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Y2S1-CVS-Pathology > Pulmonary infectious diseases > Flashcards

Pulmonary infectious diseases Flashcards

1
Q

What are the defense mechanisms of the lungs?

A

1) Innate immunity

  • Mucociliary action
  • Cough reflex
  • Alveolar macrophages
  • Neutrophils (for bacteria)
  • Compliments (C3b “opsonizes”, C3A “Attracts”)

2) Adaptive immunity

  • The URT secretes IgA (blocks the binding of the pathogen to any cell)
  • The LRT secretes IgM & IgG
  • T-cells for viruses
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2
Q

URT infections are mainly caused by what?

A

VIRUSES

  • However the LRT infections can be due to bacteria, viruses, fungus
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3
Q

What is pneumonia?

A

It is an infection of the lung parenchyma, where the alveoli are filled with inflammatory exudate, and consolidation “solidification” occurs

  • Pneumo (air) monia (disease), it is a disease in which air has been removed from the alveoli (specifically the lumen) and something else has replaced it whether exudate, fibrosis, etc
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4
Q

What are the risk factors for developing pneumonia?

A

1) Lowered systemic resistance

2) Immune deficiency, (which could be congenital or acquired “treatment, absent splenic function”)

3) Impaired local defense mechanisms

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5
Q

What are the different local mechanisms that can be impaired, and considered a risk factor for pneumonia?

A

1) Impairment of the mucociliary action (could be due to cigarette)

2) Impaired cough reflex (coma, anesthesia, etc)

3) Pulmonary congestion and edema

4) Impaired Phagocytic action of the alveolar macrophages

5) AAccumulation of secretions

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6
Q

What are the different entry portals of the causes of pneumonia?

A

1) Respiratory tract

2) Aspiration of oropharyngeal contents

3) Hematogenous spread

4) Local spread

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7
Q

What are the different classifications of pneumonia?

A

1) Depending on the anatomical distribution

2) Etiological classification

3) Clinical setting

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8
Q

What are the different types of pneumonia based on the anatomical distribution?

A

1) Lobar pneumonia

2) Bronchopneumonia

3) Interstitial pneumonia

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9
Q

What are the different types of pneumonia based on etiology?

A

1) Infective

2) Non-infective (radiation, chemical “lipoid pneumonia”, AID “SLE”, allergic “Loffler’s syndrome”)

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10
Q

What is meant by lipoid pneumonia?

A
  • Accumulation of lipids in the alveoli
  • There are two types exogenous and endogenous
  • Associated with electronic vaping acute lung injury
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11
Q

What are the different types of pneumonia in the clinical setting?

A

1) Health-care-associated pneumonia

  • Not nowadays

2) Hospital-acquired pneumonia

  • 48 hours after hospital admission
  • VAP
  • Enterobacteriaceae, P.aurginosa, and S.aureus are the main pathogens

3) Community-acquired pneumonia

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12
Q

Which pathogen is the most common cause of community-acquired acute pneumonia?

A

Streptococcus pneumonia

  • Causes otitis media
  • Gram-Positive diplococci
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13
Q

Which pathogen causes secondary bacterial pneumonia following a viral infection, and causes it in IV drug abusers?

A

Staphylococcus aureus

  • Gram-positive cocci in cluster
  • Forms a lung abscess
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14
Q

Which bacteria causes acute exacerbations of COPD?

A

Haemophilus influenza

  • Causes otitis media
  • Gram-negative coccobacilli
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15
Q

Which pathogen causes bacterial pneumonia in the elderly?

A
  • Moraxella catarrhalis
  • Gram-negative diplococci
  • 2nd most common cause of acute exacerbation of COPD
  • Causes otitis media
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16
Q

What is the most frequent gram-negative pathogen that causes bacterial pneumonia?

A

Klebsiella pneumonia (gram -ve rods)

  • It causes pneumonia in malnourished, smoking, alcoholic, malignancy and diabetes
  • It has a RED current thick gelatinous sputum, with difficulty in coughing
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17
Q

What is the most common cause of hospital-acquired pneumonia?

A

Pseudomonas aeruginosa

  • Gram Negative rods
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18
Q

Which pneumonia-causing pathogens can cause otitis media?

A

1) S.pneumonia

2) Haemophilus influenza

3) Moraxella catarrhalis

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19
Q

A patient with COPD suddenly developed a high fever, yellow sputum, cough, and dyspnea, what is the causative microorganism?

A

1) Haemophilus influenza

2) “secondary” Moraxella catarrhalis

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20
Q

If a patient came with pneumonia and had a history of artificial aquatic environments (e.g., water-cooling towers, shower heads, sink faucets, hot tubes, etc.), what would be the causative microorganism?

