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MICRO ADYA > Microbiology 14 - Respiratory Tract Infection + infective endocarditis > Flashcards

Microbiology 14 - Respiratory Tract Infection + infective endocarditis Flashcards

1
Q

How will a CXR appear in bronchitis?

A

Normal

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2
Q

How should bronchitis be managed?

A

Bronchodilators, physiotherapy and antibiotics IF bacterial cause (usually viral)

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3
Q

Which cause of CAP is associated with confusion?

A

Legionella

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4
Q

What are the typical symptoms and signs of legionella pneumonia?

A

Confusion
Abdominal pain
Diarrhoea
Hyponatraemia

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5
Q

Why are penicillins ineffective in atypical pneumonia?

A

Organisms that can cause atypical pneumonia don’t have a cell wall

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6
Q

What are the possible extrapulmonary features of atypical pneumonia?

A

Hepatitis
Hyponatraemia

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7
Q

What is the biggest risk factor for coxiella burnetti pneumonia?

A

Exposure to domestic/ farm animals

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8
Q

How is coxiella pneumonia diagnosed?

A

Serology

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9
Q

Which type of atypial pneumonia is spread by birds?

A

Chlamydia psittaci

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10
Q

What imaging is needed to diagnose empyema?

A

CT

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11
Q

How can empyema be treated?

A

Large chest drain

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12
Q

Which type of pneumonia might cause a mild anaemia?

A

M. tuberculosis

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13
Q

What is a hospital-acquired pneumonia?

A

Pneumonia that develops > 48 hours of being in hospital

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14
Q

How can upper and lower respiratory flora be identified and distinguished in HAP?

A

Bronchial lavage

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15
Q

Which organism is the most common cause of HAP?

A

Enterobactericiae

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16
Q

What is the typical CXR appearance of PCP pneumonia?

A

Bat wing

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17
Q

What antibiotic is used to treat PCP pneumonia?

A

Co-trimoxazole

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18
Q

Which patient population is most at-risk of aspergillus pneumonia?

A

Immunosuppressed (eg prolonged chemo/ HIV)

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19
Q

What is the treatment for aspergillus pneumonia?

A

Amphotericin B

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20
Q

Which 2 pneumonia-causing organisms can be tested for in urine?

A

S. pneumoniae
Legionella
NOTE: only useful in PAIRED samples

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21
Q

What is the antibiotic of choice to treat MRSA pneumonia?

A

Vancomycin

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22
Q

What is the antibiotic of choice to treat pseudomonas pneumonia?

A

Piptazobactam or ciprofloxacin

+/- gentamicin

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23
Q

What are the 1st and 2nd line antibiotic therapies for HAP?

A

1st line: Ceftazidine/ciprofloxacin +/- vancomycin (covers against enterobacter and staph aureus)

2nd line: Piptazobactam and vancomycin (covers against pseudomonas and staph aureus)

**but this ultimately depends on hospital guidelines*

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24
Q

What is light’s criteria?

A
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25
Q

Conditions that cause transudative pleural effusion

A

Congestive heart failure

Liver cirrhosis

Severe hypoalbuminemia

Nephrotic syndrome

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26
Q

Conditions that cause exudative pleural effusion

A

Malignancy

Infection (empyema due to bacterial pneumonia)

Trauma

Pulmonary infarction

Pulmonary embolism

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27
Q

Organisms that cause CAP in neonates (0-1 months)

A

Group B Streptococcus

Escherichia coli

Listeria monocytogenes (gram positive rod)

(GEL)

*can also present with CNS infections

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28
Q

Organisms that cause CAP in 1-6 months

A

Chlamydia trachomatis

Staphylococcus aureus

RSV

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29
Q

Organisms that cause CAP in 6 months- 5 years?

A

Mycoplasma pneumoniae

Influenza

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30
Q

Organisms that cause CAP in 16-30 yo?

A

Streptococcus pneumoniae

Mycoplasma pneumoniae (atypical, cold agglutinins, does not show up on gram stain)

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31
Q

Typical and atypical causes of CAP

A

Typical (85%)

  • Strep pneumoniae
  • H. influenzae
  • *Staph aureus
  • *moraxella cattharalis

Atypical (15%)

  • Mycoplasma pneumoniae
  • Legionella
  • Chlamydia Psitacci
  • Coxiella burnetti
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32
Q

Strep pneumonaie characteristics

A
  • Gram-positive cocci
  • alpha-haemolytic
  • optochin-sensitive
  • NOTE: optochin is NOT a clinically used antibiotics but it is useful for classifying bacteria
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33
Q

What % of CAP is caused by strep pnuemoniae?

