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infection > 5 Infection of resp systems PNEUMONIA > Flashcards

5 Infection of resp systems PNEUMONIA Flashcards

LRT infection !

1
Q

Examples of different pathogens that cause pneumonia ?

A
  • viruses
  • bacteria
  • fungi (pneumocystis jirovecii)
  • parasites
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2
Q

Pneumonia classified depending on source of infection how ?

A
  • community-acquired pneumonia (CAP)
  • hospital-acquired pneumonia (HAP)
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3
Q

Pneumonia diagnosis ? list 3 ways:
1. symptoms and signs of …
2. diagnosis confirmed by ….. which shows …..that’s not due to any other cause
3. different …. strategies for CAP and HAP

A

1.LRT infection
2. chest X ray showing new shadowing, not due to any other cause
3.management

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4
Q

Pneumonia risk factors that aren’t age, lifestyle, underlying medical conditions & exposure to contaminated resp therpay equipment , water sources or exposure to healthcare setting ?

A
  • impaired cough reflex
  • aspiration of naso- or oropharyngeal secretions
  • antibiotic therapy
  • surgery of head, neck, thorax, or upper abdomen
  • intubation / mechanical ventilation
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5
Q

Pneumonia risk factors that are from exposure of ….?

A
  • contaminated respiratory therapy equiment
  • contaminated water sources
  • healthcare setting
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6
Q

Pneumonia classified by sites how ?

A
  • loba - entire lobe (streptococcus pneumoniae)
  • bronchopneumonia - (Descending infection around bronchi and bronchioles, lower lobes )
  • interstitial
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7
Q

4 stages of lobar pneumonia ? and the durations of each stage

A
  1. congestion (24 - 48 hr)
  2. red hepatisation (2 - 3 days)
  3. grey hepatisation (4 - 8 days)
  4. resolution (day 8 - 4 weeks)
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8
Q

macroscopic features of congestion stage

A
  • partial consolidation of the parenchyma
  • red - purple
  • lungs are heavy , boggy
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9
Q

microscopic characteristics of congestion stage

A
  • vascular engorgement
  • intra-alveolar oedema
  • many bacteria / few neutrophils
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10
Q

macropscopic features of red hepatisation

A
  • red-pink, dry, granular, airless
  • parenchymal consolidation
  • reversible
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11
Q

microscopic characteristics of red hepatisation ?

A
  • fibrin strands replace oedema fluid
  • cellular exudate of neutrophils
  • extravasation of erthrocytes
  • desquamated epithelial cells
  • alveolar septa become less prominent
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12
Q

macroscopic features of grey hepatisation

A
  • lung appears grey
  • liver-like consistency
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13
Q

microscopic characteristics of grey hepatisation

A
  • lung appears grey
  • liver-like consistency (due to fibrin deposition)
  • red cell lysis / disintegration / clearance
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14
Q

macroscopic features of resolution

A

gradual restoration of aeration

part of body e.g. lung / portion lung tissue gradually regains its ability to take in air

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15
Q

microscopic characteristics of resolution stage of lobar pneumonia

A
  • resolution and restoration of pulmonary architecture
  • enzymatic fibrinolysis
  • macrophages remove neutrophils and debris
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16
Q

community - acquired pneumonia infection acquired where ?

A

outside of hospitals

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17
Q

In CAP mortality and morbidity increase if patients are ….

A

transferred to intensive care within 24 - 48hr admission

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18
Q

Why will ~ 10% of patients admitted with CAP will need intensive care admission ?

A
  • severe respiratory failure
  • septic shock
  • sepsis
19
Q

symptoms of CAP ? that typically present with signs / symptoms of which tract ?

A

lower respiratory tract infection
* cough
* dyspnoea (SOB)
* pleuritic chest pain
* mucopurulent sputum
* myalgia (muscle aches and pains)
* fever

onset over hours to days

20
Q

Management (assessment) of CAP and HAP that are similar ?

A

Chest x-ray
Full blood count
Oxygen saturations
Blood gas
Urine antigen testing

21
Q

management (assessment) specific to CAP ?

A

Sputum gram stain
Sputum culture
Blood culture
Test for influenza

CURB-65
Pneumonia severity index

22
Q

management (assessment) specific to HAP ?

A
  • CT scan chest
  • Chest ultrasound
  • Thoracocentesis and pleural fluid culture
23
Q

Prevention of CAP ?

