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Respiratory Medicine Exam II > Pneumonias & Respiratory Infections > Flashcards

Pneumonias & Respiratory Infections Flashcards

1
Q

Organisms responsible for typical bacterial pneumoniae

A 
S.pneumoniae
H.influenzae
M.catarrhalis
S.aureus
K.pneumoniae
P.aeruginosa
C.burnetti
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2
Q

Organisms responsible for atypical bacterial pneumoniae

A 
Mycoplasma pneumoniae
Chlamydia pneumoniae
Chlamydia psittaci
Legionella pneumophilia
Burkholderia cepacia
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3
Q

Viruses that can cause pneumonia

A

Orthomyxoviridae (influenzavirus)

Coronaviridae (SARS, MERS)

Bunyaviridae (hantavirus)

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4
Q

Fungi that can cause pneumonia

A

Aspergillus spp.
Histoplasma capsulatum
Coccidioides immitis
Blastomycoses dermatides

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5
Q

Morphology of S.pneumoniae

A

Gram-positive diplococci (lancet shaped)

Encapsulated

Alpha-hemolytic

Optochin sensitive, bile-soluble

Urinary antigen

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6
Q

Most common cause of community acquired pneumonia (CAP)

A

S.pneumoniae

[S.pneumo is also most common cause of meningitis, otitis media, and sinusitis]

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7
Q

Presentation of CAP caused by S.pneumoniae

A

Fever, chills, cough, dyspnea, weakness

RUST COLORED SPUTUM

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8
Q

Treatment for S.pneumoniae

A

Macrolides

Ceftriaxone

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9
Q

Describe S.pneumoniae vaccine given to kids vs. adults

A

Give kids <2 the protein conjugated vaccine [elicits IgG (T cell) response]

Give adults pure polysaccharide vaccine [elicits IgM (B cell) response]

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10
Q

Morphology of H.influenzae

A

Gram-negative coccobacilli

Encapsulated or no capsule

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11
Q

Media on which H.influenzae can be grown

A

Chocolate agar (H.influenzae requires factors V and X)

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12
Q

What patient populations are at increased risk of H.influenzae infection?

A 
Sickle cell
Asplenic
Smokers
COPD
Immunocompromised
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13
Q

What type of vaccine is the H.influenzae (Hib) vaccine?

A

Polysaccharide vaccine — given to infants

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14
Q

Treatment for H.influenzae prophylaxis vs. infection

A

Rifampin = prophylaxis for kids w/ close contacts

Ceftriaxone

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15
Q

Morphology of M.catarrhalis

A

Gram-negative coccobacillus

Fastidious, aerobic

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16
Q

Patient populations at higher risk of infection with M.catarrhalis

A

Smokers
COPD
Asthmatics
Malignancies

Generally exacerbates predisposing conditions then forms pneumonia

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17
Q

Morphology of S.aureus

A

Gram positive cocci

Catalase positive
Coagulase positive

Beta-hemolytic

Protein A — binds IgG, inhibiting complement acitvation and phagocytosis

Mannitol fermenting; gold/yellow in culture

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18
Q

Presentation of pneumoniae caused by S.aureus

A

Patchy infiltrates on CXR, most commonly following a URI (especially influenza virus!)

SALMON COLORED SPUTUM

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19
Q

Treatment for pneumoniae caused by S.aureus

A

Vancomycin (MRSA)

Nafcillin (non-MRSA)

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20
Q

Morphology of K.pneumoniae

A

Gram-negative bacillus

Immotile; surrounding by polysaccharide capsule

Urease positive

Lactose fermenting

Anaerobic

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21
Q

Agar on which K.pneumoniae can be grown

A

Forms pink mucoid colonies on MacConkey agar

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22
Q

Pt populations at increased risk of K.pneumoniae

A

Alcoholics (aspiration PNA!)
Asplenic
Immunocompromised

[K.pneumoniae is often nosocomial and multi-drug resistant]

