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Respiratory > Pulmonary Infections -Patel > Flashcards

Pulmonary Infections -Patel Flashcards

1
Q

What is Community Acquired Pneumonia? What organism commonly causes it?

A

an infection that begins outside of the hospital or is diagnosed within 48 h of hospital admission in a patient who has not resided in a long-term facility for 14 days or more before the onset of symptoms

Streptococcal pneumonia is the most common

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2
Q

What is hospital acquired pneumonia? What does HCAP (healthcare acquired associated pneumonia) include? Why do we care about these?

A

HAP=48 hours after admission to the hospital

HCAP=non-hospitalized patients with extensive healthcare contacts like:

  • Nursing home resident
  • Hemodialysis patients
  • Hospitalization for >2 days in last 90 days

both HAP and HCAP may be more resistant organisms–> need more broad based medication

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3
Q

What is the most common organism to cause lobar pneumonia?

A

Streptococcal pneumonia (gram + diplococci)

then Klebsiella (esp in alcoholics and diabetics)

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4
Q

What are the stages of lobar pneumonia?

A
  • congestion 24 hours –> lots of exudate in alveoli–> hypoxia
  • red hepatization (1-3 days)–> RBCs and PMNs inside ==> exudates, neutrophils and hemorrhage
  • gray hepatization (4-8 days) –> degradation of RBCs =fibrinosppurative exudate
  • resolution
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5
Q

What is bronchopneumonia? What bugs normally cause this?

A

Inflammation and exudate starts in bronchioles and extend to alveoli

Patchy distribution involving multiple** lobes

  • Staph. aureus-secondary pneumonia after viral infection
  • H influenza- pneumonia with COPD
  • Pseudomonas- pneumonia is cystic fibrosis pts
  • Legionella- source is water like water fountain or water from air conditioner–> pneumonia is immmunocompromised pts
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6
Q

What is the typical cause of interstitial pneumonia? What are the normal symptoms?

A

viral

mild symptoms –> does not affect the alveoli directly (just parenchyma)–> no hypoxia

no solid consolidation on x-ray

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7
Q

Which bug will present with GI symptoms and pneumonia?

A

Legionella

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8
Q

What is required on imaging for a diagnosis of pneumonia? If a pt with suspected pneumonia has a negative chest x-ray, what should you do next?

A

presence of infiltrate on imaging (chest x-ray) along with clinical finding

negative chest x-ray:

  • repeat in 48 hours with empiric antibiotics
  • CT chest
  • consider other diagnosis
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9
Q

What labs should be ordered for a hospitalized pt with CAP or HAP?

A
  • blood culture
  • sputum culture
  • urine antigen for lenionella and pneumococcus

optional for outpatient CAP

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10
Q

What determines whether a sputum culture is adequate?

A

-culture yield 25 neutrophils and <10 squamous epithelial cells on low-power field

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11
Q

What bug should you think of in a child with pneumonia and a middle ear infection?

A

mycoplasma

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12
Q

What is the specific diagnostic test for mycoplasma? Legionella? Streptococcal pneumonia?

A

Mycoplasma: serology for IgM and IgG, PCR

Legionella and strept pneumoniae=urine antigen test

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13
Q

What bug should be suspected in CAP found in a healthy pt?

A

strept pneumonia

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14
Q

What bug should be suspected in children < 5yo or adults >65 yo and/or functional asplenia?

A

H. influenzae

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15
Q

What bug should be suspected in pneumonia after influenza, lung abscess or nosocomial pneumonia?

A

Staph aureus

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16
Q

What is the outpatient treatment for pneumonia in a previously healthy pt with no risk of drug resistance? What if they have comorbidities or factors

A
  • healthy: macrolide or doxycycline
  • comorbidities: Beta-lactam + macrolide or doxycycline

OR flouroquinolones

17
Q

What is the treatment for pneumonia in a hospital setting (CURB-65=2+)?

A

Beta lactam + macrolide

or resp FQ (reserve for beta-lactam allergic pts)

18
Q

What is the treatment for severe pneumonia (CURB-65 >3)?

A

Potent antipneumococcal beta-lactam (cefotaxime, ceftriazone or ampicillin-sulbactam) + azithromycin or RFQ

19
Q

When should MRSA pneumonia be suspected?

A
  • Severe, rapidly progressive pneumonia
  • During influenza season (superimposed bacterial pneumonia)
  • Pneumonia with cavity on CXR (from PVL toxin)
  • -> Tend to cause necrotization of lung tissue fast.
  • Previous history of MRSA infection.
20
Q

What 3 things should be checked in pts who do not respond to treatment?

