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CRRAB II Week 6 - WLB > Intro to Micro Respiratory Infectious Disease Part 2 - Zimmer > Flashcards

Intro to Micro Respiratory Infectious Disease Part 2 - Zimmer Flashcards

1
Q

What is the most common lower respiratory tract infection?

A

Pneumonia

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2
Q

What defense mechanisms are present in the Lower Respiratory Tract to deal with pathogens that sneak past the upper respiratory tract and the muociliary elevator?

A
  • Alveolar macrophages - most important
  • Complement components
  • Alveolar lining fluid containing:
    • surfactant
    • phospholipids
    • neutral lipids
    • IgG, IgE, IgA, secretory IgA, and Factor B
  • B cells and T cells that can elicit a localized immune response to infection
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3
Q

What can happen to a microorganism once it arrives in the alveoli?

A

Opsonization by IgG facilitating the ingestion of the microorganism by the alveolar macrophages.

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4
Q

Microorganisms can survive in the lungs if they can avoid what two things?

A
  1. Avoid phagocytosis
  2. Survive in macrophages
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5
Q

What mechanisms are used to avoid phagocytosis?

A
  • Capsule production (S. pneumoniae, H. influenza)
  • Toxin production including:
    • cytotoxins
    • leukocidins
    • exotoxins
  • Parasites and fungi are often too large for the phagocyte to engulf
  • Replication inside cells
    • viruses and some bacteria are obligate intracellular parasites that replicate inside the cells of the lung avoiding phagocytosis
  • Mimicry
    • some parasites produce surface proteins which are very similar to host proteins or acquire host proteins and appear to the phagocyte as sel.
    • some bacteria produce proteins that cause host proteins to bind to their surfaces.
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6
Q

What are the mechanisms used by the microorganism to survive in the phagocyte?

A
  • Inhibition of lysosome fusion with the phagosome
  • Escape from the phagosome (Influenza virus)
  • Resistance to killing and digesting in the phagolysosome
  • Growth in the phagocytic cell (Legionella)
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7
Q

What are the potential modes of transmission of Lower Respiratory Tract infections?

A
  • Inhalation
    • (airborne transmission)
  • Aspiration
  • Hematogenous spread
    • (from another site of infection)
  • Direct extension
    • (from a contiguous site of infection, URI → LRI)
  • Exogenous penetration and contamination
    • accidental trauma or surgery
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8
Q

What is the pathogenesis behind pneumonia?

A
  1. Microorganism enters the alveoli
  2. Colonization and growth in the lung
  3. Localized tissue injury
  4. Inflammatory response
  5. Alveolar macrophage recruitment
  6. Vascular permeability increases
  7. PMN/PML infiltration
  8. Endotoxins from Gm (-) bacteria enter systemic circulation → fever & septic shock!
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9
Q

What does an opacity or consolidation on Chest X-ray in pneumonia represent?

A

Inflammatory response in the lungs

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10
Q

What is bronchitis?

A
  • Inflammation of trachea and the bronchi
    • does not involve the alveoli
  • Typically caused by viral agents
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11
Q

What do chest x-rays look like in the case of bronchitis?

A

Typically chest radiographs for bronchitis do not reveal consolidations or infiltrates.

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12
Q

What is typical to have prior to the onset of bronchitis?

A

signs of the common cold

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13
Q

What are common viral pathogens that cause bronchitis?

A
  • Influenza viruses A & B
  • Parainfluenza
  • Adenovirus
  • Respiratory syncytial virus (RSV)
  • Rhinovirus
  • Coxsackievirus A & B
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14
Q

When is bronchitis most common?

A

winter months

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15
Q

When should bronchitis be treated? What treatment?

A

If the condition lasts longer than 14 days, along with fever and purulent sputum then bacterial identification can be important along with antibiotic treatment (erythromycin or azithromycin).

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16
Q

What are the typical symptoms in bronchitis?

A
  • Cough
    • nonproductive at first, but can become mucopurulent
    • sputum production due to hypersecretion in the bronchial airways
  • Chest pain
  • Fever
  • Malaise
  • Headache
  • Sore throat
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17
Q

How long does viral bronchitis last?

A

Typically the viral infection is eliminated and the mucous membranes return to normal within 7-10 days.

(delayed in smokers)

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18
Q

What are the common pathogens causing bronchitis?

