Bacterial infx LRT Flashcards
1
Q
Why are LRTIs more severe?
A
Lungs are generally sterile, and are full of goodies
2
Q
What are the two major airway defenses?
A
Ciliated epithelium
Mucociliary escalator
3
Q
What is the main mechanism that protects the lungs from particles?
A
Mucociliary escalator
4
Q
What is pneumonia?
A
Inflammation of the lung as a result of a bacterial infection
5
Q
What are the general features of pneumonia? (5)
A
fever cough malaise pleuritic chest pain dyspnea
6
Q
What are the respiratory sounds that are present with pneumonia?
A
Crackles
7
Q
What is pneumonia often associated with?
A
Viral respiratory tract infx
8
Q
Who is at increased risk for developing pneumonia?
A
Heart disease, DM, lung issues old and very young
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
10
Q
What are the common virulence factors on bacteria in the lungs? (5)
A
Capsules, intracellular growth, IgA protease, exotoxins, and LPS
11
Q
What is accumulated in pneumonia? (4)
A
Fluid, bacteria, PMNs, and fibrin
12
Q
What are the pathogens that cause typical pneumonia? (5)
A
Strep penumonia
Staph aureus
Haemophilus influenza
Most gram negative bateria
13
Q
Which general type of bacteria usually cause typical pneumonia?
A
Gram negative
14
Q
What are the pathogens that cause atypical penumonia?
A
Mycoplasma pneumoniae
Chlamydophilia pneumoniae
Legionella pneumophila
15
Q
Why aren’t CXR 100% diagnostic for the type of bacterial infx?
A
Changes throughout course of infecion–must use lab results
16
Q
What are things that can impair the mucociliary escalator? (4)
A
Viral infections, smoke, EtOH, narcotics
17
Q
What are the three pathogens that usually cause typical pneumonia?
A
Strep pneumoniae
Staph aureus
Haemophilis influenzae
18
Q
What does typical pneumonia look like on a CXR?
A
Lobar infiltrate
19
Q
What does atypical pneumonia look like?
A
Patchy infiltrate throughout
20
Q
What is the onset of typical pneumonia? Atypical?
A
Typical = sudden Atypical = gradual
21
Q
What is the facies associated with typical pneumonia?
A
Typical = toxic appearing Atypical = normal appearing
22
Q
Which type of pneumonia has a productive cough?
A
Typical = productive Atypical = non-productive
23
Q
What is the sputum like in typical pneumonia? Atypical?
A
Typical = Purulent Atypical = Scant, watery
24
Q
Which type of pneumonia has an associated fever (usually)?
A
Typical
25
Which type of pneumonia has pleurisy?
Typical
26
Which type of pneumonia has a consolidation present?
Typical
27
Which type of pneumonia has leukocytosis with a L shift?
Typical
28
What does the CXR usually show for typical pneumonia? Atypical?
```
Typical = lobar
Atypical = patchy
```
29
What is the most common cause of typical pneumonia? Atypical?
```
Typical = Streptococcus penumoniae
Atypical = Mycoplasma pneumoniae
```
30
Which type of pneumonia is also called "walking" pneumonia?
Atypical
31
Infection with what bacteria will not follow the general pattern of symptoms of typical/atypical pneumonia?
Legionella pneumophila
32
What are the three major types of complications for pneumonia?
1. Pleural effusion
2. Hematologic
3. Chronic complications
33
What are the three hematologic complications that pneumonia have?
1. Anemia
2. Disseminated intravascular coagulation
3. Thrombocytopenia
34
What are the chronic complications that can result from pneumonia?
1. lower arterial oxygen levels
2. weight loss/muscle atrophy
3. Bronchiectasis
35
What is pleural effusion?
"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
36
What is aspiration pneumonia?
Introduction of foreign material into the bronchial tree (saliva, food nasal secretions etc). This dilutes surfactant immunity.
37
What is aspiration pneumonia associated with?
Alcoholics, coma/stroke pts
38
What is hospital acquired pneumonia usually associated with?
Ventilator use
39
What is the most frequent cause of HOP?
MDR gram negative bacteria
40
What are the gram negative bacteria that usually cause HOP? (5)
```
Pseudomonas aeruginosa
E.coli
Klebsiella pneumoniae
Acinetobacter spp.
Haemophilus influenzae
```
41
What are the gram positive bacteria that are associated with HOP? (2)
Staph aureus
| Step pneumo
42
What are the three conditions that should be ruled out when seeing a pulmonary infiltrate?
CHF
Carcinoma/lymphoma
Lupus
43
True or false: if a blood culture from a pneumonia pt is positive for the pneumonia causing agent, this is always a serious condition
True
44
What are the diagnostic criteria for evaluating sputum?
Must see >25 PMNs and <10 epithelial cells (to r/o contamination)
45
True or false: strep pneumo is a normal colonizer of the URT?
True
46
What is the gram stain and morphology of strep pneumo
Gram positive cocci
47
What is the blood hemolysis result of strep pneumo?
Alpha
48
What is the test that distinguishes strep pneumo from staph?
Catalase test (is negative for strep)
49
What are the three test results of hemolysis testing?
```
Alpha = some RBC destruction
Beta = total RBC desctruction
Gamma = none
```
50
Why type of polysaccharide does strep pneumonia?
