Conditions of Respi System

7/31/2019 Conditions of Respi System

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Part A/ModuleA2/Session 2

Part A Module A2

Session 2

Conditions

of theRespiratory System


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Objectives

1. Describe the various etiological agents that causerespiratory infections

2. Describe the clinical presentation of each

infection

3. List the recommended diagnostics and commonfindings for each infection

4. Understand the treatment and management ofrespiratory infections

5. Make a differential diagnosis using case study


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Introduction


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Overview

Pulmonary involvement is among the most commoncomplaints in AIDS patients

Bacterial pneumonia and tuberculosis can occurearly in the course of HIV infection---when the CD4

count is >500 Pneumocystis carniior p.jiroveci pneumonia (PCP)

almost always occurs when the CD4


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Differential Diagnosis

Mycobacterial infection M. tuberculosis, M.avium complex

Protozoal infectionToxoplasmosis gondii

Bacterial infection

Streptococcus pneumoniae, Haemphilusinfluenzae, Staphylococcus aureus,

Moraxella cattharalis, Klebsiellapneumoniae, Pseudomonas aeruginosa

Fungal Infection

Pneumocystis carinii or p.jiroveci (PCP),Penicillium marneffei, Cryptococcusneoformans, Histoplasmosis,

Coccidioidomycosis, Aspergillosis

Helminthic infectionStrongyloides stercoralis,

Paragonimus westermanii


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7/20Part A/ModuleA2/Session 2

Respiratory Problems

Bacterial Pneumonia

Pneumonia: Haemophilus influenzae

Pneumocystis carinii pneumonia or p.jiroveci (PCP)



Common etiological agents:Streptococcuspneumoniae

Clinical presentation: Abrupt onset with fever,cough, production of purulent sputum, dyspnea,

and pleuritic chest pain

Recommended diagnostics: Chest X-ray, bloodculture, FBC, gram stain of sputum, sputum cultureand sensitivity

Common findings: X-ray may show pneumonicconsolidation, infiltrates, or pleural effusion;leukocytosis; blood cultures may be positive

Bacterial Pneumonia



Bacterial Pneumonia



S Pneumoniae Pneumonia



Management and treatment:

Cefotaxime 2 gmIV q6h Ceftriaxone 2gm/day IV Amoxicillin 750 mg PO tid

Fluoroquinolones: Levofloxacin 500 mg PO/IV qd;

Gatiflloxacin 400 mg PO/IV qd;Moxifloxacin 400 mg PO/day

Where S. Pneumonia is not resistant to Penicillin,give 4 to 6 million units of procaine Penicillin G in2 - 4 IM injections

Alternative Treatment: Macrolide, Vancomycin

Comments: Amoxicillin is the drug most likely to beused in resource-constrained countries

Bacterial Pneumonia, continued



Etiological agent: H. influenza

Clinical presentation:

Fever, cough, purulent sputum, dyspnea,bronchopneumonia

Recommended diagnostics:

Chest X-ray, FBC, gram stain of sputum

Common findings:

X-ray may show pneumonic consolidation, morediffuse infiltrates, or pleural effusions;leukocytosis; blood cultures may be positive

Pneumonia:Haemophilus influenzae



H. influenza, continued


Cefuroxime

Alternative regimens: TMP-SMX

Cephalosporins

Fluoroquinolones

Comments:H. influenzavaccine not indicated inadults--most H.fluin patients with HIV is atypical



Pneumocystis cariniior p.jiroveci pneumonia(PCP)



PCP



PCP, continued

Etiological agent:Pneumocystis carinii orp.jiroveci

Clinical presentation: Dry cough, progressiveshortness of breath, fever, few chest signs

Recommended diagnostics: Induced sputum,broncho-alveolar lavage or biopsy

Common findings: Definitive diagnosis rests in

finding cysts in induced sputum, broncho-alveolarlavage or biopsy specimens; Chest x-ray showsbilateral lace-like interstitial infiltrates extendingfrom the perihilar region or may be normal




TMP-SMX 15 mg/kg/day(Trimethoprim) PO or IV

x 21 days + PO235mm Hg and

Prednisone 40 mg bid x 5 days, then 40 mg/day

x 5 days, then 20 mg/day to completion of

treatment

PCP, continued



Alternative Treatments:

TMP 15 mg/kg/day PO + dapsone 100mg/day x 21 days

Pentamidine 4 mg/kg/day IV x 21 days

Clindamycin 600 mg IV q8h or 300-400 mgPO q6h + primaquine 15-30 mg base/day x21 days

Atovaquone 750 mg PO bid with meal x 21

days Comment: PCP is the most frequently identified

serious OI in HIV disease

PCP, continued



Case Study:

Patient with Respiratory Symptoms



Case Study:

Patient with Respiratory Symptoms -Answers

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Conditions of Respi System