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Pulmonology > Exotic Pulmonary Pathogens > Flashcards

Exotic Pulmonary Pathogens Flashcards

1
Q

What are the Gram staining and cell characteristics of Bacillus anthracis?

A

Gram +, large non-motile rod with square ends (box car is the buzzword)

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2
Q

What are the virulence factors of Bacillus anthracis?

A

Capsule composed of D-glutamate (unique) and anthrax toxins –> also forms spores

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3
Q

How is Bacillus anthracis transmitted?

A

Cutaneous contact; can be aerosolized droplets that cause pneumonic disease

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4
Q

What are the 3 toxins produced by Bacillus anthracis?

A

Lethal factor –> cleaves host MAP kinases

Edema factor –> interferes with immune response

Protective antigen –> facilitates entry of lethal factor and edema factor into host cells

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5
Q

What are the clinical findings in Bacillus anthracis pneumonic disease (brucellosis or Malta fever)?

A

Onset 4-6 days

Sudden high fever, chills, profuse sweating, dyspnea, hypoxia, and tachycardia

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6
Q

What is seen on CXR with Bacillus anthracis?

A

Widened mediastinum with infiltrates and pleural effusions

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7
Q

How is Bacillus anthracis diagnosed?

A

1) CXR or CT
2) Can culture blood or sputum
3) Measure antibodies or toxins in blood

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8
Q

How do you treat Bacillus anthracis infection?

A

Ciprofloxacin for 60 days (dormant spores in macrophages) If severe, IV cipro + a penicillin or cephalosporin

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9
Q

What are the Gram staining and cell characteristics of Brucella spp.?

A

Small Gram negative coccobacillus –>intracellular bacterium (no capsule)

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10
Q

How is Brucella spp. infection usually contracted?

A

1) Contaminated dairy products
2) Direct contact with secretions of infected animals

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11
Q

What are the pathogenic mechanisms of Brucella spp.?

A

Live inside macrophages and illicit granuloma formation with giant cells –> endotoxin (LPS)

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12
Q

What are the clinical findings in Brucella spp.?

A

1) Fever, chills, fatigue, malaise, anorexia, weight loss
2) Enlarged lymph nodes, spleen, and liver
3) Pancytopenia
4) Large lung nodules on CXR

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13
Q

How is Brucella spp. diagnosed?

A

1) Culture in enriched media and 10% CO2 (not common)
2) Rise in antibody titer of at least 1:160 (best diagnostic)

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14
Q

How is Brucella spp. treated?

A

Tetracycline or doxycycline + rifampin

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15
Q

What are the Gram staining and cell characteristics of Burkholderia pseudomallei?

A

Gram negative rod; facultative intracellular bacterium

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16
Q

How is Burkholderia pseudomallei infection acquired?

A

Inhalation of aerosolized bacteria; typically after storms where bacteria in soil are aerosolized

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17
Q

What are the pathogenic mechanisms of Burkholderia pseudomallei infection?

A

1) Capsule
2) Can mediate host cell lysis to infect other cells
3) Can use actin network to propel itself into adjacent cells
4) Can remain dormant in host for years

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18
Q

What are the clinical findings of Burkholderia pseudomallei infection?

A

High fever, headache, anorexia, general muscle soreness, chest pain, cough

CXR shows small nodules and consolidation in upper lobes

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19
Q

What are the diagnostic tests for Burkholderia pseudomallei infection?

A

1) Culture from blood, urine, or sputum
2) Measuring specific antibodies

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20
Q

How is Burkholderia pseudomallei infection treated?

A

8 week course of ceftazidime –> 6 months if pt is immunosuppresed

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21
Q

What are the names of the disease caused by Burkholderia pseudomallei infection?

A

Meliodosis or Whoitmore’s disease

22
Q

What is the name of the disease caused by Coxiella brunetii infection?

A

Q-fever

23
Q

What are the Gram staining and cell characteristics of Coxiella brunetii?

A

Gram negative bacillus; obligate intracellular parasite

24
Q

How is Coxiella brunetii infection spread?

A

1) Found in sheep, cattle, and goats; transmitted to humans that handle contaminated viscera or drink contaminated milk
2) Infected tick bite
3) Aerosolized spores (most serious form)

25
Q

What is the pathogenic mechanism of Coxiella brunetii infection?

