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Pulmonary Block > Pneumonia Fungal and Viral Pathogens > Flashcards

Pneumonia Fungal and Viral Pathogens Flashcards

1
Q

Dimorphic fungi facts

A

most common cause of fungal pulmonary infections; grow as yeast in human tissues and as mold in lab; infection from inhalation of spores which in the lungs differentiate into yeasts or spherules; usually asymptomatic but all can cause pneumonia

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2
Q

Dimorphic fungal pathogens

A

Blastomyces dermatitidis, Histoplasma capsulatum, Coccidioides immitis, Paracoccidioides brasiliensis

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3
Q

Typical clinical manifestations of Histoplasmosis

A

varies from asymptotic to respiratory infection characterized by fever, chills, cough, chest pain. CXR findings vary from infiltrates, mediastinal LAD to cavitary lesions. If with AIDS, severe disseminated disease can develop with pancytopenia and mouth/GI mortality

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4
Q

Clinical manifestations of Paracoccidioidomycosis

A

mild respiratory infection which can progress with dissemination and development of oral, nasal, and facial nodular ulcerated lesions and submandibular lymphadenopathy

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5
Q

Clinical manifestations of Coccidioidomycosis

A

mild influenza like illness with fever and cough (“valley fever”) (erythema nodosum can develop), with dissemination occurring in 1%, most commonly bone, meninges, skin

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6
Q

Clinical manifestations of Blastomycosis

A

asymptomatic respiratory illness, however up to 50% of patients will have cough, chest pain, sputum production, fever which most often resolves spontaneously. CXR can show lobular consolidation, multi lobar infiltrates, multiple nodules, etc. Disseminated disease can result in ulcerated granulomatous lesion of the skin, bone, GU tract, and CNS

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7
Q

Diagnosis of Histoplasmosis

A

tissue biopsy: oval yeast cells within macrophages seen; serology (complement fixation or immunodiffusion) or urinary antigen

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8
Q

Treatment of Histoplasmosis

A

Ambisome for severe disease; Itraconazole otherwise

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9
Q

Diagnosis of Coccidioidomycosis

A

Spherules seen microscopically; serology for IgM or IgG; peripheral eosinophilia is common; skin test reactivity to diagnose exposure

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10
Q

Treament of Coccidioidomycosis

A

Ambisome for persistent lung lesions or disseminated disease; for meningitis give fluconazole

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11
Q

Diagnosis of Paracoccidioidomycosis

A

Tissue biopsy shows yeast cells with multiple buds; serology for IgM and IgG

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12
Q

Treatment of Paracoccidioidomycosis

A

Several months of Itraconazole. Ambisome can be used for severe disease

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13
Q

Diagnosis of Blastomycosis

A

tissue biopsy shoes thick walled yeast cells with single broad based bud; can use serology

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14
Q

Treament of Blastomycosis

A

Itraconazole is drug of choice, but Ambisome for severe disease

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15
Q

Pneumocystis jiroveci

A

usually asymptomatic infection; important cause of pneumonia in immunosuppressed; one of leading causes of death in pts w AIDS; cysts in alveoli produce inflammatory response, resulting in frothy exudate that blocks oxygen exchange; does not invade lung tissue

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16
Q

Clearance of Pneumocystis

A

CD4+ T cells recruit monocytes and macrophages which are responsible for clearance of the organism

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17
Q

How is Pneumocystis pneumonia diagnosed?

A

finding cysts by microscopic exam of lung tissues or fluids obtained by bronchoscopy, bronchial lavage, or lung biopsy; visualization of cysts by methenamine silver, Giemsa stain, or other stains; fluorescent antibody staining; PCR on respiratory tract specimens

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18
Q

Treatment for PCP (Pneumocystis Carinii Pneumonia)

A

Trimethoprim-sulfamethoxazole. Other secondary: clindamycin/Primaquine, Atovaquone, Pentamidine