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23
Q

Presentation of pneumonia caused by K.pneumoniae

A

Presents with CURRANT JELLY SPUTUM

May see cavitary lesions similar to TB (or bulging fissure)

Can be lobar or necrotizing

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24
Q

Morphology of P.aeruginosa

A

Gram negative bacillus

Motile (swarming)

Catalase positive

Obligate aerobe

Forms biofilms

Produce characteristic blue-green pigment (pyocyanin and pyoverdin); grape-smelling

Thrives in aquatic environments

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25
Q

P.aeruginosa is a common cause of nosocomial infections, and a major cause of lung infection and respiratory failure in _______ and ______ patients

A

Cystic fibrosis

Bronchiectasis

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26
Q

Treatment options for P.aeruginosa infection

A

Piperacillin

Ticarcillin

Fluoroquinolones

Aminoglycosides + Beta-lactams

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27
Q

Morphology of Coxiella burnetti

A

Gram-negative

Obligate intracellular

Endospores

Animal reservoirs — risk in farmers, shepherds, cattle birthers, vets at risk

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28
Q

Describe infection caused by Coxiella burnetti

A

Q fever — abrupt high unremitting fever, myalgias, headache, dry cough, granulomatous hepatitis (no jaundice)

May have mild pneumonia, or rapidly progress to respiratory distress

Leukocytosis and thrombocytopenia

Can also cause endocarditis and/or maculopapular rash

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29
Q

Morphology of mycoplasma pneumoniae

A

No cell wall; cell membrane w/ cholesterol

Obligate intracellular

IgM cold agglutinins

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30
Q

Agar on which mycoplasma pnuemoniae can be grown

A

Eaton’s agar

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31
Q

Presentation of infection with mycoplasma pneumoniae

A

Presents with dry cough; CXR shows reticulonodular or “patchy” infiltrate, often appearing more severe than pt symptoms

Generally self-limiting, usually follows URI

Also may see bullous myringitis

Common in military recruits living in close quarters; commonly in adults <30 y/o

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32
Q

Treatment for infection with M.pneumoniae

A

Macrolides

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33
Q

Morphology of Chlamydia pneumoniae

A

Gram negative

Obligate intracellular; no cell wall

Elementary bodies = extracellular infectious form (vs. reticulate bodies, the intracellular replicating form seen as intracytoplasmic inclusions on microscopy — Giemsa stain)

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34
Q

Preferred method for detection of Chlamydia bacteria

A

Nucleic acid amplification test (NAAT)

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35
Q

Presentation of infection with Chlamydia pneumoniae

A

Often follows URI, similar presentation to mycoplasma, but presents with HOARSENESS

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36
Q

Treatment for infection with chlamydia pneumoniae

A

Macrolides (particularly azithromycin)

Tetracyclines (particularly doxycycline)

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37
Q

Morphology of Legionella pneumophilia

A

Gram negative bacillus

Oxidase positive

Silver stain required for visualization

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38
Q

Agar on which Legionella can be grown

A

Buffered Charcoal Yeast Extract (BCYE) agar with cysteine and iron

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39
Q

Describe infection caused by Legionella including CXR and presenting sx/lab findings

A

Pontiac fever — acute, self-limiting respiratory disease with mild flu-like symptoms

CXR often shows patchy unilobar infiltrates that progress to consolidation

May present with HYPONATREMIA, headache, confusion, diarrhea, high fever (>39)

diagnosed using urine Ag test

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40
Q

Major risk factor for Legionella infection

A

Smoking

41
Q

Treatment for infection with Legionella pneumophilia

A

Macrolides

Fluoroquinolones

42
Q

Morphology of Chlamydia psittaci, and its reservoir

A

Gram-negative

Obligate intracellular, no cell wall

Reservoir = birds — transmitted via bird droppings (can see in pet shop owners, vets, ducks, turkeys)