A

Obligate intracellular parasite –> evades humoral defenses

26
Q

What are the clinical findings of Coxiella brunetii infection?

A

30-50% are asymptomatic Atypical pneumonia lasting 2-4 weeks –> sometimes has liver and heart involvement

27
Q

What diagnostic tests are used for Coxiella brunetii?

A

Serological –> looking for high antibody titers to Q-fever antigen

28
Q

How is Coxiella brunetii infection treated?

A

Most resolve spontaneously, but doxycycline can shorten duration

29
Q

What are the Gram staining and cell characteristics of Francisella tularensis?

A

small pleomorphic Gram negative rod; obligate intracellular bacterium

30
Q

What are the virulence factors of Francisella tularensis?

A

1) Atypical lipopolysaccharide that is not recognized by TLR-4
2) May produce capsule

31
Q

How is Francisella tularensis transmitted?

A

1) Tick bite, or blood-to-blood contact with infected animal (think hunters in Arkansas)
2) Aerosolized droplets
3) Ingestion in food or water

32
Q

What are the clinical findings of Francisella tularensis infection (tularemia)?

A

1) Sudden onset of flu-like symptoms
2) Regional lymph nodes become painful and swollen
3) CXR shows spotted infiltrates, lobar pneumonia, and pleural exudation

33
Q

What diagnostic tests are used for Francisella tularensis infection?

A

1) Agglutination tests
2) Fluorescent antibody staining of infected tissue

34
Q

How is Francisella tularensis infection treated?

A

Streptomycin

35
Q

What are the characteristics of the hantavirus?

A

1) Enveloped
2) Segmented
3) Single-stranded (-) sense RNA virus

36
Q

What is the epidemiology of hantavirus infection?

A

Mostly in young healthy adults that go camping and shit

37
Q

What disease is caused by hantavirus infection?

A

Hantavirus pulmonary syndrome

38
Q

How is hantavirus transmitted to humans?

A

Aerosolized rat excreta…

39
Q

What are the clinical findings of hantavirus pulmonary syndrome?

A

Flu-like symptoms and myalgia of large muscle groups that rapidly progress to interstitial pulmonary edema and respiratory failure… silly little viruses

40
Q

What are the CXR findings in hantavirus pulmonary syndrome?

A

1) Bilateral interstitial and alveolar infiltrates
2) Pleural effusion
3) Normal heart size

41
Q

How is hantavirus pulmonary syndrome treated?

A

1) Early, aggressive intensive care
2) Assisted ventilation
3) Maintaining electrolyte balance

42
Q

What are the Gram staining and cell characteristics of Yersinia pestis?

A

Small Gram negative encapsulated rod

43
Q

What are the unique staining characteristics of Yersinia pestis?

A

Bipolar staining –> resembles a safety pin (Step 1 buzzword)

44
Q

What disease is caused by Yersinia pestis infection?

A

THE PLAGUE or black death

45
Q

How is Yersinia pestis transmitted to humans?

A

Bitten by flea that has bitten infected rodent

Can also transmit from another person through aerosolized droplets (most fatal form)

46
Q

What is seen on CXR with Yersinia pestis infection?

A

Effects lower lung zones with bilateral pleural effusions

47
Q

What are the pathogenic mechanisms of Yersinia pestis?

A

Spreads regional lymph nodes –> very swollen and tender (called buboes) and can disseminate

48
Q

What are the virulence factors of Yersinia pestis?

A

1) Caps
2) Endotoxin (LPS)
3) V & W antigens allow intra-macrophage survival
4) Yersinia outer proteins injected by Type III secretion system prevent phagocytosis and cytokine production
5) Exotoxin

49
Q

What are the clinical findings of Yersinia pestis infection?

A

High fever, myalgia, extreme fatigue/collapse

Septic shock and pneumonia

50
Q

What diagnostic tests are used for Yersinia pestis?

A

1) Culture of blood or pus
2) Giemsa or Wayson stain –> safety pin appearance
3) Fluorescent antibody staining

51
Q

How is Yersinia pestis infection treated?

A

Streptomycin and tetracycline

Pulmonology (31 decks)

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