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Clin Med - Pulmonary > Pulmonary Infections > Flashcards

Pulmonary Infections Flashcards

1
Q

Define pneumonia (PNA)

A

Infection of lung parenchyma by virus, bacteria, mycobacteria, parasite, fungus or mixed infection

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2
Q

What disease

is the most common infectious cause of death in the US and the 8th leading cause of death overall?

A

Pneumonia

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3
Q

How do pathogens get into alveoli?

A

Aspiration of upper airway flora

Inhalation of aerosolized microbes

Seeding from blood

Invasion from nearby infection

Reactivation of latent infection (like TB)

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4
Q

What causes the inflammation in pneumonia?

A

Neutrophils kill the microbes and release cytokines

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5
Q

What factors impair the respiratory defenses?

A

Tobacco disrupts mucociliary and macrophage activity

Aging decreases mucociliary clearance and decreases cell-mediated immunity

Stoke, neurmuscular disease, sedatives impair cough reflex

Lung dz causes anatomic changes

Endotracheal and nasograstric tubes get in the way

Decreased immune response re HIV, etc

Neutropenia re chemotherapy

Dysfunctional macrophages re corticosteroids

Reduced granulocyte chemotaxis re aging, DM, steroids

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6
Q

What are risk factors for pneumonia?

A

Age: very young or 65+

Underlying health problems: COPD, DM, EtOH, CHF, renal, sickle cell dz

Impaired immune system: AIDS, cancer, transplants

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7
Q

How is pneumonia diagnosed?

A

History

PE (breath sounds!)

CXR

Lab studies (blood, sputum)

Bronchoscopy (perhaps)

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8
Q

What do you look for in the history re pneumonia?

A

Rapidity of onset

Degree of fever

Presense of shaking chills

Nature of cough

Severity of dyspnea

Presence of pleuritic chest pain

PMH of risk factors

Exposures

Recent travel

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9
Q

What do you look for in the PE re pneumonia?

A

Toxic or nontoxic appearance

Fever

Tachycardia and Tachypnea

Oxygenation level

Lung expansion/dullness to percussion

Breath sounds: rhonchi, bronchial, reduced, egophony

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10
Q

What does pneumonia look like on a CBC?

A

Leukocytosis

Left shift

Bandemia

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11
Q

What is an adequate sputum sample?

A

> 25 neutrophils/High Power Field

< 10 epithelial cells/HPF

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12
Q

What factors lead you to do a bronchoscopy (BAL)?

A

Immunosuppressed host

Suspected TB w/o sputum

Suspected foreight body or neoplasm

Suspected Pneumocystis

Not responding to antibiotics

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13
Q

What do you call a pneumonia

in people who are not living or working in a hospital,

and not immunocompromised?

A

Community Acquired Pneumonia

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14
Q

What is atypical pneumonia?

A

“Walking pneumonia”

Patient appears less ill than CXR

May require different antibiotics than typical pneumo

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15
Q

What are seven common causes of Community Acquired Pneumonia (CAP) ?

(typical and atypical)

A

In order from most common to least common:

Unidentified

S. pneumoniae

Atypical (Legionella, Mycoplasma, Chlamydophila)

Viruses (Influenza, RSV, corona-, adeno-)

Haemophilus influenza

Gram Neg bacteria (Klebsiella, Pseudomonas, A. baumani)

S. aureus

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16
Q

What are three “typical” pneumonia organisms?

A

S pneumoniae

H. influenza

Moraxella catarrhalis

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17
Q

What are seven atypical PNA organisms?

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Legionella pneumophilia

Chlamydia psittaci (psitticosis)

Francisella tularensis (tularemia)

Coxiella burnetii (Q fever)

Fungal diseases

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18
Q

What are three comorbidities/risk factors

for pneumonia and their

associated pathogens?

A

Alcoholism (Klebsiella, S. pneumo, anaerobes, TB)

COPD (H flu, Pseudomonas, Legionella)

Dementia (anaerobes, enteric Gram neg)

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19
Q

What are common signs, symptoms, test results of

Strepcococcus pneumoniae?

A

Single shaking chill

Productive cough with rust colored sputum

Fever

Pleuritic pain

Consolidation

Lancet shaped G+ diplococci

Positive Urinary S. pneumo Ag test

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20
Q

What are some possible complications

of S. pneumo pneumonia?

