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OS Pulmonary > Micro - respiratory infections > Flashcards

Micro - respiratory infections Flashcards

1
Q

Morphology of strep pneumo?

A

Lancet-shaped diplococci or short chains

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2
Q

How is strep pneumo spread?

A

Contact

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3
Q

What are some major risk factors for strep pneumo?

A

Asplenia is big, and the other typical ones

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4
Q

What are the major virulence factors of strep pneumo?

A

LPS capsule

Pneumolysin - pore formation

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5
Q

Is strep pneumo necrotizing or non-necrotizing?

A

Non

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6
Q

What is the OP and IP treatment of strep pneumo?

A

OP: macrolide + doxy
IP: penicillins, or macrolide + B-lactam

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7
Q

Otitis media from strep pneumo treatment?

A

amoxicillin

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8
Q

What are the two vaccines for strep pneumo?

A

Pneumovac: cargo-based, short-acting
Prevnar: protein conjugate

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9
Q

How is yersinia pestis spread?

A

Flea bites

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10
Q

Y pestis morphology?

A

Safety pins

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11
Q

Y pestis virulence factors

A

Type III secretion system injects effectors that stop phagocytosis

F1 capsule - basis of rapid tests

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12
Q

How can Y pestis be definitely diagnosed?

A

F1 capsule serology

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13
Q

What is the treatment for Y pestis?

A

Streptomycin; doxy for pneumoic because it’s contagious

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14
Q

Is Y pestis contagious?

A

Only the pneumonic form of disease

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15
Q

Describe the different types of plague and their unique features

A

Bubonic: painful LAD buboes

Septicemic: worse than bubonic, toxemia, MOF, DIC possible, etc.

Pneumonic: septicemic version disseminates to lungs; CONTAGIOUS, BLOODY AND WATERY sputum

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16
Q

Brucella - disease presentation

A

Chronic infection with granulomas in bone and liver; night sweats and long-lasting fever; back pain

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17
Q

Brucella phrase

A

Butchers in Brussels get Brucellosis from Bovines with Back Pain and Break Sweats

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18
Q

Brucella transmission

A

Raw dairy; handling animals; zoonistic in cows/sheep

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19
Q

Coxiella burnetti spread

A

aerosol and animal products

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20
Q

Coxiella burnetti associated disease

A

Q fever

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21
Q

Q fever S/S

A

Atypical pneumonia 2-4 weeks; sometimes cardiac involvement and liver.

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22
Q

Q fever treatment

A

doxycycline for coxi!

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23
Q

Which antivirals are NA inhibitors?

A

Zanamivir and oseltamivir

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24
Q

Which antivirals are best for flu B?

A

Zanamivir and oseltamivir

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25
Q

What does the flu HA protein do?

A

Facilitate attachment and penetration

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26
Q

What does the flu NA protein do?

A

Destroy receptor by cleaving sialic acid from virion and cell surface

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27
Q

What does the flu M2 protein do?

A

Only in Type A; ion channel involved in uncoating

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28
Q

Nocardia - who is most vulnerable?

A

Chronic lung disease patients; also HIV/chemo; OPPORTUNISTIC

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29
Q

Nocardia virulence factors

A

Catalse and superoxide dismutase

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30
Q

Nocardiosis features

A

Acute inflammation with necrosis and abcessation

Nocardia is Necrotic and comes in through your Nose

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31
Q

Nocardia treatment

A

Cefamandole (‘nocardia needs a man’)

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32
Q

Nocardia habitus

A

Soil and water

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33
Q

Nocardia spread?

A

Inhalation, not p to p

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34
Q

If you ate or inhaled dirt, which pathogens could you potentially contract?

A

Nocardia (inhalation)
Histoplasma (regional)
Acinetobacter (Asia/Australia)

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35
Q

Which fungal infections are considered opportunistic?

A

Aspergillus, mucormycoses, pneumocysis

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36
Q

Which fungal infections are considered systemic?