43
Q

Presentation of Chlamydia psittaci infection

A

Abrupt headache, dry cough, myalgias, dyspnea

Can have EPISTAXIS and SPLENOMEGALY

CXR indistinguishable from many bacterial and viral pneumonias

44
Q

Tx of Chlamydia psittaci

A

Macrolides (particularly azithromycin)

Tetracyclines (particularly doxycycline)

45
Q

Morphology of Burkholderia cepacia

A

Gram-negative bacillus

Catalase positive

Non-lactose fermenter

46
Q

Agar on which Burkholderia cepacia can be grown

A

BC agar (has crystal violet and bile salts - colonies are pearly gray)

47
Q

Pt populations at increased risk of Burkholderia cepacia

A

Cystic fibrosis
Bronchiectasis

Found on hospital equipment and irrigation systems

Very hard to tx, multi-drug resistant

48
Q

Morphology of orthomyxoviridae (influenzavirus)

A

Negative-sense ssRNA virus

Enveloped

49
Q

Orthomyxoviridae includes influenzavirus A, B, and C. It replicates inside the _____ of host cells and has genomes comprised of ____________.

The ________ of influenza A regulates H+ concentration around the virus, producing the proper pH for viral uncoating

A

Nucleus; 8 RNA segments

M2 proton channel

50
Q

Describe HA and NA associated with orthomyxoviridae

A

HA promotes viral entry — binds sialic acid residues on host cells

NA cleaves sialic acid residues —> release of virus from host cells

51
Q

Antigenic drift vs. antigenic shift

A

Antigenic drift is d/t point mutations in the viral genome —> changes in HA and NA glycoproteins —> epidemics

Antigenic shift — when segments of genomes from different strains combine to form novel genome —> pandemics

52
Q

Presentation of orthomyxoviridae infection

A

Fever, chills, myalgias, nasal congestion, coryza, nonproductive cough, fever (>38), LAD, diffuse pneumonitis, hypoxemia, leukopenia

53
Q

After a viral infection with influenzavirus, there is increased susceptibility to a superinfection, particularly with _____ or _____

A

S.aureus

S.pneumoniae

54
Q

Types of flu vaccine

A

Killed injectable

Live intranasal

[associated with small risk of GBS — ascending paralysis]

55
Q

The rapid flu test is suboptimal, and diagnosis by _____ is preferred

A

PCR

56
Q

Treatment options for influenzavirus infection

A

Amantadine/rimantadine inhibit M2 proton channel of influenza A virus, impeding viral uncoating

Oseltamivir/zanamivir can inhibit NA, preventing release from host cells

57
Q

______ in contraindicated in children with a viral infection

A

Aspirin [risk of Reye’s syndrome — encephalopathy, fatty liver, hepatic failure]

58
Q

Morphology of coronaviridae

A

Positive-sense ssRNA virus

Enveloped - helical capsule

59
Q

What is MERS?

A

Middle Eastern Respiratory Syndrome — caused by infection with coronaviridae

Fever, cough, dyspnea, diarrhea, abd pain, SEVERE ARDS presentation

Fecal-oral transmission

Hx of travel to middle east, especially Saudi Arabia

60
Q

What is SARS?

A

Severe Acute Respiratory Syndrome — caused by infection with coronaviridae

Initial flu-like symptoms — cough, dyspnea, severe hypoxia; can progress rapidly to ARDS

Hx of travel to China, Hong Kong, Taiwan

61
Q

Morphology and transmission of Hantavirus (bunyaviridae)

A

Negative-sense RNA virus

Obtain envelope from golgi body membrane of host cells

Genomes comprised of 3 circular RNA segments

Zoonotic — transmitted via feces, urine, and saliva of rodents

62
Q

Presentation of infection with Hantavirus

A

Prodromal phase mimics many flu-like syndromes; rapidly progresses to cardiopulmonary syndrome with respiratory distress

Thrombocytopenia, leukocytosis, elevated LDH, bilateral pulmonary infiltrates

May cause pulmonary edema d/t increased capillary permeability

May cause hypotension leading to prerenal azotemia or ARF

May cause hemorrhagic fever

63
Q

Morphology and transmission of aspergillus spp

A

Catalase positive

Septate hyphae that form 45-degree angle branches

Transmitted via spore inhalation

64
Q

Signs/symptoms of aspergillus colonization in the lung

A

May cause fever, hemoptysis, and cough

Aspergillomas (“fungus balls”) typically develop in old pulmonary cavities (from TB, sarcoid, emphysema, etc.)

