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Infections of the Lower Respiratory System Flashcards

1
Q

clinical classifications of lower respiratory tract infections

A

*pneumonitis
*pneumonia
*community acquired pneumonia
*consolidative pneumonia
*healthcare associated pneumonia
*typical pneumonia
*atypical pneumonia
*tracheitis
*bronchitis
*bronchiolitis
*alveolitis
*bronchopneumonia
*pulmonary abscess
*pleurits
*empyema

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2
Q

pneumonitis - general overview

A

*inflammation of the lung resulting in acute/subacute/chronic disease
*many causes of pneumonitis are not infectious (i.e. hypersensitivity, autoimmune, vasculitis, chemical, etc)

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3
Q

pneumonia - general overview

A

*pneumonitis due to viral, bacterial, or parasitic causes

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4
Q

community acquired pneumonia - general overview

A

*pneumonia arising in an individual in the community (not in a healthcare or long-term care setting)

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5
Q

consolidative pneumonia - general overview

A

*seen on CXR as dense alveolar infiltrate with lobar geographic boundaries
*sometimes called lobar or multilobar pneumonia

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6
Q

healthcare associated pneumonia - general overview

A

*ventilator acquired pneumonia
*hospital acquired pneumonia
*some include patients in the community with a recent significant hospitalization
*some include nursing home patients
*MUST BE 72 HOURS AFTER ADMISSION to be considered hospital-acquired

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7
Q

typical pneumonia - general overview

A

*generally refers to bacterial lobar pneumonia

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8
Q

atypical pneumonia - general overview

A

*most describes less severe nonconsolidated pneumonia (i.e. mycoplasma, chlamydophila, some viruses, Q fever, etc)

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9
Q

tracheitis - general overview

A

*inflammation of the trachea, usually due to infection

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10
Q

bronchitis - general overview

A

*inflammation of bronchi (down to terminal bronchi)
*usually due to viruses (acute) or bacteria (chronic)

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11
Q

bronchiolitis - general overview

A

*inflammation of the small and terminal bronchi
*usually due to a virus

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12
Q

alveolitis - general overview

A

*inflammation usually limited to the alveoli
*often non-infectious

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13
Q

bronchopneumonia - general overview

A

*more of a radiographic term with pneumonia and adjacent bronchi demonstrating exudates

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14
Q

pulmonary abscess - general overview

A

*focal suppurative abscess in lung

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15
Q

pleuritis - general overview

A

*inflammation of the pleura due to infectious (usually viral) or non-infectious causes

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16
Q

empyema - general overview

A

*pleural space infection
*usually due to bacteria

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17
Q

pathophysiology of pneumonia

A

*bacteria introduced into the alveoli due to airway conduction (90%; aspiration of something) or blood (10%)
*accumulation of cells, fluid, sometimes RBCs, bacterial byproducts; collapse or inundation of alveoli
*small airways occlude with alveolar material and directly de to infectious process
*ventilation does not occur to perfused lung and hypoxia results
*also decreased lung compliance and decreased global ventilation

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18
Q

host defenses against pnuemonia

A

*normal swallowing and epiglottis protect the airways
*respiratory cilia
*airway mucous
*immunoglobulin and humeral immunity in epithelial/alveolar lining fluid
*alveolar macrophages
*NK and cellular immunity, particularly for some pathogens

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19
Q

possible complications of pneumonia

A

*severe sepsis/septic shock
*secondary bacteremia (occult vs. clinically apparent)
*metastatic infection (meningitis, septic arthritis, brain abscess)
*empyema/pulmonary abscess
*complications of hypoxia
*acute respiratory distress syndrome (ARDS)

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20
Q

community acquired pneumonia (CAP) - risk factors

A

*respiratory tract disease
*smoking
*alcohol abuse
*comorbidities (diabetes, heart, renal disease, etc)
*extremes of age
*immunodeficiency
*acid reducing drugs

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21
Q

community acquired pneumonia (CAP) - pathogenesis

A

*aspiration of upper airway bacteria (90%)
*hematogenous (10%) - usually S. aureus if so

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22
Q

community acquired pneumonia (CAP) - following viral infections (3 most common pathogens)

