Pulmonary Infections- Clinical Flashcards
What is the most frequent cause of viral respiratory tract infections in the summer and fall?
Coxsackievirus
Zanamivir and oseltamivir are effective against which infections?
Influenza A and B
What is teh subtype of avian influenza A?
H5N1
What is the reservoir for the hantavirus?
Deer mouse
What are the initial Sx to hantavirus infections?
abrupt onset of respiratory distress, shock, and hypoxemia
What groups are at risk for hantavirus infections?
native american males
What shows on CXR for hantavirus infections?
b/l pulmonary infiltrates with pleural effusions
What shows on labs for hantavirus infections?
hemoconcentration, throbocytopenia, and prolonged aPTT
Which virus causes SARS?
Coronavirus
What are the initial Sx of SARS?
fever, headache, malaise, myalgia –> dry cough, dyspnea
Where are there reported cases of SARS?
Asia (hong kong, taiwan, china)
What is the #1 cause of acute sinusitis?
Pneumococci
What is the #1 cause of crhonic sinusitis?
Streptococcus
True or False: Pneumococci, H. influenzae, Streptococcus, and Staphylococcus all contribute to acute AND chronic sinusitis.
True
What is the #1 cause of community acuqired pneumonia?
strep pneumo
What are the initial Sx of strep pneumo?
fever, cough with blood/rusty tinged sputum
What shows on CXR for strep pneumo?
normal early, late shows lobar PNA, can se cavitations or effusions
Who are the pts at risk for S. aureus PNA?
Severe diabetes, IC pts, dialysis pts, IVDU, pts with influenza or measles
What shows on CXR for S. aureus PNA?
abscesses with air-fluid levels, consolidation, bronchoPNA, pneumotcele, pneumothorax, empyema
What are the 3 pts at risk for P. aeruginosa PNA?
CF
Bronchiectasis
COPD
What are the 2 drugs for the Tx of P. aeruginosa?
Cefepime (b-lactam) + Gentamicin (aminoglycoside)
What are the 2 underlying conditions that most pts with H. influenza PNA have?
COPD and alcoholism
What are the 3 diseases caused by moraxella catarrhalis?
Sinusitis
Otitis Media
PNA
What Hx do pts usually have to get morazella catarrhalis?
COPD, IC, or alcoholism
What are the lab characteristics for moraxella catarrhalis?
beta-lactamase +, resistant to PCN and amicillin
What are the Sx to Legionella infections?
Abrupt cough + pulm Sx
High fever, diarrhea + ALOC
What can u measure in the pee pee for legionella?
Legionella urinary Ag
What is the Tx for legionella?
Azithromycin or levofloxicin
What are the 3 bacterial etiologies of anaerobic PNA?
Bacteriodes melaninogenicus
Fusobacterium nucleatum
Anaerobic cocci + streptococci
What is the big risk factor for anaerobic PNA?
ALOC (aspiration)
What is the big Sx for anaerobic PNA?
foul-smelling sputum (anaerobes!)
What are the initial Sx for mycoplasma pneumonia?
Cough, fever, pneryngitis, coryza, and tracheobronchitis
hemolytic anemia, erythema multiforma, or guillian barre syndrome
What shows on CXR for myocoplasma PNA?
unilateral bronchoPNA with lower lobe involvement
What appears during the 2nd week of infection on labs for M. PNA infections?
Cold agglutinins and Complement fixation
What is the Tx for mycoplasma pneumonia?
Macrolides or fluoroquinolones
Where do u find chlamydia pneumoniae?
schoolchildren, families, military recruits
What are the Sx to clamydia pneumoniae?
Pharyngitis, PNA, brinchitis, sinusitis
What shows on CXR for chlamydia pneumoniae?
Unilateral segmental patchy opacity
What carries psittacosis?
parrots and other birds
What is the causitive agent for Q fever?
Coxiella burnetii
How do u get coxiella burnetii?
Cows
How do u get Franciesella tularensis?
wild animals and bites by ticks or deer flies
What do u see on physical exam for F. tularensis infecions?
Cutaneous ulcers and lymphadenopathy
What shows up on CXR for F. tularensis infections?
Unilateral lower lobe patchy infiltrates and pleural effusion
What shows up on gram staining for F. tularensis?
Nothing.
What is diagnostic for F. tularensis on serologic tesitng?
Agglutinins if it shows a 4-fold increase in titer
What is the bug to cause plague?
Yersinia pestis
What carries Yersinia pestis?
spread by rodents via fleas or direct contact
What are the Sx to Yersinia pestis infections?
fever, headache, bubo (groin or axilla), cough, and tachypnea
PNA in 10-20% of pts
True or False: pneumonic plague is milder than the regular plague with better outcomes.
FALSE. it’s the most serious fand fulminant form of this disease.
What shows on CXR for pneumonic plague?
b/l lower lobe alveolar infiltrates and pleural effusion
possibly nodules and cavities
What is the leukocyte levels in pneumonic plague?
higher than 15 x 10^9
An IC pt or pt with pulmonary alveolar proteinosis, necrotizing PNA, and lung abscesses is a sign of what infection?
Nocardia
A pt with severe dental caries, tissue necrosis, aspiration, fever, cough, pulmonary lesions, pleural effusion, and fistula and sinus tracts prolly has what infection?
Actinomycosis
Actinomycosis is common in pts with what problem?
Poor oral hygeine
What make up 60, 20, and 10% of hospital-acquired PNA?
