Exam 1 Part 3 Flashcards
how do you differentiate between pneumonia and pneumonitis?
- pneumonia: infection or inflammation of only alveolar spaces
- pneumonitis: inflammation of interstitial tissue
classifications of pneumonia? 6
- community acquired
- community-acquired atypical (non-bacterial)
- nosocomial
- aspiration
- necrotizing/abscess
- pneumonia in immunocompromised pts
predisposing factors to getting pneumonia? 5
- loss of cough reflex
- diminished mucin or cilia function
- accumulation of secretions
- decrease in phagocytic or bactericidal action of alveolar MOs
- pulmonary congestion & edema
does pneumonia occur in healthy people spontaneously?
NO but it is one of the most common causes of death
how long does it take for sxs of pneu to develop?
several days
URI sxs may precede
what are the typical sxs of pneu?
- cough
- fever
- fatigue
- malaise
- increased sputum production
- pleuritic chest pain
what might you find on a PE?
- fever, tachycardia, tachypnea, but sometimes can present with no cough of fever
- may be signs of lung consolidation: dullness to percussion, crackles, absent breath sounds
pneumonia is the most common what kind of infection?
nosocomial; especially for those who have been intubated and on ventilator support
how does it affect developing countries and children?
- 2nd major cause of death in developing countries
- leading cause of death worldwide for children
what is the main cause of community acquired pneumonia?
steptococcus pneumoniae
what other bugs can cause pneumonia? which one is considered atypical? which one is nosocomial?
h. influenza, m. catarrhalis, s.aureus, l.pneumophila (atypical), k.pneumoniae (nosocomial)
pneumonia leads to what two circumstances in the lungs? what is each?
- congestion: leaky dilated capillaries leads to exudate in interstitium, numerous bacteria
- consolidation: exudative rxn and solidification, maybe fibrosis
what are the 3 patterns of gross anatomic distribution of pneumonia? how can you distinguish b/w/
-lobar pneumonia (entire lobe)
-lobular pneumonia (part of a lobe)
-bronchopneumonia (patchy)
distinguish b/w by CXR
what are the 4 stages of the inflammatory response in lobar pneumonia? what does tx do?
- congestion
- red hepatization
- grey hepatization
- resolution
- tx slows or halts progression through 4 stages
what are the 7 morphologies of pneumonia?
- acute
- organizing
- chronic
- fibrosis vs. full resolution
- red vs. grey hepatization
- consolidation
- infiltrate vs. histopathology
would a classical pneumonia be more obstructive or restrictive
could be BOTH
what is red hepatization?
- RBC exudate, neutrophils and fibrin fill alveolar spaces
- consistency resembles liver tissue
what is grey hepatization? what color is it?
- RBCs disintegrate which leads to increased fibrinization
- persistent neutrophils, fibrin & supprative exudate
- alveoli consolidated
- greyish brown drier surface
what kind of pneumonia does streptococcus cause? what is 100% curative and what is 100% preventative against?
- classic lobar pneumonia
- penicillin often 100% curative
- vaccines often 100% preventative
who gets haemophilus pneumonia?
- children <2 with otitis, URI, meningitis, cellulitis, osteomyelitis
- most common from COPD in adults
moraxella catarrhalis ranks as what in the most common pneumonia?
-2nd most common after COPD pneumonia
what is the most common pneumonia following viral pneumonias?
-staph aureus
who gets klebsiella pneumonia?
- debilitated malnourished people
- alcoholics with pneumonia thought to have k. pneumonia until proven otherwise
is pseudomonas aeruginosa community acquired? who gets pseudomonas aeruginosa?
NO it is nosocomial
-cystic fibrosis pts w/pneumonia presumed to have pseudomonas until proven otherwise
when does legionella happen? what classification? how is it spread and to who? is it typical or atypical?
- often in outbreaks
- often lobar
- spread by water “droplets” to immunosuppressed pts
- bridges typical & atypical classification: can inhale aerosolized organisms or aspiration of contaminated drinking water
in resolution what happens to the consolidated exudate?what happens to the debris? is there fibrosis?
- consolidated exudate undergoes enzymatic digestion
- granular semi-fluid debris is resorbed, eaten by MOs or coughed up
- fibroblast reorganization of debris may lead to fibrous thickening or adhesions
- lung tissue returns to baseline or there’s residual scarring
when do you hospitalize?
- pts living in nursing home
- elderly or infants, particularly <1 mo
- cancer
- heart failure
- stroke
- kidney failure
- liver disease
what kinds of PE findings would lead you to hospitalize?
-altered mental status, dehydration, fast breathing, heart rate >120 bmp, systolic BP 104
what are laboratory findings that would lead you to hospitalize?
- elevated blood sugar
- fluid in sac around lung
- low oxygen in blood
- low sodium levels
- poor kidney fxns
- significant anemia
what are the 4 characteristics of an atypical community acquired pneumonia?
- mycoplasmal
- not bacterial
- viral
- cultures not helpful
community acquired atypical pneumonias are caused by what, lack what and are known as what?
- caused by less typical pathogens
- cell wall deficient bacteria
- known as ‘walking pneumonia’
what is the main bacteria which causes community acquired atypical? main viruses?
