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

Microbiology 14 - Respiratory Tract Infection + infective endocarditis Flashcards

(104 cards)

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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
Conditions that cause transudative pleural effusion
Congestive heart failure Liver cirrhosis Severe hypoalbuminemia Nephrotic syndrome
26
Conditions that cause exudative pleural effusion
Malignancy Infection (empyema due to bacterial pneumonia) Trauma Pulmonary infarction Pulmonary embolism
27
Organisms that cause CAP in neonates (0-1 months)
Group B Streptococcus Escherichia coli Listeria monocytogenes (gram positive rod) (GEL) \*can also present with CNS infections
28
Organisms that cause CAP in 1-6 months
Chlamydia trachomatis Staphylococcus aureus RSV
29
Organisms that cause CAP in 6 months- 5 years?
Mycoplasma pneumoniae Influenza
30
Organisms that cause CAP in 16-30 yo?
Streptococcus pneumoniae Mycoplasma pneumoniae (atypical, cold agglutinins, does not show up on gram stain)
31
Typical and atypical causes of CAP
**Typical (85%)** * Strep pneumoniae * H. influenzae * \*Staph aureus * \*moraxella cattharalis **Atypical (15%)** * Mycoplasma pneumoniae * Legionella * Chlamydia Psitacci * Coxiella burnetti
32
Strep pneumonaie characteristics
* Gram-positive cocci * alpha-haemolytic * optochin-sensitive * NOTE: optochin is NOT a clinically used antibiotics but it is useful for classifying bacteria
33
What % of CAP is caused by strep pnuemoniae?
30-50%
34
35
Symptoms of strep pneumoniae pneumonia
* Severe pneumonia * rusty-coloured sputum * Fever and rigors * Lobar consolidation
36
Strep pneuomniae sensiitivity to antibiotics
almost always sensitive to penicillin
37
Differentiating between strep pneumoniae and strep viridans
Both are gram positive alpha haemolytic diplococci But only S. Pneumoniae is optochinin sensitive
38
H influenzae gram stain
Gram-negative (red) cocco-bacilli
39
What proportion of CAP is caused by H influenzae? Which group of patients is more affected?
15-35% More common in people with pre-existing lung disease
40
How is legionella pneumophilia transmitted?
Aerosol spread Environmental outbreaks Spread via inhalation of infected water droplets \*\*air conditioning \*\*often returned traveller from spain
41
Sx and symptoms of legionella pneumophilia
* **Confusion** * Abdominal pain * Diarrhoea * Lymphopaenia * **Hyponatraemia** * Bilateral interstitial change on CXR
42
Diagnosis of legionella pneumophilia
Urinary antigens
43
Main complication of legionella pneumophlia
Multi organ failure
44
How is chlamydia psitacci spread?
Spread from birds
45
What antibiotic are the atypical causes of CAP sensitive to?
Macrolides (or tetracyclines) \*not sensitive to beta lactams because they don't have a cell wall
46
How do atypical pneumonias usually present/ when would you suspect them?
Often have a flu-like prodrome before fever and pneumonia Extra-pulmonary features are characteristic of atypicals
47
Causes of cavitation on CXR
* **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
If someone is not responding to ABx treatment for pneumonia what would you suspect?
* 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
Recall the CURB 65 criteria
Confusion Urea \> 7 Resp rate \> 30 BP \<90 systolic/ \<60 diastolic Age \> 65
50
Causative organisms of HAP
**Most common:** enterobacteraciea - E Coli, Klebsiella Pneumoniae Then: staph aureus, psuedomonas, Acinetobacter baumanii = 6%, Fungi (Candida spp) =7%
51
Definition of HAP
Pneumonia acquired 48 hours after hospital stay
52
WHich organism causes pneumonia in HIV patients?
Pneumocystic jirovecii - fungus (Also: TB and atypical mycobacteria)
53
Presentation of pneumocystis jirovecci pneumonia
Dry cough Weight loss SOB- desaturation on exercise Malaise
54
CXR of pneumocystis
Bat wing shadowing
55
Test for pneumocystis
PCR Sometimes silver stain
56
Which drug is used for prophylaxis and treatment of PCP?