A

Histo, blasto, coccidio

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37
Q

Histoplasma morphology

A

Dimorphic yeast with BUMP CONIDIA

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38
Q

Where is histo endemic?

A

MS and OH river valleys

Central America

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39
Q

histoplasma virulence

A

yeast resists macrophage destruction

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40
Q

What parts of the body does histo target?

A

‘Reticuloendothelial system’ - lymph, spleen, BM

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41
Q

Histoplasmosis presentation

A

Cough, fever, similar symptoms to TB, potential for renal failure and CNS in immunocompromised

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42
Q

Treatment for histoplasmosis

A

Azole for competent pts; Ampho B then azoles for compromised

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43
Q

Blasto spread

A

Airborne spores

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44
Q

Blasto morphology

A

“Broad-based” budding yeast snowmen

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45
Q

Blasto virulence

A

Yeast form IS susceptible to macrophages (unlike histo)

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46
Q

Blasto presentation

A

Acute pneumonia with PURULENT BROWN/bloody sputum

40% warty skin lesions (cutaneous)

Can spread to prostate

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47
Q

Blasto tx

A

Azole if competent; AmpB+maintenance azole if compromised

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48
Q

Coccidioides morphology

A

Dimorphic spherule (not yeast) that sporulates

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49
Q

Coccidioides transmission

A

sporulation/airborne

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50
Q

Coccidioides vulnerable pops

A

SW US; AAs, AIDS/immunocompromised

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51
Q

Coccidioides virulence info

A

Very infectious; bioweapon

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52
Q

Coccidioides disease caused

A

Valley fever/Coccidiomycosis

Fever, ARTHRALGIA, fatigue, rash; long-lasting fatigue

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53
Q

Coccidioides script

A

Black HIV+ man living in California

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54
Q

Aspergillus morphology

A

45 deg septate hyphae

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55
Q

Aspergillus spread

A

sporulation/airborne

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56
Q

Aspergillus tx

A

Ampho B

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57
Q

Zygomycetes morphology

A

90 deg septate hyphae

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58
Q

Zygomycetes buzz words exposure

A

Tornadoes/disasters

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59
Q

Zygomycetes spread

A

Sporulation/airborne

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60
Q

Zycomycetes vulnerable pops

A

opportunistic/ic’d

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61
Q

Zygomycetes tx

A

Ampho B

62
Q

Zycomycetes distinguishing S/S

A

severe HA

63
Q

Pneumocystic jerovici morphology

A

deflated soccer balls

64
Q

Pneumo jerovici who’s vulnerable?

A

Everyone is infected by ~4; AIDS at risk; opportunistic

65
Q

Pneumo jerovici virulence and dx

A

Can’t be cultured; part protozoan so can’t use AmpB (cholesterol)

Silver stain to see cysts is Dx

66
Q

Pneumo jerovici tx

A

Trimethoprim-sulfamethoxazole

67
Q

Coronavirus genome

A

Non-seg + RNA

68
Q

Flu genome

A

Segmented - ssRNA

69
Q

Coronavirus spread

A

P to P through airborne droplets

70
Q

Coronavirus virulence factors

A 
S: spike protein - stimulates prod of antibody so important!
HE: hemagg esterase
E - envelope protein
M - membrane p - budding/env formation
N - nucleocapsid p - encapsidation
71
Q

Coronavirus diseases

A

Colds, croup, SARS

72
Q

What are the major causes of croup?

A

90% viral

Paraflu, flu, adenovirus are major sources, sometimes RSV

73
Q

Coronavirus cold

A

mild URT, ~15-30% of colds

74
Q

Coronavirus croup - which virus?