A
  • Vaccination
  • Lifestyle changes
  • Good respiratory hygiene
24
Q

Treatment of CAP ?

A
  • Administration of antibiotics
  • Initiate antibiotic treatment within 4 hours of presentation
  • Supplement oxygen for patients with oxygen saturation < 94% or 88% for those at risk of CO2 retention
  • Consider risk of sepsis
25
Q

What is CAP mortality risk assessment ?

A

CURB-65

Confusion
Urea
Respiratory rate
Blood pressure
Age >= 65

26
Q

How is CURB65 scored ?

A

1 point for the presence of each crieterion (confusion, urea, respiratory rate, blood pressure, age)

27
Q

CURB65 cirterion presence for confusion ?

A

abbreviated mental test score 8 or less , or new disorientation in person , place or time

28
Q

CURB65 cirterion presence for urea ?

A

> 7 mmol

29
Q

CURB65 cirterion presence for respiratory rate ?

A

> = 30 breaths per minute

30
Q

CURB65 cirterion presence for blood pressure?

A

diastolic 60 mmHg or less
systolic less than 90 mmHg

31
Q

Using the CURB65 score how are patients stratified for risk of death ?

A
  • 0 = low risk , 1% mortality risk
  • 1 / 2 = intermediate risk , 1-10% mortality risk
  • 3 / 4 = high risk , > 10% mortality risk
32
Q

How is nosocomial pneumonia defined ? acquired when ?

A

Hospital-acquired pneumonia
* acute lower respiratory tract infection acquired at least 48 hours of admission
* not present/ incubating on admission

33
Q

risk factors of nosocomial pneumonia - HAP ?

A
  • endotracheal intubation
  • mechanical ventilation (ventilator-associated pneumonia)
  • aspiration
34
Q

symptoms / signs of HAP ?

A
  • Cough with increasing sputum production
  • Dyspnoea
  • Dever (core temperature > 38.5 )
  • Chest pain
  • Asymmetrical expansion of the chest
  • Diminished resonance
  • Raised or lower WBC counts
  • Worsening gaseous exchange and increase in O2 requirements
35
Q

Treatment of HAP ?

A

Antibiotics

36
Q

Treatment of HAP , antibiotics include what ?

A
  • Clinical judgement
  • number of days hospitalisation
  • Severity
  • Risk of complications
  • Microbiological results
  • Risk of adverse events from broad-spectrum antibiotics (e.g. clostridium difficile)
37
Q

Commonly observed pathogens of CAP and HAP ? (6)

A
  • Streptococcus pneumonia
  • Staphylococcus aureus (including MRSA)
  • Haemophilius influenzae
  • Moraxella catarrhalis
  • Klebsiella pneumoniae
  • Escherichia coli
38
Q

how do typical pneumonia and atypical pneumonia differ ?

A

in terms of causative agents, clinical presentation, severity of symptoms, and radiographic findings

39
Q

typical pneumonia of CAP ?

A
  • streptococcus pneumoniae
  • staphylococcus aureus
  • group A streptococcus
  • klebsiella pneumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
  • MRSA
  • Escherichia coli
  • other enterobacteriaceae
40
Q

atypical pneumonia of CAP ?

A
  • mycoplasma pneumoniae
  • chlamydophila pneumoniae
  • legionella pneumophilia
  • influenza pneumophila
  • chlamydophila psittaci
41
Q

Aetiology of CAP that are common secondary bacterial infections with influenza ?

A
  • streptococcus pneumoniae
  • staphylococcus aureus
42
Q

Name 9 viruses that are involved in aetiology of CAP

A
  • influenza A and B viruses
  • SARS-CoV-2
  • other coronoviruses
  • rhinoviruses
  • parainfluenza viruses
  • adenoviruses
  • respiratory syncytial virus
  • human metapneumovirus
  • human bocaviruses
43
Q

Pathogens causing HAP that doesn’t cause CAP ?

A

Pseudomonas aeruginosa
Acinetobacter species
Serratia species
Candida species

legionella
aspergillus fumigateurs

44
Q

complications of pneumonia

A
  • acute respiratory distress syndrome (ARDS)
  • pleural effusions (swelling of / fluid filling the pleura)
  • empyema (infection of fluid filling the pleura)
  • pleurisy (inflammation and swelling of pleura)
  • lung abscesses
  • respiratory failure
  • septic shock
  • sepsis
  • bacteremia

infection (33 decks)

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