneumonia (VAP): caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella spp.

CAP

Classified as "atypical" or "typical" based on patient presentation, clinical observations, and causative pathogens.
Typical CAP: associated with acute fever, chills, pleuritic chest pain, and productive cough.
Atypical CAP: associated with myalgias, fever without chills, headache, and unproductive cough.

Signs and Symptoms

Respiratory symptoms: cough, shortness of breath, difficulty breathing
Non-respiratory symptoms: fever, fatigue, sweats, headache, myalgias, mental status changes
Signs: temperature, increased respiratory rate, cyanosis, diminished breath sounds

Diagnosis

Laboratory tests: White Blood Cell count, Chest X-ray, CT scan, Microbiological tests
Diagnostic tests: Sputum gram stain and culture, Bronchoscopy (inpatient only), Blood culture

Risk Factors

Not specified in the text

Complications

Bacteremia, difficulty breathing, fluid accumulation around the lungs, lung abscess

Treatment

Goals: eradicate offending organism, achieve complete clinical cure, minimize associated morbidity
Non-pharmacological therapy: oxygen, mechanical ventilation, fluid resuscitation, nutritional support, fever control, chest physiotherapy
Pharmacologic therapy: antibiotic selection depends on pneumonia type, patient factors, and severity of disease presentation

Monitoring

Symptoms begin to resolve within 2 days of initiation of appropriate antibiotics, with full recovery expected in 10 to 14 days
Monitor improvements or worsening of clinical symptoms, laboratory and diagnostic parameters, including WBC count, chest radiograph, blood gas values, and oxygenation

Prevention

Vaccination, immune prophylaxis for RSV, minimize the risk of developing VAP by preventing aspiration and limiting the length of mechanical ventilation.