Pathology - Lung Flashcards by Adewale Odukoya

Forms of acute bacterial pneumonias

Bronchopneumonia and lobar pneumonia

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Brochoopneumonia

Patchy and involves more than one lobe

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Lobar pneumonia

Part or all of a lobe filled with exudate that can be seen as lobar or segmental

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What organism is responsible for 90% of lobar pneumonia

Streptococcus pneumoniae

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Origin of most community acquired pnemoniae

Bacterial

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Most common cause of community acquired pneumoniae

S. pneumoniae (lobar )

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Four stages of lobar pneumonial evolvement in lobes

Congestion, Red hepatization, Gray hepatization, Resolution

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Congestion Stage

Lobe is red, heavy,boggy,proteinous fluid, neutrophils and bacteria lasting for few days

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Red hepatization

lung has liver-like consistency, alveolar spaces packed with neutrophils, red cells, fibrin

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Gray hepatization

lung is dry, gray, firm due to RBCs lysing out

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Resolution

enzymes digest exudate,debris eating by macrophages, fibroblasts growing around it

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Empyema

is suppurative accumulate in the pleural cavity

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Complication of pneumoniae occurs through

Type 3 serology

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Gram positive lancet shaped diplococci is good evidence for

S. pneumoniae but be careful of false positive

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Community acquired acute pneumoniae

S. pneumoniae, H. influenza, Moraxella catarrhalis, S. aureus, Legionella, Klebsiella and Pseudomonas

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Community acquired atypical pneumoniae

Mycoplasma, Chlamydia, Coxiella, RSV, Parainfluenza, Influenza A and B, adenovirus

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Nosocomial pneumoniae

G- rods - Klebsiella, Serratia, E. coli and Pseudomonas,S aureus

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Aspiration pneumoniae

anaerobic oral flora - bacteroides, prevotella, fusobacterium, peptostreptococcus admixed with S. pneumoniae, S aureus, H. influenza, Pseudomonas. Caused mainly by aerobes

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Chronic pneumoniae

Nocardia, Actinomyces, Granulomatous-Mycobacterium, Atypical Mycobacteria, Histoplasma, Coccidiodes, Blastomyces

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Necrotizing pneumoniae and lung abscess

anaerobic bacteria, S aureus, Klebsiella, S. Pyogenes, Type 3 pneumococcus

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Pneumonia in the immunocompromised

CMV, pneumocystis, Mycobacterium avian, invasive aspergillosis, invasive candidiasis,

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Most common bacteria causing acute exacerbation in COPD

H. influenza, secondly M. catarrhali

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3 most common causes of otitis media

S. pneumoniae, H. influenza, M. catarrhalis

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IV drug use causing right sided endocarditis by which organism

S. aureus

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Most common cause of G- bacteria pneumoniae, affecting alcoholics

Klebsiella

Rapid diagnosis of legionella

Antigen in urine or PCR

Atypical pneumonia means

means moderate amount of sputum produced, no consolidation, moderate WBC count, no exudates, inflammation in alveolar septa only

Most common atypical pneumoniae organisms

Mycoplasma pneumoniae occurring in closed communities

What type of Influenza causes most pandemic and epidemic

Type A by mutations of the hemagglutinin and neuraminidase

Epidemics of Influenza A due to

antigenic drift

Pandemics of Influenza A due to

antigenic shift. Recombination with other RNA viruses

what organism seen in Cystic Fibrosis, burn and neutropenic patients

Pseudomonas

What organism is secondary to viral respiratory infections

S. aureus

What organism is seen in organ transplants

Legionella

All lung abscess possess what kind of organism

Anaerobes - Fusobacterium, Bacteroides, Peptostreptococcus and microaerophilic streptococcus

What side of lung is aspirations more common on

Right side, at posterior segment of upper lobe and in the apical segments of the lower lobe

Most important organism in chronic pneumonias

TB - center undergoing caseous necrosis

Most important risk factor for developing TB

HIV infection

Infection

seeding of a tissue with an organism without any damage

Disease

Damage caused to a tissue by an organism

Positive tuberculin test signifies

cell mediated hypersensitivity

Features of Tuberculosis

Caseating granulomas with cavitation due to destruction of tissue by host immune

how long is primary pulmonary tuberculosis

0-3 weeks ( proliferation of TB in pulmonary macrophages) with mild flu and asymptomatic

NRAMP I ( natural resistance assoc. macrophage protein I)

transmembrane ion transport found in lysosome and endosome to help with TB killing