A

Sinusitis

Otitis media

Meningitis

Empyema (parapneumonic effusion)

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21
Q

How do you treat S. pneumo pneumonia?

A

Outpatient: macrolide (azithro-,clarithro-, erythro-mycin)

Add Beta lactam if local resistance >25%

Inpatient: resp flouroquinolone (moxi-,gemi-, levo-floxacin)

or Beta lactam plus macrolide

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22
Q

Who should get a S. pneumo vax?

A

Age 65+

Current smokers

Chronic disease/immunocomp (cardic, pulmonary, renal, DM, asplenia, HIV)

Contagion risk: Military recruits, prisoners, nursing home residents

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23
Q

What are the signs, Sx and test results for

Haemophilus influenzae pneumonia?

A

High fever, chills, cough w purulent sputum, abd pain, diarrhea

Pleural effusion

Hyponatremia and increased LDH

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24
Q

Who is at risk of

Haemophilus influenzae pneumonia?

A

Elderly

COPD

Alcoholics

Immunocomp

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25
Q

What is the treatment for

Haemophilus influenzae pneumonia?

A

Hospitalization often required

Azithromycin or resp flouroquinolone

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26
Q

How do you prevent

Haemophilus influenzae pneumonia?

A

Hib vaccine

27
Q

What are the signs, Sx and test results

for “Atypical” pneumonia?

A

Gradual onset

Low grade fever with chills (except Legionella)

Non-productive cough with mild SOB

Diffuse or patchy infiltrate w little/no effusion

28
Q

Who tends to get “atypical” pneumonia?

A

< 40 years old

29
Q

What are the most common causes

of atypical pneumonia

and who do they affect?

A

Mycoplasma (young adults)

Chlamydophila (school age)

Legionella (older or immunocomp)

Others:

Psittacosis, tularemia, Q fever

30
Q

What are the signs, Sx and test results for

Mycoplasma pneumoniae?

A

Gradual onset

Sore throat

Nonproductive cough

Headache

Bullous myringitis (swollen TM)

Xray worse than Sx

Dx: serology or culture

31
Q

What is the treatment for

Mycoplasma pneumoniae?

A

Macrolide

32
Q

What causes 15-50% of all pneumonias?

A

Viruses

(Note: this conflicts with an earlier slide that says that

10-15% of community acquired pneumonia

is caused by viruses,

but another 30-50% have unidentified causes,

so perhaps those are assumed viral? )

33
Q

What viruses cause viral pneumonia

and which populations are at risk for each?

A

Respiratory Syncitial Virus (RSV): kids

Influenza

Adenovirus: kids and military

Coronavirus (SARS, MERS)

CMV: transplants, HIV

HSV, VZV less common

34
Q

What are risk factors for

viral pneumonia?

A

Premature infants

HIV/AIDS

Transplants

Lung disease

35
Q

How do you treat viral pneumonia?

A

Supportive care

Antivirals (neuraminidase inhibitors, inhaled virbavirin)

36
Q

What causes aspiration pneumonia?

A

Impaired gag or swallow reflexes

Usually anaerobic or mixed

Usually silent/unnoticed aspiration

37
Q

What is the pathophysiology of aspiration pneumonia?

A

Fluid settles in dependent area (RLL, RML)

Abscess forms

Air-fluid levels may occur

38
Q

How do you treat aspiration pneumonia?

A

Treat for oral flora and for anaerobes:

Beta lactam and Clindamycin

39
Q

How do you decide

when to admit a pneumonia patient?

A

CURB-65 Score:

Confusion

Urea >7 mmol

Respiratory rate 30+/min

Blood pressure low (<90 SBP or <60 DBP)

65+ yo

40
Q

What are danger signs

pertaining to pneumonia?

A

Antibiotic failure

Cavitary infiltrates

Pleural effusion

Severe lung disease

Leukopenia

Active alcohol abuse and/or Chronic severe liver disease

Asplenia

Recent travel

41
Q

What is empyema?

A

Pus in the pleural space: an emergency!

Often caused by pneumonia (40-60%)

Usually anaerobes

Pleural fluid: low pH, low glucose

Other tests: high LDH, bacteria on culture and gram stain

42
Q

What is acute bronchitis?

A

Inflammatory condition of tracheobronchial tree

associated with respiratory infection

43
Q

What causes acute bronchitis?

