Distinguishing features of common upper respiratory illnesses
	Viral URTI	Influenza	Streptococcal pharyngitis
Onset	Slow, stepwise, migratory, or evolving	Abrupt & often dramatic	Variable
Sx	Rhinorrhea, coryza, sneezing, mild pharyngitis	Usually mild	Predominantly pharyngeal symptoms
Systemic Sx	Usually mild	Prominent with possible high fever, myalgias, headache	Variable with possible fever & myalgias
PEx	Nasal edema with normal or slightly erythematous pharynx	Variable but often unremarkable	Pharyngeal erythema, tonsillar hypertrophy & exudates, tender cervical lymph nodes

	Pneumonia
S/S	Fever + Cough
CURB-65	o   Confusion o   Respiratory rate >30/min o   BUN >7 mmol/L or 20 mg/dL o   Room air PaO2 <60 mmHg o   O2 saturation <90% on room air o   Blood pressure <90 mmHg systolic or <60 mmHg diastolic o   Age >65
Tx	CAP Either: 1.     Azithromycin + Ceftriaxone 2.     Fq HCAP/VAP ·       MRSA: Vancomycin ·       Pseudomonas: ·       Pip-tazo ·       carbapenem PCP TMP-SMX +/- corticosteroids Empiric Tx of CAP OP ·       Macrolide or doxycycline (healthy) ·       Fluoroquinolone’ or beta-lactam + macrolide (comorbidities) IP (non-ICU) ·       Fluoroquinolone’ (IV) ·       Beta-lactam + macrolide (IV) IP (ICU) ·       Beta-lactam + macrolide (IV) ·       Beta-lactam + fluoroquinolone’ (IV)
Parapneumonic effusion	Uncomplicated Complicated ? Sterile exudate in pleural space Bacterial invasion of pleural space (Usually bigger) Fluid Analysis • pH >7.2 • Glucose 260 mg/dL • WBC <50,OOO/mm3 ·       pH <7.2 ·       Glucose <60 mg/dL ·       WBC > 50,OOO/mm3 cx ⊖ (low bacterial #) Tx Abx Abx + drainage

Legionella pneumonia
Source	Contaminated water
S/S	·       Fever >38.8 ·       Relative bradycardia ·       GI (diarrhea, vomiting, cramps) ·       Pulmonary sx delayed
Dx	·       Hyponatremia ·       CXR – Patchy unilobar or interstitial infiltrates ·       Sputum Gram stain – PMNs, few/no organisms ·       Urine Legionella antigen
Tx	Respiratory FQ or newer macrolides

Mycoplasma pneumonia
#	·       Respiratory droplets ·       Young (school, military) ·       Fall or winter
Clx	·       Indolent headache, malaise, fever, persistent dry cough ·       Pharyngitis (nonexudative) ·       Macular/vesicular rash
Dx	·       CBC: normal WBC / Hemolytic anemia (cold agglutinins) ·       CXR: b/ Interstitial infiltrate
Tx	·       Usually empiric ·       Macrolide or respiratory Fq

Lung abscess
↑ Risk in?	·       Aspiration pneumonia (most common) ·       Dysphagia, substance abuse (alcohol) ·       Gingival disease (bad teeth) ·       Oropharynx anaerobes
Sx	·       Indolent (2 weeks) Sx ·       Fever, night sweats, weight loss ·       Cough with putrid sputum ·       Hyponatremia
Dx	·       Cavitary infiltrates with air-fluid levels (can happen in upper lobes) ·       Do we need to do cx? No, rarely useful
Tx	Clindamycin

	TB	Invasive Aspergillus	Chronic Pulmonary Asperigllus	CMV Pneumonitis
Hx	Immunocompromised	immunocompromised (neutropenia, HIV)	after CAVITARY lung dz (post-TB)	Immunocompromised
S/S	·       Fever ·       SOB ·       Hemoptysis ·       Weight loss	·       Fever ·       Pleuritic chest pain ·       Hemoptysis ·       Brown Sputum	·       >3 months ·       weight loss ·       hemoptysis ·       SOB	·       Low grade Fever ·       Unproductive Cough ·       SOB
CXR	Cavitation	ⓤ UPPER LOBE Lesions	cavitary lesion w/ fungus ball (Aspirigilloma)	–
CT	Cavitation in upper/middle lobe	UNILATERAL NODULES w/ GROUND GLASS Opacity (Halo sign)		Diffuse ground glass opacities
Tx	RIPE 9 months	·      2 w of IV Voriconazole (+ capsofungin) ·      Switch to Oral Voriconazole	·       Resect asperigilloma (if possible) ·       antifungal (-azole)	Ganciclovir