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Microbiology > Lower Respiratory Tract Infections > Flashcards

Lower Respiratory Tract Infections Flashcards

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1
Q

What are some general LRT Infection syndrome?

A
  • Acute bronchitis
  • Acute exacerbation of chronic bronchitis
  • Bronchiolitis
  • Pneumonia
  • Lung abscess
  • Empyema
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2
Q

What is the causative agent for acute bronchitis?

A

Usually part of viral URTI

Acute exacerbation of chronic bronchitis - Usually pneumococci and/or H. influenzae

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3
Q

What is the most common aetiological agent for Bronchiolitis?

A

RSV

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4
Q

What is the most common aetiological agent for Bronchiolitis?

A

RSV

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5
Q

Give some features of the LRTI associated bronchiolitis.

A
  • Viral infection
  • very common in young children/babies (however adults can get this; it presents as long lasting bronchitis)
  • non productive cough; may have fever
  • thought to be the result of an immune reaction between the virus and pre-formed antibodies that the baby has obtained from the mother –> when the virus invades and comes into contact with these antibodies, complement is attracted and an immune response is mounted.
  • x-rays can indicate evidence of retention (air is trapped inside the lung) –> respiratory epithelium becomes inflamed so that the bronchioles (not supported by cartilage) are much narrower. During inspiration the bronchiole widens and the air is drawn in; during expiration it collapse and the air is trapped distally.
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6
Q

What are some common aetiological agents of actue pneumonia?

A

pneumococci; others include H. influenzae, Staph., Klebs., Legionella, TB, Chlamydophila

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7
Q

What are some common features of acute pneumonia?

A
  • pathogens of pneumonia are almost always organisms that come from the normal Microbiota that enter the alveoli.
  • Pneumococci is quite commonly associated with pneumonia.
  • Prior to antibiotics, typical pneumonia had a course of illlness that included a cough (with sputum and blood) and would either resolve or be fatal. There was another type of pneumonia prior to antibiotics; involved a cough but rarely other symptoms.
  • Staph. is usually an immunocompromised hospital acquired form of pneumonia.
  • Chlamydophila is from the same family as Chlamydia. They are an intracellular bacteria and have a life cycle. –> Has a replicating form and an infective form. Replicates by binary fission in the cell, killing the cell so that it can infect other cells.
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8
Q

What are some common aetiological agents for atypical pneumonia?

A

pneumococci; others include H. influenzae, Staph., Klebs., Legionella, TB, Chlamydophila
Mycoplasma, Chlamydia (etc.), M. catarrhalis, influenza, RSV, adenovirus, etc

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9
Q

What are some features of atypical pneumonia?

A
  • Mycoplasma has no cell wall (no fixed shape); can have many variations in morphology. Growth on agar is slow but can grow within the agar (due to the very small size falling between the strings of agar)
  • Chlamydia that causes the STI in adults can cause pneumonia in newborns due to transmission during birth. (diffuse pneumonia)
  • Typical pneumonia is usually restricted to one lobe of the lung (alveoli) whereas the atypical pneumonia is more diffuse (interstitial lung tissue)
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10
Q

What are some other causative agents of various types of pneumonia?

A

Histoplasma, Aspergillus, Pneumocystis

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11
Q

What are some additional features of various types of pneumonia?

A
  • Fungi can also cause pneumonia
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12
Q

What are some causative agents of Lung abscesses?

A

Mixed anaerobes, ?+ Staph., Klebsiella

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13
Q

What are some aetiological agents of Empyema?

A

Staph. aureus, secondary to pneumonia

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14
Q

Give some typical features of empyema?

A
  • Pus in the pleural space and can be associated with pneumonia or cause primarily by Staph. Aureus during trauma (infiltration) or another mechanism.
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15
Q

Give some reasons why pneumonia needs to be diagnosed?

A
  • Appropriate antibiotic prescribing
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16
Q

Give examples of must-know and should-know pathogens?

A
  • “Must-know” pathogens:
    • SARS, MERS, etc. –> caused by coronaviruses- very important in terms of global/population health
    • Influenza (e.g. avian flu H5N1 and H7N9) –> May have implications of greater epidemiology
    • Legionella spp. (prognosis and public health) –> Risk of others getting this condition; quite often associated with air conditioning
    • Bioterrorism agents (e.g. anthrax, plague)
    • Community-acquired MRSA (prognosis, treatment)
  • “Should-know” pathogens:
    • Penicillin G-resistant S. pneumoniae
    • GNRs, e.g. P. aeruginosa –> Gram negative rods
17
Q

How is diagnosis of pneumonia made?

A 
Diagnosis is made by:
• Clinical  
• Radiological 
• Laboratory 
	- types of specimens 
		- properly collected sputum --> Needs to be sputum and not saliva because saliva contains similar organisms that cause pneumonia and can 			confuse results
		- transtracheal aspirate 
		- aspiration via tracheostomy, endotracheal tube 
		- aspiration via bronchoscope 
		- pleural tap (if effusion) 
		- lung biopsy (by needle or open) 
		- blood for culture and serology
	- diagnostic strategies 
		- microscopy 
		- detection of antigens and nucleic acids  
		- culture 
		- serology
18
Q

What are some clinical considerations for LRT infections?

A

• Community- or hospital-acquired
• Severity index –> Still has some credibility and gives an indication of the cause
• Underlying illness: COPD, AIDS, cystic fibrosis
• Other risk factors
- Occupation: contact with animals (birds etc.), hides (used to be associated with Bacillus Anthracis), air conditioning (Legionella etc.), soil
- Travel
- Homelessness –> In Melbourne, different strains of pneumonia pathogens/TB pathogens have similar serotypes etc. in homeless populations

19
Q

Explain the mechanism for Serological Diagnosis of Pneumonia?

A 
Useful for: 
	•  Mycoplasma pneumoniae 
	•  Legionella pneumophila 
	•  Chlamydophila and Chlamydia species 
	•  Coxiella burnetii
  • Look for specific IgM, rising titre
  • Antigen detection used for:
    • Common viruses, Bordetella, Legionella pneumophila type 1
20
Q

How is pneumonia treated?

A 
Community-acquired 
	- Best guess: pen G / amoxycillin + doxycycline / macrolide  
	- Modify if: 
		- severe 
		- specific risk factors 
		- know the cause 
Hospital-acquired 
	- Depends on severity and risk group
21
Q

Explain some vaccines to prevent pneumonia?

A 
•Influenza vaccine 
•Pneumococcal vaccines 
	- 23-valent polysaccharide  
	- 13-valent conjugate 
• Specialised

Microbiology (21 decks)

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