• antipyretic
• broncho-dilators if necessary.

Complications

• Bacterial bronchitis (infection).
• Cough with muco purulent sputum associated with relatively abundant dyspnea.
• Bronchial, snoring, which may be accompanied by signs of respiratory control.
• sometimes vital prognosis.

Signs of severity of bronchitis

• Dimensions major
• Sweating important
• Cyanosis
• Confusion
• Pics hypertensive

(in this case, since resuscitation on respiratory decompensation in response to hypercapnia by hypoventilation.)
Investigations

• Radio Lung etiology.
• NFS VS if needed (hyper leukocytosis).
• ECBC in cases of bronchitis repeatedly resistant to antibiotic treatments.

The most common germs

• Pneumococcal
• Haemophilus

Treatment
Course of antibiotics for 8 days:

• Clamoxyl ® (amoxicillin).
• augmentin ® in case of resistance.
• mucolytic (thinner)
• chest physiotherapy if major congestion, or extreme ages of life.
• broncho-dilators if wheezing or asthma.
• cortisone in chronic bronchitis.
• hydration.

In case of allergy to penicillin, opt for macrolides:
josacine ®
erythromycin ®
Zithromax ® (5 days)
Healing is often positive, but if there is worsening, hospitalize the subject.
infusion therapy
O2
blood gases.

Preventing bronchitis

• Anti-influenza vaccination.
• Anti pneumococcal vaccination on fragile subject, every 5 years.
• Avoid tobacco
• Incentives immunity.

In cases of recurrent bronchitis, verify the absence of home dental sinusitis untreated.

B) Pneumonia
More serious than bronchitis, there are more germs in question.
- Infection of the parenchyma (bronchioles and alveoli related).
- In children under 6 years, speaks often of viral infection.

• RSV (respiratory syncytial virus)
• Haemophilus
• pneumococcal

- For children over 6 years pneumococcus.
- In the young adult pneumococcus, mycoplasma pneumonial.
- In the elderly:

• pneumococcal
• Haemophilus
• enterobacteria
• anaerobic
• Morganella catarrhalis

The clinic differs according to the causal bacteria.

Pneumonia Bacterial Pneumonia
= Acute lobar pneumonia.
- Start often brutal.
- Severe pain on the right side, followed by chills, fever (39/40 °)
- 2 days later, stained sputum, sometimes associated with dyspnea, especially when the pneumonia is extended.
- Crackles.
- Dullness next (associated pleural effusion).
- No pain in the lung itself (pleurisy is painful).

Reviews
- Radio pulmonary shows a home with localized alveolar opacity systematically (following a well segmented area of the lung).
- Air bronchogram: image bronchi intact.
- Pleural reaction
- NFS: show hyper leukocytosis (either very high or very low mean a sign of seriousness).
- CRP: increase
- Blood cultures if the patient is feverish, shivering.
- ECBC if we fear a germ-resistant, or nosocomial infections.

Evolution
Good, on antibiotics for 8 to 10 days with penicillin (amoxicillin ®)
afebrile patients 24 to 48 hours later.
disappearance of symptoms and pain.
radio, the lung re slower ..
If allergic to penicillin, cephalosporin 2nd or 3rd generation (Rocephine ®) or macrolides.
The evolution is usually favorable, but fear the pneumococcal pneumonia among the elderly, alcoholics and those suffering from HIV (when the blood culture is positive).

Pneumonia germs intra cellular (or atypical pneumonia).
- Mycoplasma p.
- Legionella p.
- Chlaemidiae.
The onset is gradual and usually preceded by an attack ENT.
There is a high frequency of respiratory signs associated extra.

• myalgia
• fatigue
• headache
• neurological disorders
• GI symptoms (nausea, diarrhea)
• signs urine (haematuria).
• cough, fever, dry or oily.
• dyspnea more or less important.

Will retain an epidemiological context (legionellosis)
Germs can be highlighted in a bacteriological or you search the antigens of these microbes (urine, blood, sputum), or one looks for antibodies (serology research seroconversion after 2 to 3 weeks).
Radio pulmonary pneumonia often non-systematic (diffuse).

Biology
GB normal, decreasing or increasing.
Often elevated CRP.
Hepatic disturbances.
Anemia
Macrolide treatment (not penicillin) 2 to 3 weeks.

Staphylococcal pneumonia.
Often reaches the age extremes of life, hospital patients who underwent invasive tests (resuscitation, catheters, surgery, …).
Table febrile

• Fever 39/40.
• Cough with bronchial congestion.
• Dyspnea important.
• Bilateral pneumonia, diffuse, incremental (start with a home, then develops into untreated, can cause pleurisy and pyopneumothorax).
• Often, crackling of the 2 sides.
• Poor condition of the patient.

Radio pulmonary alveolar several homes
NFS increasing GB
CRP increased
- Search for isolating bacterial germs that are 2 types, namely, the meticulously s Staph aureus, and Staphylococcus aureus meticulously r:
blood culture
ECBC
Brushing protected.
- Bi therapy immediately for 10 to 15 days.
- If patient catheter or prosthesis: sampling at this level (if causal bacteria, remove dentures or catheters).

Pneumonia gram negative bacilli (Enterobacteriaceae).
Often patients with nosocomial or older, or ethyl, or patients weakened (immunocompromised).
- Altered state generally quite profound.
- Persistent fever.
- Increasing dyspnea.
- Sputum often purulent.
The radio show pulmonary several homes, including bases (fear of inhalation pneumonia)
- Risk of abscess (lung abscess).
- Demonstration of the causative agent: difficult, especially if the germs are anaerobic.

Treatment
2 to 3 antibiotics associated (sensitivity).

C) Lung abscess
Serious complication of a bacterial lung infection that occurs in a necrotic lung obstruction.
- Bronchorrhea often causes a vomica (sputum expectoration important)
- Occurs often in a fragile subject, ethyl, or after surgery.

Three phases
pre suppurative with clinical alarming
cough, fever, purulent sputum

phase vomica, and transient improvement.

phase of chronic suppuration open
oscillating fever, bronchorrhea daily general condition altered.

The radio show necrosis (cavity in the lung with a standard hydro aerique).
NFS increase in GB.

Treatment
Antibiotics for a month.
Anaerobic augmentin è ® ® or flagyl.

Evolution
Often to poor healing.
Possible complications in the form of future malignant or aspergilloma (fungus on the cavity to be the cause of hemoptysis).
You can go to surgery to sterilize a home.

Viral Pneumonia
- Background epidemic.
- Dry cough + fever.
- Myalgia, with ENT.
Clinical and biological poor.
On the radio: image “hilifuge” not systematic.

Evolution
Spontaneously favorable few days, but with:
rest
antipyretic
O2 to extreme ages of life.
In the elderly, the fear of decompensation of diabetes or cardiovascular disease.
Treatment
Antiviral (rare)