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Host and Defense > EXAM 1 Lower Respiratory Tract Infections > Flashcards

EXAM 1 Lower Respiratory Tract Infections Flashcards

1
Q

what is the triad of infectious diseases?

A

host

pathogen

environment

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2
Q

describe the host portion of the triad of infectious disease

A
  • anatomic defenses
  • innate immunity
  • acquired immunity
    • humoral
    • cell-mediated
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3
Q

describe the pathogen portion of the triad of infectious disease

A
  • bacteria
  • mycobacteria
  • fungi
  • viruses
  • protozoa
  • metazoans
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4
Q

describe the environment portion of the triad of infectious disease

A
  • humans
  • animals
  • inanimate
  • occupational
  • travel
  • setting (CAP, HCAP)
  • inoculum
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5
Q

what is required to make a pneumonia diagnosis?

A

an x-ray of the chest showing parenchymal infiltrates

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6
Q

describe typical acute pneumonia

A
  • community-acquired (CAP) usually
  • measured in hours to days
  • onset with chills, fever, and wet cough
  • lobar consolidation or segmental or sub-segmental bronchopneumonia
  • pleura often invovled giving chest pain with inspiraiton (pleuritis)
  • micro-aspiration of upper respiratory tract colonizing bacteria
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7
Q

describe pathogenesis of typical acute pneumonia

A
  • micro-aspiration of upper respiratory tract colonizing bacteria
  • most often due to streptococcus pneumoniae
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8
Q

describe the etiology of community-acquired pneumonia

A
  • pneumococcus most common pathogen
  • haemophilus has largely disappeared
  • gram-negative pneumonia is uncommon but consider klebsiella pneumoniae
  • viral pneumonia is often seen in children (respiratory viruses) and during influenza epidemics
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9
Q

name the most common bacteria responsible for community acquired pneumonia

A
  • streptococcus pneumoniae
  • hemophilius influenzae
  • staphylococcus aureus
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10
Q

what are 3 gram negative bacilli responsible for community acquired pneumonia?

A
  • moraxella catarrhalis
  • streptococcus pyogenes
  • neeisseria meningitidis
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11
Q

what are 3 atypical agents responsible for community acquired pneumonia?

A
  • legionella species
  • mycoplasma pneumoniae
  • chalmydia pneumoniae
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12
Q

describe the histology of lobar pneumonia aka lung hepatization

A

alveolar spaces are infiltrated with neutrophils in an attempt to control the infection

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13
Q

what are 2 types of acute, atypical pneumonias?

A
  • walking pneumonia
  • environmentally acquired acute pneumonias
  • potentially fatal and require non-beta-lactam antibiotics
    • macrolides, fluroquinolones, tetracyclines
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14
Q

what bacteria are responsible for walking pneumonia?

A

mycoplasma pneumoniae and chlamydophila pneumoniae

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15
Q

what bacteria are responsible for environmentally acquired acute pneumonias?

A
  • legionella pneumophilia (legionnaire’s disease)
  • coxiella burnetii (Q fever)
  • chlamydophila psittaci
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16
Q

describe aspiration pneumonia

A
  • setting: stupor, coma, or seizures
  • focal infiltrates
  • dependent portions of lung
  • oropharyngeal flora
  • community vs hospital environments
  • may be complicated by chronic pneumonia with lung abscess formation
17
Q

describe microbiology of community-acquired aspriation pneumonia

A

gram positive

anaerobes (up to 20%)

18
Q

describe the microbiology of hospital-acquired aspiration pneumonia

A

gram negative

s. aureus

19
Q

what is the trans-tracheal aspiration method?

A
  • placing a needle with a catheter through the cricothyroid cartilage
  • syringe with saline solution is pumped into trachea, causing the patient to aspirate
  • sample is taken to determine microbial etiology
20
Q

name some cultural oral anaerobic bacteria

A
  • gram positive cocci
    • peptostreptococcus
  • gram positive bacilli
    • actinomyces, eubacterium, leptotrichia
  • gram negative cocci
    • veillonella
  • gram negative bacilli
    • fusobacterium, prevotella, porphyromonas
21
Q

what are some examples of viral pneumonia contributors?

A
  • human respiratory virus
    • common in children, rare in adults
  • hantavirus (Sin Nombre V.)
  • coronavirus (SARS, MERS)
  • bacterial pneumonia with or in the wake of influenza
22
Q

name some human respiratory viruses that contribute to viral pneumonia

A
  • influenza
  • parainfluenza
  • RSV
  • adenovirus
  • metapneumovirus
  • enterovirus
  • paraechovirus
23
Q

describe complications of acute bacterial pneumonia

A
  • necrotizing pneumonitis - death of lung parenchyma
  • lung abscess - excavation of lung parenchyma
  • empyema - spread of infection into potential space between parietal and visceral pleura - requires drainage as part of management
24
Q

what is empyema?

A
  • pleural space infection
  • invasion from lung parenchyma
  • diagnostic thoracentesis
  • drainage via chest tube hooked to water seal
  • management critical to prevent lung “entrapment”
25
Q

describe management of acute pneumonia with an empiric Rx

A
  • in most cases, microbiological diagnosis is not possible
    • new tests for antigens and nucleic acids may offer etiological diagnosis
  • possible pathogens of acute pneumonia are well established from previous studies going way back in medical history
  • the development of broad-spectrum antibiotics to cover most possible pathogens makes empiric therapy possible in most cases
    • exceptions have arisen due to antibiotic resistance including the pneumococcus, the leading pathogen for lobar and bronchopneumonia
26
Q

describe chronic pneumonia

A
  • weeks to months - not days
  • differential diagnosis
  • many non-infectious diseases
  • no empiric treatment
  • requires diagnosis by bronchoscopy or lung biopsy
27
Q

describe tuberculosis

A
  • slow-growing acid-fast human pathogen
  • cough generates droplet nuclei
  • inhaled into alveolar space
  • replicates relentlessly and spreads to lymph nodes and then systemic circulation
  • becomes dorman as host cell-mediated immunity develops
  • host at jeopardy for primary and post-primary (reactivation) disease
  • public health issues (human -> human spread)
28
Q

describe pneumonia in the immunocompromised host

A
  • host factors predominate
  • panoply of potential pathogens spanning viruses -> metazoa
  • complete history required to investigate possible environmental factors for exposure
  • may be acute or chronic
  • chest x-ray appearance: myriad of presentations
  • search for etiological diagnosis imperative for successful management

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