Pulmonary Flashcards
morbidity vs mortality
illness vs. death
CAP
community acquired pneumonia–significant morbidity and mortality
For Cap–predisposing factors:
Drug use:
Lifestyle:
- H2 blockers, antipsychotic, ACE inhibitor, glucocorticoid
- male, older, tobacco, alcohol, acidosis, malnutrition, COPD
Typical vs atypical pneumonia
TYPICAL: pneumonia caused by certain bac and typically causes CHILLS, COUGH, FEVER, and SOB short of breath
ATYPICAL: pneumonia caused by certain bacteria. Called “atypical” because the symptoms differ from those of pneumonia due to other common bacteria
Typical CAP bugs:
S. pneumoniae, H. influenzae, S. aureus, group A streptococci, Moraxella catarrhalis, anaerobes, and aerobic gram-negative bacteria
Atypical CAP bugs:
Legionella spp, M. pneumoniae, Chlamydophila pneumoniae, and C. psittaci
If pt is elderly w/ underlying pulmonary disease (COPD, cystic Fibrosis) pathogen is likely
Hemophilus influenza
Hemophilus influenza characteristics
- pleomorphic
- Gram- rods
- oxidase positive
- facultatively anaerobic
- nonmotile
Hemophilus influenza treatments
- Beta-lactam agents (amoxicillin)
- Azithromycin
Pt is <40 yo spends much time in close quarters –pathogen is likely
Mycoplasma pneumonia–respiratory droplets
Mycoplasma pneumonia characteristics
- smallest organism that can survive alone in nature
- aerobic/anaerobic
- “gliding motility”
- produce biofilms
- surface parasite–> may move inside cell and reproduce
S&S of Mycoplasma pneumonia
- Gradual Onset-
- headache
- malaise
- low grade fever
- non-productive cough
Mycoplasma pneumonia treatment
- MACROLIDS
- (azithromycin, doxycycline)
- respiratory fluoroquinolone
Pt is middle-aged or ^–been travely recently (w/ in 2 weeks), or exposed to air conditioning or mist0environments. Likely pathogen is…
Legionella spp.
Legionella spp. characteristics + S&S
- Gram - bacilli
- grows on special media
- 2-10 days before onset of symptoms
- S&S: usual symptoms, ^ fever, and GI symptoms
Legionella spp treatments and dx
- Macrolides (esp. azithromycin) or
- Respiratory Fluoroquinolones (esp. levofloxazin)
- dx w/ sputum or urinary antigen test
Pt is MILDLY ILL, not necessarly in winter, and lives in CLOSE ENVIRONMENT (care facilities, barracks) mostly likely…
Chlamydis (Chlamydophila) pneumoniae PTP
Most common infections associated w/ Chlamydia pneumoniae
Pneumonia and Bronchitis
Chlamydia pneumoniae characteristics
- Obligate intracellular bacteria
- 2nd smallest prokaryote
- No peptidoglycan in cell wall
- replication intracellularly after ingestion by phagosome
- short lived immunity
- very unusual reproductive pattern (slide 26)
Chlamydia pneumoniae S&S
- usual
- pharyngitis
- hoarseness
- airway hyperreactivity
- wheezing
Chlamydia pneumoniae treatment
-azithromycin
- If pt is not “special group” not severly sick, and possibly becoming sick in winter or early spring. Pathogen is likely…
Streptococcus pneumoniae–most common pathogen for CAP worldwide
Streptococcus pneumoniae characteristics
- gram-positive
- alpha hemolytic bac
- catalase - unlike other pyogenic orgs
- capsular polysaccaride provokes immune response and is anti-phagocytic
- adheres to epithelial cells of nasopharynx
- “forms bridges” btwn body sites
Streptococcus pneumoniae secretes ______ _______, which…
potent cytotoxin (pneumolysin)–binds to cholesterol forming pores in membranes and kills any cell.