- mycoplasma pneumoniae! also chlamydia, legionella
- viruses= RSV, parainfluenza virus, varicella, influenza A & B, adenovirus, SARS
who does mycoplasma pneumoniae infect?
older children and young adults
where do you see inflammation in community acquired atypical pneumonia?
-see interstitial inflammation and usually without alveolar involvement
viral pneumonias are typically _____ not ______
typically interstitial not alveolar
viruses are the _____ pathogen in ____ & _____. what is the most common?
- primary pathogens in infants and young children
- respiratory syncytial virus most common; includes chicken pox, para-influenza virus& influenza A & B
in adults what viruses cause pneumonia?
influenza A or varicella-zoster
what does SARS stand for? bac or virus and what kind? how do you confirm?
- SARS= severe acture respiratory syndrome
- corona virus
- confirmed by PCR
what are hospital acquired pneumonias called? what causes them? (hospital practices and bugs) what is MRSA?
- nosocomial
- debilitation, catheters & ventilators
- enterobacter, pseudomonas, staph
- MRSA= methicillin resistant staph aureus
who gets aspiration pneumonia? what part of the lobe is usually involved? what does it usually lead to?
- unconcious pts
- pts in prolonged bed rest
- lack of ability to swallow or gag
- usually aspirating gastric contents
- usually in posterior lobes
- leads to abscesses
what bacteria usually cause aspiration pneumonia?
- step
- staph
- haemophilus
what are lung abscesses from? is this a type of pneumonia?
- aspiration
- septic embolization
- neoplasia
- from neighboring structures
- any pneumonia which is severe, destructive and un-treated enough
- NOT a type of pneumonia but a complication
what is a pulmonary abscess?
localized infectious process characterized by necrosis
what can cause a pulmonary abscess?
- aspiration (most common)
- preceding lung infection
- septic embolism
- trauma or extension of soft tissue infection
- oral cavity flora, step, gram (-) organisms
what increases risk of pulmonary abscess?
- sinusitis
- dental disease
- bronchiectasis
- fungal infxns
- diminished gag reflex
where does an abscess due to aspiration usually occur?
usually single in R lung (b/c more vertical)
what are the sxs of a pulmonary abscess?
- cough
- fever
- chest pain
- weight loss
- copious amounts of foul smelling purulent or sanguineous sputum
txs for pulmonary abscess? complications?
- antimicrobial therapy
- surgical drainage
- complications= empyema, spontaneous rupture, sepsis
chronic pneumonia is often synonymous with what 4 things?
4 classic systemic fungal or granulomatous pulmonary infections: TB, histoplasmosis, blastomycosis, coccidiomycosis
does chronic (in pneumonias) mean clinically or pathologically chronic?
CLINICALLY chronic
risk factors for TB?
- poverty
- crowding
- chronic debilitating illness
what is the main bac which causes TB in non-compromised hosts? in immunocompromised hosts?
non-compromised: mycobacterium tuberculosis & m. bovis
immuno: m. avium & m. intracellularae
what is the process of TB?
-inhalation of mycobacterium, engulfed by MO, transported to hilar lymph nodes, multiply, lyse MOs and travel, get ‘quarantined’= granulomas
what kind of granuloma does TB produce and what does it look like?
caseous; cheesy
what is the fxn of a granuloma?
- prevent dissemination of mycobacteria
- local environment for communication of cells of immune system
what is a ghon focus? ghon complex?
ghon focus: initial infxn location, 2-3 wks after develops undergoes caseous necrosis, TB bacilli drain out towards hilar lymph nodes
ghon complex: ghon focus w/hilar lymph node involvement, may caclify, latent TB here
what is secondary TB?
reactivation TB
ghon complex breakdown and mycobacterium release due to poor nutrition or infections
what is military TB?
infxn into circulatory sys, millet-like seeding of TB bacilli in lungs & other organs; 1-3% of TB cases
what are sxs of TB infxn?
- fever (night sweats)
- cough (non-productive to sputum)
- pleuritic chest pain
- dyspnea
- hemoptysis
- weight loss
- fatigue
tx for TB?
- long course Abx
- vaccinations used in high risk areas
details of histoplasmosis?
- spores in bird or bat droppings
- mimics TB
- calcified pulmonary granulomas
- Ohio, Mississippi valley
- primary infxn resembles viral URI
- granulomas appear lamellar or onion-skin like
details of blastomycosis?
- spores in soil, yeast
- mimics TB
- calcified pulmonary granulomas
- LARGE distinct spherules
- Ohio, MS valley, great lakes, middle east, africa, canada, mexico
details of coccidiomycosis?
- spores in soil
- mimics TB
- calcified pulmonary granulomas
- SMALL spherules (thick walled non-budding w/in MOs or giant cells, often cavitate)
- american SOUTHWEST
- dry cough, high fever, pleural effusion
what do ppl who inhale coccidiomycosis spores develop?
- anyone who inhales become infected and thereafter develops a delayed type hypersensitivity to the fungus
- more than 80% of ppl in endemic area have + skin test
details of aspergillus?
- common mold
- cause allergies in otherwise healthy ppl
- invasive aspergillosis: opportunistic infxn seen in immunosuppressed & debilitated
- aspergilloma= fungal growth w/in lung cavity