A

Common cold viruses

Influenza or adenovirus

Seldom: M. pneumo, C. pneumo, B. pertussis

44
Q

What are the signs/Sx of

acute bronchitis?

A

Cough (following nasal and pharyngeal Sx)

Possible fever

Sputum in 50% (purulent in late stage)

Substernal chest pain if tracheal involvement

45
Q

How do you diagnose acute bonchitis

A

Hx and PE

CXR if cough perisists

46
Q

How do you treat acute bronchitis?

A

Symptomatic

(Common cause of inappropriate antibiotic use)

47
Q

Who gets influenza and who dies from it?

A

5-20% of the gen pop gets it

90% of deaths are age 65+

48
Q

What are the incubation and shedding periods for influenza?

A

Incubation: 1-4 days

Shedding: 5-10 days after Sx onset

49
Q

What are signs/Sx of influenza?

A

Fever (100-104F)

Myalgia

“Pounding” HA

Fatigue

Nonproductive dry cough and nonexudative pharyngitis

Tachicardia

Usually no rhinorrhea

50
Q

How do you diagnose influenza?

A

Rapid flu test

Rests to rule out:

Pneumonia (CXR)

Strep pharyngitis: rapid strep

51
Q

Why do you need a flu shot?

A

As a healthcare professional,

you could kill a vulnerable patient

by giving them the flu.

52
Q

How to you treat the flu?

A

Rest

Hydration

NSAIDS for fever/myalgia

STAY HOME and away from immunocomp

Neuramidase inhibitors shorten course if within 48 hrs

53
Q

What is the epidemiology of TB in the US and in the world?

A

1:3 adults in the world

Rare in USA/Western Europe/Japan EXCEPT among:

HIV/AIDS, homeless, prisoners,

immigrants from endemic countries

54
Q

How is TB transmitted

and what are the three main outcomes of contracting TB?

A

Transmission via aerosol droplets from infected person to lungs of another

Incubation: 2-12 weeks

Outcomes:

  1. Acute primary infection
  2. Latent infection, may become secondary infection
55
Q

Where does TB like to go?

A

LUNGS!

Lymph nodes

Vertebral bodies

Adrenal glands

Meninges

GI tract

56
Q

What are the symptoms of latent TB?

A

None

(that is why we need a PPD each year as healthcare workers)

57
Q

How do you diagnose TB

based on a PPD skin test?

A

>5 mm if at high risk (HIV, IDU, immunocomp)

>10 mm if medium risk (endemic country, nursing home)

>15 mm for everyone else

58
Q

What re signs/sx of ACTIVE TB?

A

Cough

Anorexia and Cachexia (wasting)

Fever

Night sweats

Hemoptysis

Chest pain

Fatigue

59
Q

How is active TB diagnosed?

A

CXR: active coin lesions or cavitations

Acid-fast bacilli in sputum

60
Q

How to you treat active TB?

A

Start with 4 drugs until isolate is known:

Isoniazid, rifampin, pyrazinamide, ethambutol/streptomycin

Consider Directly Observed Therapy (DOT) for vulnerable populations and to monitor side effects

Notify health department and get ID

61
Q

What fungi can cause pneumonia in health people?

In immunocompromised people?

A

Primary: Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatum

Opportunistic: Aspergillus, Candida, Pneumocystis jirovecii

62
Q

Blastomyces dermatitidis

Where is it found geographically?

What are the signs/Sx?

How do you treat it?

A

Blastomyces dermatitidis:

Eastern USA,

Sx: usually asymptomatic, then fever, dry cough, pulmonary infiltrate, then productive cough, fever, night sweats, weight loss, hemoptysis, dyspnea, cavitary lesions.

Tx: itraconazole

63
Q

Coccidioides immitis:

Where is it found?

What are the Sx?

How do you treat?

A

Coccidioides immitis:

SW USA;

Sx: most asymptomatic; fever, dry cough, chest pain, dyspnea, myalgia, arthralgia;

Tx: Itraconazole or fluconazole

64
Q

Histoplasma capsulatum:

Where is it found?

What are Sx?

What is Tx?

A

Histoplasma capsulatum:

Miss-Ohio River Valley re soil, chickens, bats;

Sx: fever, cough, and fatigue, can become serious

Tx: amphotericin then itraconazole

Clin Med - Pulmonary (13 decks)

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