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Respiratory Exam II > LRT Bugs > Flashcards

LRT Bugs Flashcards

1
Q

3 parts of the LRT

A
  • trachea
  • primary bronchi
  • lungs
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2
Q

acute bronchitis

A
  • inflammation of the bronchioles
  • results in reduction of air flow
  • encourages mucus accumulation in the lungs
  • triggers coughing = HALLMARK
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3
Q

chronic bronchitis

A
  • cough and excessive mucus production for at least 3 months over a 2 year period
  • COPD pts –> infection, smoking, inhalation of dust or fumes from work/home
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4
Q

what causes the most cases of bronchitis: viruses or bacteria

A

viruses

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5
Q

what are the 4 main bacterial causes of bronchitis? which 3 can also cause URT infections?

A
  • strep pneumo
  • h. flu
  • Moraxella catarrhalis
  • mycoplasma pneumonia (only one that doesn’t cause URTs also)
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6
Q

signs and symptoms of acute bronchitis

A
  • no or LOW GRADE fever
  • ACUTE cough w/ or w/o sputum
  • no underlying chronic lung ds
  • have to EXCLUDE pneumonia
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7
Q

when does acute bronchitis usually occur in pts?

A

during or following a viral infection

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8
Q

symptoms of chronic bronchitis

A
  • increase in cough or sputum production
  • SOB
  • NO evidence of pneumonia
  • main difference from acute = TIMEFRAME
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9
Q

what bugs cause acute vs. chronic bronchitis?

A
  • acute = mycoplasma pneumonia

- chronic = strep pneumo, H. flu, Moraxella catarrhalis

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10
Q

definition of pneumonia

A
  • inflammation of the lungs WITH fluid-filled alveoli and bronchioles
  • most common COD from infection in the elderly
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11
Q

3 ways the bacteria get into the lungs to cause pneumonia?

A
  1. aspiration of normal flora: URT or GI
  2. hematogenous spread from another site of infection
  3. inhalation of aerosols
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12
Q

typical pneumonia signs & symptoms

A
  • similar to pneumococcal pneumonia
  • abrupt onset
  • fever, chills, congestion, SOB, chest pain
  • PRODUCTIVE COUGH
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13
Q

bugs that cause typical pneumonia (5)

A
  • strep pneumo = #1 cause
  • klebsiella pneumonia
  • H. flu
  • Moraxella catarrhalis
  • staph aureus
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14
Q

strep pneumo lab results

A
  • gram (+) in pairs or chains
  • alpha hemolytic on blood agar = incomplete hemolysis
  • CAPSULE
  • adhesion
  • IgA protease
  • pneumolysin: lyses ciliated epithelial cells
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15
Q

optochin (+) vs. (-)

A

(+) means strep pneumo

(-) means Viridans strep

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16
Q

bacitracin (+) vs. (-)

A

no growth or bacitracin sensitive = strep pyogenes

growth or bacitracin resistant = strep agalactiae

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17
Q

typical (strep pneumo) pneumonia: seasonality? CAP or HAP? predisposing factors?

A
  • seasonal = fall and winter
  • CAP
  • predisposing factors: viral infection (flu or HIV), alcoholism, kids, elderly, SPLENECTOMY
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18
Q

how do you dx strep pneumo?

A
  • rust-colored sputum
  • alpha hemolytic
  • optochin sensitive
  • gram (+) cocci and NUMEROUS PMNs
  • antigen agglutination in urine and sputum
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19
Q

strep pneumo vaccines

A
  • pneumovax = 23 most common CAPSULE serotypes –> PPSV23; for adults
  • pneumococcal CONJUGATE vaccine = PCV13 –> kids age 2 months - 59 months
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20
Q

difference b/w capsule and conjugate vaccines

A
  • when you conjugate the capsule it creates a stronger immune response
  • capsule alone doesn’t work well for kids <5yo
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21
Q

what pts should for sure have the pneumonia vaccine?

A

anyone w/ a splenectomy

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22
Q

typical pneumonia caused by klebsiella

A
  • gram (-)
  • capsule
  • CAP & HAP
  • differentiation = thick, bloody sputum aka currant jelly sputum = BUZZ
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23
Q

risk factors for klebsiella pneumonia

A
  • alcoholics
  • hospitalized
  • on a ventilator
  • immunocompromised
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24
Q

mortality rate for klebsiella? why?

