Chest infections

Peter was the second born, but only son, of three children. He appeared fairly well for the first year but was prone to developing infections and had had a few bouts of diarrhoea. At 18 months Peter showed lymphadenopathy (enlarged lymph glands) and hepatosleno-megaly (enlarged liver and spleen) and a severe chest infection was diagnosed as pneumonia. There was no family history of relevance to Peter s condition. 

Patients with protein-calorie malnutrition, especially children with marasmus and chest infections, had very high levels of serum IgD (R7). Antigen binding activity of IgD to diphtheria-toxoid and to bovine y-globulins in some human sera have been reported (G4, H3). 

It is a semisynthetic potent cephalosporin for parenteral administration. It can be administered less frequently because of its long half life. It is used in infections of genitourinary tract, bone, joint and soft tissue infections, septicaemia, endocarditis, gonorrhoea, postoperative chest infections, biliary tract infection and surgical prophylaxis. 

N.A. Terpenoids, cineole, beta-pinene, alpha-terpineol." Antiseptic, treat cold, sore throats, coughs, chest infections. 

In 31 elderly frail women, mean age 86 years, who were randomized to receive growth hormone or placebo for 14 days after surgery for hip fracture, there was an excess of thromboembolic events and chest infections the mechanism was not clear (17). 

Individuals with certain chronic illnesses and medical conditions may also suffer severe and potentially fatal side effects from the use of nitrous oxide. For example, anyone with a history of pulmonary hypertension, asthma, airway obstruction, head injury, or chest infection should not take nitrous under any circumstances. 

Mr FG experiences a chest infection 4 days post admission and is prescribed... 

Erythromycin may cause increases in the semm levels of simvastatin. The CSM has advised that this should not be co-prescribed with simvastatin. In the first instance the pharmacist should check local policies for management of hospital acquired chest infections/pneumonia to ascertain first and second line choices. If erythromycin or any macrolide cannot be avoided then a practical way forward may be to avoid taking any dose of simvastatin for the duration of the course of macrolide. In addition a recent Dmg Safety Update from the Medicines and Healthcare Products Regulatory Agency (MHRA, 2008) on statins has highlighted statin dmg interactions and the appropriate actions to take. 

Advise and monitor the patient if she suffers from colds or chest infection Educate the patient to watch for signs of deterioration and advise when to refer. 

Monitor for chest infection Raised WCC, with raised neurophils and CRP, will require a course of antibiotics. 

Mr PM, aged 82, is admitted to hospital on a Friday evening with a chest infection, via a GP referral. You see him in your ward for the first time on Monday morning. He lives with his wife in a house and they enjoy an active social life. He has smoked since the age of 14 and currently smokes about 40 cigarettes daily. He has tried to give up smoking in the last month and failed. This is his third admission in one year for a chest infection. 

Bill has smoked for 45 years and has a chronic, productive cough. He is now very short of breath. He first noticed this when he was walking uphill, but now he is short of breath walking on the flat. In the last few years, he has had a couple of chest infections, which were successfully treated with antibiotics. His doctor prescribed an inhaler last year but it made little difference to his breathing. Bill s latest lung function test is shown below. 

Q8 The two major types of COPD are chronic bronchitis and emphysema. It is not possible to determine which of these two conditions is responsible for the problems of this patient from the information given, but they often coexist. Chronic bronchitis is characterized by recurrent chest infections with a productive cough and sputum production for at least three months in two or more consecutive years. In chronic bronchitis there is hypertrophy of the mucous glands in the airways and production of a thick, tenacious mucus that is difficult to remove from the lung and which easily becomes infected. The incidence of bronchitis is increased in smokers. 

Q3 Chandra has suffered recurrent chest infections for three years and has had a chronic cough with sputum production during this time. Although he is not a smoker, he has been exposed to occupational dusts in the mining industry, which is known to be associated with development of COPD. His lung function test results are consistent with this diagnosis (see Part 2 of the case study). 

Qll Acute exacerbations of chronic bronchitis can be caused either by viral or bacterial infections. Production of thick, green sputum suggests Chandra has a bacterial infection. Common bacterial pathogens affecting the lung include Streptococcus pneumoniae and Haemophilus influenzae. It is recommended that COPD patients receive influenza vaccine each year pneumoccocal vaccine is also often recommended in chronic lung disease and may prevent recurrence of chest infection in the elderly. 

