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LSS Respiratory System > 10 Lung Infection: Viral and Bacterial Pneumonias > Flashcards

10 Lung Infection: Viral and Bacterial Pneumonias Flashcards

1
Q

Q: What causes pneumonia? (2) Why does it seem that one doesn’t have a cause?

A

A: Community acquired (CAP)-> large percentage of cases don’t have known cause- maybe not discovered the bacteria yet or we don’t have a test for it yet

Hospital infections (‘nosocomial’)

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2
Q

Q: What can cause community acquired pneumonia that we know about and can do something about? (5- bacteria)

A 
A: Strep. Pneumoniae
Mycoplasma pneumoniae
Staph. Aureus
Chlamydophila pneumoniae
Haemophilus influenzae
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3
Q

Q: What can cause hospital acquired pneumonia? (3- bacteria)

A 
A: Staphylococcus aureus (28%)
Pseudomonas aeruginosa (21.8%)
Klebsiella species (9.8%)
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4
Q

Q: What are atypical bacteria? (2)

A

A: not covered by standard penicillin antibiotics and require specific antibiotics to treat (usually macrolides- different mechanism of action to penicillins)

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5
Q

Q: Name 3 common ‘typical’ pathogens that cause community acquired pneumonia. 3 atypical ones? (bacteria)

A

A: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

Mycoplasma pneumoniae, Chlamydophilia pneumoniae, Legionella pneumophilia

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6
Q

Q: What increases mortality from pneumonia?

A

A: higher mortality rates with age

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7
Q

Q: Risk factors for pneumonia. Demographic/lifestyle? (3)

A

A: - age (<2; >65)

  • cigarette smoking
  • excess alcohol consumption
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8
Q

Q: Risk factors for pneumonia. Social factors? (3)

A

A: - contact with children <15yrs

  • poverty
  • overcrowding
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9
Q

Q: Risk factors for pneumonia. Medications? (3)

A

A: - inhaled corticosteroids (could suppress innate antibacterial responses)

  • immunosuppressants
  • proton pump inhibitors
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10
Q

Q: Risk factors for pneumonia. Medical history? (9)

A

A: - COPD (chronic airway disease)

  • asthma (chronic airway disease)
  • heart disease
  • liver disease
  • diabetes mellitus
  • HIV / complement/Ig deficiencies
  • malignancy
  • hyposplenism
  • previous pneumonia
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11
Q

Q: Risk factors for pneumonia. Specific for certain pathogen. (3)

A

A: - geographical variation

  • animal contact
  • healthcare contact (good or bad access)
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12
Q

Q: What is seretide? Salbutamol?

A

A: steroid and bronchodilator combination

short acting bronchodilator

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13
Q

Q: What are normal oxygen saturation levels (on air)?

A

A: 94-99% (on 21% oxygen air)

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14
Q

Q: What is a normal respiration rate?

A

A: 12-20

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15
Q

Q: What are crepitations?

A

A: crackling or rattling sound

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16
Q

Q: What are the initial investigations performed for possible community acquires pneumonia? (10)

A

A: - Chest radiograph

  • Blood test: Full blood count,
  • Blood test: Urea
  • Blood test: Electrolytes
  • Blood test: Liver function
  • Blood test: C reactive Protein
  • Arterial Blood gases
  • Microbiological investigations – sputum culture
  • Microbiological investigations – blood cultures
  • Microbiological investigations – urine antigen tests
17
Q

Q: How does a chest X ray appear in someone with pneumonia?

A

A: one side/ both are more cloudy

18
Q

Q: How can you tell it’s pneumonia and not bronchitis or a cold? (6)

A

A: - New resp. symptoms or signs

  • Pleuritic chest pain
  • Usually febrile- temperature
  • Often hypoxic (can be confused)
  • New X ray changes over time eg several days -> inflammation would shift around and progress
  • Severe enough to be admitted
19
Q

Q: How can you tell it’s acute bronchitis and not pneumonia or a cold? (3)

A

A: Cough +++
Tracheal pain, not pleuritic
No new X ray changes over time

20
Q

Q: BTS guidelines for diagnosing pneumonia. (4)

A

A: 1. Acute lower respiratory tract symptoms

  1. New focal chest signs and, if in hospital, new CXR changes
  2. > 1 systemic feature (fever, shivers, aches and pains, temperature >38 degrees)
  3. No other explanation for illness
21
Q

Q: When should we admit community acquired pneumonia cases to hospital? What is also taken into account?