Aerobic gram neg (60%)
S. aureus (20%)
Strep pneumo (10%)
others- other 10%
This is a cavity in the lung with an air-fluid level with a collection of pus.
Lung abscess
What is the 30-50, 25, and 5-12% of causes for lung abscesses?
anaerobic bacilli (30-50%)
aerobic gram + cocci (25%)
aerobic gram neg bacilli (5-12%)
What shows up on CXR for a lung abscess?
air-fluid level
What is the primary cause of lung abscess?
oral infection
This is the term for a person who does not have active TB but has a + PPD test.
Latent TB infection (LTBI)
This is the diffuse presence of small (<2mm) nodules throughout the body.
Miliary TB
What are the 3 most common organs for miliary TB?
Spleen, liver, lung
This is the most common form of extrapulmonary TB and is common in kids.
TB lymphadenitis (scrofula)
What are the most common lymph nodes affected by TB lymphadenitis?
cervical lymph nodes
What is the most common location for skeletal TB?
Lumbar vertebrae (potts disease)
Where is the msot common location for TB meningitis?
base of the brain
What shows up on urine tests for genitourinary TB?
sterile pyuria
This is when a healthcare provider monitors a pt as every dose of a 6mo regiment is taken.
Directly Observed Therapy (DOT)
Which pt populations require DOT?
homeless, chronic alcoholics, IVDU, AIDS pts, and prisoners
What shows up on CXR for TB?
Fibronodular or cavitary disease in the APEX
This is the continuous uninterrupted mycobacterial proliferation, common in infants, kids, and immunosuppressed adults.
Primary TB
This is the form of TB where the bacteria go dormant and alter activate, producing active TB, causing the disease and Sx.
Latent TB
What is the nonTB mycobacteria that causes a chronic indurated nodule on the finger and hand?
Mycobacterium marinum
How do u get M. marinum?
swimming pools or cleaning and aquarium
What is the nonTB mycobacteria that is a cause of infection in AIDS pts?
Mycobacterium avium-intracelulare
What is the Tx for MAI? (2)
Clarithromycin and Azithromycin
What is the most important toxicity for anti-TB drugs (RIPE)?
Hepatitis
What are the side effects to isonazid?
peripheral neuropathy, skin rash, purpura, drug-induced systemic lupus erythematosus, seizures, optic neuritis, and arthritis
What are the side effects to rifampin?
GI tract upset, thrombocytopenia, flulike syndrome, hemolytic anemia, and cholestatic jaundice (your skin might turn orange)
What are the side effects to pyrazinamide?
liver damage, minor are hyperuricemia w/o gout, arthralgia, skin rash, nausea
What are the side effects to ethambutol?
main is retrobulbar neuritis, vision problems like blurry and color blindness and central scotoma
True or False: histoplasmosis generally resolves within a month without treatment.
True
IF there is severe histoplasmosis, what is the DOC?
Amphotericin B
Where is the endemic zone for Coccidioides Immitis?
extends from northern California to Argentina
What are teh common clinical presentations of coccidiodomycosis?
valley fever, acute PNA, disseminated disease, chronic cavitary disease
What happens if a woman gets coccidiodomycosis in late pregnancy?
Theres a higher risk of maternal and fetal mortality
What is the DOC for severe coccidiodomycosis or in pregnant women?
Amphotericin B
Where is the geographic location of blastomycosis?
southern, south-central, and Great Lakes states
What are the 4 organs affected by disseminated blastomycosis?
skin, bone, prostate, or central nervous system
What is the most characteristic CXR finding for blastomycosis?
perihilar mass that mimics carcinoma
What is the DOC for blastomycosis?
Amphotericin B
What are the occupations at risk for sporotrichosis?
farmers, florists, gardeners, horticulturists, and forestry workers
What are the clinical signs and symptoms of sporotrichosis?
Cutaneous nodules along lymphatic vessels
inhalation- induced pulmonary disease mimics cavitary tuberculosis
What are the two methods of transmission of sporotrichosis?
cutaneous inoculation and inhalation
What is the DOC for sporotrichosis?
cutaneous- itraconazole
disemminated- amphotericin B
Invasive aspergillosis in immunosuppressed hosts is the most serious form of infection and occurs mainly in what pts?
granulocytopenic patients with a hematologic malignancy
This is a mass of fungal hyphae in preexisting lung cavities, almost always in the upper lobes.
Aspergilloma (fungus ball)
What are the Sx to a aspergilloma?
hemoptysis, cough, low fever, and weight loss
How do u treat an aspergilloma?
intracavitary instillation of amphotericin
Though the lung is the portal of entry, what is the most common clinical presentation for cryptococcal infections?
subacute or chronic meningitis
Where do u culture cryptococcus for the Dx?
CSF
What are the 2 DOC’s for crytptococcus?
Amphotericin B or fluconazole
Crytopcoccal infections are common in which pts?
AIDS pts
You try to control the cryptococcal infection intially with amphotericin B and then give what drug indefinitely?
Fluconazole
Which pts get Pneumocystis jiroveci?
immunosupressed pts, like AIDS, malignancy, or post-transplant pts.
What shows up on CXR for Pneumocystis jiroveci infections?
alveolar and interstitial inflammation and edema with plasma cell infiltrates
Who gets a gradual onset of Sx for Pneumocystis jiroveci infections, AIDS pts or non-AIDS pts?
AIDS pts
What is the typical CT finding for Pneumocystis jiroveci infections?
Ground-glass attenuation
What is the DOC for Pneumocystis jiroveci infections?
Cotrimoxazole
