Lower respiratory tract infection
Definition: An infection below the level of the vocal cords.
- LRTIs = can also be applied to other types of infection including lung abscess and acute bronchitis.
- Bronchitis can be classified as either acute or chronic. 40/1000 adults/y, and consists of transient inflammation via viral infection of the major bronchi and trachea.
- Acute Exacerbations of Chronic Bronchitis (AECB) are frequently due to non-infective causes along with viral ones. 50% of patients are colonised with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhali (CAP pathogens).
- Treatment: amoxillin or doxycycline
- Pneumonia, can be either HAP/ CAP. Life-threatening in elderly and immunocompromised. The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteraemic pneumonias
Treatment and management (conservative/medical/surgical)
- Pneumonia severity (including where to treat e.g. Home, hospital or intensive care) – CURB-65 score.
- Identification of causative organism – sputum / BAL
- Analgesia of chest pain
- Oxygen therapy
- SA and LA bronchodilators and possible complications of emphysema or lung abscess.
For community acquired respiratory infections the appropriate use of fluoroquinolones is a therapeutic option.
= Amoxicillin, gentamicin
Other respiratory tree infections of note:
- Pharyngitis: Group A Strep, corynebacterium diphtheria, EBV, adenovirus, enterovirus, HIV
- Epiglottitis: H.influenzae B (HIB) – vaccinated against these days, medical emergency! Secure airway, avoid distress to avoid tongue falling back and blocking airway. IV CEFUROXIME.
- Bronchitis: acute = viral/bacterial, chronic = smoking.