Respiratory infections

Learning resources

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CPD framework

The respiratory infections CPD framework provides an outline of topics to guide your learning and development.

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1. Anatomy and development of the respiratory system including malformations

  1. Pleura
  2. Lungs
  3. Bronchopulmonary segments
  4. Trachea and bronchi
  5. Hila
  6. Pulmonary vasculature and lymphatic drainage
  7. Mediastinum
  8. Diaphragm
  9. Pulmonary lobules (site of infections can be lobar or segmental specific)

2. Immunology and defence mechanisms

  1. Ciliary mechanisms
  2. Anatomical barriers (including epithelial barrier function and how this is influenced by pathogens)
  3. Innate immune defence mechanisms, e.g. recognition of pathogen-associated molecular patterns by structural cells (airway epithelium) and subsequent anti-microbial and pro-inflammatory responses
  4. Reflex mechanisms (sneezing, cough and dyspnoea)
  5. Mucociliary clearance and fluid homeostasis
  6. Innate defence mechanisms (broad outline): professional phagocytes
  7. Acquired immune reactions with immunoglobulin and the role of IgM, IgG and IgA
  8. IgG subclasses and IgE
  9. Type 1 and type 2 inflammation
  10. Granulomatous inflammation/fibrosis induced by the cell-mediated immune response

3. Ventilation

  1. Physiology of tidal breathing: active inspiration and passive expiration
  2. Relative elastic properties of the lungs and chest wall
  3. Lung volumes
  4. Transpulmonary pressures and breathing

4. Arterial blood gas (ABG) and acid-base status assessment

  1. Step 1: Evaluate the utility of ABG, capillary blood gas and venous blood gas
  2. Step 2: Diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between arterial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PCO2) and pH
  3. Step 3: A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts
  4. Management of clinical diseases, e.g. COPD and sepsis with A-B disorders in ABG
  5. Ventilation-perfusion defect

5. Symptoms

  1. Cough
  2. Colour and nature of sputum (clear mucoid, purulent, haemoptysis, etc.)
  3. Pleuritic chest pain
  4. Fever versus night sweats
  5. Wheezing
  6. Haemoptysis (streak/blob, associated sputum, quantity and massive haemoptysis)
  7. Chest wall pain
  8. Fatigue/malaise
  9. Dyspnoea
  10. Weight loss

6. Signs

  1. Temperature
  2. Finger clubbing
  3. Cyanosis
  4. Respiratory rate
  5. Saturation
  6. Heart rate
  7. Hypotension and shock
  8. Consolidation
  9. Pleural effusion
  10. Accessory muscle use
  11. Wheezing and stridor

7. Syndrome-based approach to diagnosis and differential diagnosis

  1. Common upper respiratory tract syndromes (including acute infective rhinitis, sinusitis, pharyngitis, epiglottitis and laryngotracheitis)
  2. Acute bronchitis
  3. Exacerbation of asthma
  4. Exacerbation of COPD
  5. Community-acquired pneumonia (CAP) including nursing home-acquired pneumonia (NHAP)
  6. Nosocomial pneumonia
  7. Seasonal influenza
  8. Acute bronchiolitis
  9. Exacerbation of bronchiectasis
  10. Pulmonary TB

8. Bronchoscopy

  1. Bronchoalveolar lavage (BAL)
  2. Brushing samples
  3. Protected sampling in an intensive care unit (ICU) to prevent upper airway contamination
  4. Biopsy for culture

9. Endobronchial ultrasound (EBUS) and oesophageal ultrasound (EUS)

  1. Transbronchial lung biopsy cultures, and culture and analysis of transbronchial needle aspirates (for differential diagnosis)
  2. GeneXpert

10. Thoracentesis

  1. Indications
  2. Knowledge of indications for thoracentesis and biopsy
  3. Thoracentesis
  4. Interpretation of results
  5. Biochemical analysis for differential diagnosis

11. Thoracoscopy

  1. Indications
  2. Medical thoracoscopy with biopsy: indications
  3. Pleural fluid and pleural biopsy samples for culture