A

HVoC-NL63

75
Q

SARS S/S

A

High fever, flu-like, GI symptoms

Severe LRTI progressing to pneumonia; targets Typ e II pneumocytes

Eventually, severe ARDS

76
Q

Chlamydia diseases

A

Psittacosis

Pneumonia (atypical)

Ocular and genital infections

77
Q

Describe the chlamydia life cycle

A

Biphasic:

  • Inert EB enters cell
  • Becomes RB which undergoes binary fission
78
Q

Chlamydria morphology

A

Obligate intracellular parasite dependent on cell for many substances

79
Q

Chlamydia presentation of pneumonia

A

Mild atypical pneumonia (slow progressing) in adolescents and young adults

HA is an important finding not typical of other pneumonias

80
Q

Chlamydia virulence factors

A

TTS; tarp; CopN…

81
Q

Chlamydia Dx

A

IgM titer

82
Q

Chlamydia often has this area of involvement along with pneumonia

A

Ocular!

83
Q

Legionella morphology

A

Aerobic G- rods

facultative intracellular parasites

84
Q

Which pathogens are intracellular parasites, either facultative or obligate?

A

Legionella (facultative)
Chlamydia (obligate)
Brucella (facultative)
Coxiella

85
Q

Legionella spread

A

Not P to P; through water sources

86
Q

Legionella mech

A

Replicates in alveolar macrophages; avoids phagolysosome fusion; creates ‘special vacuole’

87
Q

Legionella Dx

A

urine test

88
Q

Legionnaire’s disease S/S

A

Incubates 2-10 days;
HIGH fever
cough, chills

89
Q

Pontiac fever S/S

A

Flu-like; passes in 2-5 days; incubates 36-48 hours

90
Q

Mycoplasma pneumonia vulnerable pops

A

LITTLE KIDS 1-5

And younger > older in general

91
Q

Mycoplasma CAP

A

5-10% of CAP
GRADUAL, insidious onset of days/weeks
Especially consider if cough of > 3 weeks

92
Q

Adenovirus srpead

A

Inhalation of droplets from fecal-oral

93
Q

Adenovirus vulnerable pops

A

Children, military, pools/etc for eye infections

94
Q

Adenovirus virulence factors

A

Hexon proteins and capsid

95
Q

Which adenovirus serotypes affect GI only?

A

40, 41

96
Q

Which adenovirus serotypes cause ARD?

A

4, 7

97
Q

Adenovirus dx

A

cytopathic effect on culture

98
Q

Adenovirus S/S of respiratory infection

A

Erythema, cough, fever, sore throat

Ocular: ‘sand’ in eye, runny nose, fever, sore throat

GI: N/V/D, fever

AdV can persist for several months after acute episode!

99
Q

Acinetobacter gram __

A

-

100
Q

Acinetobacter vulnerable pops

A

Australians and Asians with CAP and chronic disease

101
Q

Acinetobacter virulence

A

Low virulence; apoptosis of laryngeal epithelium via OMP 38

102
Q

Acinetobacter dx

A

culture

103
Q

Acinetobacter S/S pneumonia

A

Fever, other typical
chest pain

If cutaneous: orange, bumpy skin

104
Q

Acinetobacter tx

A

MDR - use meropenem other things….

105
Q

Corynebacterium morphology

A

chinese letters, G+

106
Q

Corynebacterium virulence

A

Diptheria toxin:

  • B subunit facilitates entry/endocytosis
  • A subunit: 1 molecule can kill cell
107
Q

Diphtheria dx

A

culture

108
Q

Corynebacterium S/S

A

Colonizes pharynx and forms PSEUDOMEMBRANE and VERY sore throat
Can cause heart issues

109
Q

Which pathogens can potentially involve cardiac damage?

A 
diphtheria
Q fever (coxiella)
110
Q

Bordetella morphology/char

A

Fastidious G-

111
Q

Bordetella transmission

A

Very contagious; P to P!

