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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
What is the treatment for Haemophilus influenzae pneumonia?
Hospitalization often required Azithromycin or resp flouroquinolone
26
How do you prevent Haemophilus influenzae pneumonia?
Hib vaccine
27
What are the signs, Sx and test results for "Atypical" pneumonia?
Gradual onset Low grade fever with chills (except *Legionella*) Non-productive cough with mild SOB Diffuse or patchy infiltrate w little/no effusion
28
Who tends to get "atypical" pneumonia?
\< 40 years old
29
What are the most common causes of atypical pneumonia and who do they affect?
Mycoplasma (young adults) Chlamydophila (school age) Legionella (older or immunocomp) Others: Psittacosis, tularemia, Q fever
30
What are the signs, Sx and test results for Mycoplasma pneumoniae?
Gradual onset Sore throat Nonproductive cough Headache Bullous myringitis (swollen TM) Xray worse than Sx Dx: serology or culture
31
What is the treatment for Mycoplasma pneumoniae?
Macrolide
32
What causes 15-50% of all pneumonias?
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
What viruses cause viral pneumonia and which populations are at risk for each?
Respiratory Syncitial Virus (RSV): kids Influenza Adenovirus: kids and military Coronavirus (SARS, MERS) CMV: transplants, HIV HSV, VZV less common
34
What are risk factors for viral pneumonia?
Premature infants HIV/AIDS Transplants Lung disease
35
How do you treat viral pneumonia?
Supportive care Antivirals (neuraminidase inhibitors, inhaled virbavirin)
36
What causes aspiration pneumonia?
Impaired gag or swallow reflexes Usually anaerobic or mixed Usually silent/unnoticed aspiration
37
What is the pathophysiology of aspiration pneumonia?
Fluid settles in dependent area (RLL, RML) Abscess forms Air-fluid levels may occur
38
How do you treat aspiration pneumonia?
Treat for oral flora and for anaerobes: Beta lactam and Clindamycin
39
How do you decide when to admit a pneumonia patient?
CURB-65 Score: Confusion Urea \>7 mmol Respiratory rate 30+/min Blood pressure low (\<90 SBP or \<60 DBP) 65+ yo
40
What are **danger signs** pertaining to pneumonia?
Antibiotic failure Cavitary infiltrates Pleural effusion Severe lung disease Leukopenia Active alcohol abuse and/or Chronic severe liver disease Asplenia Recent travel
41
What is empyema?
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
What is acute bronchitis?
**Inflammatory** condition of **tracheobronchial tree** associated with **respiratory infection**
43
What causes acute bronchitis?
Common cold viruses Influenza or adenovirus Seldom: M. pneumo, C. pneumo, B. pertussis
44
What are the signs/Sx of acute bronchitis?
**Cough** (following nasal and pharyngeal Sx) Possible fever Sputum in 50% (purulent in late stage) Substernal chest pain if tracheal involvement
45
How do you diagnose acute bonchitis
Hx and PE CXR if cough perisists
46
How do you treat acute bronchitis?
**Symptomatic** (Common cause of **inappropriate antibiotic use**)
47
Who gets influenza and who dies from it?
5-20% of the gen pop gets it 90% of deaths are age 65+
48
What are the **incubation** and **shedding** periods for influenza?
Incubation: 1-4 days Shedding: 5-10 days after Sx onset
49
What are signs/Sx of influenza?
Fever (100-104F) Myalgia "Pounding" HA Fatigue Nonproductive dry cough and nonexudative pharyngitis Tachicardia Usually **no rhinorrhea**
50
How do you diagnose influenza?
**Rapid flu test** Rests to rule out: Pneumonia (CXR) Strep pharyngitis: rapid strep
51
Why do you need a flu shot?
As a healthcare professional, you could kill a vulnerable patient by giving them the flu.
52
How to you treat the flu?
Rest Hydration NSAIDS for fever/myalgia STAY HOME and away from immunocomp Neuramidase inhibitors shorten course if within 48 hrs
53
What is the epidemiology of TB in the US and in the world?
1:3 adults in the world Rare in USA/Western Europe/Japan EXCEPT among: HIV/AIDS, homeless, prisoners, immigrants from endemic countries
54
How is TB transmitted and what are the three main outcomes of contracting TB?
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
Where does TB like to go?
LUNGS! Lymph nodes Vertebral bodies Adrenal glands Meninges GI tract
56
What are the symptoms of latent TB?
None (that is why we need a PPD each year as healthcare workers)
57
How do you diagnose TB based on a PPD skin test?
\>5 mm if at high risk (HIV, IDU, immunocomp) \>10 mm if medium risk (endemic country, nursing home) \>15 mm for everyone else
58
What re signs/sx of ACTIVE TB?
Cough Anorexia and Cachexia (wasting) Fever Night sweats Hemoptysis Chest pain Fatigue
59
How is active TB diagnosed?
CXR: active coin lesions or cavitations Acid-fast bacilli in sputum
60
How to you treat active TB?
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
What fungi can cause pneumonia in health people? In immunocompromised people?
**Primary**: Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatum **Opportunistic**: Aspergillus, Candida, Pneumocystis jirovecii
62
**Blastomyces dermatitidis** W**here** is it found geographically? What are the **signs/Sx**? **How do you treat it?**
**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
**Coccidioides immitis:** Where is it found? What are the Sx? How do you treat?
**Coccidioides immitis:** SW USA; Sx: most asymptomatic; fever, dry cough, chest pain, dyspnea, myalgia, arthralgia; Tx: Itraconazole or fluconazole
64
**Histoplasma capsulatum:** Where is it found? What are Sx? What is Tx?
**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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