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Block 3 Found Sci > 4-Lower Respir Infections Bacteria > Flashcards

4-Lower Respir Infections Bacteria Flashcards

1
Q

bronchitis bugs

A

bordetella pertussis
mycoplasma pneumoniae

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2
Q

acute bacterial bronchitis clinical

A

acute onset cough W/O fever, tachypnea, rales (pneumonia signs)
-usually viral

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3
Q

bordetella pertussis

A

fastidious so require complex media, specific environ
-adheres to ciliated respir mucosa
-restricted to humans (person to person spread) esp unvac or <1 yr

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4
Q

pertussis presentation stages

A
  1. incubation ~7-10 days
  2. catarrhal- fever, malaise, sneezing, anorexia ~1week
  3. paroxysmal- repetitive cough w whoops, cyanosis, vomit ~2 weeks
  4. convalescent- diminished paroxysmal cough, secondary comps ~3 weeks
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5
Q

bordetella pertussis virulence factors

A
  1. filamentous hemagglutinin to attach to ciliated cells
  2. pertussis toxin- AB toxin, inc cAMP to inc respir secretions = paroxysmal cough
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6
Q

pertussis dx

A

multiplex NAAT PCR test (specific and sens)

treat with antibiotics

prevent with DTaP vac

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7
Q

pneumonia symptoms

A

fever + cough + chest pain + dyspnea + sputum production (rust colored or purulent or foul or water)

in older pts maybe no fever but major complaint of mental status changes

tachycardia, tachypnea, hypoxemia, abnormal auscultations (crackles/rhonchi)

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8
Q

risk factors pneumonia

A

secondary to viral RTI
-heart dz, diabetes, lung dz, cancer, immunosup, cystic fibrosis
-age extremes
-smoking, alc, narcotics

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9
Q

pneumonia pathogenesis

A

enter small airways then grow in rich lung environ
-capsules, intracell growth, IgA protease, exotoxins LPS virulence factors

inflamm + acc fluid, neutrophils, fibrin = consolidation or infiltrate
-irreversible if caseous necrosis or cavitation

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10
Q

aspiration pneumonia

A

foreign material into bronchial tree
-saliva, food, nasal secretions carry bacteria

alcoholics, coma pts, stroke pts

secondary bacterial pneumonia after aspiration

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11
Q

lobar pneumonia

A

localized to only one lobe of lung

most gram neg bacteria
-strep pneumoniae
-staph aureus
-H. influenzae

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12
Q

bronchopneumonia

A

pus thru bronchi
-multi lobes or places not just one lobe

mycoplasma pneumoniae
chlamydophila pneumoniae
legionella pneumophila

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13
Q

typical pneumonia features

A
  1. sudden onset
  2. toxic facies
  3. productive cough
  4. purulent/bloody sputum
  5. fever
  6. inc neutrophils
  7. strep pneumoniae usually

lobar

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14
Q

atypical pneumonia

A
  1. gradual onset
  2. well appearing facies
  3. non productive cough
  4. scant watery sputum
  5. normal or elevated WBC not huge inc
  6. patchy infiltrate on Xray
  7. mycoplasma pneumoniae
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15
Q

community acquired pneumonia

A

not from healthcare setting
MDR gram neg less likely

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16
Q

hospital acquired pneumonia

A

hospitalized pts
-ventilator associated pneumonia
-MDR gram negatives more likely in VAP > HAP > CAP

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17
Q

pneumonia dx

A

not need testing for etiologic agent and no definitive ID of agent made

do culture, urine antigen test, gram stain, PCR
-pos blood culture = severe dz

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18
Q

CAP dx

A

made via clinical signs/symptoms with chest xray
-hard to disting b/t bacterial or viral
-antibiotics
-do CBC and blood culture

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19
Q

strep pneumoniae

A

normal colonizer of URT
-has capsule of polysacs so vaccines have polysacs from various serotypes
-IgA protease and polysac anti phagocytic virulence factors

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20
Q

classic pneumococcoal pneumonia presentation

A

-abrupt onset of cough, fever, chest pain, crackles, sputum (rust)
-poor oxygenation

should resolve in a week

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21
Q

S. pneumoniae lab dx

A
  1. PCR tests
  2. gram stain
  3. culture blood (bile sol, optochin sens)
  4. urine collection for pneumococcal polysac
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22
Q

S. pneumoniae treatment

A

antibiotics

vaccines:
23 valent and 13 valent (conjugate)

