Lecture 24 - Pneumonia

Question 1

Bronchitis vs Pneumonia

Answer 1

Bronchitis - viral inflammation of conducting airways
-antibiotics cannot treat

Pneumonia - infection at terminal bronchioles in the air spaces, these fill with puss, does not cause bronchitis
-strepococcus does not interact with bronchi

Listen to the lungs - chest expansion for pnemonia decreased, sacs filled with pus, and also can hear crakles
-if examine someone good enough do not need a chest Xray

Question 2

How does pneumonia get into lungs?

Answer 2

Bacteria get in through upper airways through nose and mouth - breathing
-nasty infection, and person unable to clear it with immune system

Question 3

Risk factors for pneumonia

Answer 3

age less than 2, over 56
chronic lung disease
smoking
immune dysfunction

-problem with lung innate immune system

Question 4

What are main causes of pneumonia

Answer 4

Streptococcus pneumonia (MAJOR CAUSE) 
also can have haemophilus influenza and staph aureus 

-often cannot actually find the cause

Question 5

Streptococcus pnuemonia

Answer 5

• alpha haemolytic (partially haemolyses RBCs)
• colonises nasopharynx
• prevalence of colonisaiton increases in winter

Capsule - causes disease

• prevents neutrophil recognition and phagocytosis
• prevents compliment opsonisation

Also has ..
-when gets into lungs, it produces a toxin (pneumolysin) and this damages neutrophils and epithelial cells
-choline binding protein on the outside which binds immunoglobulin on epithelial cells and allows entrance into cells
-Pneumococcal surface protein A helping it bind to epithelial cells and prevents opsonisation
Pili - help to colonise and bind to human cells
Pspc - prevents activation of complement cascade

Question 6

trends of pneumonia

Answer 6

• increase in young children and elderly

- also increases in winter

Question 7

Tests on people with pneumonia

Answer 7

• In an otherwise healthy person with pneumonia, can give antibiotics and dont really need to do many of the other tests
• However if they are very unwell, maybe on ventilator - need to do other tests to find out waht the cause is so we can treat it better

Chest xray is first test
Sputum culture
Nasopharyngeal swab 
blood cultures
urine ICT
Serology 
CT chest bronchoscopy

Question 8

Treatment

Answer 8

Antibiotic treatment necessary

• reduces duration of illness and reduces risk of death
• penicillin resistance increaseing
• also give IV
• can get over this by increasing the dose of penicilin

are differences for mild, moderate and very sick people - look at page 175

Question 9

Ribosomes and macrolides

Answer 9

• bacterial ribosomes are different to human ones
• various targets on the ribsomes
• interferes with protein synthesis
• macrolides are used against these - for example of people have resistance to penicilin

-however there are some side effects GIT upset, sudden death, drug drug interactions