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Bacterial infx LRT Flashcards

1
Q

Why are LRTIs more severe?

A

Lungs are generally sterile, and are full of goodies

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2
Q

What are the two major airway defenses?

A

Ciliated epithelium

Mucociliary escalator

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3
Q

What is the main mechanism that protects the lungs from particles?

A

Mucociliary escalator

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4
Q

What is pneumonia?

A

Inflammation of the lung as a result of a bacterial infection

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5
Q

What are the general features of pneumonia? (5)

A 
fever
cough
malaise
pleuritic chest pain
dyspnea
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6
Q

What are the respiratory sounds that are present with pneumonia?

A

Crackles

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7
Q

What is pneumonia often associated with?

A

Viral respiratory tract infx

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8
Q

Who is at increased risk for developing pneumonia?

A

Heart disease, DM, lung issues old and very young

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9
Q

What are the local effects of bacterial infx of the lung, that are produced from the inflammatory immune response?

A

irritation
Pain
Dypsnea

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10
Q

What are the common virulence factors on bacteria in the lungs? (5)

A

Capsules, intracellular growth, IgA protease, exotoxins, and LPS

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11
Q

What is accumulated in pneumonia? (4)

A

Fluid, bacteria, PMNs, and fibrin

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12
Q

What are the pathogens that cause typical pneumonia? (5)

A

Strep penumonia
Staph aureus
Haemophilus influenza
Most gram negative bateria

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13
Q

Which general type of bacteria usually cause typical pneumonia?

A

Gram negative

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14
Q

What are the pathogens that cause atypical penumonia?

A

Mycoplasma pneumoniae
Chlamydophilia pneumoniae

Legionella pneumophila

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15
Q

Why aren’t CXR 100% diagnostic for the type of bacterial infx?

A

Changes throughout course of infecion–must use lab results

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16
Q

What are things that can impair the mucociliary escalator? (4)

A

Viral infections, smoke, EtOH, narcotics

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17
Q

What are the three pathogens that usually cause typical pneumonia?

A

Strep pneumoniae
Staph aureus
Haemophilis influenzae

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18
Q

What does typical pneumonia look like on a CXR?

A

Lobar infiltrate

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19
Q

What does atypical pneumonia look like?

A

Patchy infiltrate throughout

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20
Q

What is the onset of typical pneumonia? Atypical?

A 
Typical = sudden
Atypical = gradual
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21
Q

What is the facies associated with typical pneumonia?

A 
Typical = toxic appearing
Atypical = normal appearing
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22
Q

Which type of pneumonia has a productive cough?

A 
Typical = productive
Atypical = non-productive
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23
Q

What is the sputum like in typical pneumonia? Atypical?

A 
Typical = Purulent
Atypical = Scant, watery
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24
Q

Which type of pneumonia has an associated fever (usually)?

A

Typical

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25
Q

Which type of pneumonia has pleurisy?

A

Typical

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26
Q

Which type of pneumonia has a consolidation present?

A

Typical

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27
Q

Which type of pneumonia has leukocytosis with a L shift?

A

Typical

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28
Q

What does the CXR usually show for typical pneumonia? Atypical?

A 
Typical = lobar
Atypical = patchy
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29
Q

What is the most common cause of typical pneumonia? Atypical?

A 
Typical = Streptococcus penumoniae
Atypical = Mycoplasma pneumoniae
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30
Q

Which type of pneumonia is also called “walking” pneumonia?

A

Atypical

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31
Q

Infection with what bacteria will not follow the general pattern of symptoms of typical/atypical pneumonia?

A

Legionella pneumophila

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32
Q

What are the three major types of complications for pneumonia?

A
  1. Pleural effusion
  2. Hematologic
  3. Chronic complications
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33
Q

What are the three hematologic complications that pneumonia have?

A
  1. Anemia
  2. Disseminated intravascular coagulation
  3. Thrombocytopenia
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34
Q

What are the chronic complications that can result from pneumonia?

