胸部感染（英文ppt）chest

ChestInfections LawrencePike ChestInfections AcutebronchitisAcuteexacerbationofchronicbronchitisCommunityacquiredpneumonia Acutebronchitis Acutebronchitisistypicallyself limitinglasting7to14days Usuallycausedbyadenovirus rhinovirusorinfluenzavirus Bacteriararelycauseacutebronchitis however theymayactassecondaryinvadersfollowingaviralinfection BacteriaimplicatedincludeStreptococcuspneumoniae Haemophilusinfluenzae MoraxellacatarrhalisandoccasionallyStaphylococcusaureus especiallyduringinfluenzaepidemics Acuteexacerbationofchronicbronchitis Increasedpurulentsputum worseningcough pyrexiaandincreasedbreathlessness Haemophilusinfluenzae StreptococcuspneumoniaeandMoraxellacatarrhalisarecommonlygrownfromsputumsamples Communityacquiredpneumonia Anacutelowerrespiratorytractinfectionwithpurulentsputum cough fever breathlessnesscombinedwithsignsonexaminationandchangesonchestx ray UsualbacteriaimplicatedincludeStreptococcuspneumoniae mostcommon Haemophilusinfluenzae MoraxellacatarrhalisandoccasionallyStaphylococcusaureus especiallyduringinfluenzaepidemics AtypicalinfectionsincludethosecausedbyMycoplasmapneumoniae Chlamydiapneumoniae ChlamydiapsittaciandLegionellapneumoniae Incidence 17 ofall acute consultationsareforacuterespiratoryinfectionsInpreviouslyhealthysubjectsacutebronchitisisusuallyself limitinginnature However around5 arepneumoniasAcuteexacerbationofchronicbronchitisisassociatedwithviralinfectionsin50 ofcases Mycoplasmapneumoniaeoccursinepidemicswitha4 yearcycle Itismostcommoninchildren SymptomsandSigns Clinicalpresentationsrangefromcoughwithoutsputumorchestsigns toanillnesscharacterisedbyexpectorationofmucopurulentsputum fever dyspnoea pleuriticchestpainanddiffuseorfocalsignsinthechest Considerpneumoniainanypatient ofanyage withcoughanddyspnoea tachypnoeaandpleuriticchestpain and orfocalsignsinthechest especiallyiftheyaresystemicallyunwell Legionellapneumoniashouldbeconsideredifriskfactorssuchasrecenttravelorrecentrepairofplumbingarepresent DifferentialDiagnosis InfluenzaCongestivecardiacfailureChronicobstructiveairwaysdiseasePulmonaryembolismAcutepulmonaryoedemaChestinfectionwithunderlyingmalignancySubdiaphragmaticpathology e g cholecystitis pancreatitis perforatedduodenalulcer subphrenic hepaticabscess ShouldIuseanantibiotic Coughmaypersistfor2to3weeksafterpresentationandisunlikelytoresolveorimprovemorequicklyasaresultofantibiotictherapy Unnecessaryuseofanantibioticmaycauseresistanceoforganismstothedrugandincreasedpatientexpectationsofantibioticsforfutureminorillness Antibioticsmayalsocauseside effects ResistanceofStreptococcuspneumoniaetopenicillinVhasincreasedfrom0 3 in1989to7 5 in1996 andtoerythromycinhasincreasedfrom3 3 in1989to11 8 in1996 ShouldIuseanantibiotic Tominimiseresistance itisimportanttoprescribeonlywhenappropriateandnecessary Antibioticsmaybeofbenefitiftwoorpreferablythreeofthefollowingarepresent increasedsputumvolumepurulentsputumdyspnoea Inchildrentheprobabilityofaviralcauseishigherthaninadults ShouldIuseanantibiotic Antibiotictherapyshouldbeconsideredforthefollowinggroups 1 Reducedresistancetoinfection 2 Co existingillness diabetes congestivecardiacfailure asthma 3 Historyofpreviouspersistentmucopurulentcough 4 Clinicaldeterioration WhichAntibiotic MostcasesofbacterialchestinfectioninthecommunityremainsensitivetoamoxycillinIftreatmentwithamoxycillinshowsnoimprovementwithin48hours erythromycinshouldbesubstituted Erythromycinisfirstchoiceifanatypicalorganismissuspected However azithromycinorclarithromycinmaybemoreactivethanerythromycinagainstHaemophilusinfluenzaeandalsohavelessGIupset WhichAntibiotic ForexacerbationsofchronicbronchitisAmoxycillinoraTetracycline anderythromycininpencillinallergy areappropriatefirstchoicesifanyantibioticistobeused 5 ofStreptococcuspneumoniaeand5 ofHaemophilusinfluenzastrainsaretetracycline resistant 15 H influenzastrainsareamoxycillin resistant WhichAntibiotic Pneumoniainapreviouslyhealthychest amoxycillinisstillthefirstchoiceantibiotic IfStaphylococcusaureusissuspectede g afterinfluenzaormeasles addflucloxacillin Staphylococcalpneumoniarequirestreatmentfor2to3weeks then ifsymptomspersist seekadvicefromaspecialist IfMycoplasmapneumoniae considerthisduringanoutbreak orLegionellainfectionsuspected e g recenttravel useerythromycin Legionellapneumonia willrequireaprolongedcourseofantibioticuntilprovenresolution andadmissionshouldbestronglyconsideredorspecialistadvicesoughtinallcases Erythromycinisthehistoricaldrugofchoice althoughthenewermacrolidesmaybeanalternative WhichAntibiotic Chlamydiainfections useatetracyclineorerythromycinfor10to14days Quinolones Ciprofloxacin Ofloxacin havepooractivityagainstStreptococcuspneumoniaeandshouldnotbeusedassingleagentsin blindtherapy ofchestinfections Fi