A
  • higher mortality than pneumococcal or mycoplasma pneumonia
  • causes necrosis of the lung tissue
  • bacteremia and release of LPS
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25
Q

lab results for klebsiella? what culture do you use?

A
  • gram (-) rods –> MacConkey agar

- lactose (+)

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26
Q

tx for klebsiella

A
  • gentamicin or ciprofloxacin
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27
Q

what does KPC or CRKP mean?

A
  • means the klebsiella bug is resistant b/c it is producing carbapenamse = destruction of carbapenems = destroys the abx
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28
Q

characteristics of H. flu

A
  • short, fat rod
  • found in normal flora of URT
  • capsule
  • adhesins
  • endotoxin
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29
Q

risk factors for H. flu

A
  • elderly
  • smokers
  • chronic pulmonary ds
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30
Q

dx of H. flu: lab results

A
  • gram (-) coccobacillus

- grows on chocolate agar –> requires factor X (heme) and factor V (NAD)

31
Q

distinctive features of staph aureus pneumonia

A
  • salmon pink sputum

- empyema AKA pyothorax = pus that collects in the pleural cavity

32
Q

what pts do you normally see get aspiration pneumonia? what bug most often involved?

A
  • pts w/ influenza
  • very young
  • elderly
  • COPD
  • -> usually staph aureus
33
Q

how does staph aureus spread?

A
  • hematogenous pneumonia –> implied in bacteremia and endocarditis
34
Q

what other bacteria cause typical pneumonia? what do you see w/ this bug?

A
  • community-acquired MRSA (CA-MRSA)
  • rapid, severe form on pneumonia
  • massive hemoptysis
  • septic shock
  • high mortality rate
  • children and young adults
35
Q

what bugs normally cause atypical pneumonia?

A
  • mycoplasma pneumonia
  • chlamydophila spp.
  • legionella pneumophila
  • coxiella burnetii
36
Q

signs & symptoms of atypical pneumonia? what are the key differences from typical pneumonia?

A
  • fever, HA, malaise
  • myalgia, nausea, diarrhea = different
  • NONPRODUCTIVE cough = dry, hacking; no sputum
37
Q

mycoplasma pneumonia atypical pneumonia

A
  • primary atypical pneumonia AKA walking pneumonia

- CAP

38
Q

distinguishing factors of mycoplasma pneumonia

A
  • persistent, nonproductive cough
  • EXCESSIVE SWEATING, night sweats
  • can last several weeks - months
  • no seasonality
39
Q

what populations are predominant for mycoplasma pneumonia?

A
  • high school and college aged students

- generally pts <40yo

40
Q

virulence factors for mycoplasma

A
  • capsule

- adhesion: attaches and destroys the base of the cilia

41
Q

lab results for mycoplasma

A
  • will not gram stain b/c has no cell wall

- will see large number of PMNs

42
Q

what test can you do quickly to see if a bug is mycoplasma?

A
  • cold agglutinins will be (+)
43
Q

tx for mycoplasma

A
  • erythromycin or azithromycin

- could also use doxycycline

44
Q

chlamydophila pneumonias characteristics

A
  • gram (-)
  • CAP
  • obligate intracellular bacteria
45
Q

how do you dx chlamydophila pneumonias?

A
  • microscopy/gram stain = no orgs grow but large # of PMNs

- can also do ELISA

46
Q

what is the weird thing about chlamydophila?

A
  • has 2 stages/bodies
  • the elementary body is the infectious form that gets into the cell
  • elementary body is changed to reticulate body inside the cell = metabolically active
  • the elementary body gets released from the cell and goes to infect other cells
47
Q

symptoms and tx for chlamydophila

A
  • symptoms: mild fever, sore throat, malaise, persistent cough
  • tends to be a mild infection; most don’t even seek treatment
  • tx: erythromycin or azithromycin; can also use doxycycline
48
Q

what bug causes Psittacosis? associated with?