65
Q

What is ABPA?

A

Allergic Bronchopulmonary Aspergillosis

Type I HSR

Presents with migratory pulmonary infiltrates, wheezing, and increased serum IgE

Most commonly CF and asthma pts

66
Q

Invasive pulmonary aspergillosis typically occurs in _____ and _____ patients; it can spread hematogenously to kidneys, endocardium, brain, skin, and paranasal sinuses, causing infection and infarction

A

Immunosuppressed; neutropenic

67
Q

Treatment of aspergillus spp infection

A

Voriconazole

Amphotericin B

68
Q

Morphology of Histoplasma capsulatum

A

Microconidia

Dimorphic fungus (yeast in body, mold in natural environment)

Narrow-based budding

69
Q

Transmission of Histoplasma capsulatum; where is it endemic?

A

Bat and bird droppings (caves, chicken coops, etc.) - transmitted via inhalation of mold spores

Endemic to midwestern and east central US, near Ohio and Mississippi River valleys

70
Q

Detection of Histoplasma capsulatum

A

Macrophages phagocytize the yeast form in the lungs — these small oval yeast forms can be seen within macrophages on microscopy

Can also be detected in body fluids such as serum or urine

71
Q

Clinical manifestations of Histoplasma capsulatum infection

A

Presents as mild cough, fatigue, weight loss, upper lung lobe cavitations (coin lesion); clinically resembles secondary TB

Can cause variety of calcific deposits in the lungs (i.e., calcified mediastinal/hilar LNs)

Associated with ERYTHEMA NODOSUM

May also see HSM — seen with disseminated infection (primarily in immunocompromised)

72
Q

Treatment of Histoplasma capsulatum

A

Azoles

Amphotericin B

73
Q

Morphology, transmission, and endemic regions of coccidioides immitis

A

Dimorphic fungus

Transmitted via inhalation of mold spores found in soil

Endemic to southwest US (California, New Mexico, Arizona) and Northern Mexico

74
Q

Coccidioides immitis can be seen in tissue samples as large, yeast-like spherules containing ______

A

Endospores

75
Q

Clinical manifestations of coccidioides immitis infection

A

Causes San Joaquin Valley fever and community acquired PNA

Chest pain, cough, fever, arthralgia

CXR may be unremarkable, or show unilateral infiltrates, ipsilateral hilar LAD, or pulmonary nodule formation

Associated with ERYTHEMA NODOSUM

Disseminated infection in immunocompromised — skin, bones, meningitis

76
Q

Treatment of coccidioides immitis infection

A

Azoles (particularly itraconazole and fluconazole)

Amphotericin B

77
Q

Morphology, transmission, and endemic regions of Blastomycoses dermatides

A

Dimorphic fungus

Broad-based budding

Transmitted via inhalation of mold spores

Endemic to eastern and central US near Ohio and Mississippi River Valleys and Great Lakes region

78
Q

Clinical manifestations of blastomycoses dermatides

A

CXR findings vary, most commonly patchy opacities or densities

Can lead to pulmonary granuloma formation

Disseminated infection in immunocompromised — skin, bone, GU involvement

79
Q

Detection of blastomycoses dermatidis

A

Detected in body fluids such as urine

80
Q

Tx of blastomycoses dermatides

A

Azoles (particularly itraconazole and fluconazole)

Amphotericin B

81
Q

Primary location of infection, CXR/CT pattern, US pattern, and organisms associated most often with Lobar PNA

