MI7.{2-3,5} | Lower Respiratory Tract Infections — Summary & Reflection

REFLECT

A 40-year-old daily wage labourer presents with 2-month cough and weight loss. He is a migrant worker living in crowded conditions. His sputum smear shows 2+ AFB. Before you start treatment, what additional tests would you order and why? How would you counsel him about treatment adherence, and what does NI-KSHAY mandate in terms of notification and support?

KEY TAKEAWAYS

Lower respiratory tract infections span a wide microbiological spectrum. Aetiology is dictated by host factors: age (RSV in infants, Mycoplasma in young adults), immune status (PCP and Aspergillus in HIV/immunosuppressed), and acquisition setting (S. pneumoniae for CAP; Pseudomonas/Acinetobacter for HAP). TB is the cornerstone of LRTI in India: ZN stain for rapid detection, GeneXpert for molecular confirmation and RIF resistance, LJ culture for reference. Sputum processing (quality, correct stain selection, interpretation) is a core practical skill — correlate Gram stain morphology, AFB status, and clinical syndrome before reporting. Prevention pillars: BCG, PCV13, influenza vaccine, PCP prophylaxis in HIV (CD4 <200), DOTS adherence, and NI-KSHAY notification.