A
  • Chlamydophila psittaci
  • AKA parrot fever
  • associated w/ exposure to birds
49
Q

characteristics of Legionella pneumophila

A
  • gram (-) –> doesn’t gram stain well
  • intracellular; lives in amoeba in environment or alveolar macrophages in humans
  • water cooling towers and A/C units = main source
50
Q

symptoms of legionnaires’

A
  • abrupt onset of fever, HA, pleurisy, chills, myalgia, dry cough
  • can have complications w/ GI, CNS, liver, kidneys
  • HYPOTNATREMIA
51
Q

risk factors for legionella

A
  • smokers, COPD, elderly = main ones
  • alcoholic
  • immunosuppressed
  • renal transplant pts or pts on dialysis
52
Q

how can you dx legionella?

A
  • fastidious so only grows on BCYE agar –> needs iron salts and cysteine as growth factors
  • can do fluorescent antibody staining –> can detect antigen in urine
53
Q

common causes of nosocomial (HAP) pneumonia

A
  • pseudomonas aeruginosa
  • staph aureus
  • H. flu
  • enterics = enterobacter, klebsiella, e. coli, serratia marcescens
54
Q

risk factors for pseudomonas

A
  • think CF pts and hot tub folliculitis

- hospitalized pts on ventilation

55
Q

what happens w/ CF pts and pseudomonas

A
  • CF pts colonized w/ staph aureus first
  • then colonized w/ pseudomonas by age 5
  • then burkholderia cepacia comes on the scene
56
Q

what can clue you in to an anaerobic infection?

A
  • copious amounts of foul smelling sputum
57
Q

risk factors for anaerobes?

A
  • aspiration of resp or gastric material (vomit)
  • dental work
  • loss of consciousness
  • can get mix of bacteroides and fusobacterium from the mouth –> necrotizing; lung abscesses, empyema
58
Q

what are some potential bioterrorism agents

A
  • anthrax
  • plague
  • Q fever
  • tularemia
  • brucellosis
59
Q

characteristics of anthrax

A
  • gram (+) large rod = “box car shaped”
  • endospores are what you inhale
  • has capsule and anthrax toxin
60
Q

symptoms of anthrax? initial vs. later

A
  • initial = sore throat, mild fever, myalgia, cough

- later (after several days) = severe coughing, n/v, lethargy, confusion, shock, death

61
Q

what is different about the anthrax capsule?

A

it has a protein capsule NOT a polysaccharide one

62
Q

tx and prevention of anthrax

A
  • tx = penicillin, doxycycline, ciprofloxacin; DOC is uually pen or cipro
  • prevention = vaccine, but only for military or researchers –> high risk individuals
63
Q

what is the bug that causes pneumonic plague

A

Yersinia pestis

64
Q

symptoms of yersinia

A
  • fever
  • chills
  • cough
  • difficulty breathing
  • FROTHY, BLOODY SPUTUM
65
Q

lab results for yersinia

A
  • gram (-) coccobacillus
  • bipolar or safety pin staining = stains darker on the ends than on the middle
  • stain should be red b/c of gram (-)
66
Q

transmission and treatment of pneumonic plague

A
  • transmission = inhalation or hematogenous spread

- tx = isolation; abx = streptomycin, tetracycline, chloramphenicol

67
Q

what bug causes Q fever

A

Coxiella burnetii

68
Q

lab results for coxiella burnetii

A
  • gram (-) coccobacillus

- obligate intracellular

69
Q

transmission of Q fever? what are the primary carriers?

A
  • inhalation of contaminated dust
  • ingestion of unpasteurized milk
  • carried in cattle, sheep, goats
  • occupational hazard for slaughterhouse workers, farmers, veterinarians
70
Q

symptoms of Q fever?

A
  • acute onset
  • severe HA
  • nonproductive cough
  • muscle pain
  • fever
71
Q

tx for Q fever?

A

doxycycline or erythromycin

72
Q

that bug causes tularemia?

A

Francisella tularensis

73
Q

characteristics of francisella

A
  • gram (-) coccobacillus
  • facultative intracellular
  • fastidious; grows on BCYE
74
Q

how is francisella transmitted? tx?

A
  • ingestion of contaminated water or food or inhalation of aerosolized bacteria –> direct contact w/ infected animals (rabbits) or bites from infected insects
  • tx = streptomycin

Respiratory Exam II (7 decks)

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