A
  • Rhinovirus
  • Paramyxovirus
  • Respiratory Syncytial Virus
  • Influenza virus A, B, C
  • Coxsackie virus A & B
  • Adenovirus
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
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19
Q

What is the viral classification of Rhinovirus?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • RNA virus
  • Icosahedral Nucleocapsid
  • Nonenveloped
  • SS (+) Nonsegmented Genome (Class IV)
  • Picornaviridae
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20
Q

What is the viral classification of Paramyxovirus (Parainfluenza virus)?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • RNA virus
  • Helical Nucleocapsid
  • Enveloped
  • SS (-) Nonsegmented Genome (Class V)
  • Paramyxoviridae
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21
Q

What is the viral classification of Respiratory Syncytial Virus?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • RNA Virus
  • Helical Nucleocapsid
  • Enveloped
  • SS (-) Nonsegmented (Class V)
  • Paramyxoviridae
  • Pneumovirus
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22
Q

What is the viral classification of Influenza virus A, B, C?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • RNA virus
  • Helical Nucleocapsid
  • Enveloped
  • SS (-) Nonsegmented Genome (Class V)
  • Orthomyxoviridae
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23
Q

What is the viral classification of Coxsackievirus A + B?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • RNA virus
  • Icosahedral Nucleocapsid
  • Nonenveloped
  • SS (+) Nonsegmented Genome (Class IV)
  • Picornaviridae
  • Enterovirus
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24
Q

What is the viral classification of Adenovirus?

  • DNA
  • Nucleocapsid shape
  • Envelope status
  • Class
  • Family
A
  • DNA virus
  • Icosahedral Nucleocapsid
  • Nonenveloped
  • DS linear DNA (Group I)
  • Adenoviridae
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25
Q

What are the most common causes of atypical pneumonia?

A
  • Mycoplasma
  • Legionella
  • Chlamydia
  • Viruses
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26
Q

What are the most common causes of pneumonia in adults (18-40 years)?

A
  • Mycoplasma
  • C. pneumoniae
  • S. pneumoniae
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27
Q

What are two bacterial causes of bronchitis that are neither Gm (-) or Gm (+)?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
28
Q

What are two obligate intracellular parasites (require host ATP for energy)?

A
  • Clamydiae
    • Clamydiae replicate within inclusion bodies.
  • Rickettsiae
29
Q

Clamydiae replicate within what cells?

A

Clamydiae replicate within inclusion bodies.

30
Q

How is bronchiolitis diagnosed?

A

Diagnosis based on clinical signs and symptoms with a chest X-ray needed to rule out pneumonia.

Antigen testing for RSV could be appropriate.

31
Q

What is bronchiolitis?

A
  • Inflammation of the bronchial tree as low as the bronchioles – no alveoli involvement.
    • Typically a disease of infants younger than 1 year of age due to narrow, developing airways.
    • Typically preceded by a minor viral URI.
32
Q

What are the most common pathogens causing bronchiolitis?

A
  • Paramyxovirus
  • Respiratory Syncytial Virus
  • Adenovirus
33
Q

What are the most common causes of pneumonia in young children?

A
  • RSV
  • Parainfluenza virus
34
Q

What are the most common causes of conjunctivitis?

A
  1. H. influenza
  2. Adenoviruses
  3. S. pneumoniae
35
Q

What are the two distinct symptom phases of Pertussis?

A
  1. Catarrhal stage
    • after incubation period (3-21) days
    • begins when bacteria present in the respiratory tract
  2. Paroxysmal stage
36
Q

What are the classic symptoms of the Catarrhal stage of Pertussis? How long do they last?

A
  • cold symptoms, most notably a runny nose
  • lasts 1 to 2 weeks
37
Q

What are the classic symptoms of the Paroxysmal stage of Pertussis? How long do they last?

A
  • Severe and uncontrollable coughing
    • (a paroxysm can be thought of as a convulsive attack)
  • Violent coughing spasms can result in burst blood vessels in the eyes or even vomiting
  • In the worst cases, seizures result from small hemorrhages in the brain.
38
Q

What occurs during the recovery phase or “Convalescent Phase” of Pertussis?

A
  • pertussis bacteria are decreasing and no longer cause ongoing symptoms
    • the active stages of the disease damage the cilia on respiratory tract epithelial cells, and complete recovery of these surfaces requires weeks or even months
  • During this time, other microorganisms can more easily colonize and cause secondary infection (have vulnerable cells).
39
Q

What does the Pertussis toxin do?

A

Pertussis toxin – AB toxin – results in high levels of cyclic AMP and lots of mucus production.

Tracheal cytotoxin kills ciliated cells.

40
Q

What is the bacterial classification of Bordetella pertussis?

Gm +/-

Shape

Growth medium

A
  • Bacteria
  • Gram (-)
  • Coccobacilli, pleomorphic
  • Growth on Bordet-Gengou medium
41
Q

What are the major virulence factors of Bordetella pertussis?

A

Its virulence factors include:

  • pertussis toxin
  • filamentous hemagglutinin
  • pertactin
  • fimbria
  • tracheal cytotoxin
42
Q

What are the most common pathogens that cause Influenza?

A
  • Initial infection:
    • Influenza A, B, C
  • Secondary infection:
    • S. aureus
    • S. pyogenes
    • H. influenzae
    • S. pneumoniae
43
Q

What is the bacterial classification of Staphylococcus aureus?