A

*CAP can follow viral infection, particularly influenza (loss of respiratory epithelial cells and ciliary functions)
*3 common pathogens:
1. Strep pneumoniae
2. Strep pyogenes
3. Staph aureus

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23
Q

community acquired pneumonia (CAP) - symptoms

A

*fever/chills
*cough (often productive)
*chest pain (often pleuritic)
*shortness of breath
*hypoxia
*symptoms due to severe sepsis/septic shock

24
Q

most common bacterial pathogens associated with community acquired pneumonia (CAP)

A
  1. Strep pneumoniae
  2. Haemophilus influenzae
  3. Moraxella caterrhalis
  4. Legionella pneumophilia
  5. Bordetella pertussis
25
common pathogens of non-cell-wall bacterial community acquired pneumonia (CAP)
1. Mycoplasma 2. Chlamydophilia
26
community acquired pneumonia (CAP): STREP PNEUMONIAE features
*aerobic encapsulated gram positive coccus in streptococcus family *on gram stain of direct specimens: -LANCET SHAPED gram positive (purple) diplococci *alpha hemolytic *major virulence factor = antiphagocytic polysaccharide capsule *teichoic acid is proinflammatory
27
community acquired pneumonia (CAP): STREP PNEUMO clinical infection
*main host defense: serospecific antibodies *high colonization to infection rate due to antibody acquisition due to sensitization during colonization or prior infection *can be minor self-limiting infection *sometimes rapidly fatal (esp. in splenectomized patients)
28
community acquired pneumonia (CAP): HAEMOPHILUS INFLUENZAE features
*small facultative anaerobic encapsulated short gram negative bacilli in Pasteurellaceae family *on gram stain of direct specimens: -small, short, gram negative (pink) rods / coccobacilli *fastidious *requires highly nutritious "chocolate" agar *factors X and V required for growth
29
community acquired pneumonia (CAP) - Moraxella catarrhalis
*H. flu "want-to-be" *less virulent than H. flu *pathophysiology and clinical features similar to H. flu
30
diagnosis of community acquired pneumonia (CAP)
*CXR (CT usually not needed) *baseline labs and pulse ox to determine need for hospitalization *gram stain and culture of sputum, sterile body fluid/blood *PCR of sputum or positive blood culture
31
treatment for community acquired pneumonia (CAP)
*most common: beta-lactam (amoxicillin or ceftriaxone) *"atypical" pneumonia (mycoplasma or chlamydia): azithromycin macrolide *fluoroquinolone (moxifloxacin or levofloxacin) if they can't take the others
32
prevention of community acquired pneumonia (CAP)
*vaccination with 15 or 20 valent pneumococcal conjugate vaccine (all children, elderly, immunocompromised, and splenectomized) *HiB vaccine (all children and splenectomized)
33
community acquired pneumonia (CAP): LEGIONELLA PNEUMOPHILIA features
*very poor staining slender aerobic gram-negative (pink) rods *fastidious *requires special media for culture (BCYE agar); requires cysteine and iron salts for growth
34
community acquired pneumonia (CAP): LEGIONELLA PNEUMOPHILIA risk factors
*older age *lung disease *kidney, liver, or heart disease *immunocompromised *cigarette smoking *Etoh abuse
35
community acquired pneumonia (CAP): LEGIONELLA PNEUMOPHILIA pathophysiology
*acquired by INHALATION OF DROPLET NUCLEI FROM AN INFECTED AEROSOL *cooling towers, showers, spas, whirlpools, fountains, grocery store and flower show misters *organism able to survive in hot water tanks (biofilms and intracellularly in amoebae)
36
diagnosis for legionella pneumonia
*URINE ANTIGEN TEST: detection of serogroup 1 specific lipopolysaccharide antigens in urine
37
treatment for legionella pneumonia
*macrolide (azithromycin), fluoroquinolone, or rifampin antibiotics *supportive care, often in ICU
38
mycoplasma pneumonia - epidemiology
*infection of older children and young adults *can occur in epidemics in 6-8 year cycles *colonizes the nose, throat, trachea, and lower airways of infected individuals *spread via large respiratory droplets during coughing episodes
39
chlamydophila pnemoniae
