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Respiratory Block: Microbiology > Lower Respiratory Tract Infections 2 > Flashcards

Lower Respiratory Tract Infections 2 Flashcards

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1
Q

What is aspiration pneumonia?

A

Contents of oral / upper GIT pass through larynx and trachea and enter lungs
- may occur in a community or hospital setting

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2
Q

What is macroaspiration?

A

Large volume of aspiration

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3
Q

What are risk factors for aspiration pneumonia?

A
  • swallowing dysfunction
  • altered mental status
  • enteral feeding
  • poor oral hygiene
  • colonization with virulent organisms
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4
Q

Which organisms are often implicated in aspiration pneumonia?

A
  • anaerobic organisms
  • gram-negative bacilli
  • Staphylococcus Aureus
    (from the mouth)
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5
Q

What can occur if “sterile” gastric contents are aspirated?

A

Can cause chemical pneumonitis

- acidic stuff into stomach = inflammation not infection

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6
Q

What is hospital acquired pneumonia?

A

Pneumonia not incubating at the time of admission and presenting clinically >48 hours after admission

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7
Q

How common is hospital acquired pneumonia?

A

Common nosocomial infection, particularly in ICU settings

- significant morbidity and mortality associated

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8
Q

What is ventilator associated pneumonia?

A

Pneumonia that presents >48 hours after endotracheal intubation (especially common)

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9
Q

What is the pathophysiology of HAP/VAP?

A

Similar to that of CAP

- aspiration of oropharyngeal secretions

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10
Q

What are factors that contribute to the development of HAP/VAP?

A
  • supine position
  • use of sedatives
  • impaired mucociliary clearance
  • use of proton pump inhibitors
  • NG tubes
  • endotracheal tube colonization and biofilm
  • depressed immune function
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11
Q

What are common sources of VAP pathogens?

A
  1. Aspiration
  2. Intubation procedure
  3. Biofilm formation
  4. Contaminated secretions
  5. Contaminated respiratory equipment
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12
Q

What are some factors to consider in the approach to empiric antibiotic selection for HAP/VAP?

A
  1. Early vs. late onset pneumonia
  2. Other risk factors for colonization with nosocomial pathogens, IV antibiotic use in the preceding 90 days
  3. Local epidemiology (institution and unit-specific)
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13
Q

What are possible causative agents of HAP/VAP that should be considered?

A
  • enteric gram-negative bacilli (Klebsiella species)
  • non-fermenter gram-negatives (Pseudomonas Aeruginosa, Acinetobacter Baumannii)
  • Methicillin resistant S. Aureus (MRSA)
  • other multi-drug resistant (MDR) organisms
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14
Q

What is healthcare-associated pneumonia?

A

Pneumonia in non-hospitalized patients who have had significant contact with the healthcare system

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15
Q

Why are healthcare-associated pneumonia patients at higher risk?

A

Contact with the healthcare system may increase risk for MDR pathogens
BUT
Underlying patient characteristics also important determinants of risk for MDR pathogens (cancer patients receiving chemo; renal - dialysis; HIV - ARVs etc.)

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16
Q

What is a pleural effusion?

A

Excess fluid that accumulates in pleural cavity

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17
Q

What is an exudative effusion associated with?

A

Inflammation

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18
Q

What is empyema?

A

Exudative effusion with pus (microbes and dead white cells)

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19
Q

What are some causes of empyema?

A
  1. Parapneumonic (most common)
  2. Thoracotomy
  3. Trauma
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20
Q

What will determine the causative agents of empyema?

A

Causative agents are associated with the source of the empyema.

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21
Q

What are likely causative agents of empyema in community acquired pneumonia patients?

A
  1. S. Pneumoniae

2. S. Aureus

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22
Q

What are likely causative agents of empyema in community acquired empyema patients?

A
  1. Streptococcus Anginosus Group

2. Anaerobes

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23
Q

What are likely causative agents of empyema post trauma / surgery?

A
  1. Staphylococcus Aureus

2. Aerobic GNBs

24
Q

What are likely causative agents of empyema as a complication of viral influenza?

A
  1. S. Pneumoniae
  2. S. Aureus
  3. S. Pyogenes
25
Q

What are likely causative agents of sub-diaphragmatic empyema?

