Lung Pathology Bugs & Drugs Flashcards
Sinusitis (Most common & main 2 BACTERIAL)
Viral is Most Common
Bacterial:
Strep pneumoniae
H. flu
Community acquired pneumonia (CAP)
Gram, Bug (and finding w/Bug)
Bacterial: Strep PNA gram (+) cocci
“rusty colored sputum”
Viral: Influenza, Adenovirus, RSV, Parainfluenza
Acute Exacerbation Bronchitis Bug & Drug
H. flu
Gram (-) rod
Tx: Augmentin
Atypical PNA Bugs (3)
Legionella pneumonia- high mortality
Mycoplasma pneumoniae
Chlamydophila pneumonia
Moraxella c. PNA Bug & Drug (4 choices)
Gram (-)
Tx:
Augmentin, Macrolides, Sulfa, Flouroquinolones
Influenza Sx,
Test?
ACUTE ONSET HIGH FEVER
body aches, runny nose
flu swab
Hospital Acquired PNA Definition?
Highly resistant Bugs
Common in which pts?
developing >48hrs after admission
Common in vented pts (VAP)
MRSA & Pseudomonas
Aspiration PNA risk factors
which side of lung?
Impaired swallowing (neurological disorders, esophageal disorders, ETOH, Drugs)
Right sided!
MRSA PNA vulnerable population?
Drug
Children at risk
Tx:
Vancomycin historically
Linezolid more effective
Chronic Bronchitis Definition?
3 cardinal Sx?
__/3 Sx is bacterial suggestive?
Bug(3) & Drug?
Daily cough x3 months x 2 years (continuous)
- inc SOB
- Inc Sputum volume
- Inc sputum purulence
2/3 = bacterial
H. flu
Strep pna
M. cat
Tx:
Augmentin
Acute Bronchitis Bug
Usually Viral
Fungal Lung infect
Most common Bug?
At risk pts?
drug?
Aspergillus
Neutropenic fever, bone marrow transplants
Tx:
Voriconazole
Pertussis Bug?
Pop most at risk of M&M?
Bordetella Pertussis
Unvaccinated Children & infants <12mo
Pneumocystis PNA Bug
Pneumocystis jerovecii
Tuberculosis Bug?
Reservoir?
Transmission?
Mycobacterium tuberculosis
Humans only reservoir
Transmitted by airborne droplet
Mycobacterium Family stain?
Acid Fast (+) (AFB)
Management of (+) TB test (3)
- Obtain CXR
2, Obtain Quantiferon or T spot - Obtain 3 sputums on 3 diff days for AFB smear & Cx
TB bug
Typical or Atypical Mycobacterium Family
Active Vs Latent TB (contagious?)
Definition of Latent TB (skin test/sx/CXR)?
Active- Contagious
Latent-Not contagious
(+) skin test but no Sx/CXR findings
Tests for Mycobacterium Tuberculin? (3)
- do they differentiate b/w latent & active?
- which is preferred first line?
- which is used in pt’s experiencing symptoms?
Mantoux Tuberculin-Skin test (TST)
-preferred first line test
QuantiFERON (TB test or GOLD)-blood test
-used in symptomatic pts
Colorado- T-spot testing (doesn’t rely on CD4 levels)
they DO NOT DIFFERENTIATE b/w latent & active
What kind of Hypersensitivity Rxn does TST cause
Delayed Type IV
Reading TST
time?
What to look for?
how to record?
after 48-72hrs
Measure induration NOT erythema!
induration-hard feel.
RECORD IN mm!!
(+) TST readings (3)
(+) at 5mm for:
-immunocompromised, live with TB pt, (+)CXR, HIV, organ transplant
(+) at 10mm for:
-children <4y, recent immigrants, drug users
(+) at 15mm for:
-healthcare workers, no known risk factors
Sx suggestive of Bacterial Sinusitis (4)
Sx >10d
Unilateral Maxillary facial sinus/tooth pn
Unilateral Purulent nasal D/C
Double or 2nd sickening
Cough & Discolored nasal D/C are not good predictors
CURB 65 use?
to determine whether or not to hospitalize a pt w/CAP
CURB 65 Acronym
C- Confusion U- uremia (BUN >20mg/dL) R- Resp Rate > 30/min B- BP (SBP<90; DBP <60) 65 - age >65y
when to admit CURB 65?
