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Pathoma - Respiratory Tract Pathology > Pulmonary Infections > Flashcards

Pulmonary Infections Flashcards

1
Q

What is pneumonia?

A

Infection of the lung parenchyma

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2
Q

When does pneumonia occur?

A

When normal defense are impaired.

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3
Q

What are examples of normal defenses being impaired in pneumonia?

A
  • Impaired cough reflex (can’t remove organisms, chemicals)
  • Damage to mucociliary escalator (beats upward and allows up to clear out things trapped in the mucous)
  • Mucus plugging (blocks airway and increases infection risk)
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4
Q

How can viral pneumonia impair normal defenses in the lung?

A

Viral pneumonia damages respiratory epithelial cells. This inactivates the elevator and increases the risk of bacterial infection in addition to the viral pneumonia.

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5
Q

What are the clinical features of pneumonia?

A
  • Fever and chills
  • Productive cough with sputum
  • Tachypnea
  • Pleuritic chest pain
  • Decreased breath sounds
  • Dullness to percussion
  • Elevated WBC count
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6
Q

What type of sputum might you see in pneumonia?

A
  • yellow-green (pus)

- rusty (bloody) sputum

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7
Q

How is a pneumonia diagnosis made?

A
  • CXR
  • Sputum gram stain
  • Sputum culture
  • Blood culture
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8
Q

What causes pleuritic chest pain?

A

From stretching pleural.
-Bradykinin & PGE2 sensitizes nerves in the area
(these are two key mediators of pain)

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9
Q

What are the three classic pneumonia presentations seen on chest x-ray?

A
  1. Lobar pneumonia
  2. Bronchopneumonia
  3. Interstitial (atypical) pneumonia
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10
Q

What is the interstitium of the lungs?

A

Connective tissue of the alveolar air sac.

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11
Q

What causes fever and chills in pneumonia?

A

Bacteria spilling into the blood

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12
Q

What type of pneumonia is usually bacterial?

A
  • Lobar pneumonia

- Bronchopneumonia

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13
Q

What type of pneumonia is usually viral?

A

-Interstitial (atypical) pneumonia

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14
Q

What is Lobar pneumonia?

A

Characterized by consolidation of an entire lobe of the lung

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15
Q

What are the top causes of Lobar Pneumonia? What is the percentage associated with those causes?

A

Usually bacterial

  1. Most common cause (95%) Streptococcus pneumoniae
  2. Klebsiella pneumoniae
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16
Q

What are the four classic gross phases of Lobar Pneumonia?

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution
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17
Q

What causes congestion?

A

Due to congested vessels and edema.

dilated vessels leads to an increased amount of blood

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18
Q

What causes red hepatization?

A

Due to exudate, neutrophils and hemorrhage filling the alveolar air spaces, giving the normally spongy lung a solid consistency

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19
Q

What causes gray hepatization?

A

Due to degradation of red cells within exudate.

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20
Q

What causes resolution?

A

Healing of the lung is done through regenerating tissue normally present at that site.

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21
Q

What is hepatization?

A

“Liver like change”

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22
Q

What is a Type II pneumocyte?

A

Stem cell of the lung that helps regenerate the lining of the air sacs.

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23
Q

What age group is lobar pneumonia common in?

A

Middle aged adults and elderly

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24
Q

What is secondary pneumonia?

A

Bacterial pneumonia superimposed on a viral upper respiratory tract infection.

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25
Q

What is the most common cause of community-acquired lobar pneumonia and secondary lobar pneumonia?

A

Streptococcus pneumoniae (95%)

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26
Q

What causes Klebsiella pneumoniae lobar pneumonia?

A

Enteric flora that has been aspirated

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27
Q

What populations does Klebsiella pneumoniae lobar pneumonia affect?

A

Malnourished and debilitated individuals, especially in nursing homes, alcoholics and diabetics

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28
Q

What type of sputum is characteristic of Klebsiella pneumoniae?

