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Lower respiratory tract infection

Definition
  • Infections affecting the airways below the level of the larynx, primarily bronchi and lungs.
Types
  • Bronchitis: Infection of the bronchi.
  • Pneumonia: Infection of the lung parenchyma.
  • Bronchiolitis: Infection of the bronchioles, typically seen in infants.
Common Pathogens
  • Bacteria: *Streptococcus pneumoniae*, *Haemophilus influenzae*, *Mycoplasma pneumoniae*.
  • Viruses: Influenza, respiratory syncytial virus (RSV), adenovirus.
Clinical Features
  • Persistent cough, sometimes productive.
  • Fever and malaise.
  • Chest discomfort or pain.
  • Dyspnoea and tachypnoea.
  • Crackles on auscultation in pneumonia.
Investigations
  • Chest X-ray: Consolidation suggests pneumonia.
  • Sputum culture: Identifies causative organism.
  • Full blood count: Raised white cell count suggests bacterial infection.
  • Arterial blood gases if severe.
Management
  • Antibiotics: Choice depends on suspected pathogen. Amoxicillin or doxycycline often used as first-line for community-acquired pneumonia in adults.
  • Supportive: Analgesia, antipyretics, and hydration.
  • Oxygen therapy for hypoxic patients.
  • Viral bronchitis often requires only supportive care.
Complications
  • Empyema: Pus in the pleural space.
  • Respiratory failure.
  • Septic shock.
  • Lung abscess.
Prevention
  • Vaccination, e.g., pneumococcal vaccine, influenza vaccine.
  • Hand hygiene and respiratory precautions.

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