ALS Lecture 3 - Acute Respiratory Infection and Pneumonia DONE Flashcards
physical/anatomical defence mechanism of respiratory tract (2)
- nasal hair filters particles
- nasal turbinates act as baffles
physiological/mechanical defence mechanism of respiratory tract (4)
mucus, cilia, sneezing, coughing
innate immunity defence mechanism of respiratory tract (2)
alveolar macrophages, antimicrobial substances
acquired immunity defence mechanism of respiratory tract (1)
specific IgA secretion
cough reflex is mediated by
sensory nerves in pharynx, motor nerves
mucociliary escalator
push mucus up and out
label the diagram of the mucociliary escalator
done
cells protecting our lungs via innate immunity (8)
alveolar macrophage, tissue macrophage, dendritic cell, mast cells, eosinophils, innate lymphoid cells, cytokines, antimicrobial peptides
humoral immunity is mainly
antibodies from B lymphocytes
antibody in upper airways
secretory IgA, antibacterial, antiviral
antibodies that reach airways via blood vessels
IgG, IgM
alveoli contain which antibody?
IgG
acquired immunity is mostly controlled by
T-lymphocytes
acquired immunity is very important for adaptive immunity against
intracellular pathogens, e.g. Mycobacteria, Legionella
flowchart of acquired immunity process
inhaled antigens cross epithelium –> APC –> BALT –> memory T + effector cells
commensalism is a relationship between two organisms where
one benefits, other unaffected
infection is the presence of a
microorganism damaging body tissues
opportunistic infection is an infection caused by a microorganism that
doesn’t usually cause disease, becomes pathogenic when defences compromised
label the diagram of the upper respiratory tract and the bacteria that colonise them
done
commensals/colonisers of the respiratory tract include
Viridans streptococci, Haemophilus influenzae, Streptococcus pneumoniae
colinisation
no harmful effects, host defences keep microorganisms at bay
infection
destruction/invasion/production of toxins
Streptococcus pneumoniae is the commonest cause of
bacterial pneumonia
Haemophilus influenzae is the commonest cause of
acute bacterial bronchitis
Staphylococcus aureus produces
toxins that kill tissue (lung cavity)
Gram negatives, e.g. Klebsiella species are common in
immunocompromised patients, in hospitals
group A streptococus is rarely
in lung
Legionella pneumoniae
no cell wall, intracellular, abx on cell wall won’t work
bacteria that have no cell wall, intracellular, abx on cell wall won’t work
legionella pneumoniae, mycoplasma pneumoniae, chlamydophila pneumoniae
URTIs can occur anywhere in the airway above
epiglottis
common symptoms of URTIs include (8)
nasal congestion, runny nose, sore throat, cough, sneezing, headache, facial pain, fever
LRTIs occur in the airway below
glottis
leading cause of death amongst all infectious diseases
LRTIs
acute bronchitis is
trachea-bronchial tree inflammation
symptoms of acute bronchitis (4)
cough, SOB, wheeze, chest pain
in acute bronchitis, chest x-ray is
normal
viruses that cause acute bronchitis (5)
rhinovirus, coronavirus, adenovirus, parainfluenza, influenza A/B
bacteria that cause acute bronchitis (4)
Haemophilus influenzae, Streptococcus pneumoniae, Staphylococus aureus, Mycoplasma pneumoniae
exacerbations of COPD occur in patients with
COPD
COPD exacerbations have sustained increase in COPD symptoms such as (3)
SOB, cough, wheeze
pathologically, exacerbations of COPD are
acute bronchitis on top of COPD
COPD exacerbations can be (2)
infective, non-infective
what suggests bacterial infection in COPD exacerbations? (2)
sputum volume, purulence
in COPD exacerbations, chest x-ray is
normal
lung consolidation is when the air in alveoli is
replaced with something else (e.g. blood, pus, water, cells)
the difference between acute bronchitis and pneumonia is that with pneumonia
we see consolidation on CXR
pneumonia is
symptoms/signs of acute LRTI with new x-ray findings
label the x-ray of pneumonia
done
in a classical pneumonia picture there is _____ of the lung but the ___ are open
consolidation, bronchi
air bronchogram
on CXR, can see open bronchi (black lines within consolidation)
different classifications on pneumonia (6)
lobar, bronchopneumonia, community, nosocomial, typical, atypical
lobar pneumonia involves a
whole/large are of lobe
bronchopneumonia is inflammation from
walls of bronchioles with foci consolidation
community acquired pneumonia is
seen by GP or new hosp admission
nosocomial pneumonia is when a pt
in hosp >48hrs, recently discharged (includes VAP)
typical pneumonia-causing organism is
S. pneumoniae
atypical pneumonia-causing organisms are (3)
Legionella pneumophila, Mycoplasma, Chlamydia
most commonly used classifications on pneumonia are
community/nosocomial
community/nosocomial classifications are most used because they
help us predict which pathogen
bacteria that cause CAP include (7)
Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Staphylococcus aureus
viruses that cause CAP include (5)
influenza, parainfluenza, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), adenovirus
most common symptoms of CAP (4)
chills, fever, pleurisy, cough
blood tests of CAP (2)
high WCC, C-reactive protein (CRP)
Legionella pneumophila resides in
warm water (e.g. air conditioning)
Legionella pneumophila causes 2 syndromes
Legionnaire’s disease, Pontiac fever
Legionella pneumophila on chest x-ray shows
patchy consolidation
Legionella pneumophila urine test
urine antigen
Legionella pneumophila treatment
macrolide or quinolone, penicillins won’t work
Mycoplasma pneumoniae CXR test
rapid molecular testing of URT swab
Mycoplasma pneumoniae treatment
macrolide, tetracycline
common pathogens that cause hospital acquired pneumonia
Klebsiella spp, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus/MRSA
risk factors for pneumonia (6)
intubation, smoking, alcohol, sepsis, immunosupression, drugs
label the symptoms of infectious pneumonia diagram
done
diagnosis for pneumonia (4)
history, examination, imaging, bloods
blood tests for pneumonia
FBC, U&Es, LFT, CRP
fill in the diagram of CURB-65 score to assess pneumonia severity
done
