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ClinSci 2 Exam 2 > Bacterial Lower Airway Disease > Flashcards

Bacterial Lower Airway Disease Flashcards

1
Q

what horses are predisposed to bacterial pneumonia?

A

foals
race training
racing
transportation

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2
Q

what makes a horse more susceptible to develop pneumonia?

A

stress, open windows/shavings, poor air quality

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3
Q

symptoms of pneumonia

A
  • cough
  • fever
  • lethargy +/- anorexia
  • mucopurulent nasal dc
  • increased RR +/- effort
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4
Q

symptoms of pleuropneumonia

A
  • often no/mild cough
  • fever
  • severe lethargy, anorexia
  • mucopurulent dc
  • increased RR and resp effort
  • edema forelimbs + chest
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5
Q

how are pleuropneumonia and pneumonia symptoms different?

A

pleuropneumonia often doesnt have a cough, whereas pneumonia does

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6
Q

why is tying a horse’s head up in trailer bad?

A

prevents them from lowering their head, which decreases pulmonary clearance. if they trailer with the head high, need to stop intermittently and release the horse’s head so they can go down, but better is to take them off the trailer to stretch legs, etc

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7
Q

what is a common risk factor for a horse developing pleuropneumonia?

A

owners tying their heads up high in the trailer

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8
Q

pathogenesis of equine pneumonia

A
  • airways exposed to >10,000 L of air/day: dust, chemicals, microorganisms
  • resp tract has factors to prevent from developing disease and allows clearance of other particles as well
  • nasal passages: >10 um won’t travel very far and won’t reach lower airways. gets stuck in upper RT
  • smaller: 3-10 um: can go URT or into trachea

ones that are a problem with actually reaching the lower airways are the very small particles

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9
Q

lower airway with pneumonia

A

lower airway defense mechanisms like immune cells come into play because small particles can make their way down

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10
Q

what are ways to clear the upper airway?

A

coughing, sneezing, swallowing

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11
Q

what are ways to clear the lower airway?

A
  • phagocytic cells
  • cellular immunity
  • humoral immunity

as well as typical mucociiliary clearance

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12
Q

pneumonia results when the defense mechanisms are

A

impaired or overwhelmed: opportunistic organisms because airway defense mechs overwhelmed, and cause dz

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13
Q

gram + organisms that can cause pneumonia

A

Strep zooepidemicus
Strep pneumoniae
Rhodococcus equi (foals)
Strep equi (rare)

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14
Q

what are gram - organisms that can cause pneumonia

A

pasteurella spp
E. coli
enterobacter spp
klebsiella

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15
Q

what are things that can interfere with upper airway mechanisms? (coughing sneezing swallowing etc)

A

laryngeal paralysis
anesthesia!

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16
Q

what are things that can interfere with mucociliary clearance?

A

ammonia: paralyzes the cilia
viral disease: stops the cilia from beating

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17
Q

how does ammonia interfere with mucociliary clearance?

A

paralyzes the cilia: they stop beating

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18
Q

what are things taht can interfere with lower airway mechanisms?

A

immunosuppression, pulmonary edema

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19
Q

what causes loss of cough

A

anesthesia
neuromuscular
drugs
pain

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20
Q

what causes loss of epithelium

A

viral infx
toxic gases

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21
Q

what causes loss of clearance

A

immunosuppression
pulmonary edema

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22
Q

in the vast majority, pneumonia is caused by single/combo of organisms

A

combination! rarely one

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23
Q

what bacteria is almost always in pneumonia cases?

A

streptococcus zooepidemicus

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24
Q

streptococcus zooepidemicus

A

almost always present in bacterial infx because is a commensal but also normally lives in the respiratory tract