Chronic bronchitis is an obstructive pulmonary disease linked to smoking and prolonged working in dusty environments and is characterized by excessive mucus production with repeated chest infections. 

Common bacteria causing exacerbation of chronic bronchitis include S. pneumoniae and H. influenzae. The antibiotics usually prescribed for chest infections in patients with chronic bronchitis are amoxicillin and erythromycin. 

A 53-year-old Canadian lawyer taking long-term fluoxetine and nitrazepam developed a frank psychosis 1-3 days after starting to take clarithromycin 500 mg/day for a chest infection (175). His symptoms resolved on withdrawal of all three drugs, and did not recur with erythromycin or when fluoxetine and nitrazepam were restarted in the absence of antibiotics. 

Visual hallucinations developed in a 56-year-old man with chronic renal insufficiency and underlying aluminium intoxication maintained on peritoneal dialysis 24 hours after he started to take clarithromycin 500 mg bd for a chest infection, and resolved completely 3 days after withdrawal (177). 

Pneumonia is a common complication in elderly patients confined to bed. Chest infection is particularly common after stroke because of impairment in swallow and cough reflex, poor respiratory movement and pulmonary embolism. The risks can be reduced by good nursing and chest physiotherapy. A pharyngeal airway may be required, particularly in drowsy patients or after a brainstem stroke, and ventilation may be considered in certain patients. 

Patient 1 is an obese 45-year-old with raised transaminases which were discovered on admission to hospital with a chest infection. There is no past medical history or drug history of note. Investigations were undertaken for hepatitis. 

A 41-year-old woman presented with pain and pallor in the leg and a sensation of coolness exacerbated by exercise (34). For many years she had been taking a formulation containing ergotamine 1 mg plus caffeine 100 mg, at a dose of one or two tablets daily, for both prophylaxis and treatment of migraine. For 7 days she had also taken clarithromycin (dose is not stated) for a chest infection. Her legs were cool and cyanosed, with no palpable popliteal or foot pulses and an ankle-brachial index of only 0.6 (normal >0.8). 

An 86-year-old woman, with a history of stable schizophrenia, chronic obstructive pulmonary disease, ischemic cardiomyopathy, and type 2 diabetes, was admitted with cardiac insufficiency, which was treated by introduction of enalapril. A chest infection was treated with co-amoxiclav with gradual alleviation of sjmp-toms over 10 days. At this point, furosemide was begun, because of persistent signs of heart failure. After 3 days, erythema and bullae were noted on her pahns and soles, and later on the trunk, extremities, hard palate, and buccal mucosa. Biopsy showed the characteristic features of linear IgA bullous dermatosis, with linear deposition of IgA along the basement membrane. Co-amoxiclav and furosemide were withdrawn no new lesions were noted thereafter. 

On two occasions a 49-year-old asthmatic woman who took levofloxacin for a chest infection developed worse respiratory distress, requiring intubation (32). The second reaction was accompanied by a marked skin reaction. 

Chronic bronchitis is a long-term productive cough accompanied by episodes of shortness of breath. It is caused by chronic irritation of the airways by inhaled substances, most commonly tobacco smoke. Sufferers often have a history of acute chest infections that become more frequent and severe until there is a permanent cough. 

The symptoms are indicative of influenza and he may have developed a secondary bacterial chest infection. He is also considered an at-risk patient because of his age and his cardiovascular conditions. For these reasons you should tell his daughter to contact his doctor immediately. 

It is not uncommon for coughs to persist for several weeks in children after a chest infection. However, the child may have an allergy and be developing asthma. If so, the most likely cause is house dust mite or dander (fur particles) from a household pet. You should ask the mother for further clues for example is he worse in any particular room of the house, or worse after dust is raised, say with vacuuming or with changing the bed sheets Do any other family members suffer from asthma, hayfever or eczema On the other hand the child may have another viral upper respiratory tract infection, but as you are unable to decide the cause you should advise the mother to take him back to the doctor. 

---