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Respiratory II > Micro: Lower Respiratory Tract Infections > Flashcards

Micro: Lower Respiratory Tract Infections Flashcards

1
Q

What are the organisms that make up the normal flora of the Lower Respiratory Tract ?

A

PSYCH ! Trick question, the LRT is a sterile environment and should not have a colonization by bacteria.

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2
Q

Infections in the LRT are cause by Virus, Fungi and Bacteria. Where do bacteria that cause infections usually come from ?

A 
Typically from upper respiratory tract infections --> LRT
Ear Infections/ URT
S.pneumoniae
H. Influenzae
Moraella

Mycoplasma pneumoniae

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3
Q

In acute brochitis, what kind of fever will you see ?

A

Either none or a very low grade. If it is high grade, most likely pneumonia not bronchitis.

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4
Q

What must be excluded in order to come to a diagnosis of Acute Bronchitis

A

COPD

Pneumonia

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5
Q

Define pneumonia

A

Inflammation of the lungs accompanied by fluid filled alveoli and bronchioles

Most common cause of death due to infection in the elderly

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6
Q

How are pneumonias classified ? (3)

A

Causitive agent
Where acquired (Community, Nosocomial)
Typical v. Atypical (Productive cough)

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7
Q

What is the #1 cause of typical pneumonia ?

A

S. pneumoniae

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8
Q

Describe the signs and symptoms of an Typical Pneumonia

A

abrupt onset
Fever, chills, Congestion SOB
PRODUCTIVE COUGH (the hallmark)

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9
Q

Describe the Lab diagnostics for S.pneumoniae

A 
Gram +
Catalase -
Pairs of chains
Alpha Hemolytic
Optochin Sensitive
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10
Q

What is the most important virulence factor for S.pneumoniae ?

A

The Capsule (allows for adhesion)

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11
Q

List other virulence factors for S.pneumoniae besides the capsule

A

Adhesin (for adhesion)
IgA protease (Breaks down IgA. This is very important in the lungs
Pneumolysin (lyses ciliated epithelial cells)

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12
Q

What may predispose someone to pneumococcal pneumonia ?

A 
Previous Viral infection
Alcoholism (this is not specific, more telling for Kleb)
Children
Elderly 
SPLENECTOMY 
NON_IMMUNIZED !
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13
Q

How would you describe the productive cough associated with S.pneumoniae ?

A

Rust Colored Sputum

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14
Q

What would you see in microscopy with S.pneumo ?

A

Gram + cocci, and NUMEROUS PMN’s (neutrophils)

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15
Q

PPSV23

A

AKA Pneumovax, 23 most common capsule serotypes –> Adult !!

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16
Q

PCV13

A

Pneumococcal conjugate vaccine

Children 2 moths - 59 months

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17
Q

What is the most important virulence factor for Klebsiella pneumonia >

A

Capsule

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18
Q

Describe the productive cough associated with Kleb Pneumoniae ?

A

Current Jelly Sputum (due to blood and capsule)

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19
Q

Is Klebsiella CAP or HAP ?

A

BOTH !

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20
Q

Is S.pneumos CAP or HAP ?

A

CAP

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21
Q

Being hospitalized and on a ventilator are big risk factors for Kleb pneumoniae . What is the another huge risk factor ?

A

Alcoholism

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22
Q

Why is Kleb pneumoniae associated with higher mortality than pneumococcal pneumonia ?

A

Causes necrosis of the lung tissue.

LPS can be released (Gram -) leading to shock.

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23
Q

Describe the Lab diagnostics for K. pneumonia

A

Gram- rod
Lactose fermenter ( Lac + leads to purlple discoloration of agar due to acid)
Indole - ( not e.coli)
Grows on MacKonkey Agar

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24
Q

DOC for K.pneumoniae

A

Gentamicin

Ciprofloxacin

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25
Q

Why may K.pneumo be difficult to treat ?

A

Carbapenem resistence (contains a carbapenamase)

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26
Q

Describe the lab finding for H.influenzae

A

G- coccobacillus
Grows on Chocolate Agar (Factor V(NAD)and X)
Although G-, it will not grow on MacKonkey.
Often a normal fluora of the URT.

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27
Q

List the main virulence factors for H.influenzae

A

CAPSULE
LPS (endotoxin, can cause shock)
Adhesisn

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28
Q

Who is at risk for H.influenzae ?

A

Elderly
Smokers
COPD

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29
Q

Describe the lab diagnostics for S.aureus

A

G+ coccus

Catalase and Coagulase +

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30
Q

Describe the productive cough caused by S.aureus

A

“Salmon Pink” sputum

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31
Q

How is S.aureus typically disseminated to the LRT ?

A 
Aspiration 
Hematogenous (bacteremia or endocarditis
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32
Q

What is a typical area of the lung for S.aureus to infect ?

A 
Pleural cavity (Empyema = pus filled pleural cavity)
Abscesses (causes or inhabits ?)
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33
Q

Suppose you encounter a patient with severe hemoptysis and shock. You notice Gram + cocci on microscopy. What organism do you suspect

A

CA- MRSA

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34
Q

What will you see on gram stain with organisms that cause atypical pneumonia ?

A

NOTHING !

Most eitehr do not have a gram reaction or they are intracellular pathogens.

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35
Q

mycoplasma pneumoniae is CAP or HAP ?

A

CAP

36
Q

Pneumonia due to mycoplasma pneumonia is also known as ..

A

Walking pneumonia (#1 cause)

37
Q

Why does mycoplasma not show on gram stain ?

A

No cell wally !

38
Q

T or F: Mycoplasma is encapsulated

A

True !

39
Q

what virulence factor allows mycoplasma to bind to ciliated epithelial cells ?