25
rhodococcus equi
- probelm in foals with non perfect immune systems - not a problem in animals with healthy immune systems
26
what type of antibiotic do you want to pick when dealing with a pneumonia case?
broad spectrum, bc there are many gram + and gram - that are commonly present with pneumonia cases. often need to treat before we get culture results back and need to make a decision based on antimicrobials
27
how does pleuropneumonia occur?
in most cases, pneumonia is the starting point. pleuropneumonia occurs as an extension of pneumonia into that thoracic cavity. but sometimes you can have clinical features of pleuro pneumonia but it didn't start out as pneumonia (ex was horse that ingested a wire that migrated)
28
what are the 3 stages of pleuropneumonia?
1. exudative stage 2. fibropurulent stage 3. organization stage
29
exudative stage
increased permeability, sterile fluid tissue and blood vessels are permeable bc of inflamm changes sterile fluid from vasculature leaking into the thoracic cavity *early on, this is sterile fluid! usually no bacteria there yet at this point. can have high protein, but cell count will be low
30
fibropurulent stage
bacterial invasion, WBC transmigration, fibrin deposition translocation of bacteria followed by WBC and fibrin ultrasound can tell this stage pretty quick bc fluid characteristic changes from hyperechoic and then start to see echogenicity within the fluid: these are cells and fibrin strand
31
organization stage
- fibroblast growth - abscesses form - fibrin replaced by scar tissue (fibroblasts growing into the fibrin deposit and forms a nonresolved surface) if affecting the whole lung tissue, is called a pleural peel. once this develops, the lung loses its elasticity and cannot expand anymore
32
what is a pleural peel?
inelastic membrane: fibrin replaced by scar tissue (fibroblasts growing into the fibrin deposit and forms a nonresolved surface) if affecting the whole lung tissue, is called a pleural peel. once this develops, the lung loses its elasticity and cannot expand anymore
33
anaerobes that can be present with pleuropneumonia
- clostridium spp - bacterioides spp
34
if you suspect pleuropneumonia, what other organisms should you think about?
anaerobes! - clostridium spp - bacterioides spp
35
what gram - bacteria are present with pleuropneumonia
- pasteurella - E coli - enterobacter - klebsiella
36
bacteriodes spp (esp B. fragilis) is often resistant to
penicillin!
37
what is tricky about treating pleuropneumonia cases?
anaerobes are present like B. fragilis which is resistant to penicillin: need to add in metronidazole which has a good anaerobic activity
38
what antibiotic has good anaerobic spectrum?
metronidazole: really useful for pleuropneumonia with Bacteroides spp: B. fragilis
39
you go to listen to a horse with pneumonia. what do you expect to hear?
- expect to hear increased lung sounds cranioventrally - increased respiratory effort - consolidation of lung tissue, alveoli are obstructed or are shut - **decreased air and tissue interface**: sound being generated in the air filled structures is not as filtered anymore: sound wave doesn't have to travel thru that many air-tissue interfaces (which filters the sound): now is one big blob, and sound can travel easily thru that consolidated tissue US: see consolidated lung lobe
40
why might you expect to hear increased lung sounds in an animal with pneumonia?
- increased respiratory effort - consolidation of lung tissue, alveoli are obstructed or are shut - **decreased air and tissue interface**: sound being generated in the air filled structures is not as filtered anymore: sound wave doesn't have to travel thru that many air-tissue interfaces (which filters the sound): now is one big blob, and sound can travel easily thru that consolidated tissue US: see consolidated lung lobe
41
names of things you would expect to hear on thoracic auscultation with a horse with pneumonia
- secretion sounds over trachea bc more mucous in airway - crackles and wheezes: may be present across both lung fields
42
what things do you expect to hear with pleuropneumonia?
- decreased or not audible lung sounds if you have fluid accumulation - secretion sounds: in lower airway - line on percussion: where auscultation or sound changes. at top still have some air space, and once you get to fluid accumulation the sound is dull - above line, hear lung sounds (maybe even increased) bc that is the part of the lung that the horse can still inflate = increased air movement - below the line, expect to hear no lung sounds or at the most, bronchial sounds if fluid, heart sounds may radiate more
43
T/F: in a horse with pleuropneumonia you don't need to do a rebreathing exam
true: they are already respiratory compromised and can pass out. can make problems for the horse
44
with a pleuropneumonia we often talk about a "line" with thoracic auscultation. what is this
- line on percussion: where auscultation or sound changes. at top still have some air space, and once you get to fluid accumulation the sound is dull - above line, hear lung sounds (maybe even increased) bc that is the part of the lung that the horse can still inflate = increased air movement - below the line, expect to hear no lung sounds or at the most, bronchial sounds
45
in a horse with pneumonia, waht would you expect to see on a hemogram?
- inflammatory leukogram - neutrophilia (or neutropenia if earlier in the disease process) - hypergammglobulinemia - increased plasma protein - increased fibrinogen (depends on timing though)
46
what is the classic thing seen on a radiograph with pneumonia horses
alveolar pattern: truly characterized by air bronchograms fluid accumulation within the small airways: alveoli and small airways. get fuzzy appearance bc of increased soft tissue opacity in the alveoli. bc the alveoli are now fluid filled and become soft tissue density, the airway that is still air filled will become silhouetted/outlined by the soft tissue density classic is that the bronchial tree becomes outlined
47
pleuropneumonia radiographs?
don't bother, if a lot of fluid accumulation just see a lot of white and it whites out the radiograph. can see dorsal aspect but ventral aspects are usually completely whited out. not super useful for pleuropneumonia useful if you want to rule something out
48
ultrasound for pneumonia and pleuropneumonia?
pneumonia early on: comet tails: specific finding. basically just evidence by small areas of fluid accumulation or consolidation = aka V lines (makes shadow)y
49
you are ultrasounding a 30 year old horse and you see comet tails on ultrasound. your coworker starts freaking because they believe they must have pleuropneumonia. what do you tell them
they can be normal with age change, don't jump right to pleuropneumonia
50
what is the most sensitive modality to see fluid in the chest cavity?
ultrasound
51
diagnostics for pneumonia
rads and US good
52
diagnostics for pleuropneumonia
just US, radiographs not helpful
53
airway endoscopy for pneumonia/pleuropneumonia?
usually only useful to say: yes there is mucus, pus, and allows to get sample. in most cases, base findings on auscultation. visual not super useful, using to get sample for culture. transendoscopic wash or transtracheal wash are better, but need god technique. benefit is that you don't get contamination like you do with the endoscope going down the URT and bringing things down
54
what is the main goal of a tracheal wash?
get a sample for culture: aerobic and anaerobic. ideally prior to ABC administration stop ABC for 24-72 hours. if you can't, still take sample. but optimal to stop the antibiotics
55
cytology for pneumonia/pleuropneumonia?
okay, but usually skip because you know what you are going to find usually.
56
thoracocentesis for pneumonia/pleuropneumonia?
can be used diagnostically 6th or 7th ICS, US guided if possible releasing fluid to allow lung expansion in cases with a lot of fluid can be therapeutic endotoxemia! removing source of toxins and issues so also addressing that
57
antimicrobials with pneumonia/pleuropneumonia?
- ideal: culture and sensitivity - never expect to se an anaerobic sensitivity bc most labs don't have, so use historical references (ie B. fragilis resistant to pen!) - broad spectrum - long term usually empiric
58
additional treatments for pneumonia/pleuropneumonia?
- oxygen - NSAIDs - fluids - bronchodilators - nutrition

ClinSci 2 Exam 2 (13 decks)

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