Lower Respiratory Tract Bacterial Infections Flashcards by J D

What is a key feature of the lower respiratory tract?

It is supposed to be a sterile environment. No microorganisms

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Define Acute Bronchitis

Inflammation of the bronchioles: results in reduced airflow, encourages mucus accumulation in the lungs, and triggers coughing

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Define Chronic Bronchitis

Cough and excessive mucus production for at least 3 months over a 2 year period.
Can lead to COPD: infection, smoking, inhalation of dust or fumes from workplace

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How do you get bronchitis?

Viruses

Bacteria

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Can you name 4 bacteria associated with bronchitis? Which one is associated with Acute?

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae (acute)

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Signs and symptoms of Acute Bronchitis

Low grade fever
acute cough (may have sputum)
No lung disease, exclude pneumonia

Usually during or following viral infection

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Signs and symptoms of Chronic Bronchitis

Increased cough, sputum
No evidence of pneumonia

Combination of infection and environmental factors

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Bronchitis Treatment

Treat the symptoms

If bacterial treat with antibiotics

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Define Pneumonia

Inflammation of the lungs accompanied by fluid filled alveoli and bronchioles

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Most common cause of death in elderly?

Pneumonia

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How do you get Pneumonia? (3)

Aspiration of normal flora
Hematogenous spread from another infection
Inhalation of aerosols

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PRODUCTIVE COUGH

Abrupt onset, fever, chills, congestion, SOB, chest pain

Signs/Symptoms of Typical Pneumonia

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Can you name the #1 cause of Typical Pneumonia?

Streptococcus pneumoniae

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What bacteria cause Typical Pneumonia? (5)

Streptococcus pneumoniae
Klebsiella pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus

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Tell me about the characteristics of Streptococcus pneumoniae

Lobar pneumonia
Gram positives; alpha hemolytic; optochin sensitive
capsule
adhesion
IgA protease
Pneumolysin: responsible for lysing ciliated epithelial cells

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fall and winter; CAP
Predisposing factors (viral infection, alcoholism, children, elderly, splenectomy)
Rust colored sputum
microscopy: gram pos cocci and numerous PMNs

Typical Pneumonia cause by streptococcus pneumoniae

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How do you treat Typical Pneumonia?

Streptococcus pneumoniae

Ampicillin
Erythromycin/azithromycin
Vaccine: Pneumovax or Pneumococcal conjugate vaccine

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Typical Pneumonia caused by Klebsiella pneumoniae can be described as?

normal flora of the mouth
gram neg
capsule
CAP & HAP
Thick bloody sputum & Currant jelly sputum

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Risk factors of Typical Pneumonia Klebsiella pneumoniae

Alcoholics, immunocompromised, hospitalized, on a ventilator

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Does Klebsiella pneumoniae have a higher or lower mortality rate?

Higher mortality than pneumococcal or mycoplasma pneumonia.

Necrosis of the lung and bacteremia and release of LPS

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Diagnosis and treatment of Klebsiella pneumoniae?

MacConkey agar
Treatment: Gentamicin, ciprofloxacin
Carbapenem resistance: KPC or CRKP

Chracteristics of Haemophilus influenzae

Short fat rods; Normal flora of the URT

Capsule; Adhesins; Endotoxin

Diagnosis of Haemophilus influenzae

Microscopy/gram stain
Fastidious
X and V factor on Chocolate agar.

Staphylococcus aureus

normal flora, sputum: salmon pink
Empyema
Aspiration pneumonia: influenza, very young, elderly, COPD
Hematogenous pneumonia: bacteremia, endocarditis

``` Severe form of pneumonia Massive hemoptysis septic shock high mortality rate children and young adults ```

CA-MRSA

What makes something an Atypical Pneumonia and name to organisms?

