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Immuno mikro eng > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What is pneumonia vs bronchitis vs bronchiolitis?

A

Pneumonia - infection of the lung parenchyma
Bronchitis - inflammation of the medium to large airways
Bronchiolitis - Inflammation of small airways (children <2 years)

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2
Q

What is the most common cause of infection related mortality?

A

pneumonia

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3
Q

Are the airways below the larynx sterile? Why?

A

No, but microbial levels are low because they are cleared by cilia, humoral immunity (IgA), and cellular immunity (phagocytosis)

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4
Q

What are two ways host defenses can be disrupted and acute pneumonia can arise?

A
  1. Presence of especially virulent organisms

2. Large inoculum

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5
Q

What is microaspiration?

A

A common way of acquiring pneumonia, when epithelial surfaces of upper airway are colonized

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6
Q

What are some factors that interfere with normal host defenses?

A
  1. Ciliary disruption - i.e. viral infection or cigarettes
  2. Altered consciousness - i.e. alcohol, or especially when intubated
  3. Iatrogenic manipulation - bronchoscopies
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7
Q

Why do older people often get pneumonia?

A

Diminished ciliary clearance, abnormal elastic recoil of lungs, and diminished T and B cell response

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8
Q

What are the three most common symptoms of pneumonia?

A
  1. Cough
  2. Shortness of breath
  3. Chest pain - pleuritic (pain on inspiration)
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9
Q

What are the four most common clinical signs of pneumonia?

A
  1. Fever
  2. Tachypnea
  3. Tachycardia
  4. Purulent sputum
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10
Q

Why does poor dentition put you at risk for pneumonia?

A

Aspiration of anaerobes from abscesses is a common source of infection

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11
Q

What are two chest signs on physical exam that point to pneumonia?

A
  1. Chest splinting - cannot expand on both sides

2. Evidence of consolidation - i.e. dullness, egophony, bronchophony, crackles

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12
Q

What are two lab signs that point to pneumonia?

A
  1. Elevated white cell count with left shift

2. High inflammatory markers (procalcitonin, C-reactive protein)

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13
Q

What is a left shift of WBC?

A

more band form PMNs found -> indicates rapid production of PMNs and likely infection

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14
Q

What are two common patterns of Chest X-rays for pneumonia?

A
  1. Lobar consolidation

2. Diffuse interstitial

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15
Q

What is the most sensitive test for pneumonia and when do you order it?

A

CT of chest

For very sick / immunocompromised only, due to expensive and radiation exposure

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16
Q

What is the definition of a good sputum sample?

A

<10 epithelial cells and >25 PMNs per low power field

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17
Q

What is the sensitivity / specificity of gram staining for pneumonia? What organisms would not be picked up?

A 
85%
Organisms not picked up: Atypicals 
Bacterial - Mycoplasma, Mycobacteria, Legionella
Viral - Influenza
Fungal - PCP
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18
Q

What stains can be used to visualize TB?

A

Ziehl-Neelsen, or Auramine-rhodamine fluorescent stain

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19
Q

What is the morphology of Moraxella catarrhalis and who does it most commonly affect?

A

Gram negative diplococci

Affects COPD patients and elderly, much like Moraxella catarrhalis

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20
Q

Why can sputum culture be misleading?

A

S. pneumoniae will always be significant, but organisms like E. coli may just be colonizers

21
Q

What are the sputum consistencies / features for mixed anerobic aspiration pneumonia vs pneumococcal pneumonia?

A

Mixed anaerobic - foul smelling

Pneumococcal - rusy colored

22
Q

Why is a blood culture useful for pneumonia?

A

If positive (20%), proves etiology and can be used to test susceptibility of the organism

23
Q

What are two urine antigen tests that are always used and why are they appealing?

A

Very quick turnaround - 1 hour

  1. Pneumococcal urine antigen
  2. Legionella urine antigen (serotype 1)
24
Q

When do you use bronchoscopy with bronchoalveolar lavage? Lung biopsy?