A

Red currant jelly

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29
Q

What causes the currant jelly sputum seen in Klebsiella pneumoniae lobar pneumonia?

A

Thick mucoid capsule results in gelatinous sputum.

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30
Q

What is Klebsiella pneumoniae lobar pneumonia often complicated by?

A

Abscess

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31
Q

What characterizes Bronchopneumonia?

A

Scattered patchy consolidation centered around bronchioles; often multifocal and bilateral

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32
Q

What types of organisms cause Bronchopneumonia?

A

USUALLY BACTERIAL

Variety of bacterial organisms

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33
Q

What is the most common cause of Secondary Bronhopneumonia?

A

Staphyloccus aureus

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34
Q

What is Staph. aureus Bronchopneumonia often complicated by?

A

Abscess or Empyema

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35
Q

What is another common cause of secondary bronchopneumonia and also pneumonia superimposed on COPD? What does this lead to?

A

Haemophilus influenzae.

When this bug is superimposed on COPD, it leads to an exacerbation of COPD.

36
Q

What population does Pseudomonas aeruginosa commonly cause Bronchopneumonia in?

A

Cystic fibrosis patients

37
Q

What two types of Bronchopneumonia can Moraxella catarrhalis cause?

A
  1. CAP (community-acquired pneumonia)

2. Pneumonia superimposed on COPD

38
Q

What three types of Bronchopneumonia can Legionella pneumophila cause?

A
  1. CAP (community-aquired pneumonia)
  2. Pneumonia superimposed on COPD
  3. Pneumonia in immunocompromised states
39
Q

How is Legionella pneumophila transmitted?

A

Transmitted from water source

40
Q

What type of organism is Legionella pneumophila and how can it be visualized?

A
  • Intracellular organism!

- Silver stain

41
Q

What is Interstitial Pneumonia? What is it also referred to as?

A

Atypical pneumonia

-Characterized by diffuse interstitial infiltrates

42
Q

What do you see in CXR of Interstitial (Atypical) Pneumonia?

A

Increased lung markings

43
Q

What types of organisms are the most common cause of Interstitial (Atypical) Pneumonia?

A

VIRUSES!!

44
Q

What does Interstitial (Atypical) Pneumonia typically present with?

A

Relatively mild upper respiratory symptoms (minimal sputum, cough and low fever); atypical presentation

45
Q

What types of organisms can cause Interstitial (Atypical) Pneumonia?

A

Viruses or Bacteria

46
Q

What do you see microscopically in Interstitial (Atypical) Pneumonia?

A
  • Predominantly empty air sacs

- Many inflammatory cells in the wall of the interstitium

47
Q

What is the most common cause of Interstitial (Atypical) Pneumonia?

A

Mycoplasma pneumoniae

48
Q

What groups does Mycoplasma pneumoniae usually effect?

A

Young adults (classically military recruits and college students living in the dormitory)

49
Q

What are complications of Mycoplasma pneumoniae?

A
  • Autoimmune hemolytic anemia

- Erythema multiforme

50
Q

What causes cold hemolytic anemia in Mycoplasma pneumoniae Interstitial pneumonia?

A

IgM against I antigen on RBCs

51
Q

Why isn’t Mycoplasma pneumoniae visible on gram stain?

A

Due to lack of cell wall.

52
Q

What is the second most common cause of Atypical Pneumonia in young adults?

A

Chlamydia pneumoniae

53
Q

What is the most common cause of atypical pneumonia in infants?

A

Respiratory syncytial virus (RSV)

54
Q

What is the most common cause of atypical pneumonia with post transplant immunosuppressive therapy?

A

Cytomegalovirus (CMV)

55
Q

What is the cause of Atypical pneumonia in elderly, immunocompromised, and those with preexisting lung disease?

A

Influenza virus

56
Q

What atypical pneumonia cause leads to increased risk for superimposed S. aureus or H. influenzae bacterial pneumonia?