A

wrong organism?

complication? (empyema, lung abscess, occult infection)

wrong diagnosis?

21
Q

What can aspiration pneumonia lead to? What is a common pathophysiology of this?

A

chemical pneumonitis (abrupt onset of dyspnea with low grade fever, cyanosis and diffuse crackles)

lung abscess (necrotizing pneumonia)

*often due to compromised consciousness (alcoholism, anesthesia)

22
Q

What are some signs of an aspiration pneumonia–> lung abscess (necrotizing pneumonia)? What are some causes of this?

A
  • Patient is sick for few days
  • Foul smelling sputum
  • Chest x-ray shows consolidation with cavity

TANKS

  • TB
  • Anaerobes (Bacteroides, fusobacterium, peptostreptococcus, provetella)
  • Nocardia
  • Klebsiella (red currant sputum)
  • S. aureus (PVL toxin)
23
Q

If a pt is infected with mouth anaerobes, will the sputum culture be +?

A

probably not because the bugs need a special culture to grow

mixed flora is common in aspiration pneumonia

24
Q

Where are lung abscesses likely to form? How long does this take?

A

Right lower lobe

takes 7-10 days for necrosis

25
Q

What are the clinical features of aspiration pneumonia? What should it be treated with?

A
  • Indolent course with cough, fever, night sweats for 2 weeks or more
  • Sputum culture does not help in making diagnosis.
  • Rx : clindamycin or carbapenems should be used to treat.
26
Q

What 3 bugs are likely to cause HAP? What should be used to treat these?

A

Multidrug-resistant (MDR) bacterial pathogens:

  • pseudomonas (5 days amino glycoside therapy with B-lactam)
  • enterobacteriaceae (carbapenem)
  • MRSA (linezolid or vancomycin)
27
Q

What has to be obtained prior to starting HAP pts on antibiotics?

A

lower reap tract culture

obtained bronchoscopically

28
Q

What is nosocomial pneumonia? What should be done to prevent nosocomial pneumonia?

A

all healthcare related pneumonia

prevention=

  • decontaminate oropharynx (chlorhexidine 0.12%)
  • prevent aspiration (sit semi-recumbent and subglottic suction)
29
Q

What are the 2 tests for latent TB?

A
  • PPD –> type IV hypersensitivity reaction

- interferon gamma release assay (IGRA) –> Tcell response to M TB antigen

30
Q

Can a BCG vaccine convert a PPD test?

A

NO!

31
Q

What is a considered a + PPD test? (3 different populations)

A

induration > 5mm for HIV infection, organ transplant, recent contact with active TB or chest ray consistent with old TB

induration > 10 for recent arrival (< 5 yrs) from a high risk country, IV drug user, health care worker, children < 4yo or exposed to adults with high risk for TB

induration > 15 mm for no risk factors

32
Q

A 32-yr-old man working as full time RN, has PPD results showing 11 mm induration. Is this PPD positive for latent TB?

A

Yes

Induration > 10=+

33
Q

What are some features of Primary Active TB?

A

arises after initial exposure

causes focal, caveating necrosis of lower lobes

noncavitary lesion

calcification of ipsilateral hilar lymph nodes

caseating necrosis –> Ghon complex

34
Q

What are some features of Reactivation TB?

A
  • immune suppression
  • Upper lobe cavitation or fibronodular infiltrate
  • atypical presentation common in HIV pts
35
Q

What are some features of Miliary TB?

A
  • hematogenous seeding
  • fine, well-demarcated nodules, uniform in size
  • nodules enlarge –> fluffy and results in diffuse airway filling defects
36
Q

What is the diagnostic approach for suspected TB?

A
  • any pt with cough > 2-3 weeks or with at least 1 other symptom (fever, night sweats, weight loss, hemoptysis)
  • -> chest x-ray
  • if suggests TB, admit/isolate and :
  • collect 3 sputum cultures for acid-fast bacilli (AFB) smear microscopy and culture (one should be tested using nucleic acid amplification (NAA) test)
37
Q

If the sputum is positive for AFB stain and culture is pending, will you empirically treat for TB?

A

Yes

start treatment before get culture back –> presumptive diagnosis (epidemiological exposure, x-ray findings, sputum/fluid analysis, histopathology)

38
Q

What should be done for inpatient infection control in TB?

A
  • airborne isolation

- negative pressure room with N95 mask

39
Q

What is the treatment for TB?

A

INH+RIF+ETH+PZA for 2 months –> if sputum negative, go down to 2 drugs (INH and RIF) for total 6-9 months

(INH= isoniazide
RIF = rifampin
ETH= ethambutol
PZA= pyrazinamide)

Respiratory (19 decks)

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