*sinusitis, pharyngitis, bronchitis, and pneumonia *believed to be transmitted person to person by respiratory secretions *causes "atypical" pneumonia
40
diagnosis of mycoplasma/chlamydophila pneumonia
*too difficult to culture *serology *respiratory PCR
41
treatment of mycoplasma/chlamydophila pneumonia
*macrolide (azithromycin), tetracycline, or fluoroquinolones *NO BETA LACTAMS (because they do not have cell walls)
42
hospital-acquired pneumonia - clinical course
*prototype is ventilator-acquired *patients usually have underlying health care problems *after 3-5 days of hospitalization and/or respiratory tract instrumentation, normal naso/oropharyngeal flora transition to enteric and water associated gram negative rods
43
hospital-acquired pneumonia - common pathogens
*GNRs: serratia, klebsiella, E. coli, enterobacter, PSEUDOMONAS *MRSA and other staph aureus *note - drug resistance is a problem and must be taken into consideration
44
hospital-acquired pneumonia: PSEUDOMONAS AERUGINOSA features
*nonfermentive slender aerobic gram negative rods *grows fairly easily on blood agar media *some strains produce pyocyanin, which is a GREEN PIGMENT *has a characteristic MUSTY GRAPE ODOR *found in moist, warm environmental soils, plant materials and water
45
hospital-acquired pneumonia: diagnosis
*gram stain, culture of infected tissue, sputum, BAL, blood *multiplex PCR of blood/sputum *bronchoscopy sometimes needed for specimen acquisition
46
treatment for hospital-acquired pneumonia (esp. pseudomonas)
*advanced anti-pseudomonal penicillins: PIPERACILLIN, TICARCILLIN (piperacillin/tazobactam, ticarcillin/clavulanate) *cefipime (4th gen cephalosporin) also covers pseudomonas
47
Bordetella pertussis (Whooping Cough)
*small aerobic, gram-negative coccobacilli *diagnosed with PCR *pathogenesis: inhalation of B. pertussis organisms → adherence to ciliated respiratory epithelial cells of upper respiratory tract and nasopharynx → local tissue damage → loss of ciliated protective respiratory cells → cough
48
Bordetella pertussis - clinical features
1. coughing paroxysms: series of vigorous coughs (10-15) occurring during a single expiration 2. inspiratory "whoop": inspiration with partially closed clottis 3. post-tussive emesis
49
diagnosis of bordetella pertussis
*PCR of nasopharyngeal swab
50
treatment of bordetella pertussis
macrolide or fluorquinolone
51
prevention of bordetella pertussis
*vaccination of children, adolescents, and now adults and pregnant women
52
acute bronchitis
*almost always due to respiratory viruses *self limited *cough is the major symptom; sometimes with fever *antibiotics not indicated
53
acute bacterial exacerbations of chronic bronchitis (ABECB)
*inflammation of the airway due to infection, limited to larger airways *a complication of COPD *due to increase in bacterial load and inflammatory host response in patients with chronic bronchitis/COPD, usually following viral infections *major pathogens: H. flu, Moraxella catarrhalis, sometimes strep pneumo *important to treat only is persistent symptoms of increased amount and purulence of sputum *treatment with 5 day course of doxycycline, amoxicillin, or sometimes fluoroquinolone
54
tracheitis - common pathogen
*almost always due to S. aureus (usually MRSA) *usually intubated, ventilated/tracheostomy patients with fever and increased purulent tracheal secretions *treat with 7 days of vancomycin (confirm susceptibilities)
55
empyema - common pathogens
*staph aureus > anaerobes > alpha hemolytic strep > GNRs *usually seen on CT scan (enhancement of contrast in pleura) *treatment = chest tube or surgical drainage
56
lung abscess - common pathogens
*anaerobes, alpha hemolytic strep, sometimes staph *2-4 months of antibiotics (clindamycin is a good choice)
57
common pathogens affecting people with cystic fibrosis/bronchiectasis
*Pseudomonas aeuriginoa *Burkholderia cepacia *S. aureus, including MRSA

Pulmonology Exam (36 decks)

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