A
  1. lower arterial oxygen levels
  2. weight loss/muscle atrophy
  3. Bronchiectasis
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35
Q

What is pleural effusion?

A

“excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. This excess can impair breathing by limiting the expansion of the lungs” wiki

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36
Q

What is aspiration pneumonia?

A

Introduction of foreign material into the bronchial tree (saliva, food nasal secretions etc). This dilutes surfactant immunity.

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37
Q

What is aspiration pneumonia associated with?

A

Alcoholics, coma/stroke pts

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38
Q

What is hospital acquired pneumonia usually associated with?

A

Ventilator use

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39
Q

What is the most frequent cause of HOP?

A

MDR gram negative bacteria

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40
Q

What are the gram negative bacteria that usually cause HOP? (5)

A 
Pseudomonas aeruginosa
E.coli
Klebsiella pneumoniae
Acinetobacter spp.
Haemophilus influenzae
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41
Q

What are the gram positive bacteria that are associated with HOP? (2)

A

Staph aureus

Step pneumo

42
Q

What are the three conditions that should be ruled out when seeing a pulmonary infiltrate?

A

CHF
Carcinoma/lymphoma
Lupus

43
Q

True or false: if a blood culture from a pneumonia pt is positive for the pneumonia causing agent, this is always a serious condition

44
Q

What are the diagnostic criteria for evaluating sputum?

A

Must see >25 PMNs and <10 epithelial cells (to r/o contamination)

45
Q

True or false: strep pneumo is a normal colonizer of the URT?

46
Q

What is the gram stain and morphology of strep pneumo

A

Gram positive cocci

47
Q

What is the blood hemolysis result of strep pneumo?

48
Q

What is the test that distinguishes strep pneumo from staph?

A

Catalase test (is negative for strep)

49
Q

What are the three test results of hemolysis testing?

A 
Alpha = some RBC destruction
Beta = total RBC desctruction
Gamma = none
50
Q

Why type of polysaccharide does strep pneumonia?

51
Q

What are the five most important virulence factors that pneumococcal bacteria produce?

A 
Surface adhesins
IgA protease
Pneumolysin
Teichoic caidpeptidoglycan
Thick polysaccharide capsule
52
Q

What is the effect of pneumolysin?

A

Virulence factor found on strep penumo that forms pores in host cells

53
Q

What is the role of teichoic acid/peptidoglycan in pneumonia?

A

Inflammation

54
Q

What is rust colored sputum specific for (but not sensitive to)?

A

Pneumococcal pneumonia

55
Q

Is penumococcal pneumoia a self-limiting disease?

56
Q

Which type of pneumonia is pneumococcal pneumonia

57
Q

What are the three tests that can be used to diagnose S. pneumoniae? (4)

A

Gram stain sputum (positive)
Culture (alpha hemolysis)
Bile solubility
Urine collection for pneumococcal polysaccharide

58
Q

What is the bile test result for S.pneumoniae?

A

Positive solubility

59
Q

What is the test that can differentiate S. pneumonia from Strep mutans? Result?

A

Optochin test.

S. pneumonia is sensitive to it

60
Q

What is the treatment for S. pneumo?

A

Empiric therapy with penicillin or macrolides

61
Q

Serious cases of strep pnuemo should be treated with what?

A

Azithromycin + cephalosporin

62
Q

What is the gram stain and morphology of staph aureus?

A

Gram positive cocci

63
Q

What is the catalase test result for staph?

64
Q

What is the coagulase test result for staph aureus? How does this compare to other staph?

A

Positive, unlike other staph species

65
Q

What are the virulence factors for staph aureus?

A

Coagulase
Protein A
Panton valentine leukocidin?

66
Q

What is the protein A part of staph aureus do?

A

Binds Fc portion of an antibody, and coats itself with antibody

67
Q

What is the panton valentine leukcidin virulence factor that staph aureus produces?