``` Not seen on gram stain (except legionella) Mycoplasma pneumoniae Chlamydophila spp Legionella pneumophila Coxiella burnetii ```

fever, headache, malaise, myalgia, nausea, diarrhea Non-productive cough (no sputum) dry hacking cough

Signs and symptoms of Atypical Pneumonia

``` Primary Atypical pneumonia CAP Excessive sweating Lasts several weeks to months Lack of seasonality Predominant in high school and college age ```

Mycoplasma pneumoniae

Mycoplasma Pneumoniae Characteristics & transmission

no cell wall capsule adhesin : attachment to base of cilia Inhalation of aerosols

``` Usually not seen in microscopy large number of PMNs Grows slowly in culture (2-6 weeks) cold agglutinins PCR ```

Mycoplasma pneumoniae

Treatment of Mycoplasma pneumoniae and Chlamydophila pneumoniae

Erythromycin/azithromycin | Doxycyclin can also be used.

Chlamydophila pneumonias TWAR (Respiratory droplets)

Characteristics: gram neg, CAP, obligate intracellular bacteria no organisms seen large number of pmns, ELISA 2 stages: Elementary body, Reticulate body symptoms: mild fever, sore throat, malaise, persistent cough, tends to be a mild infection

Abrupt onset of fever, headache, pleurisy, chills, myalgia, dry cough hyponatremia complications involving GI tract, CNS, liver and kidneys are common

``` Legionnaires' Disease gram negatives; intracellular water cooling towers/air conditioner BYCE (iron salts and cysteine) Fluorescent antibody staining: antigen detected in urine ```

RF: Elderly, smokers, chronic pulmonary disease

Risk factors of haemophilus Influenzae

Large # of PMNs

strep pneumoniae mycoplasma pneumoniae Chlamydophila pneumoniae

Parrot Fever

Chamydophila psittaci

RF: smokers, COPD, elderly, high alcohol, immunosuppressed, renal transplant, patients

RF: Legionella pneumophila

What is Pontiac Fever?

a less severe form of Legionella pneumonphila

Pseudomonas aeruginosa Staph. Aureus H. Influenza Enterics: Enterobacter, Klebsiella, E. Coli, Serratia marcescens

HAP- hospital acquired pneumonia

Pseudomonas aeruginosa Risk factors

Cystic fibrosis: s aureus first and then p. aeruginosa then burkholderia cepacia Ventilation: p. aeruginosa and burkholderia cepacia

Why is pseudomonas aeruginosa hard treat?

Resistance to many anti-microbials

Risk Factors: Dental work and loss of consciousness

Anaerobes Aspiration of respiratory or gastric materials Mixture of bacteroides and fusobacterium (necrotizing, lung abscesses, and empyema)

How does you treat an anaerobe?

metronidazole: 2-4 months

Bioterrorism agents

Anthrax, Plaque, Q fever, Tularemia, Brucellosis

Gram positive endospores capsule* inhalation of endospores

Bacillus anthracis | recall anthrax toxin

Initially: Sore throat, mild fever, myalgia, cough | After several days: severe coughing, nausea/vomiting, lethargy, confusion, shock, death

Bacillus anthracis Treat with penicillin, doxycyclin, ciprofloxacin

fever, chills, cough, difficulty breathing, frothy bloody sputum

Pneumonic Plague | Yersinia pestis: gram neg coccobacillus

Plague incubation

``` few hours to 2 days Inhaled or spread through the blood Treat with isolation Begin immediately Treatment: streptomycin/gentamycin tetra/doxycyclin chloramphenicol ```

acute onset, severe headache, nonproductive cough, muscle pain, fever

Q fever | Coxiella burnetii: obligate intracellular, gram neg coccobacillus

Cattle, sheep, and goats

Q fever | Transmitted: inhalation of contaminated dust, unpasteurized milk, occupation

``` Gram negative coccobacillus Facultative intracellular Fastidious Cysteine glucose blood agar Buffered charcoal yeast agar ```

Francisella tularensis inhalation of aerosolized bacteria/ingestion of contaminated water or food/direct contact treat: streptomycin