Lecture 7: Pneumonia

Question 1

Routes to lower respiratory tract (3)

Answer 1

Inhalation, aspiration, bloodstream

Question 2

Host defenses in lungs include…(4)

Answer 2

Removal of inhaled material, antimicrobial peptides, phagocytic and inflammatory cells, adaptive immune responses (humoral and cellular)

Question 3

Removal of inhaled material by these three mechanism

Answer 3

Progressively branching airways, cough, mucociliary tract

Question 4

First cellular line of defense

Answer 4

Pulmonary alveolar macrophages

Question 5

Can viruses/bacteria affect our natural defenses?

Answer 5

Yes: some pathogens can damage our ciliary system, inhibit phagocytosis, damage IgA

Question 6

Why would we be exposed to a large inocolum of pathogen?

Answer 6

Large volume due to laryngeal/gastric dysfunction or large concentration of pathogen due to gum/sinus disease, low stomach acid, prolonged illness, or being on a ventilator

Question 7

Most common pneumonia bug

Answer 7

Streptococcus pneumoniae (50% of cases); gram positive diplococci

Question 8

Virulence factor of Streptococcus pneumoniae

Answer 8

Polysaccharide capsule protects from phagocytosis

Question 9

Another gram positive, seen in clusters. Associated with what settings?

Answer 9

Staphylcoccus aureus –> secondary complication of resp tract infections due to influenza and hospitalized patients

Question 10

What’s a small coccbacillary gram-neg organism that can cause pneumonia. Associated with what patients?

Answer 10

Hemophilus influenzae; patients with COPD

Question 11

Klebsiella pneumoniae associated with what two things?

Answer 11

Currant jelly sputum, often seen in alcoholics

Question 12

Pseudomonas aeruginosa is primarily seen in patients who are…

Answer 12

Hospitalized, previously treated with antibiotics

Question 13

Pseudomonas aeruginosa and Klebsiella pneumoniae are both (type of bacteria)

Answer 13

Gram-negative bacillus

Question 14

Where do we find Legionella pneumophila. Can this affect healthy people? What kind of bacteria?

Answer 14

Cooling towers; yes; poorly staining gram-negative

Question 15

What kind of bacteria is Chlamydophila pneumoniae

Answer 15

Obligate intracellular parasite

Question 16

What is special about Mycoplasma pneumoniae and what does it cause?

Answer 16

Smallest living free organism; “walking pneumonia” (chest looks worse than clinical presentation)

Question 17

How would we get an anerobic organism infection?

Answer 17

Aspiration of secretions due to impaired consciousness or difficulty swallowing

Question 18

Association between viruses and pneumonia

Answer 18

Do not cause pneumonia very often, but influenza can cause it

Question 19

Definition of pneumonia

Answer 19

Infection and inflammation of pulmonary parenchyma

Question 20

Define bronchopneumonia

Answer 20

Distal airway inflammation prominent + alveolar disease with patchy distribution (S. aureus and gram negatives)

Question 21

Define lobal pneumonia

Answer 21

Infectious process throughout entire lobe with dense consolidation; infection spreads from alveolus –> alveolus

Question 22

Define interstitial pneumonia

Answer 22

Inflammatory process w/in interstitial walls rather than alveolar spaces; diffuse and bilateral markings; mycoplasma and viruses

Question 23

Lung pathophysiology in pneumonia

Answer 23

Inflammation and infection –> decreased ventilation (V/Q mismatch) which can become shunt if bad enough –> hypoxemia

Question 24

When might a patient have CO2 retention?

Answer 24

If they already have an extremely limited reserve (healthy patients hyperventilate to get rid of excess CO2)

Question 25

Symptoms of pneumonia (4)

Answer 25

Fever, cough (productive if bacterial but dry if viral/mycoplasm in interstitium), SOB, pleuritic chest pain

Question 26

Lung exam of pneumonia

Answer 26

Rales and consolidation (high pitched bronchial breath sounds, tactile fremitus, egophony, whispered pectorliquoy, dullness to percussion)

Question 27

Typical pneumonia description

Answer 27

Acute, productive cough, consolidation, increased WBC, X-ray demonstrates lobar consildation

Question 28

Typical pneumonia bugs

Answer 28

Strep pneumoniae, hemophilus influenza, klebsiella pneumoniae, staph aureus, anaerobes

Question 29

Atypical pneumonia description

Answer 29

Gradual presentation, non-productive cough, normal WBC, more systemic complaints

Question 30

Atypical pneumonia bugs

Answer 30

Mycoplasma, chlamidophyla, legionella, viruses

Question 31

Fungus that can cause pneumonia

Answer 31

Histoplasmosis, coccidiomycosis, blastomycosis, cryptococcosis, aspergillus, pneumocystis jiroveci

Question 32

Histoplasmosis

Answer 32

Ohio River valley, dimorphic (yeast in body), can lead to granulomas, should be self-limited in healthy people

Question 33

If someone has chronic lung disease, what an they get with Histoplasmosis?

Answer 33

Chronic pulminary histoplasmosis, which looks like tuberculosis

Question 34

Coccidiomycosis

Answer 34

San Joaquin Valley, can cause granulomas, self-limited in healthy but disseminated in immunocompromised, can look like TB if someone has chronic pulmonary disease

Question 35

Blastomycosis

Answer 35

Soil-dwelling, midwestern US, primary response is neutrophilic + granulomas

Question 36

Acute infection of Blastomycosis?

Answer 36

Looks like typical pneumonia, generally self-limited unless immunocompromised

Question 37

Cryptococcosis

Answer 37

Soil contaminated with bird droppings, cleared in healthy but pneumonia or dissemination in immunocompromised

Question 38

Scary complication of cryptococcosis

Answer 38

Meningoencephalitis

Question 39

Aspergillus

Answer 39

Acute angle branching, it’s everywhere so only immunocompromised patients get it

Question 40

What are the complications of aspergillus

Answer 40

Allergic bronchopulmonary aspergillosis, aspergilloma, invasive aspergillosis, chronic necrotizing pulmonary aspergillosis

Question 41

Allergic bronchopulmonary aspergillosis (ABPA)

Answer 41

Happens to asthmatis, organism acts as antigen causing inflammation (doesn’t invade)

Question 42

Aspergilloma

Answer 42

Happens to people with pre-existing cavity in lungs which is colonized (ball of fungus), little tissue invasion, may be asymptomatic or with hemoptysis if it bursts

Question 43

Invasive aspergillosis

Answer 43

Happens to people who are immunocompromised (neutropenic), invades into lung tissue

Question 44

Chronic necrotizing pulmonary aspergillosis

Answer 44

Happens to people with underlying lung disease/mild immuncompromised, necrosis often leads to cavity formation

Question 45

Pneumocystis jiroveci

Answer 45

Seen in immunocompromised, alveolar filling leads to hypoxemia

Question 46

Compliations of pneumonia

Answer 46

Lung abscess (generally by bugs that cause necrosis), empyema (pneumonia extends to pleural surface causing pus in pleural space)

Question 47

Why do we drain empyema?

Answer 47

Without you can get scarring (fibrothorax) cause antibiotics won’t go to this poorly perfused space

Question 48

If community-acquired pneumonia…

Answer 48

Common bugs, treatment should cover these bugs: macrolide or doxycyclne OR fluroquinolone OR beta-lactam plus macrolide

Question 49

If hospital-acquired pneumonia…

Answer 49

Could be gram-negatives or MRSA

Question 50

If health-care associated pneumonia…

Answer 50

Could be resistant strains

Question 51

What’s a type of pneumonia related to a medical device?

Answer 51

Ventilated-associated pneumonia