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23
Q

Staph aureus

A

normal microbiota
-catalase and coagulase pos (differentiate from other staph)

virulence factors: protein A for Fc portion of antibody, panton valentine leukocidin for pore forming cytotoxin, coagulase

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24
Q

MRSA

A

methicillin resistant Staph aureus
-resist all beta lactams but not more virulent just harder to treat

treat with linezolid (50S inhib) or vancomycin

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25
Q

gram neg causing pneumonia

A
  1. klebsiella pneumoniae (fac anaerobe)
  2. pseudomonas aeruginosa (aerobes)

more likely in HAP and secondary to aspiration pneu

part of normal microbiota

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26
Q

gram neg pneumonia features

A
  • often have comordibities
  • foul smelling sputum
  • any lobe affected
  • antibiotic resistance big problem
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27
Q

gram neg pneumonia dx

A

multiplex PCR test/sputum culture/gram stain, blood culture

treat with braod spectrum antibiotic cocktails

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28
Q

Klebsiella special features

A

-produce extended spectrum beta lactamases
-have mucoid colonies for capsule, very sticky

29
Q

Kleb pneumonia clinical

A

present as classic lobar + bloody sputum ‘currant jelly’

treat with broad spectrum antib but inc rate of resistance
prevent by disinfecting environ and use sterile respir equipment

30
Q

Kleb virulence factors

A
  1. LPS
  2. capsule
31
Q

pseudomonas special features

A

-motile
-obligate aerobe
-blue/yellow/green pigments
-smells like grapes
-likes to grow in hand soaps, dilute antiseptics, water with no minimal nutrients
-forms biofilms

32
Q

pseudo pneumonia risk factors

A
  1. burns
  2. immunosupp therapy
  3. ventilator use
  4. cystic fibrosis
33
Q

pseudo virulence factors

A
  1. toxin A = cell death from ADP ribosylation of EF-2
  2. antiphagocytic capsule
  3. leukocidin
  4. phospholipace C
  5. blue pigments
34
Q

cystic fibrosis

from pseudo

A

-convert non-mucoid to mucoid = sig affects pulmonary fxn
-almost impossible to eradicate bc biofilms and continued impairment

35
Q

atypical pneumonia

aka bronchopneumonia

A
  1. walking - mycoplasma pneu, chlamydia pneumoniae
  2. toxic - legionella pneumophila

patchy pattern xrays

36
Q

atypical pneumonia dx

A

-gradual onset of fever, headache, muscle ache, watery sputum

treat with empiric therapy based on CAP/HAP/VAP

37
Q

mycoplasma pneumoniae special features

A

-no peptidoglycan, sterols instead
-look like fried egg
-restricted to humans

38
Q

mycoplasma pneu virulence factor

A

-P1 adhesin binds to ciliated epi cell to damage = loss of escalator

cough > pneumonia

39
Q

mycoplasma pneu clinical

A

-gradual onset bronchopneumonia
-anemia (IgM resp)
-patchy infiltrates
-self limiting to 2 weeks

40
Q

mycoplasma pneu dx

A

-NAAT PCR
-NOT culture, cold aggultinin, or serology

treat with antibiotics but not beta lactams bc no peptidoglycan
-no prevention

41
Q

chlamydia pneumoniae

A

atypical CAP but not clinically disting from other causes
-associated with atherosclerotic plaque form, refractory asthma, MS, rheumatoid arthritis

dx with multiplex NAAT
treat with antibiotics not beta lactam

42
Q

legionella pneumophila

A

causes legionnaires dz and pontiac fever
-pontiac is self limiting, no person person spread, low mortality, no pneumonia, very mild
-legionnaires has underlying pulm dz, in late summer or autumn, must treat with antibiotics

43
Q

legionella special features

A

-2 morphologies dep on location
-slow growing
-needs special agar with high humidity so ubiquitous in freshwater, intracellular pathogen esp amoeba

44
Q

legionella spread

A

-where disinfectants are diluted out/improper disinfection
-cooling/humidifying systems old buildings, hotels, factories, hospitals, aerosols from manmade water supplies

45
Q

legionella virulence

A

-attach to alveolar macrophages
-inject protein into host cell via type 4 secretion system to hijack (induces uptake, prevents fusion with lysosome, recruits organelles)
-lyse macrophage to release enzymes = inflamm, lung necrosis, systemic toxicity