How long for cell mediated immunity to develop in TB

3 weeks after exposure

What cytokines needed for macrophage/dendritic cells to get help

IL-12, CD4+ of the Th1 type( secretes IF-gamma)

Role of CD4+ -Th1 subtype in TB control

Secretes IF-gamma needed to activate macrophage

Role of Activated macrophage in TB control

secrete TNF ( recruit monocytes),express inducible NO synthase and ROS

What are the total cytokines needed to effectively deal with TB

IL-12, IFN-gamma, TNF, NO production

What primarily mediates immunity response to TB infection

TH1 cells to stimulate macrophages

Ghon focus

gray white inflammatory consolidation after unsensitized person encounter first TB

Ghon Complex

parenchymal lesion and nodal involvement of TB. TB traveling i the lymph to regional nodes

Ranke complex

Progressive fibrosis and calcification of Ghon complex

Progressive primary TB

seen in HIV+ people with CD count of <200

Primary TB

TB that develops in a person previously unexposed and therefore unsensitized

Secondary TB ( Reactivation TB)

pattern of disease seen in a previously sensitized person

Location of secondary pulmonary TB

one or both upper lobes

Does cavitation occur in primary or secondary TB infection and why?

Secondary because individual already sensitized and they quickly mount immune response to fibrocase the TB in that upper lobe

Miliary pulmonary disease

TB drains through lymphaticsand gets into ride side of heart and into pulmonary arteries

Most frequent form of extrapulmonary tuberculosis

lymphadenitis usually in the cervical region

Hallmark of host reaction to TB in immunocompromised persons is

Granulomas presence

Cavity lesion in lung apices means

secondary or reactivation

Features of Mycobacterium avium

Disseminated non-tuberculous disease

Epidemiology of Histoplasma

Ohio and Central Mississippi Rivers enriched by bats and birds small yeast

Epidemiology of Coccidioides

Western US....San Joaquin Valley, thin walled, non budding spherules with endospores

Epidemiology of Blastomyces

Overlaaping areas with histoplasmosis - broad-based budding, larger than Histo

"Owl eye" -giant cell, within the nucleus an enlarged inclusion with a celar halo

Cytomegalovirus

Cause of infectious mononucleosis type infection

CMV

Most common opportunistic viral pathogen in AIDS

CMV, yet it spares the CNS system

NAme of most opportunistic CMV

CMV retinitis

Diagnosis of CMV

viral inclusions in tissue cultures

What is Pneumocystis pneumoniae

fungus

When AIDS person get Pneumocystis pneumoniae

CD4+ <200cells/uL

Most sensitive test for diagnosing Pneumocystis pneumoniae

Identify organism in induced sputum

Most common disease causing fungus

Candida albicans with pseudohyphae

What players defend against Candida

TH17, CD4+

Mutation on TH17

Job syndrome

Most common fungal endocarditis

Candida

Diagnosis of Crytococcus

Gelatinous capsule in a clear halo with India Ink

Non-septate hyphae, at right angle causing Mucormycosis

Zygomycetes

Septate branched at acute angles causing Mucormycosis

Aspergillus

Wha molds invade blood vessels causing vascular necrosis

Aspergillus and Rhizopus and Mucor

What mold invades diabetic patient

Mucor and Rhizopus

CD4+ >200cell/uL in AIDS patient

Bacterial and TB infections

CD4+<200cells/uL in AIDS patient

Pneumocystis pneumoniae

CD4+<50cells/uL in AIDS patient

CMV and M. avium

Animal reservoirs of cholera

Shellfish and plankton

What causes disease by cholera

preformed enterotoxin interacting with ADP ribosylation factors and activate Gs opening the CFTR which releases Cl ion to the lumen

Source of Campylobacter

improper cooked chicken, unpasturized milk,

Organisms in self limited colitis

Campylobacter, Shigella, Salmonella, Yersenia, E. coli

Low infective doses

Shigella, Salmonella and Campylobacter

Site of Shigella in body

Left colon

Triad of arthritis, urethritis and conjunctivitis( reactive artritis) - what organism

Shigella

HUS organisms

Shigella and EHEC

Sources of Salmonella

Raw meat, poultry, eggs and milk

Rose spots

Salmonella

What organisms go by M cells

Shigella, Salmonella

Pseudomonas membrane

Clostridium difficle

Most common cause of severe childhood diarrhea

Rotavirus

Most common pathogenic parasitic in humans

Giardia

Most common bacterial enteric pathogen in developed countries

Campylobacter