A

Influenza virus

57
Q

What atypical pneumonia cause is seen in farmers and veterinarians?

A

Coxiella burnetii

58
Q

What symptom is associated with Coxiella burnetii Atypical Pneumonia?

A

High fever (Q fever)

59
Q

How does Coxiella burnetii spread?

A

Coxiella spores are deposited on cattle by ticks or are present in cattle placentas

60
Q

What type of organism is Coxiella burnetii?

A

Rickettsial organism

61
Q

Why is Coxiella burnetii distinct from most other rickettsial organisms (three reasons)?

A

(1) It causes pneumonia
(2) It does not require arthropod vector for transmission (survives as highly heat-resistant endospores)
(3) It does not produce a skin rash

62
Q

What patients is Aspiration Pneumonia seen in?

A

Patients at risk for aspiration (e.g., alcoholics, comatose patients)

63
Q

What is Aspiration Pneumonia often due to?

A

Anaerobic bacteria in the oropharynx (e.g., Bacteroides, Fusobacterium and Peptococcus)

64
Q

What does Aspriation Pneumonia classically result in?

A

Right lower lobe abscess

65
Q

Why does Aspiration Pneumonia often result in right lower lobe abscess?

A

Anatomically, the right main stem bronchus branches at a less acute angle than the left (this makes it easier for aspirate to go down the right rather than left bronchi!)

66
Q

What causes Tuberculosis (TB)?

A

Due to inhalation of aerosolized Mycobacterium tuberculosis.

67
Q

What is Primary TB?

A

It arises with initial TB exposure

68
Q

What does Primary TB result in?

A

-Focal, caseating necrosis in the lower lobe of the lung and hilar lymph nodes

69
Q

What happens to the focal, caseating necrosis in primary TB?

A

It undergoes fibrosis and calcification, forming a Ghon complex.

70
Q

What is a Ghon complex?

A

Fibrosed, calcified nodule in the subpleural lung and lymph nodes

71
Q

What symptoms are associated with Primary TB?

A

Generally asymptomatic

72
Q

What test result does Primary TB lead to?

A

A positive PPD.

73
Q

What is Secondary TB?

A

It arises with reactivation of Mycobacterium tuberculosis (reactivated Ghon complex)

74
Q

What commonly causes reactivation of TB?

A
  • Commonly due to AIDS

- May also be seen with aging

75
Q

Where does secondary TB most often occur?

A

At the apex of the lung

76
Q

Why does secondary TB often occur at the apex of the lung?

A

There is relatively poor lymphatic drainage and high oxygen tension.

77
Q

What is formed during secondary TB?

A

Cavitary foci of caseous necrosis

78
Q

What does the caseous necrosis lead to in secondary TB?

A

It may lead to:
(1) Miliary pulmonary TB
OR
(2) Tuberculous bronchopneumonia

79
Q

What is miliary pulmonary TB?

A

Tiny regions of TB scattered across the lung!

80
Q

What are the clinical features of Secondary TB?

A
  • Fevers
  • Night sweats
  • Cough with hemoptysis
  • Weight loss
81
Q

What does biopsy of Secondary TB reveal?

A

Caseating granulomas

82
Q

What does AFB stain of Secondary TB reveal?

A

Acid-fast bacilli

83
Q

What should you know about systemic spread of secondary TB?

A

Systemic spread often occurs and can involve any tissue!

84
Q

What are common sites of secondary TB spread?

A
  1. Meninges (meningitis)
  2. Cervical lymph nodes
  3. Kidneys (sterile pyuria)
  4. Lumbar vertebrae (Pott disease)
85
Q

What do you see in sterile pyuria?

A

WBC in the urine but no bacteria!

86
Q

What is meningitis cause by secondary TB?

A

It is meningitis with granulomas at the base of the brain!

Pathoma - Respiratory Tract Pathology (9 decks)

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