112
Q

Bordetella virulence factors

A

Pertussis toxin paralyzes cilia and causes inflammation

FHA: filamentous hemagg

113
Q

Pertussis phases and symptoms

A

3 phases

  1. Catarrhal (low fever, progressive cough)
  2. Paroxysmal (wax/wane whoop, fatigue, cyanosis, N/V)
  3. Convalescent (recovery, still some cough)
114
Q

Pertussis vaccine

A

DTaP: acellular

115
Q

Bacillus anthracis morphology

A

boxcars - the anthrax children

G+ aerobic SPOREs

116
Q

Anthrax virulence

A

Non-antigenic capsule
AB toxin:
-B allows receptor binding
-A: two subunits - EF edema factor - swelling; LF lethal factor - disrupts cell signals

117
Q

Inhalational anthrax S/S

A

Two phases

  1. Flu-like symptoms
  2. Hemorrhagic mediastinitis with pleural effusion

MEDIASTINAL WIDENING ON CXR
INC UP TO 6 WKS

118
Q

Hantavirus genome

A

Segmented (-) RNA

119
Q

Hantavirus spread

A

Aerosolized rodent waste, esp.
DEER MOUSE

‘Santa loves reindeer; Hanta loves deer (mice)’

120
Q

Hantavirus virulence

A

HPS causes PULMONARY CAPILLARY PERMEABILITY - edema edema edema

121
Q

How does the immune system contribute to hantavirus infection pulmonary syndrome?

A

Lymphos and macros recruited by high viral burden - provokes endothelial overactivation and edema/migration

122
Q

What is the hantavirus ‘triplet’ of S/S?

A

Elevated HCT
Thrombocytopenia
Leukocytosis with left shift

123
Q

What are the two stages of hantavirus RDS?

A
  1. Fever and myalgias, NO SIGNS OF TYP URI

2. Lots of edema, cough, low BP

124
Q

Hantavirus tx

A

no specific, but low fluids and use pressors

125
Q

Anthrax tx

A

Cipro or Doxy IV

126
Q

RSV vulnerables

A

kids, daycare, premature babies, immunodeficient

127
Q

RSV genome

A

Enveloped, nonseg (-) RNA

128
Q

RSV virulence

A

Respiratory tract only
Two envelope proteins -
1. F protein
2. G protein

129
Q

RSV dx

A

F protein serology

130
Q

RSV S/S

A

Airway inflammation, necrosis, sloughing, edema, …

SEASONAL

131
Q

RSV tx

A

palvizumab

132
Q

prophylaxis for RSV

A

ribavirin

133
Q

ALL of the syncytial viruses have this genome

A

Env nonseg - RNA

134
Q

Actinomyces morphology

A

Produce hard yellow granules

135
Q

Actinomyces virulence

A

not highly

136
Q

Actinomyces manifestation areas

A

Pulmonary, facial, lumpy jaw, GI

137
Q

Actinomycosis S/S

A

Chest pain w/ inspiration, phlegm, weight loss

138
Q

Actinomycosis tx

A

Penicillin IV 4-6 wks

139
Q

Rhinovirus genome

A

Unenv (+) RNA

140
Q

Rhinovirus spread

A

direct contact

141
Q

Rhinovirus virulence

A

IRES elements - selective translation of viral

Local inflammation responsible for smyptoms as opposed to virus

Lives long on surface

142
Q

Rhinovirus infection symptoms/Signs

A

Sore throat –>rhinorrhea/congestion

HA, facial pressure possible

Normal pharynx - no erythema!

Cough and hoarseness possible

143
Q

TB phase 1

A

droplet of nuclei inhalted

144
Q

TB phase 2

A

7-21 days post-infection; unrestricted multiplication and macrophage migration

145
Q

TB phase 3

A

Macrophage activation by T cells
Tuberculin + now
Caseating necrosis begins

146
Q

TB phase 4

A

MTB grows in weak macrophages and dissemination possible

147
Q

TB phase 5

A

Caseous liquefication - rapid growth - bronchial necrosis/rupture - everywhhherre

148
Q

TB treatment

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol/strepto

149
Q

Francisella morpho

A

G- non-sporing cocco

150
Q

Francisella S/S

A

Patchy infiltrates on CXR!!

Ulceroglandular most common -
Fever, chills, HA, exhaustion
SKIN ULCER at bite site

151
Q

Francisella spread

A

rabbits; fleat bites; dead animals; NOT p to p

152
Q

Francisella tx

A

streptomycin

OS Pulmonary (13 decks)

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