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Medical Microbiology > Pneumonia & other lower respiratory tract infections > Flashcards

Pneumonia & other lower respiratory tract infections Flashcards

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Biology 101 flashcards USMLE® Step 1 flashcards
1
Q

What scoring system is used for people with pneumonia to determine severity?

A

CURB-65 = Confusion, Urea, Respiratory rate, Blood pressure
Urea > 7mmol/l
Respiratory rate>30
BP systolic<90mmHg or diastolic<60mmHg
Age>65
Each feature scores 1 if present

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2
Q

What are general tests to order for pneumonia cases?

A

FBC
CRP
Blood cultures
Sputum MCS
CXR
HIV
Urine

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3
Q

What is consolidation in an xray?

A

Fluid in the lung e.g. pus, blood, water instead of air

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4
Q

What are signs and symptoms of pneumonia?

A

Malaise/confusion
Fever/chills
Rigor
Tachycardia
Tachypnoea/dyspnoea
Cough (productive)
Vomiting
Diarrhoea

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5
Q

What are risk factors of pneumonia?

A

Older than 65
Smoker
Malnourished
Underlying lung disease
Immunocompromised
Certain medications
Recent resp infection

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6
Q

What are some pulmonary defences?

A

Cough reflex
Mucus secretion
Alveolar macrophages
IgA antibody
Microflora
Nose hairs

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7
Q

What are some causative bacterial organisms?

A

Strep. pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Legionella spp
Mycoplasma pneumoniae
Mycobacterium tuberculosis

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8
Q

What are some causative viral organisms?

A

Influenza
Parainfluenza
Respiratory syncytial virus
Human metapneumovirus
Rhinovirus
Coronaviruses

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9
Q

What are some causative fungi organisms?

A

Pneumocystis jirovecii
Asperillus sp
Histoplasma sp
Cryptococcus sp

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10
Q

How can pneumonia be classified?

A

Community acquired
Hospital acquired
Ventilator associated
Aspiration

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11
Q

Describe community acquired pneumonia

A

No hospitalisation within month prior to presentation
Strep pneumoniae, viruses, H.influenzae, Mycoplasma

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12
Q

Describe hospital acquired pneumoniae

A

Acquired after at least 2 days of hospitalisation
E.coli, Klebsiella, Enterobacter, viruses

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13
Q

Describe ventilatory associated pneumonia?

A

Occurring more than 48h after intubation
Staph aureus, pseudomonas, stenotrophomonas, acinetobacter

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14
Q

Describe aspiration pneumonia

A

Occurring as a result of inhalation of stomach contents
Chemical pneumonitis, oral anaerobes, alpha-haem strep

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15
Q

What antibiotics should be given to someone with pneumonia with a CURB score of 0-1?

A

Doxycycline
Erythromycin
Amoxicillin 3-5 days

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16
Q

What antibiotics should be given to someone with pneumonia with a CURB score of 2-5?

A

IV benzylpenicillin and doxycycline/erythromycin
Oral amoxicillin +/- doxycycline/erythromycin OR levofloxacin

17
Q

What is legionellosis?

A

Outbreaks associated with water systems, cooling towers, water features, showers
Caused by Legionella sp

18
Q

Describe Legionella sp

A

Environmental
Survive in protozoa
Aerobic gram negative flagellated bacteria
Fastidious (difficult to culture)
Can be detected by urine antigen test

19
Q

What are the 2 species of Legionella sp?

A

L.pneumophilia (water)
L.longbeachae (soil, compost)

20
Q

What is the pathophysiology of Legionella?

A

Inhalation of micro-aerosis
Survives and replicates in macrophages - toxin, enzyme production
Pontiac fever 4-6h

21
Q

What are antibiotics used to treat legionellosis?

A

1st line = levofloxacin 750mg IV/oral
2nd line = doxycycline 200mg oral, 7-10 days

22
Q

Why are organisms that cause VAP different to CAP?

A

Microaspiration of oropharyngeal/GI colonisers
Contaminated ventilation devices
Immune suppression
Inhalation of infectious aerosols
Hospital acquired MDR organisms

23
Q

What antibiotics are given to treat HAP?

A

co-amoxiclav IV/ oral 5-7 dayd OR levofloxacin

24
Q

What antibiotics are given to treat VAP?

A

piperacillin-tazobactam IV and amikacin (or meropenem) + vancomycin and rifampicin if MRSA

25
Q

What are risk factors of aspiration pneumonia?

A

Reduced consciousness
Neurological deficit (dysphagia)
UGIT disorder (GORD)
Mechanical disruption (scope/intubation)
Vomiting
Poor dental hygiene

26
Q

Describe aspiration pneumonia

A

Chemical pneumonitis - acidic stomach contents
Oedema
Peribroncheal haemorrhage
Damage to bronchial epithelial cells

27
Q

What can occur, but very rarely, as a result of aspiration pneumonia?

A

Bacterial super-infection (13-26%) by S.aureus, pseudomonsa, aerobic falcultative gram-negative bacilli
Anaerobes - peptostreprococcus, fusobacterium, prevotella, bacteroides

28
Q

What are fungi that cause pneumonia in immunosuppressed individuals?

A

Pneumocystis jirovecii
Aspergillus sp.
Cryptococcus
Histoplasma

29
Q

Mycobacteria that cause pneumonia in immunosuppressed?

A

M. Tb
NTM - non-tuberculosis mycobacteria

30
Q

Viruses that cause pneumonia in immunosuppressed?

A

CMV
VZV
SARS-CoV2

31
Q

How can the causative organism be identified?

A

Nose/throat swab - PCR, lateral flow
Sputum/BAL - microscopy, culture, PCR
Blood - culture, PCR, biomarkers, serology
Urine - antigen agglutination tests

32
Q

What agar is used for strep pneumoniae?

A

Horse blood agar
Draft shape colonies

33
Q

What agar is used for H. influenzae?

A

Chocolate agar

34
Q

What agar is used for aspergillus?

A

Sabaroud dextrose agar

35
Q

What agar is used for pseudomonas?

A

CLED - cysteine lactose electrolyte deficient

36
Q

What are the gram positive bacteria causing pneumonia?

A

Staph aureus
Strep pneumoniae

37
Q

What are the gram negative bacteria that cause pneumonia?

A

E.coli
Klebsiella
Pseudomonas
Haemophilus
Moraxella

38
Q

What bacteria are urine antigen tests used for?

A

Strep pneumoniae
Legionella pneumophila

Medical Microbiology (23 decks)

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