A

Pore forming cytotoxin that leads to necrotizing penumonia

68
Q

What is MRSA, and what is it resistant to?

A

Methicillin resistane staph, that is also resistant to all beta lactams

69
Q

Is MRSA more virulent?

A

No, just harder to treat

70
Q

What is the treatment for MRSA?

A

vancomycin or linezolid

71
Q

What is the treatment for staph infections that are not MRSA?

A

Penicillins/cephalosporins

72
Q

What are the five gram negative, facultative anerobes bacteria that cause pneumonia?

A 
Klebsiella pneumoniae
E. coli
Enterobacter
Serratia
Proteus
73
Q

What are the two gram negative aerobes that cause pneumonia?

A

Pseudomonas aeruginosa

Acinetobacter

74
Q

Which type of bacteria are more likely to be associated with aspiration pneumonia?

75
Q

Which type of bacteria causes pneumonia more often in patient who already have an underlying disease?

A

Gram negative

76
Q

Which type of bacteria produce foul smelling sputum?

77
Q

Which type of pneumonia are gram negative pneumonias (typical or atypical)?

78
Q

What are the two labs that can aid in the diagnosis of gram negative bacterial pneumonia?

A

Sputum culture

Blood culture

79
Q

What is the treatment for gram negative pnuemonias?

A

Broad spectrum abx with abx synergism, including gentamycin/cephelxxin

80
Q

What are the three abx used to treat psuedomonas?

A

Ticarcillin
Piperacillin
Amikacin

81
Q

What is the gram stain and morphology of klebsiella pneumoniae?

A

Gram negative rod

82
Q

Is klebsiella motile or note?

A

Not motile

83
Q

What is the enzyme that klebsiella produces that makes them harder to treat?

A

Beta lactamases

84
Q

Infection with what bacteria results in currant jelly sputum?

A

Klebsiella

85
Q

What type of pneumonia does klebsiella produce (lobar vs bronchiolar)

86
Q

What are the two virulence factors that klebsiella has?

A

LPS

Capsule

87
Q

What is the treatment for infection with klebsiella?

A

Same as other gram-negative pneumonias—

88
Q

What is the gram stain and morphology of pseudomonas aeruginosa? Specialization?

A

Gram negative rods, with flagella?

89
Q

Is pseudomonas aeruginosa an anaerobe or aerobe? Oxidase positive or negative? sugar fermentation positive or negative?

A

Obligate aerobe
Oxidase positive
Sugar ferment negative

90
Q

What do pseudomonas aeruginosa colonies smell like?

91
Q

pseudomonas aeruginosa usually grows where?

A

hand soaps, water with minimal nutrients, dilute antiseptics

92
Q

Most infection sources of pseudomonas aeruginosa are what?

A

Humidifiers, sink traps

93
Q

What are the other infections that pseudomonas aeruginosa can cause?

A

Septicemia, UTIs, wound infections, meningitis in severe burns

94
Q

What are the 6 virulence factors that pseudomonas aeruginosa has?

A
  1. Toxin A
  2. Leukocidin
  3. Phospholipase C
  4. Capsule
  5. Pyocyanin
  6. Pyoverdin
95
Q

What is the effect of toxin A that pseudomonas aeruginosa produces?

A

ADP ribosylation of EF-2

96
Q

What is the effect of phospholipase C that pseudomonas aeruginosa produces?

A

Membrane disruption

97
Q

What is the effect of pyocyanin that pseudomonas aeruginosa produces?

98
Q

What is the effect of pyoverdin that pseudomonas aeruginosa produces?

A

Green fluorescent virulence factor

99
Q

What is the treatment for pseudomonas aeruginosa?

A

Ticarcillin or piperacillin plus an aminoglycoside

100
Q

What is the “scourge” of the CF community? Why?

A

Pseudomonoas aeruginoasa, because it cannot be cleared via the mucociliary escalator, and creates a biofilm.

Microbio (50 decks)

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