when to ICU
2-3 pts
4-5 pts
indication/Prevention of CAP
> 65y
Immunocompromised
asplenic
Prevnar 13 (polyvalent pneumococcal vaccine)
Hand Hygene
Gram (-) bugs
(F**K) but polite…
Pseudomonas
Haemophilus
E coli
Klebsiella
Gram (-) Tx
Flouroquinolones
Augmentin
Macrolides
Cephalosporins
Gram (+) Tx
Pencicillins, Macrolides, Flouroquinolones
Acute Bacterial Sinusitis Tx- Adults
Beta Lactam Allergy Tx Adults
Augmentin
Beta Lactam Allergy-Doxycycline
Children
Acute Bacterial Sinusitis Tx
Beta Lactam Allergy Tx
Tx- Augmentin
Beta Lactam Allergy-Levofloxacin
What antibiotic s not recommended for sinusitis?
Macrolides (-), (+)
Most deadly infectious disease in US?
CAP
Mycoplasma p. Tests
“walking PNA”
IgM test
cold aggulins- old tech
Legionella p. cause?
Dx (3 tests)
Outbreak from human-made water systems
Dx: Sputum Cx, Ag testing, CXR
Influenza Strains?
H?
N?
A most common (can infect mammals)
B, C only humams
H- Hemaglutin (bind virus to cell being infected)
N- Neuraminadase (virulence)
Influenza Immunization
Trivalent?
Quadrivalent? who always gets Quadrivalent?
Trivalent- 2A, 1B
Quadrivalent- 2A, 2B (>65yo)
Who should be vaccinated for flu?
Everyone >6mo
Who should not be vaccinated?
Severe rxn to chicken/eggs, GB, <6mo, Illness w/a current fever
Empyema Risk factor (70%)
Can progress to ___? (25-75% mortality in elderly)
Tx?
Untreated or complicated PNA
SEPSIS
Surgery & tailored ABX
Pertussis Drug? Prophylax?
1st- Macrolides
2nd- Sulfa
Prophylax close contacts (w/in 3 wks)
3 Stages of Pertussis-
timelines & Sx for each?
Which is the communicable period?
Incubation Period?
Cataharral- 7-10d
Coryza, fever, cough (mild)
COMMUNICABLE PERIOD
Paroxysmal- 1-6 WEEKS
Paroxysms of numerous rapid coughs- thick mucous
Long aspiratory effort w/ high pitched WHOOP at end
cyanosis (61%)
Vom/Exhaustion
Convalescent- 7-10d
Gradual recovery
Cough disappear 2-3wks
INCUBATION PERIOD- 5-10d
Pneumocystic Pneumonia classification?
Fungus
PJP gold standard Dx?
Silver strain
what lab will be elevated in 90% of pt’s w/PJP?
LDH
What is the classical finding for PJP on CXR?
BILATERAL diffuse hilar opacification
PJP prevention?
prophylaxis & Drug?
Stop Smoking!
Tx & prophylax with:
Bactrim (-), MRSA
1 infectious disease killer worldwide?
TB (3mil deaths/yr)
When does TB go from Latency to active?
if TB bacteria escape macropage cage (mast cell granuloma)
CXR findings for TB?
Which lobes?
Advanced Infection finding?
Active infection finding?
Patchy/nodular infiltrates
Upper lobes
Advanced infection- Cavity formation (caseating granuloma)
Active infection- Calcified nodules
Aspiration PNA bug
Anaerobic organisms:
Peptostrep, Prevotella, Fusobacterium, Bacteroides
Influenza Tx
Tx:
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Baloxavir (Xofluza)
Legionella Tx?
NL? Comorbids?
Tx: (Same as CAP)
NL pt (no comorbids/ MRSA/ pseudomonas): Amoxicillin 1g TID
or
Doxycycline 100mg BID
Comorbids: (Augmentin or Cephalosporin) + Macrolide
or only Flouroquinolone
Influenza Antigen Shift?
Antigen Drift?