3 categories?

A

A: CRB65 severity score

being over 65

0 points: can go home with antibiotics

1-2: can consider hospital

3-4: high severity and needs hospital NEEDS URGENT ANTIBIOTICS

22
Q

Q: Supportive therapy for pneumonia. (4)

A 
A: Oxygen (for hypoxia)
Fluids (for dehydration)
Analgesia (for pain)
Nebulised saline (may help expectoration of mucous / phlegm)
Chest physiotherapy
23
Q

Q: What do you follow for antibiotic therapy? What’s critical? How long for?

A

A: local guidelines
time crucial : esp if sepsis has occured
usually for 1 week

24
Q

Q: What causes community acquired pneumonia in terms of viruses? (2)

A

A: influenza A or B, respiratory syncytial virus

25
Q

Q: The effects of viruses on the lung (3). Effect on epithelium? (4)

A 
A: 1. cellular  inflammation  
2. mediator  release  
3. local  immune  memory  
4. damage  to  epithelium  
o  loss  of  chemoreceptors  
o  poor  barrier  to  antigen  
o  bacterial  growth  
o  loss  of  cilia
26
Q

Q: Common cold agents. (7)

A

A: -rhinoviruses (lots of serotypes due to error prone replication)

  • coronaviruses
  • influenza
  • Parainfluenza viruses
  • Respiratory syncytial virus
  • Adenoviruses
  • Enteroviruses
27
Q

Q: What can cause a more severe disease? (5)

A

A: -highly pathogenic flu strain (could be better equipped to invade immunity or interfere with host response)

  • viral load
  • absence of prior immunity -> innate immunodeficiency, B cells, T cells
  • co pathogens take advantage of damaged epithelium etc (uncontrolled bacterial infection can kill)
  • weakened host immune response: frail elderly, COPD/ asthma, diabetes, pregnancy, heart disease

need to take into account host, pathogen and potential co pathogen

28
Q

Q: What is RSV bronchiolitis? Who does it mostly affect? Clinical symptoms? (7)

A

A: Respiratory syncytial virus (acute)

newborns (particularly less than 2yrs)

  • chest wall retractions
  • nasal flaring
  • hypoxemia and cyanosis (bluish tint on skin/lips)
  • croupy cough
  • expiratory wheezing (prolonged expiration)
  • rales and rhonchi (rattling sounds from lung)
  • tachypnea with apneic episodes (breathing suspension)
29
Q

Q: What can RSV predispose you to?

A

A: asthma

30
Q

Q: What can happen to someone with rhinovirus infection?

A

A: even when rhinovirus leaves-> bacterial infection could take over symptoms (opportunistic)

31
Q

Q: What happens when opportunistic bacteria come into contact with the microbiome in GIT? On the flip side, how can they aid viral function? (3)

A

A: can compete and eventually remove threat of opportunistic bacteria

  • suppression of innate IFN production due to e.g. PRR expression, oxidative stress (CF cells)
  • expression of viral entry receptors
  • modulation of cytokine expression
32
Q

Q: Lung microbiome?

A

A: not sterile environment

33
Q

Q: Viral-bacterial interactions in respiratory tract (during secondary bacterial infection). (6)

A

A: -compromised barrier functions -> – mucociliary clearance e.g. loss of ciliated cells, reduction of ciliary beat frequency; loss of epithelial tight junction

  • enhanced receptor availability for bacterial binding -> ++ expression of host receptors (e.g. PAFR); display of viral proteins on cell surface
  • immunological aberrances: – expression and responsiveness of PRRs; – no. of alveolar macrophages, NK cells, CD4+ and CD8+ T-cells
  • impaired immune cell functions: – phagocytosis, cytokine, AMP and antibody production
  • immunosuppression by viral components
  • changes of microenvironment: ++ nutrient availability for bacterial growth; ++ temperature and extracellular ATP altering bacterial transcriptome Bact
34
Q

Q: What is a congenital defect that can cause the cilia not to work?

A

A: There is an inner dynein arm but NO outer dynein arm

This is a DYNEIN ARM DEFECT

Because of this congenital defect, the patient’s cilia does NOT work

LSS Respiratory System (15 decks)

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