A

Legionella pneumophila

  • Gram -ve
  • Causes a Pontiac fever (self-limited URT without pneumonia symptoms)
  • Recall that we have taken a disease also related to ACs 🡪 extrinsic allergic alveolitis/ hypersensitivity pneumonia
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21
Q

Which bacterial pathogen is common among children and young adults that might occur sporadically or in closed communities?

A

Mycoplasma pneumonia

  • Causes local epidemics
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22
Q

What is the most common bacterial cause of pneumonia?

A

Streptococcus pneumonia (pneumococcus)

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23
Q

Bacteria that cause pneumonia and COPD exacerbation

A

Haemophilus influenza

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24
Q

Which bacteria causes pneumonia in the elderly?

A

Moraxella catarrhalis

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25
Q

Which bacteria causes pneumonia following a viral respiratory illness?

A

Staphylococcus aureus

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26
Q

Which bacteria causes pneumonia in debilitated “weak” and malnourished people?

A

Enterobacteria (klebsiella pneumonia)

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27
Q

Which bacteria causes pneumonia in hospitalized patients and patients with neutropenia?

A

Pseudomonas aeruginosa

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28
Q

Which bacteria causes pneumonia in organ transplant recipients?

A

Legionella pneumophila

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29
Q

Which bacteria causes a rust-colored sputum?

A

Streptococcus pneumonia

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30
Q

Which bacteria causes red currant-jelly sputum?

A

Klebsiella pneumonia

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31
Q

Which bacteria causes the sputum to have a foul odor?

A

Anaerobic infections (aspiration)

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32
Q

Describe the stages of lobar pneumonia

A
  • S.Pneumonia is the most common cause

1) Congestion (<24 hrs):

2) Red hepatization (2-3 days)

3) Grey hepatization (5-7 days)

4) Resolution

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33
Q

What happens in congestion?

A

1) The lobe is:

Gross:

  • Enlarged
  • Wet
  • Bloddy

Microscopically:

  • Alveolar capillaries are congested
  • Alveolar walls are thickened
  • Few neutrophils, RBC, and numerous bacteria are found in the alveolar space
34
Q

What happens in red hepatization?

A
  • inflammation is highest here, with exudate, more neutrophils, and due to the capillary congestion fibrin made its way in there. There is no longer air!

The lobe gets:

Gross:

  • Enlarged
  • RED
  • Firm “hepatized”

Microscopically:

  • Alveolar capillaries are congested
  • Alveolar walls are thickened
  • Exudate, fibrin, neutrophils, & RBC are found in the alveolar spaces
35
Q

What happens during grey hepatization?

A
  • Here everything decreases except macrophages & fibrin (what gives it its grey color)

The lobe is:

Gross:

  • Enlarged
  • Grey
  • Hepatized

Microscopic:

  • Alveolar capillaries congestion is reduced
  • Alveolar walls are thinned
  • Exudate with dead bacteria, RBC hemolysis, decreased neutrophils, and increased macrophages to clear the debris
36
Q

Describe the resolution stage

A

The lobe is:

1) Grossly:

  • Occurs in the absence of necrosis
  • Air spaces re-open

2) Microscopically:

  • Exudate within the alveolar space is broken down/reabsorbed/ingested by the macrophages
37
Q

Which pathogen can cause bronchopneumonia?

A

P.aeruginosa

38
Q

What is meant by aspiration pneumonia?

A

Pneumonia due to the entrance of oral or gastric contents into the airway

  • It could be chemical or bacterial (mixed of anaerobes)
39
Q

What are the risk factors for aspiration pneumonia?

A

1) Inhalation of septic material

2) Absence of a cough reflex

3) Aspiration from the mouth or stomach

40
Q

What is meant by lung abscess?

A

It is the destruction of lung tissue with the accumulation of pus (liquified necrotic tissue containing dead bacteria and neutrophils)

  • Primary lung abscess (due to the aspiration of mixed anaerobes)
  • Secondary lung abscess (develops as a complication)
  • Mainly in the right bronchus (shorter and more vertical)
41
Q

What are the complication of lung abscess?

A

1) Spread to other parts

2) Fibrosis and bronchiectasis

3) Pleurisy, empyema, bronchopleural fistula

42
Q

What are the complications of pneumonia?

A
  • SOS

1) Secondary bacterial infection (in case of viral pneumonia)

2) Organization

3) Spread of infection (could be local and could be distant)

43
Q

Which lung lobe is affected by mycobacterium avium-intracellulare (M.avium complex)?

A

Upper lobe

  • Tissue examination: No granuloma. Foamy macrophages “stuffed” with atypical mycobacteria
44
Q

Which patients are in risk of being infected with M.avium?

A

Immunosuppressed individuals (HIV), when their CD4+ cell count drops below 50 cell/microliter

45
Q

What is atypical pneumonia?