Capsular
51
What are the five most important virulence factors that pneumococcal bacteria produce?
```
Surface adhesins
IgA protease
Pneumolysin
Teichoic caidpeptidoglycan
Thick polysaccharide capsule
```
52
What is the effect of pneumolysin?
Virulence factor found on strep penumo that forms pores in host cells
53
What is the role of teichoic acid/peptidoglycan in pneumonia?
Inflammation
54
What is rust colored sputum specific for (but not sensitive to)?
Pneumococcal pneumonia
55
Is penumococcal pneumoia a self-limiting disease?
Yes
56
Which type of pneumonia is pneumococcal pneumonia
Typical
57
What are the three tests that can be used to diagnose S. pneumoniae? (4)
Gram stain sputum (positive)
Culture (alpha hemolysis)
Bile solubility
Urine collection for pneumococcal polysaccharide
58
What is the bile test result for S.pneumoniae?
Positive solubility
59
What is the test that can differentiate S. pneumonia from Strep mutans? Result?
Optochin test.
S. pneumonia is sensitive to it
60
What is the treatment for S. pneumo?
Empiric therapy with penicillin or macrolides
61
Serious cases of strep pnuemo should be treated with what?
Azithromycin + cephalosporin
62
What is the gram stain and morphology of staph aureus?
Gram positive cocci
63
What is the catalase test result for staph?
Positive
64
What is the coagulase test result for staph aureus? How does this compare to other staph?
Positive, unlike other staph species
65
What are the virulence factors for staph aureus?
Coagulase
Protein A
Panton valentine leukocidin?
66
What is the protein A part of staph aureus do?
Binds Fc portion of an antibody, and coats itself with antibody
67
What is the panton valentine leukcidin virulence factor that staph aureus produces?
Pore forming cytotoxin that leads to necrotizing penumonia
68
What is MRSA, and what is it resistant to?
Methicillin resistane staph, that is also resistant to all beta lactams
69
Is MRSA more virulent?
No, just harder to treat
70
What is the treatment for MRSA?
vancomycin or linezolid
71
What is the treatment for staph infections that are not MRSA?
Penicillins/cephalosporins
72
What are the five gram negative, facultative anerobes bacteria that cause pneumonia?
```
Klebsiella pneumoniae
E. coli
Enterobacter
Serratia
Proteus
```
73
What are the two gram negative aerobes that cause pneumonia?
Pseudomonas aeruginosa
| Acinetobacter
74
Which type of bacteria are more likely to be associated with aspiration pneumonia?
Anaerobic
75
Which type of bacteria causes pneumonia more often in patient who already have an underlying disease?
Gram negative
76
Which type of bacteria produce foul smelling sputum?
Anaerobic
77
Which type of pneumonia are gram negative pneumonias (typical or atypical)?
Typical
78
What are the two labs that can aid in the diagnosis of gram negative bacterial pneumonia?
Sputum culture
| Blood culture
79
What is the treatment for gram negative pnuemonias?
Broad spectrum abx with abx synergism, including gentamycin/cephelxxin
80
What are the three abx used to treat psuedomonas?
Ticarcillin
Piperacillin
Amikacin
81
What is the gram stain and morphology of klebsiella pneumoniae?
Gram negative rod
82
Is klebsiella motile or note?
Not motile
83
What is the enzyme that klebsiella produces that makes them harder to treat?
Beta lactamases
84
Infection with what bacteria results in currant jelly sputum?
Klebsiella
85
What type of pneumonia does klebsiella produce (lobar vs bronchiolar)
Lobar
86
What are the two virulence factors that klebsiella has?
LPS
| Capsule
87
What is the treatment for infection with klebsiella?
Same as other gram-negative pneumonias---
88
What is the gram stain and morphology of pseudomonas aeruginosa? Specialization?
Gram negative rods, with flagella?
89
Is pseudomonas aeruginosa an anaerobe or aerobe? Oxidase positive or negative? sugar fermentation positive or negative?
Obligate aerobe
Oxidase positive
Sugar ferment negative
90
What do pseudomonas aeruginosa colonies smell like?
Grapes
91
pseudomonas aeruginosa usually grows where?
hand soaps, water with minimal nutrients, dilute antiseptics
92
Most infection sources of pseudomonas aeruginosa are what?
Humidifiers, sink traps
93
What are the other infections that pseudomonas aeruginosa can cause?
Septicemia, UTIs, wound infections, meningitis in severe burns
94
What are the 6 virulence factors that pseudomonas aeruginosa has?
1. Toxin A
2. Leukocidin
3. Phospholipase C
4. Capsule
5. Pyocyanin
6. Pyoverdin
95
What is the effect of toxin A that pseudomonas aeruginosa produces?
ADP ribosylation of EF-2
96
What is the effect of phospholipase C that pseudomonas aeruginosa produces?
Membrane disruption
97
What is the effect of pyocyanin that pseudomonas aeruginosa produces?
Toxin
98
What is the effect of pyoverdin that pseudomonas aeruginosa produces?
Green fluorescent virulence factor
99
What is the treatment for pseudomonas aeruginosa?
Ticarcillin or piperacillin plus an aminoglycoside
100
What is the "scourge" of the CF community? Why?
Pseudomonoas aeruginoasa, because it cannot be cleared via the mucociliary escalator, and creates a biofilm.
