Pulmonary Infectious Diseases Flashcards
Self limiting clinical condition caused by acute inflammation of trachea and bronchi usually secondary to infectious process
Very common
Acute Bronchitis
Acute bronchitis cough typically lasts how long?
10-20 days
Indications for CXR in patients with an acute cough syndrome to exclude pneumonia are:
Abnormal vital signs: P>100/min, RR >24, T >38 degrees C
Pulmonary exam findings
Nonspecific inflammation of terminal bronchioles (small, 2mm
airways)
Viral inflammation of bronchioles in infants and young children causing airway obstruction
Acute Bronchiolitis
What virus is most commonly responsible for acute bronchiolitis?
RSV
When to hospitalize in acute bronchiolitis?
<2 months old
Hypoxemic on room air (<95%)
Significant feeding difficulty due to tachypnea
Marked respiratory distress
dehydration
an inflammation/infection of the pulmonary parenchyma (the structure of the lung)
May involve only interstitial tissue or alveoli, alveoli and adjacent bronchi, or even entire lobe
Pneumonia
What is the #1 most deadly infectious disease in the United States?
Pneumonia
What are the most common agents in infants who develop pneumonia?
Viruses
What are the most common agents in children who develop pneumonia?
Mycoplasma pneumoniae
What are the two classifications of pneumonia?
Community Acquired Pneumonia (CAP)
Hospital Acquired Pneumonia
What are the two types of community acquired pneumonia?
Classic CAP
Atypical CAP
What is the most common pathogen in classic CAP?
Streptococcus pneumonia
What is the most common pathogen in atypical CAP?
Mycoplasma pneumonia
Mnemonic to remember CAP pneumonia organisms – SHAM
S – Streptococcal pneumonia
H – Haemophilus influenzae
A – Atypicals
M – Moraxella catarrhalis
Which organism is common in patients with underlying obstructive lung disease (ex: COPD)?
H. influenzae
Which type of CAP is more commonly seen in young
healthy adults?
Atypical CAP
What symptom is a common complaint with children who have pneumonia?
Abdominal pain
Which pathogen should you suspect with single rigor and rust colored sputum?
Streptococcus pneumoniae
Which pathogen should you suspect with currant jelly sputum and is seen more often in alcoholics?
Klebsiella pneumoniae
What pathogen do you see more often in alcoholics?
Klebsiella pneumoniae
Bullous myringitis is associated with which CAP pathogen?
Mycoplasma Pneumoniae
Which medication is a good selection in smokers with community acquired pneumonia?
Clarithromycin
Atypical CAP do not respond to which classes of medication?
PCNs and Cephalosporins
What is the first line medication class for atypical CAP?
Macrolides
Treatment of Pneumonia - Children < 5 years old first line medication class?
Amoxicillin or Augmentin
Treatment of Pneumonia - Children > 5 years old first line medication class?
Macrolides
Most common cause of death from nosocomial infection
Hospital Acquired Pneumonia
Second most common type of nosocomial infection
Hospital Acquired Pneumonia
What are the most common agents in hospital acquired pneumonia?
Staph aureus (MRSA)
Pseudomonas
Which pathogen in hospital acquired pneumonia has the worst prognosis?
Pseudomonas
What is the most common pathogen in HIV-related pneumonia?
Pneumocystic jiroveci
What is the treatment for aspiration pneumonia?
Clarithromycin
Method to assess severity of pneumonia and need for hospitalization
Pneumonia Severity Index 🡪 PORT Score
Empyema with thick purulent fluid is hallmark of which pathogen?
Staph pneumonia
Number one cause of adolescent pneumonia is what pathogen?
Mycoplasma pneumonia
Slow growing, obligate intracellular pathogen
Acid-fast bacillus
Tuberculosis
What pathogen is responsible for Tuberculosis?
Mycobacterium tuberculosis
How is TB transmitted?
Transmitted by airborne droplets
What are some common risk factors for TB infection?
Impaired immunity (host factors)
Increased exposure
Occurs when an individual becomes infected but does not become acutely ill
These macrophages contain the mycobacterium but doesn’t necessarily eradicate it and this is known as
latent TB infection
This is another manifestation of primary TB infection that is very aggressive
Miliary Tuberculosis
Now used to denote all forms of progressive, widely disseminated hematogenous TB (even if classical pathologic or radiologic findings are absent)
Miliary Tuberculosis
What is the most common extrapulmonary TB manifestation?
TB Lymphadenitis
Spinal TB is also called what?
Pott’s disease
Which is a good TB screening test good for diagnosis on
individual as long as their immune system is intact?
Mantoux (purified protein derivative- PPD)
What does the Mantoux (purified protein derivative- PPD) test evaluate for?
Evaluates both latent and active TB, but can’t distinguish between them
PPD Test injects how much intradermally?
5 tuberculin units or 0.1mL intradermally in forearm raising a wheal
6-10mm in diameter
When do you read a PPD test? What are you looking for?
Read within 48-72 hours, looking for induration diameter (measure)
Does a negative reaction rule out TB? If not, why?
a negative reaction does NOT rule out TB
Some patients immunocompromised and won’t mount a response
the inability to react to skin test because of immunosuppression
Anergy
Skin testing is no longer recommended for whom?
those who develop anergy - false negatives
BCG vaccine - false positives
Two step testing is used for initial TB testing of individuals who will be
tested annually such as?
healthcare workers
What vaccine has variable effect on TB skin test?
BCG vaccine
≥5mm is a positive PPD test in which individuals?
HIV positive
Contacts of individuals with active TB
Persons with CXR consistent with old healed TB
Organ transplants
Immunocompromised patients
High dose long term steroids
> 10mm is a positive PPD test in which individuals?
Military
Recent immigrants (<5years) from high risk countries (Asia, Africa, Latin
America)
IV drug users
Mycobacteriology lab personnel
Residents/employees of high risk congregate settings (nursing homes,
prison, homeless shelters)
High risk medical patients (DM, silicosis, renal failure, leukemia, lymphoma, etc)
Infants/children (<4 years old)
Infants, children, adolescents exposed to adults at high risk
> 15mm is a positive PPD test in which individuals?
Everyone else – patients with no TB risk factors
Acid-fast bacilli on stain of sputum should make you think of what disease?
tuberculosis
If a patient is positive for TB, what other disease do you need to work up the patient for?
HIV
If you are infected with TB and it is active – something will show
up on what?
Chest Xray
CXR Findings in TB:
The primary area of TB infection associated with a lymph node
As it calcifies, it becomes visible on a CXR
Ghon Complex
CXR Findings in TB:
What the Ghon complex turns into after it and the associated lymph
node has further calcified – this indicates healing
Ranke complex
What is the major cause of treatment failure and drug resistance in TB?
Non-compliance
ALL possible or proved cases of TB should be reported to what agency(s)?
local and state public health departments
Name the five drugs used to treat TB
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
Consider which disease in all HIV-infected patients with undiagnosed pulmonary disease?
TB
Properly treated TB patients are usually cured with less than what percentage rate of recurrence?
5%
Mycobacterium Avium Complex consists of what?
M. avium
M. intracellulare
Mycobacterium Avium Complex’s common patient populations include
AIDs patients
Patients with chronic underlying lung disease (ex. COPD)