A

30-50%

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34
Q
A
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35
Q

Symptoms of strep pneumoniae pneumonia

A
  • Severe pneumonia
    • rusty-coloured sputum
  • Fever and rigors
  • Lobar consolidation
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36
Q

Strep pneuomniae sensiitivity to antibiotics

A

almost always sensitive to penicillin

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37
Q

Differentiating between strep pneumoniae and strep viridans

A

Both are gram positive alpha haemolytic diplococci

But only S. Pneumoniae is optochinin sensitive

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38
Q

H influenzae gram stain

A

Gram-negative (red)

cocco-bacilli

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39
Q

What proportion of CAP is caused by H influenzae? Which group of patients is more affected?

A

15-35%

More common in people with pre-existing lung disease

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40
Q

How is legionella pneumophilia transmitted?

A

Aerosol spread

Environmental outbreaks

Spread via inhalation of infected water droplets

**air conditioning

**often returned traveller from spain

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41
Q

Sx and symptoms of legionella pneumophilia

A
  • Confusion
  • Abdominal pain
  • Diarrhoea
  • Lymphopaenia
  • Hyponatraemia
  • Bilateral interstitial change on CXR
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42
Q

Diagnosis of legionella pneumophilia

A

Urinary antigens

43
Q

Main complication of legionella pneumophlia

A

Multi organ failure

44
Q

How is chlamydia psitacci spread?

A

Spread from birds

45
Q

What antibiotic are the atypical causes of CAP sensitive to?

A

Macrolides

(or tetracyclines)

*not sensitive to beta lactams because they don’t have a cell wall

46
Q

How do atypical pneumonias usually present/ when would you suspect them?

A

Often have a flu-like prodrome before fever and pneumonia

Extra-pulmonary features are characteristic of atypicals

47
Q

Causes of cavitation on CXR

A
  • Staphylococcus aureus- can follow influenza A infection, can lead to thin walled abscesses that break down to give rise to cystic spaces
  • Klebsiella pneumoniae- upper lobe cavitation, alcoholics, sudden onset systemic upset, RED CURRANT JELLY SPUTUM
  • TB - classically upper lobe cavitation, weight loss, haemoptysis etc. can lead to complications such as abscesses and empyema
48
Q

If someone is not responding to ABx treatment for pneumonia what would you suspect?

A
  • Empyema/ abscess
  • Resistant organisms (travel is important)
  • Not receiving/ absorbing antibiotics
  • Immunosuppression
  • Unusual cause e.g. Aspergillus fumigatus
  • Other diagnosis
    • Lung cancer
    • Cryptogenic organising pneumonia
49
Q

Recall the CURB 65 criteria

A

Confusion
Urea > 7
Resp rate > 30
BP <90 systolic/ <60 diastolic
Age > 65

50
Q

Causative organisms of HAP

A

Most common: enterobacteraciea - E Coli, Klebsiella Pneumoniae

Then: staph aureus, psuedomonas, Acinetobacter baumanii = 6%, Fungi (Candida spp) =7%

51
Q

Definition of HAP

A

Pneumonia acquired 48 hours after hospital stay

52
Q

WHich organism causes pneumonia in HIV patients?

A

Pneumocystic jirovecii

  • fungus

(Also: TB and atypical mycobacteria)

53
Q

Presentation of pneumocystis jirovecci pneumonia

A

Dry cough

Weight loss

SOB- desaturation on exercise

Malaise

54
Q

CXR of pneumocystis

A

Bat wing shadowing

55
Q

Test for pneumocystis

A

PCR

Sometimes silver stain

56
Q

Which drug is used for prophylaxis and treatment of PCP?

A

Co-trimoxazole

57
Q

Empirical therapy for CAP:

1) Mild-moderate
2) Moderate-severe

A

1) Mild-moderate

Amoxicillin OR clarithryomycin

2) Moderate-severe:

Co-amoxiclav + clarithromycin

58
Q

Spectrum of antibiotics

A
59
Q

Which organism affects neutropaenic patients?

A

aspergillus fumigatus - halo sign on cxr

60
Q

what classic sign do you see on cxr with aspergilus fmugatus?

A

halo sign

61
Q

which organism affects bone marrow transplant patients?

A

CMV

**also affects renal transplant patients

62
Q

Which organism affects splenectomy patients?

A

encapsulated organisms such as:

  • strep pneumoniae
  • h. influenzae
  • malaria
63
Q

WHich organisms are implicated in bronchitis? WHich patient groups are usually affected?

A

Organisms: Viruses, Strep pneumoniae, Hameophilus Influenzae, Morazella Cathallris (infective exacerbation of COPD)

Patient groups: smokers, asthma

64
Q

CXR findings of SARS COV 2

A

Ground glass opacification

65
Q

Presentation of TB

A

Prolonged prodrome

Fevers

Weight loss

Haemoptysis

Night sweats

necrotising granulomas

66
Q

CXR of TB

A
  • upper lobe cavitation
  • RUZ shadowing
  • complete whiteout
  • can see miliary pattern if miliary TB
67
Q

Tests for TB

A
  • CXR
  • sputum sample via BAL

–> staining with

a) Ziehl Neilson stain: red on blue
b) auramine: reddish-yellow fluorescence

68
Q

Treatment of TB

A
69
Q

Features of ABPA

A

Chronic wheeze

Eosinophilia

Bronchiectasis

70
Q

Aspergilloma vs invasive aspergillosis

X-ray signs of aspergilloma

A

Aspergilloma:

  • Fungal ball, often in pre-existing cavity such as that formed by TB, lung cancer or cystic fibrosis (bronchiectasis), emphysema
  • May cause haemoptysis

Invasive aspergillosis:

  • Immunocompromised
  • Tx: amphotericin B

xray signs: target shaped lesion with air crescent sign

71
Q
A
72
Q

Which organisms can be detected via urinary antigen testing?