A

Location: alveoli

CXR/CT: Dense consolidation; air bronchograms

US: Consolidation (often extensive); dynamic air bronchograms

Organisms: S.pneumoniae, K.pneumoniae, Legionella

82
Q

Primary location of infection, CXR/CT pattern, US pattern, and organisms associated most often with bronchopneumonia

A

Location: bronchi

CXR/CT: Patchy opacities

US: patchy B-lines, may have some consolidation

Organisms: WIDE variety of bacteria — mycoplasma, chlamydia, staph, pseudomonas

83
Q

Primary location of infection, CXR/CT pattern, US pattern, and organisms associated most often with interstitial PNA

A

Location: interstitium

CXR/CT: diffuse hazy opacities; septal thickening

US: patchy B-lines; may have some consolidation

Organisms: viruses, PJP, mycoplasma

84
Q

Which pneumonia-causing organism has “fried-egg” appearance on microscopy?

A

Mycoplasma pneumoniae

85
Q

What 2 bacterial species are grown on chocolate agar?

A

Haemophilus influenzae

Neisseria meningitidis

86
Q

Empiric abx regimen for community acquired pneumonia

A
  1. Ambulatory — macrolide (if pt can’t tolerate, go with doxycycline)
  2. Possible drug-resistance — Fluoroquinolone or Macrolide + Beta-lactam
  3. Hospitalized pts — Fluoroquinolone
  4. ICU — fluoroquinolone + antipneumococcal beta-lactam (3rd gen cephalosporin or ampicillin sulbactam); add piperacillin-tazobactam, cefepime, or a “penem” for pseudomonal coverage
87
Q

What lab can be ordered to aid in differentiating between viral and bacterial PNA?

A

Procalcitonin

[calcitonin precursor that becomes elevated in proinflammatory stimuli, especially those bacterial in origin]

88
Q

What criteria are used to determine whether pt with PNA needs to be admitted?

A 
CURB-65 Severity Score:
Confusion = 1 pt
BUN >20 = 1 pt
RR >30 = 1 pt
BP <90syst or <60diast = 1 pt
Age >65 = 1 pt

0-1 pts = low risk; outpatient tx

2 pts = short inpatient hospitalization or closely supervised outpatient tx

3-5 = severe; hospitalization required. Consider ICU admission

89
Q

What are the lactose fermenting bacteria?

A

Fast fermenters: Klebsiella, E.coli, Enterobacter

Slow fermenters: Citrobacter, Serratia

90
Q

Non-enveloped, icosahedral dsDNA virus that causes the common cold, viral keratoconjunctivitis, pharyngitis; dx by viral culture, direct assay, or enzyme immunoassay

A

Adenovirus

91
Q

What bacteria can be detected by urinary antigens?

A

S.pneumoniae

Legionella

92
Q

Bacteria to consider in neutropenic and CF pts

A

Pseudomonas

93
Q

Bacteria to consider in asplenic pts

A

Klebsiella
S.pneumoniae
H.influenzae
Neisseria spp

[susceptible to encapsulated organisms]

94
Q

Bacteria to consider in smokers, COPD

A

Moraxella catarrhalis

Haemophilus influenzae

95
Q

Bacteria to consider in alcoholics

A

Klebsiella

96
Q

Bacteria to consider in bird handlers

A

C.psittaci

97
Q

Criteria for hospital acquired PNA (HAP)

A

Infection acquired during hospital stay (>48 hrs)

98
Q

Criteria for healthcare associated PNA (HCAP)

A

Hospitalized for at least 2 days within the last 90 days

OR

In the last 30 days: nursing home, infusions, dialysis pts, wound care

OR

Family member with multidrug resistant organism

99
Q

Criteria for ventilator associated PNA (VAP)

A

ET intubation with 2 of the following: Fever, Leukocytosis, Purulent sputum

New or progressive opacity on CXR

Respiratory Medicine Exam II (11 decks)

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