Lower Respiratory Tract Infections

Question 1

Triad

Answer 1

Host
- anatomic defenses
- innate/acquired imm
Parasite
- bacteria
- mycobac
- fungi
- viruses
- protazoa
- metazoans
Enviro
- humans
- animals
- inanimate
- occupational
- travel
- setting
- inoculum

Question 2

Diagnosis of pneumonia requires:

Answer 2

Chest x ray with parenchymal infilitrates

Question 3

Acute pneumonia (most typical)

Answer 3

community acquired usually
hours-days
onset of chills, fever, wet cough
lobar consolidation, segmental, or sub-segmental bronchopneumonia
pleura gives chest pain with breath in
micro-aspiration of upper resp tract colonizing bac
**Streptococcus pneumoniae

Question 4

Pathogens

Answer 4

Strep Pneumoniae (most common)
H Flu
Staph
-colonizes down this list to pave way for others

Gram - Bac

• Moraxella
• Strep pyogenes
• Neisseria meningitidis

Atypical

• Legionella
• Mycoplasma
• Chalmydia

Viruses

Aspiration*** important for dent

Question 5

Lobar pneumonia

Answer 5

lung hepatization
neutrophils fill alveoli and air exchange cannot occur, resp failure can occur.

If recovers though lung can return to normal

Question 6

Empyema

Answer 6

bacteremia and spread of infection from lung to parenchyyma

Question 7

Treatment

Answer 7

penicillin G (most effective), moxifloxacin

old tests make it possible to know what bac to target

all respond to Rx but pneumococcus has built resistance

Question 8

Walking pneumonia pathogens

Answer 8

mycoplasma pneum

Chalmydiophila

Question 9

Enviro pathogens

Answer 9

legionella
coiella (Q fever)
Chlamydophil

Question 10

Atypical pneumonia treatment

Answer 10

could be lethal
non beta lactam antibiotics
- macrolides
-fluroquinolones
-tetracyclines

Question 11

Aspiration pneumonia

Answer 11

stupor, coma, seizures
focal infiltrates
oropharyngeal flora
dependent portions of lungs

community acquired: gram + anaerobes!
hospital acquired: gram - staph aureus

could be complicated with chronic and form abscess

Question 12

Oral Anaerobic Bacteria

Answer 12

Gram + cocci: Peptostreptococcus

Gram + bacilli: Actinomyes, eubacterium, leptotrichia

Gram - cocci: veillonella

Gram - bacillia:
fusobacterium, prevotella, phophyromonas

Question 13

Pulmonary Actinomycosis

Answer 13

anaerobic gram - bacilli

oral flora** linked to gingivitis

aspiration pneumo often too

bacteria has no boundries, drills though tissues

Longterm antibiotics (6-12 mo)

Penicillin IV or clindamycin

Question 14

Viral Pneumonia

Answer 14

influenza, parainfluenza, RSV, adenovirus etc. (children)

Hantavirus
Coronavirus (SARS, MERS)

bac influenza often too

Question 15

Complications with Acute pneumonia

Answer 15

Necrotizing pneumo (death of lung)
Lung abscess (excavation of lung), from aspiration
Empyema: spread to space between partietal and visceral pleura (drainage req), thoracentisis to diagnose

Question 16

Chronic pneumo

Answer 16

no drug treatment
many non-infectious disease
diagnosis by bronchoscopy or lung biopsy
wks-mos
differential diagnosis

causes cavities and total lung destruction

Question 17

Tuberculosis

Answer 17

slow-growing acid fast
cough
inhaled to alveolar space
dormant
host as jeopardy for primary and reactivation disease
replicates and spreads to lymph and human systemic circulation

immunize against secondary infection

Question 18

Granulomatous inflammation

Answer 18

multinuc giant cells, epithelioid cells w vascular nuclei, collar of lymph

Question 19

Immunocompromised host pneumonia

Answer 19

complete history!
acute or chronic
panoply of potential pathogens spanning viruses (metazoa)

chest x-ray has lots of presentations

host factors predominate