A

Legionella

Strep Pneumoniae

73
Q

Which organism can be detected via immunofluorescence?

A

PCP

74
Q
A

Strep pneumomaie- classic lobar pneumonia

75
Q

What is the sail sign?

A

Double heart border- sign of left lower lobe collapse

76
Q
A

Legionella

  • due to bilateral interstitial change
  • hyponataramiea
  • confusion
77
Q

What is the diagnosis?

*not getting better w/ antibiotics

A

Empyema

78
Q
A

TB

79
Q
A

PCP

  • was immunosuppressed for a while
80
Q
A

Aspergillus

81
Q

What type of pneumonia can CMV cause?

A

Bilateral pneumonia

82
Q

Rusty-coloured sputum.
Lobar on CXR.

+ve diplococci

A

Strep pneumoniae

83
Q

Assoc. w/ smoking, COPD
-ve cocco-bacil

A

Haemophilus influenzae

84
Q

Assoc. w/ smoking -ve cocci

A

Moraxella Catarrhalis

85
Q

Assoc. w/ recent viral infection (post- influenza) ± cavitation on CXR

gram + ve cocci “grape-bunch clusters”

A

Staph auereus

**see cavitation

86
Q

Alcoholcs, elderly, haemoptysis

-ve rod, enterobacter

A

Klebsiella pneumoniae

87
Q

Which bacteria cause typical pneumoniae? (including community and hospital acquireD)

A

Strep pneumoniae

H. influenzae

Moraxella catarrhalis

Staph auerus

Klebsiella pneumoniae

88
Q

Travel, air conditioning, water towers, hepatitis, hyponatraemia

A

Legionella

89
Q

Uni students / boarding schools, dry cough, arthralgia, cold agglutinin test / AIHA, erythema multiforme

A

Mycoplasma pneumoniae

90
Q

Which organism does neutropenia make you susceptibel to?

A

Aspergillus

91
Q

Typical vs atypical pneumomnia

A

Typical = classic signs and symptoms (i.e. chesty cough, fast onset), classic CXR changes (i.e.
consolidation), respond to penicillin Abx o Atypical = no / atypical signs and symptoms (dry cough, potentially slower onset) , not in-keeping with CXR, don’t
respond to penicillin Abx (because no cell wall). Therefore need macrolides. May have extra-pulmonary
features, e.g. hepatitis, hyponatraemia o NB this has nothing to do with how common the pathogen is – some atypical
pneumonias are common!

92
Q

ABx treatment of CAP depending on CURB 65

A
93
Q

Tx of aspiration pneumonia

A

Tazocin (piperacillin+tazobactam) + metronidazole

94
Q

Organisms that cause acute infective endocarditis

A

Strep pyogenes

Staph auereus

Coagulase negative staph (staph epidermidis)

95
Q

Most common cause of IE in IVDU?

A

Staph aureus

96
Q

Most common cause of IE in prosthetic valve

A

CoNS

97
Q

Causes of subacute IE

A

Subacute (low-virulence bacteria): Staph epidermidis, Strep viridans, HACEK
o HACEK organisms are uncommon causes and do not grow on culture à
consider if high suspicion but culture -ve
§ Haemophilus, Acinetobacter, Cardiobacterium, Eikinella, Kingella

**not staph aureus**

98
Q

Which type of IE do you see embolic and immune phenomena?

A

Subacute

*maybe because it takes time for these phenomena to happen?*

Embolic phenomena: Janeway lesions, splinter haemorrhages,
splenomegaly, septic abscesses in lungs/brain/spleen/kidney, microemboli

o Immune phenomena: Roth spots, Osler’s nodes, haematuria (due to
glomerulonephritis)

99
Q

How many blood cultures b4 abx in IE?

A

3

100
Q

Duke’s criteria

A
101
Q

Tx of IE

A

**don’t get caught up with the guidelines**

102
Q

What antibiotic is used for atypical pneumonia?

A

Macrolide

103
Q

Osler’s nodes vs janeway lesions

A

Janeway: non tender, on palms

Osler’s nodes: tender, on fingers

o for Ouch

104
Q

From passmed: if you suspect that pneumonia is caused by influenza thenw hat do you need to add?

A

flucloxacillin

MICRO ADYA (22 decks)

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