12. Chest X-ray

  1. Miliary TB pattern
  2. Mediastinal lymph nodes
  3. Lung cavities
  4. Halo-sign
  5. Septic emboli
  6. Abscess
  7. Hydatid cyst
  8. Sequestrum
  9. Signs of pleural infection/parapneumonic effusion
  10. Atelectasis signs
  11. Signs of bronchiectasis
  12. Consolidation and air bronchogram sign
  13. Ground glass opacities
  14. Solitary nodule

13. Thoracic ultrasound

  1. Thoracic ultrasound to guide thoracentesis/aspiration
  2. ICU patients that cannot be moved
  3. Pneumonia diagnosis
  4. Empyema diagnosis
  5. Complicated parapneumonic effusion

14. Computed tomography scan

  1. Aspergillus-related appearances
  2. Tree-in-bud sign and infections
  3. Bronchiectasis
  4. Non-resolving pneumonia
  5. Cryptogenic organising pneumonia
  6. Empyema
  7. Mediastinal lymph nodes
  8. Bronchopleural fistula
  9. Radiological signs of:
    1. Diseases associated with Aspergillus
    2. Non-tuberculous mycobacteria (NTM)

15. Sputum assessment

  1. Common pathogens and their antibiotic sensitivities
  2. Samples and specific pathogens
  3. Acid-fast bacilli: number, interpretation of quality, sputum induction indication and culture versus immunofluorescence (IF) versus PCR
  4. Likelihood of a laboratory report being correct (e.g. Gram-negative pathogens or gonococcal pharyngitis); Nocardia as an acid-fast organism
  5. Whole-genome sequencing (WGS) and targeted next-generation sequencing of Mycobacterium tuberculosis and other mycobacteria
  6. GeneXpert

16. Basic microbiological methods

  1. Conventional microbiological methods such as Gram staining, culture and sensitivity testing for different pathogens, such as atypical bacteria, viruses and fungi, and for Pneumocystis jirovecii pneumonia (known in the past as Pneumocystis carinii pneumonia (PCP))
  2. Indications for and collection of biological specimens, Gram staining, culture, molecular methods, IF and genetic testing
  3. Interferon gamma release assay, interpretation of microbiological results provided by BAL, quantitative culture, particularities in immunocompromised patients, particularities in nosocomial infection and types of sputum harvest (spontaneous, induced and bronchial aspirate)
  4. Airway microbiome in relation to relation to epigenetic and transcriptomic profiles in lung tissue
  5. Microbiologic diagnosis of TB (smear examination, liquid and solid culture media, molecular study of resistance and phenotypic/genotypic methods)

17. Inhaled drug therapy

  1. Problems with inhaled therapy
  2. When to use inhaled drugs, e.g. amikacin in bronchiectasis
  3. Delivery modules
  4. Indications and application at an ICU

18. Systemic pharmacotherapy

  1. Interpreting laboratory results and choosing antibiotics
  2. Use of antivirals in flu epidemics
  3. Antibiotic stewardship and adherence to guidelines
  4. Place of corticosteroids
  5. Pharmacokinetics and pharmacodynamics

19. Respiratory physiotherapy

  1. Role of physiotherapy in sputum induction
  2. Postural drainage in bronchiectasis
  3. Muscle strengthening
  4. Aerobic exercise as a method for airway clearance

20. Pulmonary rehabilitation

  1. Rehabilitation and airway clearance to help reduce exacerbations of chronic respiratory diseases such as COPD and bronchiectasis
  2. Prevention of infections

21. Palliative care

  1. Oxygen therapy
  2. Sedation
  3. Pain therapy

22. Preventative measures

  1. Vaccination
    1. Influenza
    2. Pneumococcal
    3. Bacillus Calmette–Guérin (BCG)
    4. Other vaccinations
  2. Smoking cessation
  3. Dental care
  4. Aspiration management
  5. Infection control
  6. Cough hygiene
  7. Infection surveillance
  8. Universal precautions for respiratory isolation
  9. Isolation and reverse isolation, including specific microbes in cystic fibrosis (CF) and bronchiectasis (e.g. Pseudomonas)
  10. Infectious risks to healthcare workers (HCWs): control and elimination of TB including the BCG vaccine
  11. Segregation under infection control and relevance to CF and TB
  12. Study of TB patient contacts, TB isolation criteria and indications for diagnosis and treatment of TB
  13. Role of air pollution

