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micro exam 2 > lecture 28-lower respiratory tract infections > Flashcards

lecture 28-lower respiratory tract infections Flashcards

1
Q

bacterial pneumonia
describe infection
sputum features
symptoms

A
  • often a secondary infection from a viral respiratory tract infection
  • inflammation of lung as result of bacterial infection
  • sputum-rust colored, foul smelling, watery, purulent (pus)
  • symptoms- crackles upon auscultation, fever, malaise, pleuritic chest pain, dyspnea,
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2
Q

common virulent factors for bacterial lung pneumonia

A

-virulence factors- capsid, intracellular growth, IgA protease, exotoxins, LPS endotoxin

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3
Q

what does the chest xray look like for a pt who has pneumonia?

A
  • opacity
  • fluid, bacteria, neutrophils and fibrin that leads to consolidation (lungs so full that they cant expand) or infiltrate that shows that opacity
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4
Q

bacterial pneumonia lobar vs patchy cxr patterns and the bacterias that cause this

A
  • *-lobar- part of TYPICAL PNEUMONIA PATTERN- covers entire lobe and leads to consolidation: streptococcus pneumoniae, s. aureus, H influenzae, most gram negative bacteria = PIA
  • *patchy- ATYPICAL pneumonia -patchy and not full consolidation= mycoplasma pneumonae, chlamydophila pneumonae and legionella pneumophila (mike was in the legion with chlamydia and he’s super atypical)
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5
Q

how do the lungs look for a lobar vs bronchopneumonia

A

bronchopneumonia- has pus and looks uglier and darke

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6
Q

symptoms of typical vs atypical

A
  • onset- typical sudden/atypical gradual
  • looks- toxic/well (walking pneumonia)
  • purulent (bloody)/scant, watery
  • WBC count- left shift-causes lobar pneumonia/ patchy infiltrate
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7
Q

most common cause of typical pneumonia

most common cause of atypical pneumonia

A

typical- streptococcus pneumoniae

atypical- mycoplasma pneumoniae

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8
Q

complications of pneumonia

A
  • pleural effusion -effusion into pleural space
  • anemia and thrombocytopenia
  • decreased pO2
  • muscle atrophy
  • bronchiectasis- irreversible dilation of the bronchi and bronchioles caused by muscle and elastic tissue damage
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9
Q

aspiration pneumonia

A
  • different from typical and atypical
  • aspiration of foreign material into the bronchial tree
  • carry bacteria in and dilute out things needed to clear normal crap
  • typical in alcoholics (puke) coma pt, stroke pt
  • secondary bacterial pneumonia
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10
Q

Cap vs Hap

A

community acquired pneumonia- pneumonia acquired anywhere else besides hospital
hospital acquired- associated with intubation that interferes with mucocilliary escalator- OFTEN CAUSED BY GRAM NEG BACTERIA

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11
Q

differential diagnoses of pneumonia

A

-CHF, lymphoma, carcinoma, lupus, drug hypersensitivity, lung vasculitis

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12
Q

what do the labs look like for a pneumonia pt

A

elevated wbc (left shift)
elevated immature neutrophils
positive blood culture
sputum >25 PMNs and <10 epithelial cells

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13
Q 
streptococcus pneumoniae
what does it cause?
what kind of bacteria?
alpha or beta hemolytic?
catalase neg or pos?
seroypes?
aka-
 bile solubility?
A

-normal in upper respiratory tract
-causes; pneumococcal pneumonia
-gram positive- diplococci in chains
-alpha hemolytic (some not hemolyzed-green)
-catalase neg
serotypes >90
aka -pneumococcal
bile-positive

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14
Q

pneumococcal virulence factors

A
  • capsule
  • surface adhesins
  • IgA protease- (cleaves IgA and prevents clearance)
  • pneumolysin -pore forming toxin
  • teichoic acid and peptidoglycan- inflammation
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15
Q

how does streptococcus (pnumococcal) pneumoniae work?

A
  • cough, fever, dyspnea, chest pain, crackles and sputum-rust colored
    -preceded by days of rhinorrhea
    -abrupt spiking fever
    -pleuritic chest
    -poor oxygen
    resolves 7-10 days
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16
Q

treatment and prevention of s. pneumoniae for pneumonia

A

treatment- PCN, azithromycin and cephalosporin

prevention- 2 vaccines

17
Q

staphylococcus aureus
type:
catalase?
coagulase?

A
  • gram pos
  • catalase- positive (different from strepto pneumonae)
  • coagulase-positive- in order to distinguish from other staph’s
18
Q

virulence factors of s. aureus

A
  • protein A-binds Fc portion of antibody- coats itself in antibody to make it look like antibody vs antigen
  • coagulase- clotting fac
  • Panton Valentine leukocidin- severe necrotizing pneumonia and pore-forming cytotoxin
19
Q

MRSA

A

-methicillin resistant staph aureus
-resistant to all beta lactam antibiotics including cephalosporin
-Harder to treat, no necessarily more virulent
-treatment- PCN and cephalosporin (if not resistant)
if resistant- linezoloid or vancomysin

20
Q

what are the two main gram negative bacterias that cause typical pneumonia-aerobic and anaerobic

A

anaerobic- klebsiella pneumoniae
aerobic- pseudomonas aeruginosa
(menumonic-arrogant surgeon gives you oxygen and if you get clubbed you don’t get oxygen)
= usually hospital acquired and come from aspiration pneumonia -generally pt have underlying disease

21
Q

what’s the biggest prob when it comes to gram negative pneumonia

A

antibiotic resistance

22
Q

treatment and diagnosis of gram neg pneumonia

A
  • diagnosis- blood culture pos in 20% of pt
  • > 25PMNs , 10<epithelial cells
    treatment: broad spectrum antibiotics and multidrug therapy
23
Q

klebsiella pneumoniae
type
what does it have that make them resistant to antibiotics

A
  • gram neg rod that causes pneumonia
  • non-motile
  • mucoid colonies (capsule)
  • strains contain beta-lactamases that make them resistant to beta lactam antibiotics
24
Q

where are klebsiella pneumoniae found? and what virulence factors does it have?
symptoms? mortality rate?
oxidase?

A
  • found in resp tract and in SOME peoples feces
  • has capsule and LPS (b/c it’s gram neg)
  • bloody sputum and necrosis, classic lobar- “currant jelly sputum”
  • 50%
  • oxidase neg
25
Q

pseudomonas aeruginosa

A
  • main aerobic gram neg bacteria that causes pneumonia
  • obligate aerobe
  • oxidase pos
  • blue/yellow and green pigments
  • CULTURE SMELLS LIKE GRAPES
26
Q

where can pseudomonas aeruginosa grow

A

in hand soaps
diluted antiseptics
water with minimal nutrients

27
Q

virulent factors of pseudomonas aeruginosa

A
  • Toxin A
  • Leukocidin-pore forming toxin (like s. aureus)
  • phospholipase C-disrupts membrane
  • capsule
  • pyocyanin- blue compound that’s toxic
  • pyoverdin- green iron uptake protein
28
Q

treatment of p. aeruginosa

A
  • antipsudomonal pcns (ticarcillin and piperacillin)
    AND
    -aminoglycoside- gentamicin
29
Q

what is the main killer of cystic fibrosis pt

A
  • pseudomonas aeruginosa

- strains found to impair pulmonary fxn and to create a mucocilliary film that is impossible to irradicate

micro exam 2 (8 decks)

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