Antigen Shift- 2 strains combine to form a new strain-PANDEMIC
Antigen Drift- Point mutations over time
Factors causing False (+) TB test (7)
- nontuberculosis mycobacteria
- BCG vaccine
- Anergy
- Recent TB infection (2-10d post exposure)
- newborns
- live virus vaccination
- poor technique
Anergy
inability to surmount an immune response
(i.e. No reaction to a TST skin test 2/2 weakened immune system)
HIV
Before initiating TB Tx (4)
- R/O TB Dz
- Determine prior Hx of Tx for TB
- Assess risk/benefits
- Determine current/prev drug therapy
If CXR/ Quantiferon or Tspot (+)
and 3x Sputum (-) for TB…
Proceed with Tx for LATENT TB
If CXR/ Quantiferon or Tspot (+)
and 3x Sputum (-) for TB…
Active TB is R/O
Proceed with Tx for LATENT TB (LTBI)
Latent TB Tx
Isoniazid + Rifampin
Which TB Rx causes dark urine (redish-orange)
Rifampin
Which TB Rx causes peripheral neuropathy?
Isoniazid
If CXR/ Quantiferon or Tspot (+)
and 3x Sputum (+) for TB…
What is the Tx regiment called?
Active TB
highly communicable
Directly Observed Tx
What ABX should negate a vision test?
Ethambutol
First line TB Tx (4)
for how long?
R- Rifampin
I- Isoniazid
P- Pyrazinamide
E- Ethambutol
6mo!
9mo if pregnant
Which TB Rx are hepatotoxic?
R.I.P.E (all of them)
Which TB Tx should NOT be used in HIV pts?
Rifampin
When to substitiute TB Tx? which class?
Strain resistance/1st line Rx not tolerated
Flouroquinolones (-), (+)
Which TB Rx causes ear/kidney damage?
Streptomycin
Which TB Rx do you NOT use w/pregnant pts?
Streptomycin & pyrazinamide
Which TB Rx causes birth control to not work?
Rifampin
Intitial phase time for TB Rx?
2mo
Continuation phase time for TB Rx?
4mo
Which TB Rx negates a test for ischicara?
Ethambutol
Pregnancy Tb Rx?
Time?
Rifampin
Isoniazid
Ethambutol
9mo
CAP Tx?
1st line & 2nd line
Tx: KNOW THIS NL pt (no comorbids/ MRSA/ pseudomonas): Amoxicillin 1g TID OR Doxycycline 100mg BID
Comorbids: (Augmentin or Cephalosporin) + Macrolide
or only Flouroquinolone
Mycoplasmic pna Tx (3)
Tx:
Macrolides (+), (-)
Flouroquinolones, (+), (-)
Tetracyclines (+), MRSA
Aspiration pna Tx? (2 choices)
Tx:
Pipericillin/Tazo (Zosyn) or Clindamycin -Lincosamide (+), (anaerobes)
most frequent atypical mycobacterial infection in US
Mycobacterium avium
Mycobacterium avium risk factors
Ubiquitous in water & soil
Immunocompromised hosts
Female, caucasian
Atypical Mycobacterium Sx
chronic cough, sputum production and fatigue, fever less common
Disorder of large bronchi characterized by permanent abnormal dilation and destruction
Caused by recurrent inflammation/infection of aiways
Bronchiectasis
50% of cases of bronchiectasis caused by
Cystic Fibrosis
Main sx of Bronchiectasis (___ w/______)
Preceeding Hx of ___?
Chronic productive (copious sputum) cough with dyspnea and wheezing
Preceeding history of recurrent pulmonary infection or inflammation
Abnormal membrane chloride channel causes abnormal mucus production and viscocity causes obstructions
Cystic Fibrosis
Empiric Tx for Bronchiectasis (while waiting for Cx)?
Flouroquinolones (-), (+)
In respiratory tract, inadequate hydration impairs mucociliary function= damaged mucociliary elevator
Results in chronic lung infections
Cystic Fibrosis
What other organ can be affected by CF?
Pancreas (Cl- membrane channel)
Pulmonary toilet technique
Pounding on someone’s back to loosen mucous
Drug of choice for Stenotrophomonas m. (Cystic Fibrosis)
Bactrim (-), MRSA
CF Bugs (4)
STENOTROPHOMONAS A.
PSEUDOMONAS
Staph a
Burkholderia c.
Drug classes of choice for Pseudomonas in CF (5)
Cefepime (4th gen cephalosporin) (-),(+) Flouroqionolones (-), (+) Pipercillin/taxobacta (zosyn) Carbapenims (NOT ERTAPENIM!!!!!!!!!) (-) Aminoglycosides (-)
Incubation 2-5 days
Affects mucous membranes of upper respiratory tract
Gradual onset with low grade fever, sore throat, DIFFICULTY SWALLOWING, malaise, loss of appetite
Diptheria
Hallmark Feature of Diptheria
appearance of PSEUDOMEMBRANE
typically grayish color
cuts off the airway!