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19
Q

Prophylactic PCP treatment for AIDS patients

A

Bactrim, Dapsone, Atovaquone

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20
Q

Common features of Aspergillus infection

A

Fungus ball formation in cavities of the lung, which can produce hemoptysis; allergic infection of the bronchi that produces asthmatic symptoms and high IgE titer; causes expectoration of brownish plugs containing hyphae; invasive pneumonia producing hemorrhage, infarction and necrosis, especially in those with heme malignancies and neutropenia

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21
Q

Mucormycosis risk factors

A

opportunistic infection caused by bread mold; risk factors - DM, neutropenia, iron overload, burns/surgical wounds, corticosteroid use

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22
Q

Mucormycosis Transmission and infection

A

Transmitted by airborne spores, invade tissues (also angioinvasive) of patients with reduced host defense; causes invasive rhino cerebral sinusitis, pneumonia, and cutaneous infections

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23
Q

Aspergillus on biopsy and culture

A

characterized by septate, acute-angle branching hyphae

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24
Q

Mucor on biopsy and culture

A

Characterized by nonseptate broad hyphae with frequent right angle branching

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25
Q

Aspergillus treatment

A

Voriconazole. Ambisome or echinocandins if patient does tolerate Voriconazole. Remove the fungal balls; for ABPA use steroids and antifungals

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26
Q

Mucor treatment

A

treat underlying disorder plus Ambisome and surgical removal of necrotic infected tissue (Posaconazole can be used)

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27
Q

Cryptococcus neoformans facts

A

Yeast present in solid and pigeon shit; oval budding yeast with wide polysaccharide capsule that forms narrow-based bud; causes meningitis in immunosuppressed and pneumonia in everyone (immunocompetent will be asymptomatic)

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28
Q

Cytomegalovirus

A

DNA enveloped virus; usually asymptomatic infection; enters latent state primarily in monocytes and can be reactivated when cell-mediated immunity is decreased.

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29
Q

Nocardiosis

A

Aerobic, found in soil, thin branching filaments, gram+, many isolates are weakly acid fast

30
Q

Nocardiosis infections

A

In immunocompromised produce lug infection and may disseminate especially to brain, causing abscesses; can cause pneumonia, lung abscess with cavity formation, lung nodules, or empyema

31
Q

Nocardiosis Diagnosis

A

Gram stain/acid fast stain; culture

32
Q

Nocardiosis Treatment

A

Trimethoprim-sulfamethoxazole; sometimes needs combination therapy; resistance can occur - check sensitivities.

33
Q

CMV Infections

A

Immunosuppressed get pneumonitis. AIDS patient get colitis and retinitis, not pneumonitis

34
Q

Type of pneumonia caused by pneumonia

A

atypical pneumonial; usually acute, febrile respiratory disease characterized by patchy inflammatory changes in the lung, usually confined to the alveolar septa and pulmonary interstitium

35
Q

Features of RSV

A

pleomorphic, enveloped, negative-sense single-stranded, linear RNA

36
Q

Diagnostic methods for RSV

A

Rapid antigen test or RT-PCR on nasal swab or washings

37
Q

Groups at risk for RSV pneumonia

A

immunocompromised, institutionalized elderly, infants with chronic lung disease, infants born during RSV season and are less than 6mo, infants born before 35wks gestation

38
Q

Usual course of RSV infection

A

usually resolves without complication; the more severe the infection the more complications particularly apnea and respiratory failure

39
Q

Treatment and prevention of RSV

A

inhaled Ribavirin, Palivizumab, supportive care with hydration, albuterol, oxygen

40
Q

Palivizumab

A

monoclonal antibody against F protein which prevents pneumonia caused by RSV in premature infants by neutralizing virus infectivity

41
Q

Ribavirin

A

routine use in children is not recommended because efficacy is not proven; may be beneficial for some adults

42
Q

Adenovirus

A

transmitted via aerosal droplet, fecal-oral, or direct inoculation; pneumonia is typically seen in infants and can be accompanied by lethargy, diarrhea, vomiting; outbreaks in military common; no treatment, diagnosed clinically

43
Q

Adenovirus vaccine

A

live oral enteric-coated using serotypes 4&7 are used by the military; not approved for general public use

44
Q

Influenza

A

most common cause of respiratory tract infections that result in physician visits

