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

Lower Respiratory Tract Infections 2 Flashcards

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
What are likely causative agents of sub-diaphragmatic empyema?
Often polymicrobial, anaerobes
26
What are some other causes of pleural effusion / empyema?
1. MTB | 2. Amoebiasis - Entamoeba Histolytica
27
Pleural Effusion / Empyema: How should a diagnosis be made?
1. Chest X-Ray +/- Sonar / CT Scan | 2. Pleurocentesis for diagnostic purposes (Protein, LDH, MC&S)
28
Pleural Effusion / Empyema: How should the patient be managed?
Intercostal drainage required for empyema | in addition to appropriate antibiotics
29
What is a lung abscess?
Localized necrosis of lung tissue caused by infection producing one or more cavities
30
What is a lung abscess often associated with?
Often communicates with large airways and is associated with coughing up purulent sputum
31
What are primary lung abscesses associated with most often?
Associated with aspiration (most common) | - frequently posterior segment of the right upper lobe
32
What are secondary lung abscesses associated with?
Airway obstruction or immunosuppression
33
What organisms are likely implicated in a lung abscess?
Polymicrobial: oral cavity anaerobes and streptococci | - Less commonly S. Aureus or Klebsiella species
34
What should be your approach to diagnosis of a lung abscess?
Chest X-Ray +/- CT scan | - cavity with an air-fluid level seen on X-Ray
35
How should a lung abscess be treated?
With a prolonged course of antibiotics
36
What is Leoffler's Syndrome?
Acute Pulmonary Eosinophilia | - self-limiting, non-infectious pulmonary inflammation associated with increased eosinophils in tissues and blood
37
What are some of the underlying causes of Leoffler's Syndrome?
1. Idiopathic 2. Parasitic infection 3. Various drugs
38
How does Leoffler's Syndrome present clinically?
Usually mild symptoms: - chest pain - dry cough - fever - dyspnoea
39
How is Leoffler's Syndrome managed?
Usually self-limiting and mild | - treatment of underlying cause
40
What is Pertussis also known as?
Whooping cough
41
What is the causative agent in pertussis?
Bordetella Pertussis (small gram-negative cocco-bacilli)
42
What are the main virulence factors of pertussis?
Toxins and adherence factors
43
Is vaccination for Pertussis routine in SA?
Acellular pertussis vaccine is part of the SA Expanded Program of Immunization
44
How long does immunity for Pertussis last?
Immunity after vaccination is not long and wanes over time
45
How is Pertussis transmitted?
Transmitted through respiratory secretions | - HIGHLY INFECTIOUS
46
What is the incubation period of Pertussis?
7-10 days
47
What are the symptoms of Pertussis?
Wide range of symptoms, disease may be mild or severe
48
What are the three phases in the clinical features of Pertussis?
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
How may infants with Pertussis present?
With apnoeas
50
How may adolescents and adults who were previously vaccinated present with Pertussis?
May present with mild symptoms, often missed
51
What are some of the complications of Pertussis?
Complications include: - hypoxia - seizures - encephalopathy - secondary respiratory tract infections
52
What is the mortality of Pertussis?
Significant mortality in infants <3 months old.
53
How is Pertussis diagnosed?
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
How is Pertussis treated?
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
What should be remembered in Pertussis management?
Close contacts require prophylaxis

Respiratory Block: Microbiology (7 decks)

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