Description of pseudomembrane of Diptheria
Firm Fleshy to gray in color Adherent Bleeds after attempt to dislodge Fatal airway obstruction can occur
Diptheria Toxin Tx? Bug Tx?
Equine Antitoxin (Balto!)
ABX:
Erythromycin (+),(-) or PCN
Prevention of Diptheria children, adults?
kids- DTaP
adults- TDaP
Which carbapenims can you use for Pseudomonas covrage in CF?
Carbapenims: (-) Doripenim Imipenim Meropenim NOT ERTAPENIM!!!
CF Epmiric ABX add on while waiting for Cx?
Vancomycin (+), MRSA
Ability to appear well but have severe hypoxia is seen in (2)
PJP
COVID
Ground glass opacity in CT is seen in (2)
PJP
COVID
Covid Rx for admitted, ill pts (2)
Remdisivir + Dexamethazone
Covid Rx for outpt treatment (2)
Molnuprivir + Monoclonal AB
Dexamethazone as a covid Tx
More beneficial than prednisone, etc.
Tamps down the Cytokine storm, decreases progression to ARDS.
What Tx has fallen out of favor- not working for COVID
convalescent plasma
Monoclonal AB vs. Convalescent plasma
Monoclonal AB- manufactured AB to COVID
Convalescent plasma- from donors
what 3 structures of spike protein makes COVID a ‘Wily little virus’
Sugar coating- hide from detection
Flexible stock- grabs other cells
Receptor binding domain
2 important structures of COVID
- Spike protein
2. Nucleocapsid protein
3 types of COVID vaccines
Genetic-mRNA
Vector vaccines
Protein subunit vaccines
why should we not worry about mRNA becoming incorporated into cellular DNA?
it dissolves so quickly.
Cannot last long enough to develop reverse transcriptase.
Instructs human cells to make a protein that is unique to the virus (spike protein)
Cells make copies of the protein for B and T cell recognition
mRNA vaccine
Pfizer/Moderna
Contain viruses engineered to carry coronavirus genes
Illicit B and T cell response by recognition of viral proteins
Vector Vaccine
Johnson&Johnson
Contain coronavirus proteins but no genetic material
Nanoparticle for delivery
T and B cell response by recognizing foreign protein
Protein Subunit Vaccine
Novavax
COVID Rx that inhibits RNA dependent RNA polymerase-prevents replication
MOA
Covid Outpt Rx
inhibits COVID replication by introducing typing errors during viral RNA replication
use w/in 5d of sx onset
Molnipiravir
Pts who are EMERGENCY approved to use Molnipravir
meet 2 criteria
- outpt
2. pt’s w/ HIGH RISK to develop severe disease
Theoretical concern from Molnupiravir
2/2 theoretical concern of introducing harmful mutations in human DNA
-concern for fetus in pregnant women
Covid Outpt Rx
Protease inhibitor
from Pfizer
use w/in 3d of sx onset
Paxlovir
Covid Rx
target spike protein
use w/in 10d of sx onset
Monoclonal AB
Criteria for eligibility for Monoclonal AB
- Test COVID positive
- Onset of symptom within 10 days
- Not hospitalized or on oxygen due to COVID infection
- At risk of severe disease-65 years old or more, 5. Obesity BMI 25 or more, pregnancy
- Underlying conditions-LOTS!!!!!!
What to know about Viral Mutations
Virus mutate/evolve in order to continue replicating, ideally WITHOUT killing off a host.
Original type of a virus is called the
Wild Type
Boosters now recommended in pts
> 18yo
Covid Testing:
Standard test (screening test)
Good for ACTIVE infection
Will pick up variants but doesn’t necessarily differentiate variants
PCR
Covid Testing:
Rapid at home tests
Not as high of accuracy when compared to PCR
Should pick up variants
Ag
Covid Testing:
Determines previous infection
Not reliable in determining vaccine efficacy
Antibody
Predominant COVID Strain in Colorado as of 12/08/21
Delta
2 ways to measure how Colorado is doing with COVID
- Hospitalizations
2. % positives (want to be below 5%)