A

Often polymicrobial, anaerobes

26
Q

What are some other causes of pleural effusion / empyema?

A
  1. MTB

2. Amoebiasis - Entamoeba Histolytica

27
Q

Pleural Effusion / Empyema: How should a diagnosis be made?

A
  1. Chest X-Ray +/- Sonar / CT Scan

2. Pleurocentesis for diagnostic purposes (Protein, LDH, MC&S)

28
Q

Pleural Effusion / Empyema: How should the patient be managed?

A

Intercostal drainage required for empyema

in addition to appropriate antibiotics

29
Q

What is a lung abscess?

A

Localized necrosis of lung tissue caused by infection producing one or more cavities

30
Q

What is a lung abscess often associated with?

A

Often communicates with large airways and is associated with coughing up purulent sputum

31
Q

What are primary lung abscesses associated with most often?

A

Associated with aspiration (most common)

- frequently posterior segment of the right upper lobe

32
Q

What are secondary lung abscesses associated with?

A

Airway obstruction or immunosuppression

33
Q

What organisms are likely implicated in a lung abscess?

A

Polymicrobial: oral cavity anaerobes and streptococci

- Less commonly S. Aureus or Klebsiella species

34
Q

What should be your approach to diagnosis of a lung abscess?

A

Chest X-Ray +/- CT scan

- cavity with an air-fluid level seen on X-Ray

35
Q

How should a lung abscess be treated?

A

With a prolonged course of antibiotics

36
Q

What is Leoffler’s Syndrome?

A

Acute Pulmonary Eosinophilia

- self-limiting, non-infectious pulmonary inflammation associated with increased eosinophils in tissues and blood

37
Q

What are some of the underlying causes of Leoffler’s Syndrome?

A
  1. Idiopathic
  2. Parasitic infection
  3. Various drugs
38
Q

How does Leoffler’s Syndrome present clinically?

A

Usually mild symptoms:

  • chest pain
  • dry cough
  • fever
  • dyspnoea
39
Q

How is Leoffler’s Syndrome managed?

A

Usually self-limiting and mild

- treatment of underlying cause

40
Q

What is Pertussis also known as?

A

Whooping cough

41
Q

What is the causative agent in pertussis?

A

Bordetella Pertussis (small gram-negative cocco-bacilli)

42
Q

What are the main virulence factors of pertussis?

A

Toxins and adherence factors

43
Q

Is vaccination for Pertussis routine in SA?

A

Acellular pertussis vaccine is part of the SA Expanded Program of Immunization

44
Q

How long does immunity for Pertussis last?

A

Immunity after vaccination is not long and wanes over time

45
Q

How is Pertussis transmitted?

A

Transmitted through respiratory secretions

- HIGHLY INFECTIOUS

46
Q

What is the incubation period of Pertussis?

A

7-10 days

47
Q

What are the symptoms of Pertussis?

A

Wide range of symptoms, disease may be mild or severe

48
Q

What are the three phases in the clinical features of Pertussis?

A
  1. Catarrhal Phase: initial symptoms similar to that of the common cold with a mild, dry cough
  2. Paroxysmal Phase: later cough can become more severe - episodes of paroxysms followed by a whooping sound and / or vomiting after coughing
  3. Convalescent Phase
49
Q

How may infants with Pertussis present?

A

With apnoeas

50
Q

How may adolescents and adults who were previously vaccinated present with Pertussis?

A

May present with mild symptoms, often missed

51
Q

What are some of the complications of Pertussis?

A

Complications include:

  • hypoxia
  • seizures
  • encephalopathy
  • secondary respiratory tract infections
52
Q

What is the mortality of Pertussis?

A

Significant mortality in infants <3 months old.

53
Q

How is Pertussis diagnosed?

A

Diagnosis can be made clinically.
Laboratory diagnosis:
- PCR: very sensitive
- Culture: gold standard, but fastidious organism
- Serology: useful for diagnosis late in the course of disease

54
Q

How is Pertussis treated?

A

Erythromycin for 7 days
OR
Azithromycin for 5 days
- must be started early to impact course of infection
- eradicate organism for nasopharynx (so patient no longer infectious)

55
Q

What should be remembered in Pertussis management?

A

Close contacts require prophylaxis

Respiratory Block: Microbiology (7 decks)

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