A

Adhesin

40
Q

What will you see on microscopy of aspirate from a lung with mycoplasma infection ?

A

large # of PMN’s w/o organisms !

41
Q

What are the characteristics associated with mycoplasma ‘walking pneumonia’ ?

A

Non- productive, persistent cough.

Excessive sweating !*

42
Q

Igm for Mycoplasma and RBC’s that are diagnostic for the organism are also known as..

A

Cold Agglutinins

43
Q

Why will you not see Chlamydophila pneumonias on gram stain ?

A

It is an intracellular pathogen !

It is gram - however, so if it were to be out of the host organism, you would see it as a pink blot.

44
Q

What is the infectious stage of Chlamydophila ?

A

Elementary body

45
Q

What is the replicative form of Chlamydophila ?

A

Reticulate body

46
Q

What would you see upon microscopy of a patient suspected of having chlamydophila ?

A

Large amount of PMN’s but no organisms

47
Q

What is treatment for Chlamydophila ?

A

Azythromycin
Arythromycin
Doxycycline

(Treatment for G-)

48
Q

Chlamydophila psittaci cause what disease ?

A

Parrot fever

49
Q

Although it does not show up on gram stain, how could we classify Legionella ?

A

Gram - (does not gram stain well however)

50
Q

What two building structures are associated with legionella ?

A

water cooling towers and air conditioning units.

51
Q

Besides, not gram staining well. Why would yu not see legionella on gram stain ?

A

Intracellular bacteria

52
Q

What cells does legionella infect within the body ?

A

Alveolar macrophages

53
Q

how is legionella transmitted ?

A

Aerosolized droplets (really likes h20)

54
Q

Describe the signs and symptoms of legionella infection

A 
ABRUPT ONSET of fever
Pleurisy
Chills
Myalgia
Dry Cough --> Hyponatremia

Complications with liver or kidneys are common

55
Q

Patients at risk for legionella include:

A

Smokers
COPD
Elderly
RENAL TRANSPLANT or DIALYSIS !

56
Q

What media will Legionella grow on ?

A

Buffered Charcoal Yeast Extract. (Iron and cysteine salts)

57
Q

In What body fluid can you detect legionella antigen with fluorescence ?

A

Urine.

58
Q

What are the common causes of nosocomial pneumonia ?

A 
Pseudomonas aeruginosa
S.aureus
H.influenzae
Enterics (due to aspiration)
      Enterobacter
      Kleb
      E.coli
      Serratia
59
Q

In cystic fibrosis, what bacteria colonizes the lung prior to pseudomonas ?

A

S. aureus

Pseudomonas colonizes by 5 yo

60
Q

What are some key signs of pseudomonas infection

A

copious green sputum , grape smell

Hot tub folliculitis also caused by pseudomonas.

61
Q

Why is pseudomonas difficult to treat ?

A

resistant to many antimicrobials

62
Q

How do most anaerobes get into the lungs to cause pneumonia ?

A

Aspiration of gastric material into the respiratory tract.

63
Q

What are the major classes of anaerobes that are found in aspiration pneumonia ?

A

Bacteriodes and Fusobacterium

64
Q

What do bactericides and fusobacterium typically cause within the lung ?

A

Necrotizing lung disease

Lung abscess and empyema (pyothorax)

65
Q

Describe the productive cough associated with anaerobes

A

Copious amounts of foul smelling sputum.

66
Q

What is the DOC for anaerobic bacteria ?

A

Metronidozole for 2-4 months.

67
Q

Bacillus anthrax is gram + or gram - ?

A

Gram +

68
Q

describe the shape of bacillus anthrax

A

Boxcar shaped

69
Q

How is anthrax transmitted ?

A

Inhalation of endospores

70
Q

what is the most important virulence factor associated with anthrax ?

A

Anthrax toxin

71
Q

Describe the course of inhalation anthrax infection

A

Early: Sore throat, mild fever, myalgia and cough

After a few days : Severe coughing, NV, Lethargy, Shock and Death.

72
Q

How would you treat inhalation anthrax

A

Penicillin, Ciprofloxacin, doxycycline. Prayer.

73
Q

Yersinia pestis is less affectionatel known as ..

A

PLAGUE !

74
Q

What kind of gram stain organism is yersinia pests

A

Gram -, Coccobacillus.

75
Q

Describe the productive cough seen in Yersinia infection ?

A

Frothy bloody sputum

Fever, chills, cough, difficulty breathing.

76
Q

What would you seen on microscopy with stained Yersinia samples ?

A

Bi-polar coccobacilli (Safety pin staining, darker at the ends)

77
Q

What is the treatment for yersinia pestis?

A

Streptomycin/Gentimycin
Tetracycline/Doxycycline
Chloramphenicol

78
Q

What organism is responsible for Q fever ?

A

Coxiella burnetti

79
Q

Why will you not see Coxiella on gram stain ?

A

Although it is gram - , you will not see it since it is an intracellular parasite.

80
Q

What are the primary carriers of Coxiella ?

A

Cattle, Sheep and goats.

81
Q

How is Coxiella transmitted ?

A

Inhalation of contaminated dust
Ingestion of unpasteurized milk
Working in a slaughterhouse farm or vet office

82
Q

Describe the symptoms associated with coxiella

A

acute onset, severe headache, non-productive cough, muscle pain and fever.

83
Q

What animal is Francisella tularensis associated with ?

A

Rabbitts –> Tularemia

84
Q

Will you see Francisella on gram stain ?

A

No, it is an intracellular pathogen (although, it is gram -coccobacillus)

85
Q

What culture media will Francisella grow on ?

A

BCYE and Cysteine Glucose blood agar !

86
Q

TOC for francisella ?

A

Streptomycin

Respiratory II (8 decks)

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