Lung Drugs & Bugs Flashcards
What are some signs and symptoms of an infection of the lungs?
- Cough
- Chest pain
- Fever
- Fatigue
- Dyspnea
- Increased tactile fremitus
- Egophony
- Tubular breath sounds
- Wheezes
- Dullness
- Elevated WBC
- Abnormal chest imaging
Nosocomial pneumonia is defined as a pneumonia that begins _ hours after admission
Nosocomial pneumonia is defined as a pneumonia that begins 48 hours or more after admission
Ventilator-associated pneumonia is defined as a pneumonia that begins _ hours after intubation
Ventilator-associated pneumonia is defined as a pneumonia that begins 48 hours after intubation
Name the defense mechanisms in the airways/lungs that pneumonia must overcome
- Mechanical filtering (nose and upper airways)
- Mucociliary clearance and cough
- Antimicrobial substances (IgA, lactoferrin, lysozymes, defensins)
- Cellular immunity (macrophages, T cells, PMNs)
Infection of the lung can take one of three routes of entry:
Infection of the lung can take one of three routes of entry:
1. Aspiration (pathogens colonizing the oropharynx, GI)
2. Inhalation (droplets or particles in the air)
3. Hematogenous (ex: Staph that gets in via IV drug use)
Aspiration pneumonia is most common in _ population
Aspiration pneumonia is most common in individuals with altered mental status
* Aspiration pneumonia is the reason that we can’t eat before surgery
Explain microaspiration vs gross aspiration
Microaspiration is a minor aspiration event where individuals aspirate pathogens colonizing the oropharynx without even noticing
Gross aspiration involves contents of the mouth or GI tract
This is _ pneumonia
This is lobar pneumonia
This is _ pneumonia
This is bronchopneumonia
This is _ pneumonia
This is interstitial pneumonia
What type of pneumonia?
Bronchopneumonia
What type of pneumonia?
Lobar pneumonia
A pneumonia caused by _ may be confirmed with urine antigens
A pneumonia caused by Legionella may be confirmed with urine antigens
A pneumonia caused by mycoplasma may be confirmed by _
A pneumonia caused by mycoplasma may be confirmed by mycoplasma
_ is the most common cause of pneumonia in an immunocompromised host; however, _ are also possible
Streptococcus pneumoniae is the most common cause of pneumonia in an immunocompromised host; however, possible to have:
* Atypical mycobacterium
* M tuberculosis
* Pneumocystis jiroveci
* Crytococcus
* Histoplasma
The most common cause of community-acquired pneumonia is _
The most common cause of community-acquired pneumonia is streptococcus pneumoniae
* It is also a cause of childhood otitis media, sinusitis, conjunctivitis
* It colonizes the upper respiratory tract
* Spreads via respiratory droplets
Strep pneumoniae is _ hemolytic, has _ shape, is catalase _ and optochin _
Strep pneumoniae is alpha hemolytic, has diplococci shape, is catalase negative and optochin sensitive
“Rusty sputum” is usually pathoneumonic for
“Rusty sputum” is usually pathoneumonic for strep pneumo
Strep pneumo has 4 important virulence factors:
Strep pneumo has 4 important virulence factors:
1. Polysaccharide capsule to hide from phagocytosis
2. Adhesins to bind host cells
3. Pneumolysin a pore-forming toxin
4. IgA protease which cleaves mucosal IgA
We can take advantage of the _ structure of strep pneumo to vaccinate individuals < 2, > 65, and chronic medical conditions
We can take advantage of the polysaccharide capsule of strep pneumo to vaccinate individuals < 2, > 65, and chronic medical conditions
* We now recommend the conjugate vaccine Prevnar
What makes conjugate vaccines so effective against bacteria with polysaccharide capsules like strep pneumo?
In these vaccines, the polysaccharides are covalently conjugated to carrier proteins that will engage the help of T cells
What color will strep pneumo be when plated on blood agar plate?
