B4-060 Pulmonary Infection Flashcards
major morphologic patterns in RTIs
3
- intra-alveolar accumulation of neutrophils
- interstitial expansion by mononuclear inflammatory cells
- granulomatous inflammation
phases of acute pneumonia
3
- red hepatization
- gray hepatization
- resolution or organization
- most common cause of lobar pneumonia
- most common cause of CAP pneumonia
s. pneumoniae
most common cause of bronchiopneumonia
S. aureus
- causes a bronchiopneumonia
- most commonly occurs in young children after viral infection or lung damage
H. influenzae
- malaise, fever, SOB, productive cough
- ill appearing, cough, ronchi, wheezing
- dullness, egophany
suppurative pneumonia
interstitial infiltrate of mononuclear cells
interstitial atypical pneumonia
- less productive cough, low grade fever,
- not toxic appearing
- SOB, URI symptoms
- no left shift in WBC
interstitial atypical pneumonia
lymphopenia
cytokine storm
hypercoaguable state
covid
TB and fungal organisms cause
granulomatous pneumonia
outpatient treatment for CAP
no comorbidities/MSRA/pseudomonas
amoxicillin or
doxycycline or
macrolide
treatment
inpatient non severe pneumonia
B lactam + macrolide or
fluoroquinolones
treatment
severe inpatient pneumonia
B lactam + macrolide or
B lactam+ fluroquinolone
greater than 48 hours after hospital admission
HAP
prevention of HAP
- mask ventilation
- head elevated
typical organisms causing lobar pneumonia
3
- S pneumo
- Legionella
- Klebsiella
typical organisms causing bronchopneumonia
4
- S pneumo
- S aureus
- H. flu
- Klebsiella
typical organisms causing atypical pneumonia
4
- mycoplasma
- clamydophilia
- coxiella
- viruses
- intra alveolar exudate leads to consolidation
- may involve entire lobe or whole lung
lobar pneumonia
- acute inflammatory infiltates from bronchioles into adjacent alveoli
- patchy distribution involving more than one lobe
bronchopneumonia
- diffuse patcy infiltration localized to interstitial areas at alveolar walls
- bilateral multifocal opacities on CXR
- follows indolent course
interstitial atypical pneumonia
aspiration of oropharyngeal or gastric contents causing pulmonary infection
aspiration pneumonia
- AMS
- dysphagia
- neurologic disorders
- NG tubes
all are risk factors for…
aspiration pneumonia
- aspiration, anaerobic bacteria
- strep viridans
- mycobacteria
can result in what complication?
abscess
if macrophages are overwhelmed, they recruit […] from pulmonary capillaries
neutrophils
infections with mycobacteria cause a […] inflammatory response
granulomatous
CURB65 stands for
Confusion
blood Urea nitrogen
Respiratory Rate
Blood Pressure
.>65 years of age
CURB65 is useful for deciding
if/where to admit
seasonal influenza vaccination is recommended to
all persons 6+ months
generally healthy patients are mostly affected by what pneumonia type
atypical
lymphocytes, plasma cells, and macrophages in interstitum
atypical pneumonia
treatment for mycoplasma
macrolides
lack a cell wall
MDR pathogens
4
- pseudomonas
- Klebsiella
- Acinetobacter
- MRSA
treatment of MDR VAP
general
1 gram positive coverage
2 gram negative coverage
ex. carbapenem + fluoroquinoline + vanc
voluminous, foul smelling sputum
lung abscess
anaerobic bacteria
altered mental status
think..
aspiration pneumonia
acute alcoholism
anesthesia
Alzheimer’s
risk factors for
aspiration
aspiration to the […] is more common
right lung and lower lobe
most commonly implicated pathogen in lung abcesses
S. aureus
- […] are normally found in the oral cavity and thus aspirated
- common causes of lung abcesses
anaerobes
bacteroides, peptococcus, fusobacterium
lesion with air-fluid level
abscess
granulomatous lesions with central cavitation
TB
- lead to chronic abscesses but lack a liquefied component
- affect immunocompromised patients
nocardia
actinomycotic
most likely agent to be cultured in CAP
paticularly lobar
S. pneumo
can produce a lobar pneumonia, but typically associated with HAP
pseudomonas
produce granulomatous disease
mycobacteria
gram negative coccobacillus
H. flu
previously a common cause of pneumonia in children but has decreased since the vaccination
H. flu
uncapsulated form is a common pathogen affecting those with COPD or CF
H. flu
- gram negative bacteria that resides in GI tract
- affects those prone to aspiration
klebsiella
- ceftriaxone + azithromycin
- levofloxacin
treatment options for…
CAP with no risk of MRSA/pseudomonas
if patient is at risk for HAP with MDR organism, what treatment is appropriate?
need MRSA + pseudomonas coverage
ex. vancomycin + cefepime + levofloxacin
people with alcoholism are prone to what kind of pneumonia?
aspiration
- normal flora of GI tract
- affects those prone to aspiration of gastric contents
klebsiella
most common cause of gram negative pneumonia
klebsiella
red, gelatinous sputum
klebsiella
all adults of the age of […] should receive the pneumococcal vaccine
65
in acute lobar pneumonia, the alveolar infiltrate consist mostly of [cell type]
neutrophils
viral, clamydial, and mycoplasma pneumonias are […]
interstitial
hilar lymphadenopathy is characteristic of
TB
common etiology of young, healthy patients
atypicals- mycoplasma
treatment for mycoplasma
macrolides (azithromycin)
mycoplasma has no cell wall
phagocytize small particles and microorganisms within the parenchyma
macrophages
if overwhelmed, recruit neutrophils from alveolar septal capillaries
macrophages