23. Chest tube insertion

  1. Empyema
  2. Indications for and management of chest tube insertion
  3. Endopleural lysis

24. Lung transplantation

  1. Course of opportunistic infections after lung transplantation
  2. Differentiation between organ rejection and infection
  3. Prophylaxis
  4. Post-transplant management

25. Evaluation of respiratory emergencies

  1. CAP
  2. Hospital-acquired pneumonia (HAP)
  3. Sepsis
  4. Bioterrorism

26. Differential diagnosis

Differential diagnosis using clinical and radiological findings of infectious diseases (i.e. those caused by bacteria, viruses, fungi, mycobacteria and other difficult-to-treat microorganisms) in contrast with those of non-infectious disorders

27. Immediate management steps

  1. Time to first intravenous antibiotics
  2. Use of oxygen (pneumonia versus COPD)
  3. Sepsis

28. Guidelines for first-line treatment of:

  1. CAP
  2. HAP
  3. Ventilator-associated pneumonia (VAP)
  4. NHAP

29. Upper airway diseases

  1. Common upper respiratory tract syndromes (including acute infective rhinitis, sinusitis, pharyngitis, epiglottitis, laryngotracheitis and tonsillitis)
  2. Allergies and the upper respiratory tract

30. Asthma

  1. Molecular mechanisms of exacerbation
  2. Infectious management of exacerbation
  3. Allergic bronchopulmonary aspergillosis
  4. Infectious causes of eosinophilia

31. Bronchitis

Acute bacterial and viral bronchitis

32. COPD and emphysema

  1. Molecular mechanisms of exacerbation
  2. Infectious management of exacerbation, i.e. viral and bacterial
  3. Immunomodulatory therapy
  4. Risks associated with inhaled corticosteroids
  5. Vaccination
  6. Bacterial colonisation
  7. Long-term macrolides

33. Bronchiolitis

  1. Respiratory syncytial virus
  2. Differential diagnosis
  3. Other viruses and bacteria

34. Bronchiectasis

  1. Diagnostic and aetiological work-up
  2. Management of exacerbation
  3. Bacterial and non-bacterial surveillance
  4. Eradication
  5. Long-term antibiotic and immunomodulatory therapy
  6. Vaccination
  7. Rehabilitation
  8. Respiratory physiotherapy
  9. Classification severity
  10. Haemoptysis and management

35. Lower respiratory tract infections

  1. CAP (including NHAP and HCAP)
  2. Nosocomial pneumonia
  3. Specific risk factors

36. Pleural infections

  1. Diagnostic methods in radiology and ultrasound parapneumonic effusion and empyema pleuritis
  2. Indication for large-bore pleural drainage
  3. Indication for medical and surgical thoracoscopy
  4. Evaluating the accuracy of microbiological methods

37. Lung abscesses and other infections

  1. Choice and duration of antibiotic treatment in particular situations, such as intravenous drug users, and aspiration
  2. Surgical intervention

38. Influenza, pandemics and severe acute respiratory syndrome prophylaxis

  1. Population groups with a worse prognosis
  2. Infection control
  3. Medical treatment

39. Infections in an immunocompromised host

  1. PCP
  2. Empirical antibiotic selection and treatment particularities in patients with acquired immunodeficiency, neutropenic patients, patients with solid organ malignancy, lung and other solid organ transplant recipients, haematopoietic cell transplant recipients, patients with other haematological conditions, patients with secondary immunodeficiency induced by drugs and biologicals and patients with primary immune deficiency syndromes
  3. Antibiotic prophylaxis
  4. Indication for immunoglobulins
  5. Role of invasive diagnostic testing
  6. Diabetes
  7. Lupus
  8. Fungal infections
  9. Pulmonary TB