A

Not unless diagnosis is in doubt / patient is not improving, but it is minimally invasive

Lung biopsy - rare, only as last resort because highly invasive

25
Q

When and who is most likely to get CAP?

A

Can happen year round, but mostly in winter, mostly people with age >65

26
Q

What are “typical” pathogens of CAP?

A

S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus

27
Q

What are the risk factors for severe S. pneumoniae disease?

A
  1. Asplenia - failure to clear capsular organisms

2. Abnormal immunoglobulin response (myeloma, lymphoma, HIV) - failure to bind Ab to capsule

28
Q

What are the risk factors for S. aureus CAP?

A

Elderly, or post-influenza in normal adults

29
Q

What is the clinical presentation of atypical pneumonias?

A

Low grade fever, mild respiratory illness, dyspnea, non-productive cough, in yonug adults

30
Q

What is seen on chest Xray for atypical pneumonias? Gram stain?

A

Typically diffuse lung disease, except Legionella may be focal

Gram stain: Nothing appears

31
Q

What are the specific features of Mycoplasma pneumoniae? Is it transmitted person to person?

A

Walking pneumonia, sore throat is initial finding, X-ray looks way worse than it actually is

Yes, transmitted person to person

32
Q

What is one specific finding that happens in about 5% of Mycoplasm pneumoniae?

A

Bullous myringitis -> inflammation of the tympanic membrane

33
Q

What is a common chest X-ray finding for Chlamydia pneumonia?

A

Multi-lobar findings with gradual progression

34
Q

What do viruses typically cause in terms of respiratory infections?

A

Acute bronchitis in children, but can also be seen in adults and set the stage for bacterial superinfection

35
Q

Which virus causes bronchiolitis in children <2 years?

A

RSV

36
Q

What other common viruses seed bacterial infections?

A

Influenza, parainfluenza type 3, adenovirus, CMV in immuncompromised host

37
Q

What is HAP vs VAP?

A

Nosocomial pneumonias
HAP - Hospital-acquired pneumonia (>48 hours post admission)
VAP - Ventilator-associated pneumonia (>48 hours after intubation)

38
Q

What microbes are frequently implicated in nosocomial pneumonias, and do we worry about Candida?

A

Gram negative aerobes (Pseudomonas, Acinetobacter)
MRSA

Candida is often cultured, but does NOT cause disease and should not be treated

39
Q

What are the two most common patient populations which have TB?

A
  1. HIV+

2. Patients receiving TNF inhibitors

40
Q

What are the clinical features of TB?

A

Indolent course

Fever, dry cough, weight loss, nightsweats, hemoptysis

41
Q

Where is TB commonly found?

A

Upper lung lobe, from reactivation, due to high oxygen tension

42
Q

What are three risk factors for Aspergillosis pneumonia?

A
  1. Neutropenia
  2. Prolonged, high dose steroid use
  3. Chronic granulomatous disease
43
Q

What are the clinical features of aspergillosis pneumonia?

A

Fever, pleuritic chest pain, cough with hemoptysis

44
Q

What are the X-ray features of aspergillosis?

A

Nodular lesions with “halo sign” that often progresses to cavities

45
Q

What is seen on biopsy of aspergillosis?

A

Acute angle branching hyphae, It is often a contaminant of sputum culture unless a high risk patient

46
Q

Which of the endemic fungi is most likely to disseminate, and how are they often detected?

A

Blastomycosis disseminates in normal hosts at times, but they can all disseminate in immunocompromised.

Detect via urine antigen

47
Q

What does chest X-ray for PCP pneumonia cause?

A

Diffuse interstitial disease, but may be normal

48
Q

What are the clinical features of PCP pneumonia?

A

Indolent clinical course, mild cough with minimal sputum, and progressive dyspnea and hypoxia

49
Q

What lab is usually elevated in PCP pneumonia?

A

Serum beta-glucan

Immuno mikro eng (56 decks)

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