Gram-neg bacillie – uncommon in pneumonia but…
- Klebsiella pneumoniae
- E coli
- Enterobacter spp
- Serratia spp
- Proteus spp
- Pseudomonas aeruginosa
- Acinetobacter spp
hospital acquried
nosocomial
Klebsiella pneumoniae characteristics
- Nosocomial, but CAP in alcoholics, diabetics, or COPD
- New pulmonary infiltrate w/ fever, cough, ^ sputum, WBC crackles
- short, plum bacilli
- Gram neg
Klebsiella pneumoniae dx
- X-ray–lobar pneumonia like S. pneumoniae
- “currant jelly” sputum (lung necrosis)
Klebsiella pneumoniae treatment
based on culture and sensitivity testing by lab
VIRAL:
Virus likely to cause pneumonia secondary to bacterial URI or pulmonary infection
influenza
Acute viral pneumonia–all ages. Winter. hand-hand transfer. “Apnea in infants”
Respiratory syncytial virus RSV
Mild viral URI–S&S fever, rhinorrhea, cough, sore throat
parainfluenza
viral pneumonia increased peribronchial markings, patchy alveolar
adenovirus
SARS
severe acute respiratory syndrome
Fungal pneumonia
unusual but some
- Cryptococcus
- hystoplasma
- coccidoides
avian influenza aka
Hantavirus
Varicella
higher risk of pneumonia complications
- persons w/ chronic pulmonary, cardio, renal, hepatic disorder
- children 65 yo
N/V/D
nausea, vomiting, diarrhea
pneumonia physical exam (5)
- 80% febrile (pos. not older pts)
- possible tachypnea and tachycardia
- crackles (rales)
- bronchial breath sounds
- dullness to percussion if consolidation is present
on X-ray – looks like hole in lung
cavitation
If CAP pt is hospitalized order
- blood culture
- sputum gram stain
- sputum culture
Imp for CAP treatment
What drug do I suspect–and backup plan.
Factors to not use Macrolide for CAP
- recent antibiotic use
- comorbitities
COPD
Liver disease
Cancer
Macrolides _______ _____ ______ in Strep pneumoniae
block protein assemply
Acute bronchitis S&S
- peristent cough – lasting 10-20 days
- possible mucus
- wheezing
- low fever
- chest tightness
- pain
Bronchitis Xray
usually non-specific–important to distinguish from pneumonia
Acute bronchitis PE
- dullness ot percussion
- decreased breath sounds
- rales
4 bronchophony
for test in regards to bronchitis and pneumonia
know difference–anyone can get bronchitis (higher likelihood in COPD pts)
Bronchitis treatment
- symptomatic care
- treat cough– anti tussive
- humidifier
- steroids to reduce inflammation
Bronchitis etiology
Chlamydiophila pneumoniae–Obligate intracellular parasite
UR symptoms followed by LRI w/ inflammation resulting in wheezing or crackles in children <2 yo–often after viral infection
Bronchiolitis
Bronchiolitis S&S
- increased respiratory effort-
1. nasal flaring
2. tachypnea
3. hypoxemia
4. accessory muscle use
5. grunting
whooping cough aka and characteristics
Bordatella pertussis-
- <2 yo
- PTP
- temp immunity
Whooping cough stages (3)
- Catarrhal stage (2 weeks)
- Paroxysmal stage–burst of rapid cough followed by deep high pitched inspiration (WHOOP)
- Convalescent stage (4 weeks)
Pertussis treatement
- Macrolide
2. Trimethoprim-sulfamethoxazole
TB Xray
PA and Later Chest
TB treatment
- 6-9 month med regimen (low compliance)
FUNGAL lung infection from bat and bird droppings
Histoplasmosis–aerosolization from disturbed soil
Histoplasmosis treatment
- Itraconazole
2. IV Amphotericin when illness severe (deadly treatment)
Influenza-like symptom fungal infection
Coccidiodomycosis