Co-trimoxazole
57
Empirical therapy for CAP: 1) Mild-moderate 2) Moderate-severe
1) Mild-moderate Amoxicillin OR clarithryomycin 2) Moderate-severe: Co-amoxiclav + clarithromycin
58
Spectrum of antibiotics
59
Which organism affects neutropaenic patients?
aspergillus fumigatus - halo sign on cxr
60
what classic sign do you see on cxr with aspergilus fmugatus?
halo sign
61
which organism affects bone marrow transplant patients?
CMV \*\*also affects renal transplant patients
62
Which organism affects splenectomy patients?
encapsulated organisms such as: - strep pneumoniae - h. influenzae - malaria
63
WHich organisms are implicated in bronchitis? WHich patient groups are usually affected?
Organisms: Viruses, Strep pneumoniae, Hameophilus Influenzae, Morazella Cathallris (infective exacerbation of COPD) Patient groups: smokers, asthma
64
CXR findings of SARS COV 2
Ground glass opacification
65
Presentation of TB
Prolonged prodrome Fevers Weight loss Haemoptysis Night sweats necrotising granulomas
66
CXR of TB
- upper lobe cavitation - RUZ shadowing - complete whiteout - can see miliary pattern if miliary TB
67
Tests for TB
- CXR - sputum sample via BAL --\> staining with a) Ziehl Neilson stain: red on blue b) auramine: reddish-yellow fluorescence
68
Treatment of TB
69
Features of ABPA
Chronic wheeze Eosinophilia Bronchiectasis
70
Aspergilloma vs invasive aspergillosis X-ray signs of aspergilloma
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
72
Which organisms can be detected via urinary antigen testing?
Legionella Strep Pneumoniae
73
Which organism can be detected via immunofluorescence?
PCP
74
Strep pneumomaie- classic lobar pneumonia
75
What is the sail sign?
Double heart border- sign of left lower lobe collapse
76
Legionella - due to bilateral interstitial change - hyponataramiea - confusion
77
What is the diagnosis? \*not getting better w/ antibiotics
Empyema
78
TB
79
PCP - was immunosuppressed for a while
80
Aspergillus
81
What type of pneumonia can CMV cause?
Bilateral pneumonia
82
Rusty-coloured sputum. Lobar on CXR. +ve diplococci
Strep pneumoniae
83
Assoc. w/ smoking, COPD -ve cocco-bacil
Haemophilus influenzae
84
Assoc. w/ smoking -ve cocci
Moraxella Catarrhalis
85
Assoc. w/ recent viral infection (post- influenza) ± cavitation on CXR gram + ve cocci "grape-bunch clusters"
Staph auereus \*\*see cavitation
86
Alcoholcs, elderly, haemoptysis -ve rod, enterobacter
Klebsiella pneumoniae
87
Which bacteria cause typical pneumoniae? (including community and hospital acquireD)
Strep pneumoniae H. influenzae Moraxella catarrhalis Staph auerus Klebsiella pneumoniae
88
Travel, air conditioning, water towers, hepatitis, hyponatraemia
Legionella
89
Uni students / boarding schools, dry cough, arthralgia, cold agglutinin test / AIHA, erythema multiforme
Mycoplasma pneumoniae
90
Which organism does neutropenia make you susceptibel to?
Aspergillus
91
Typical vs atypical pneumomnia
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
ABx treatment of CAP depending on CURB 65
93
Tx of aspiration pneumonia
Tazocin (piperacillin+tazobactam) + metronidazole
94
Organisms that cause acute infective endocarditis
Strep pyogenes Staph auereus Coagulase negative staph (staph epidermidis)
95
Most common cause of IE in IVDU?
Staph aureus
96
Most common cause of IE in prosthetic valve
CoNS
97
Causes of subacute IE
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
Which type of IE do you see embolic and immune phenomena?
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
How many blood cultures b4 abx in IE?
3
100
Duke's criteria
101
Tx of IE
\*\*don't get caught up with the guidelines\*\*
102
What antibiotic is used for atypical pneumonia?
Macrolide
103
Osler's nodes vs janeway lesions
Janeway: non tender, on palms Osler's nodes: tender, on fingers o for Ouch
104
From passmed: if you suspect that pneumonia is caused by influenza thenw hat do you need to add?
flucloxacillin

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