40. Aspiration pneumonitis

  1. Choice of antibiotics
  2. Prognosis
  3. Supportive care
  4. Preventative measures
  5. Risk factors for aspiration pneumonitis

41. Pulmonary TB including multidrug-resistant/extensively drug-resistant (MDR/XDR) TB

  1. Consideration of TB in the differential diagnosis of respiratory infections
  2. Epidemiology, burden of disease and risk factors: know when to investigate and what tests to ask for
  3. Indication for isolation and discontinuation of isolation
  4. Risk factors for MDR/XDR TB
  5. Drug susceptibility and treatment
  6. Directly observed therapy (DOT) / Video observed therapy (VOT)
  7. Miliary TB
  8. Adverse events (AEs)
  9. Diagnostic tests
  10. Molecular tests
  11. WGS

42. Extrapulmonary TB

  1. Differential diagnosis
  2. Diagnosis of lymphatic TB and indication for EBUS
  3. Rate of associations with pulmonary TB
  4. Role of immunological tests for increasing the probability of diagnosis in patients with relevant risk factors and symptoms
  5. Pleural TB

43. Latent TB infection

  1. Diagnosis
  2. Contact investigation
  3. Treatment
  4. Surveillance of side effects
  5. Alternative regimens in case of AEs
  6. Treatment of latent TB infection in immunocompromised patients
  7. Selection of candidates to treat

44. Non-TB mycobacterial diseases

  1. Adherence to diagnostic criteria
  2. Indication for treatment
  3. Treatment
  4. Monitoring of drug responses including relapse, re-infection and cure
  5. Epidemiology and risk factors for NTM
  6. Clinical presentation of NTM diseases
  7. HIV co-infection
  8. Immunosuppression

45. Acute respiratory failure

  1. Management of pneumonia
  2. Rationale for the use of guidelines for antibiotic therapy
  3. Management of severe exacerbation of COPD

46. Mediastinitis

  1. Differential diagnosis and testing
  2. Treatment
  3. Antibiotics
  4. When to perform surgery
  5. Oesophageal perforations
  6. Transoesophageal fistulae

47. Primary immunodeficiency syndromes

  1. Patterns of pulmonary involvement in primary immunodeficiency disorders
  2. Recognition, assessment and management of the severity of respiratory disease in patients with primary immunodeficiency disorders
  3. Appropriate vaccination and prophylaxis regimens
  4. Emphasise the most common primary immunodeficiency syndromes

49. CF

  1. Diagnosis and differential diagnosis
  2. Infection control and cross-infection
  3. Infection surveillance
  4. Microbiological evaluation
  5. Universal precautions
  6. Isolation and reverse isolation
  7. Physiotherapy
  8. Particularities in treatment (pharmacokinetics)
  9. Immunomodulatory drugs
  10. Antibiotic management for eradication
  11. Suppression
  12. Acute exacerbation
  13. New CF transmembrane conductance regulator (CFTR)-specific medications
  14. Non-respiratory management
  15. CFTR modulators
  16. NTM infections in CF
  17. When and how to go for screening

50. Genetic susceptibility to respiratory infections

  1. Differential diagnosis and recognition of primary ciliary dyskinesia
  2. Diagnostic testing
  3. Diagnosis of primary ciliary dyskinesia
  4. α1-antitrypsin

51. Occupational respiratory infections in HCWs

  1. Hepatitis
  2. TB screening in HCWs
  3. TB prevention in HCWs
  4. TB infection control training for HCWs
  5. Precautions for pregnant HCWs: measles, influenza and TB
  6. Zoonosis
  7. Influenza in exposed HCWs

53. Lifestyle

  1. Alcohol abuse
  2. Smoking including electronic cigarettes, marijuana and water pipes

Guidelines on respiratory infections

Access the catalogue of ERS guidelines, statements and technical standards relating to the topic of respiratory infections.

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