46
Q

legionella pneumophila clincal

A

-progressively worsening over 3-6 days
-rapid onset fever with fatigue
-chills, pleurisy, vomit, diarrhea, confusion, delirium
-high mortality esp HAI

47
Q

legionella pneumophila dx

A

-exposure hx linked by location indicating outbreak
-patchy infiltrates on xray
-hyponeutremia (low sodium)

NAAT of sputum or lavage
legionella urine antigen test

48
Q

mycobacteria categories

A
  1. M. tuberculosis complex
  2. non tuberculosis (NTM) > rapid or slow growing
  3. M. leprae and M. lepromatosis
49
Q

mycobactera structure

A

-rods with lipid rich cell wall (waxy)
-acid fast staining (Ziehl Neelsen or Kinyoun)
-humans only reservoir but usually latent carriers

50
Q

drugs for mycobacterium

A
  1. isoniazid- targets mycolic acid
  2. ethambutol- targets LAM
51
Q

primary TB outcomes

A
  1. clearance
  2. latent
  3. active
52
Q

latent TB features

A

-cannot spread to others, not infectious
-small viable inactive bacteria in body
-not feel sick
-pos TB skin test or IGRA
-normal chest xray
-sputum cultures neg
-not require isolation but strong consider treat

53
Q

active TB features

A

-large amount of active bacteria
-may spread to others via aerosols
-feel sick and cough, weight loss, night sweat, fever
-pos TB skin test or IGRA
-normal or abnormal chest xray
-pos sputum cultures
-isolation and require treat

54
Q

TB pathogenesis

A

-taken up by phagocytes then survives and recuits B/T/NK cells
-if macrophage migrates to hilar lymph node then granuloma to prevent spread (latent) or systemic spread
-if active TB then CMI cannot control Mtb

55
Q

TB and CMI

A

most of pathology and dz from CMI resp bc inc activation = more necrotic lesions and inflamm, tissue damage

56
Q

active TB symptoms

A

fatigue + unexpected weight loss + weakness + fever + night sweats + cough +2/3 weeks
-sputum range from scant to yellow/blood streaked

primary TB is asymptomatic

57
Q

how latent TB gets active

A

granulomas fall apart and allow Mtb to move to other parts of lung

58
Q

disseminated TB

A

AIDS or immunocomp/HIV
-granulomas in any body tissue

aka miliary or extrapulmonary TB

59
Q

TB dx

A

-tuberculin skin test
-interferon gamma release assay IGRA
-chest radiograph
-med history important
-culture or NAAT test or microscopy for acid fast rods

60
Q

AFB sputum smears

A

for acid fast bacterium using auramine-O to bind mycolic acid
-can confirm mycobacterial dz but not specific for Mtb

61
Q

tuberculin skin test

A

intradermal injection of purified protein derivatives (PPDs) from Mtb envelope
-BCG vac people can test pos

measure wheel size

cannot rule out if neg

62
Q

IFN-y release assay IGRA

A

IFN-y release by T cells in blood stim with Mtb antigen so good for BCG-vac people

cannot rule out if neg

63
Q

drugs to treat TB

A
  1. isoniazid INH- inhib mycolic acid
  2. ethambutol EMB- disrupt arabinogalactan syn
  3. rifampin RIF- inhib RNA syn
  4. rifapentine RPT- inhib RNA syn
  5. pyrazinamide PZA-prevents vitamin B5

bad side effects so low compliance, need direct observation

64
Q

treating latent TB

A

3-4 mo of daily or weekly drugs (1-2) to reduce chance of reactivation

65
Q

treating active TB

A

DOT required + 6.5 months of daily 2-4 drugs

direct observation therapy

66
Q

drug resistance TB

A
  1. multidrug resist TB = isoniazid and rifampicin
  2. extensive drug resist TB = MDR + any fluoroquinolone and 1+ second line inject drug
67
Q

BCG vaccine

A

live attenuated or inactive M. bovis
-in endemic countries not in US tho
-limited efficacy after infancy

drawback is that skin tests pos

68
Q

nontuberculous mycobacteria

A

atypical, environment
-usually immunocomp, elderly, lung comorbid
-M. avium or M. intracellulare = pulmonary active TB like
-M. kansasii = chronic granulomatous pulmonary dz
-distinguish from Mtb by culture

no latency or reactivation but treat similar to Mtb

Block 3 Found Sci (60 decks)

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