Gm +/-

Shape

Catalase +/-

Coagulase +/-

A
  • Bacteria
  • Gram (+)
  • Cocci
  • Catalase (+)
  • Coagulase (+)
44
Q

What is the bacterial classification of Streptococcus pyogenes?

Gm +/-

Shape

Catalase +/-

Hemolysis

A
  • Bacteria
  • Gram (+)
  • Cocci
  • Catalase (-)
  • Beta Hemolytic
  • Bacitracin Sensitive
45
Q

What is the bacterial classification of Streptococcus pneumoniae?

Gm +/-

Shape

Catalase +/-

Hemolysis

A
  • Bacteria
  • Gram (+)
  • diplococci
  • Catalase (-)
  • Alpha-Hemolytic
  • Bile-Esculin Negative
  • Optochin Susceptible
46
Q

What is the bacterial classification of Haemophilus influenzae?

Gm +/-

Shape

A
  • Bacteria
  • Gram (-)
  • Coccobacilli, Pleomorphic
  • X & V Factors Required
47
Q

What are the most common causes of meningitis in children aged 6 months to 6 years?

A
  • S. pneumoniae
  • N. meningitidis
  • H. influenzae type B
    • (rate decreasing with the use of the Hib vaccine)
48
Q

What are the most common causes of pneumonia in Adults (40-65 yrs)?

A
  • S. pneumoniae
  • H. influenzae
  • Legionella
49
Q

What are the most common causes of pneumonia in Adults (>65 yrs)?

A
  • S. pneumoniae
  • Gram (-) rods
  • H. influenzae
50
Q

What are the most common causes of meningitis in 60+ yrs?

A
  • S. pneumoniae
  • Gram (-) rods
  • Listeria
51
Q

How does the Influenza virus attach to human cells? What two proteins are important in the process?

A
  • Viral hemagglutinin (HA) envelope protein makes contact with with sialic acid on cell surfaces
    • leads to endocytosis
  • The viral neurominidase (NA) envelope protein is important for cleaving HA bound to sialic acid
    • this permits viral spread.
52
Q

When does ANTIGENIC DRIFT occur in Influenza virus?

A
  • Occurs when minor changes in antigens occur due to gene mutation in influenza virus.
    • Influenza A and B only
53
Q

When does ANTIGENIC SHIFT occur in Influenza virus?

A
  • Antigenic shift occurs when major changes in antigens occur due to gene reassortment/rearrangement in influenza virus.
    • Influenza A only
54
Q

How are influenza vaccines made?

A

Vaccines are made by infecting chicken eggs with the flu virus strain needed for that season followed by viral inactivation and injection.

55
Q

How is pneumonia defined?

A

Inflammatory condition of the lung in which fluid fills the alveoli.

56
Q

What are the three most common pathogens causing pneumonia?

A
  • Streptococcus pneumoniae
  • Streptococcus agalactiae (Group B Strep)
  • Nocardia asteroides
57
Q

What is the bacterial classification of Nocardia asteroides?

Gm +/-

Shape

A
  • Bacteria
  • Gram (+)
  • Beaded Filaments
  • Weakly Acid Fast
  • Obligate Aerobe
58
Q

What is the bacterial classification of Streptococcus agalactiae?

Gm +/-

Shape

Catalase +/-

Hemolysis

A
  • Bacteria
  • Gram (+)
  • Cocci
  • Catalase (-)
  • Beta-Hemolytic
  • Bacitracin Resistant
  • Group B Strep
59
Q

What pathogen does Rust-colored sputum indicate for pneumonia?

A

Streptococcus pneumoniae

60
Q

What pathogen does green sputum indicate for pneumonia?

A

Pseudomonas, Haemophilus, and pneumococcal species

61
Q

What pathogen does Red currant-jelly sputum indicate for pneumonia?

A

Klebsiella species pneumonia

62
Q

What pathogens do foul-smelling or bad-tasting sputum indicate in pneumonia?

A

Anaerobic infections

63
Q

What are the two bacteria that are acid-fast staining?

A

Nocardia asteroides and Mycobacteria tuberculosis

64
Q

What is the bacterial classification of Mycobacterium tuberculosis?

A
  • Acid-fast staining
  • Aerobic
  • Bacilli
  • Visible growth takes 3 to 8 weeks on solid media
  • Takes a long time to grow!
  • An estimated 10,000 organisms/mL are required for sputum smear positivity
  • Pulmonary cavities contain huge numbers of organisms
65
Q

What selective growth media is used to grow Bordetella pertussis?

A
  • Bordet-Gengou Agar traditionally allowed for the selective growth of Bordetella spp.
  • Now Regan-Lowe medium (blood, charcoal, antibiotic) is used
  • Resistant to cephalexin/penicillin

CRRAB II Week 6 - WLB (11 decks)

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