Green- alpha hemolytic
Pseudomonas aeruginosa has gram _ rods and is _ hemolytic and _ positive
Pseudomonas aeruginosa has gram negative rods and is beta- hemolytic and oxidase positive
“fruity odor”
Pseudomonas aeruginosa
Pseudomonas has a _ pigment when plated due to its _
Pseudomonas has a blue-green pigment when plated due to its pyocyanin
Pseudomonas can be found in _
Pseudomonas can be found in soil, water, human throat and stool
In healthy individuals, Pseudomonas can cause _ or _
In healthy individuals, Pseudomonas can cause hot tub folliculitis or otitis externa (swimmer’s ear)
We primarily worry about pseudomonas in immunocompromised patients like patients with _
We primarily worry about pseudomonas in immunocompromised patients like patients with burns, CF, AIDs, diabetes, neutropenia
* Often cause hospital acquired infections (VAP, CAUTIs)
Pseudomonas virulence factors include:
Pseudomonas virulence factors include:
* Alginate/biofilm formation- encapsulated
* ExoA- inhibits host cell protein synthesis
* ExoS- disrupts the host cytoskeleton
* Elastase- disrupts the ECM
Pseudomonas has two exotoxins;
ExoA _
ExoS _
Pseudomonas has two exotoxins;
ExoA ADP ribosylates EF2 and inhibits host cell protein synthesis
ExoS disrupts host cytoskeleton
Gram-negative coccobacilli, non-hemolytic, aerobic, twitching motility via pili
Gram-negative coccobacilli, non-hemolytic, aerobic, twitching motility via pili: Acinetobacter baumannii
Acinetobacter baumannii is found in _
Acinetobacter baumannii is found in in moist environments; colonizes human skin and RT
* It is an opportunistic pathogen that causes VAP
The smallest free-living organism that only infects humans is _
The smallest free-living organism that only infects humans is mycoplasma penumoniae
Bacteria that has a “fried egg” appearance when plated
Bacteria that has a “fried egg” appearance when plated: Mycoplasma pneumoniae
Mycoplasma pneumoniae cannot be gram stained because _
Mycoplasma pneumoniae cannot be gram stained because it lacks a cell wall
_ is the most common cause of community-acquired “atypical” pneumonia
Mycoplasma pneumoniae is the most common cause of community-acquired “atypical” pneumonia
Mycoplasma pneumoniae does not have any known toxins; instead it secretes _ to cause damage
Mycoplasma pneumoniae does not have any known toxins; instead it secretes H2O2 to cause damage
_ bacteria lives within amoebas in freshwater and often causes pneumonia in people who are exposed to contaiminated water in AC units and water towers
Legionella bacteria lives within amoebas in freshwater and often causes pneumonia in people who are exposed to contaiminated water in AC units and water towers
Legionnaires disease occurs when _
Legionnaires disease occurs when Legionella colonizes the lower RT and alveolar macrophages phagocytose the bacteria –> pneumonia
_ is a flu-like infection that is caused by legionella (not pneumonia)
Pontiac fever is a flu-like infection that is caused by legionella (not pneumonia)
Legionella must be stained using _ stain and it requires _ to grow
Legionella must be stained using silver stain and it requires charcoal yeast extract agar with iron and cysteine to grow
Actinomyces can be found in _ so is often associated with _
Actinomyces can be found in normal oral flora so is often associated with cervicofacial abscesses
_ forms “molar tooth” colonies on plates
Actinomyces forms “molar tooth” colonies on plates
Nocardia: forms dry, chalky, wrinkled colonies on plates & fluffy, “cotton balls” under dissecting scope
If patient has had recent amoxicillin use or cannot have amoxicillin, we might give _ drug on its own to treat mild or severe inpatient pneumonia
If patient has had recent amoxicillin use or cannot have amoxicillin, we might give fluoroquinolone on its own to treat mild or severe inpatient pneumonia
* Alternatively we can combine 3rd generation cephalosporin with a macrolide or with doxy
Fluoroquinolone treatment for CAP must be a respiratory pneumonia like _
Fluoroquinolone treatment for CAP must be a respiratory pneumonia like levofloxacin, moxifloxacin, gemifloxacin
* Note that ciprofloxacin is not a respiratory fluoroquinolone because it is not effective against Strep pneumo
Name an example of each
_ is a influenza’s glycoprotein that binds to the host sialic acid for attachment
Hemagglutinin (HA) is a influenza’s glycoprotein that binds to the host sialic acid for attachment
Ribavirin works as a _ to disrupt the action of _
Ribavirin works as a nucleotide analog to disrupt the action of viral RNA polymerase in a number of ways
Amantadine is a flu drug that inhibits _
Amantadine is a flu drug that inhibits M2; it blocks virus uncoating
Oseltamivir, zanamivir, and peramivir are all release inhibitors; they inhibit the action of _
Oseltamivir, zanamivir, and peramivir are all release inhibitors; they inhibit the action of neuraminidase
Nirmatrelvir is a _ that can be used to treat SARS; it is often paired with _ in order to slow the metabolism
Nirmatrelvir is a protease inhibitor that can be used to treat SARS; it is often paired with ritonavir in order to slow the metabolism
Ritonavir is a CYP3A4 _
Ritonavir is a CYP3A4 inhibitor