45
Q

Populations at risk for complications from influenza

A

young children and elderly, chronic disease, immunosuppressed, pregnant or 2 weeks postpartum, morbidly obese, nursing home residents, native Americans and Alaskan natives

46
Q

Surface proteins of influenza

A

hemagglutinin, which serves to attach the virus to its cellular target, and Neuraminidase, which facilitates the release of newly formed virions

47
Q

Influenza transmission

A

transmitted by airborne respiratory droplets; virus is inhaled, gains access to respiratory cells of URT and LRT

48
Q

Pathology of influenza infection

A

necrosis of superficial layers of the respiratory epithelium; myalgias due to circulating cytokines

49
Q

Reason people are infected yearly by influenza

A

antigenic drift results in the emergence of new viral strands

50
Q

Antigenic drift

A

results from random spontaneous mutations in viral genome as it replicates

51
Q

Antigenic shift

A

results from reassortment of the genome segments encoding the HA and NA genes - generating an antigenic ally new virus with pandemic potential

52
Q

Influenza diagnostic test

A

RT-PCR, direct fluorescent antibody, rapid viral antigen test, and viral culture (not usually used) of nasopharyngeal swab

53
Q

Treatment for influenza

A

supportive care, Oseltamivir or Zanamivir, and antibiotics for secondary bacterial pneumonia

54
Q

Who should get the influenza vaccine

A

everyone 6 months of age or older

55
Q

Complication of influenza

A

Reye’s syndrome

56
Q

Complication of adenovirus

A

bronchievtasis or brochiolitis obliterans

57
Q

Complication or RSV

A

asthma

58
Q

Reye’s syndrome

A

condition characterized by encephalopathy and liver degeneration; rare, life threatening complication in kids post viral infections; aspirin has been implicated in its cause

59
Q

What type of virus causes SARS and what is the reservoir

A

Coronavirus; masked palm civet, horseshoe bat

60
Q

SARS clinical presentation

A

China, flu like symptoms progressing to respiratory distress with tachypnea; fever, crackles bilaterally; CXR showing pneumonia with diffuse edema resulting in hypoxemia

61
Q

MERS

A

Coronavirus of animal origin, transmitted human-to-human

62
Q

MERS clinical presentation

A

severe illness with PNA, ARDS, AKI; fever, chills/rigors, cough, SOB, hemoptysis, sore throat, myalgias, n/v/d, abdominal pain

63
Q

Hantavirus

A

Bunyavirus that is transmitted by aerosol inhalation of infected rodent excreta (deer mouse)

64
Q

Sin Nombre Virus

A

most important Hantavirus in US; multiplies in pulmonary capillary endothelial cells, leading to bilateral pleural effusions with interstitial infiltrates of mononuclear cells; present with flu like symptoms, rapidly progressive SOB, pulmonary edema, thrombocytopenia, hypotension. Mortality >50%; no treatment

65
Q

Human Metapneumovirus (HMPV)

A

major cause of more serious LRTI in children and adults; transmitted via respiratory droplets; recurrent epidemics during winter months

66
Q

HMPV clinical scenario

A

infant with nonproductive cough, nasal congestion, rhinorrhea, fever, irritability; febrile, wheezing; infiltrates on CXR

67
Q

HPIV-1 symtoms

A

young child with barking cough “seal-like,” and inspiratory stridor; fever, rhinorrhea, sore throat, mild respiratory distress, febrile, tachypneic, wheezing

68
Q

Typical clinical presentations of parainfluenza viruses

A

mild upper respiratory tract infection in children and adults; Croup (laryngotracheobronchitis) in infants and young children; bronchiolitis and pneumonia in young children and infants

69
Q

Parainfluenza virus

A

4 distinct versions; Croup is caused by 1-3; hPIV3 causes pneumonia and bronchiolitis; hPIV4 causes mild respiratory illness

70
Q

PIV infection path

A

initially infect mucous membrane of the throat; more extensive infections will involve larynx and upper trachea

71
Q

Prognosis of parainfluenza virus infection

A

good, most children recover after a few days; reinfection is common

Pulmonary Block (8 decks)

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