A

Pneumonia not associated with fever and productive cough

  • Radiological pattern is associated with patchy inflammation within the pulmonary interstitium (any inflammation that is in the interstitium instead of the alveoli lumen)
46
Q

Which pathogens can cause atypical pneumonia?

A

1) Chlamydia pneumonia

2) Chlamydia psittaci

3) RSV

4) Influenza A and B

5) Adenovirus (in military ppl)

47
Q

Describe the morphology of atypical pneumonia

A

1) Grossly:

  • Patchy or whole lobe
  • Affected area are red-blue

2) Microscopic:

  • Interstitial inflammation
48
Q

What is the corona virus?

A
  • Enveloped
  • Single-stranded RNA (ssRNA)
  • Transmits via respiratory droplets
  • There is two types, Weak pathogen (mild cold), and highly pathogenic pathogen (severe, fatal pneumonia “SARS-CoV-2”
49
Q

What are the risk factors for the severe corona virus?

A

1) Elderly

2) Obesity, smoking, etc (comorbidities)

3) Genetic factors

50
Q

Describe the pathogenesis of the coronavirus

A

1) Viral spike “S” protein with interact with the ACE-2 receptors on the surface of the nasopharyngeal epithelium and type-2 pneumocytes

2) The viruses will use TMPRSS2 to cleave the S glycoprotein (ADAM17)

51
Q

hOW DOES A VIRAL INFECTION OF TYPE-2 ALVEOLAR EPITHELIUM CAUSE DAMAGE?

A

1) Direct cytopathic effect

2) Increasing the immune response (cytokine storm, etc)

52
Q

What are the different fungus that can cause pneumonia?

A

1) Cryptococcus neoformans

2) Cryptococcus gatti

3) Aspergillosis

4) Mucormycosis

5) Histoplasmosis

6) Blastomycosis

7) Coccidioidomycosis

53
Q

What is cryptococcus neoformans?

A
  • Transmitted by inhalation
  • C.neoformans is encapsulated yeast (obligate aerobe)
  • They are obligate aerobe
  • It is present in soil and in bird
54
Q

Where is cryptococcus neoformans found?

A
  • Soil
  • Bird
55
Q

Where is C.gattii found?

A
  • Trees
  • Soil around trees
56
Q

Where is the cryptococcosis lesion found?

A
  • Solitary pulmonary granuloma in healthy individuals
  • CNS
  • It is an opportunistic infection in immunocompromised patients (mainly CNS “Like AIDS PTN”)
  • When CD4+ cells is less than 100
  • They are the second most common fungus in the CNS after toxoplasmosis
57
Q

AIDS patient and he starts showing signs of confusion and seizures. CD4 T-cell count is 70 and brain MRI shows a focal lesion, what is the most probable cause?

A

Toxoplasmosis then cryptococcus

58
Q

Which opportunistic infection occurs when we have less than 50 CD4 cells?

A

Mycobacterium avium intracellulare

59
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66
Q

Where is histoplasmosis found?

A
  • Ohio and Mississippi rivers
  • It is found in the excreta of the birds and bats
  • Hides in the macrophages
  • They form a granuloma with coagulative necrosis which undergoes fibrosis and calcification
67
Q

Which fungi is found in central and southern US states, Canada, Mexico, middle east, Africa and India?

A

Blastomycosis

68
Q

Which fungi is found in ohio and Mississippi rivers?

A

Histoplasmosis

69
Q

Where is blastomycosis found?

A
  • found in the soil and leaves
  • It has a supportive granuloma (blastomycosis is budding)
  • Found in central and southern US, Canada, Mexico, the Middle East, Africa, India
70
Q

Which fungi are found in the southwest, western US, California, and Mexico?

A

Coccidioidomycosis

71
Q

What is coccidiodomycosis?

A
  • Causes valley river
  • Found in southwest and western US, California, and Mexico
  • Found in the soil and dust, releasing endospores into the body
  • They form pyogenic/granulomatous lesions
72
Q

Which pathogen forms a soap bubble lesion in the grey matter bl CNS?

A

Cryptococcosis (fungus)

  • lives in the perivascular spaces in the cerebral cortex and dilates them, so this + its thick gelatinous capsule 🡪 soap bubble lesion
73
Q

What is aspergillosis?

A
  • It is a family of fungi including:
  • A.Fumigatus, A.flavus and A.niger
  • They can transmit through inhalation, contaminated water, and nosocomially
  • Bronchial asthma is type-1 hypersensitivity this fungi will transform it to type 4
74
Q

Describe the different pathologies of aspergillosis

A

1) Colonizing aspergilloma (in pre-existing cavities like in TB)

2) Allergic “bronchopulmonary” aspergillosis (Bronchocentric granulomas in asthmatics, you will find elevated levels of IgE, increased mucin, and a yellow-green mucus plug)

3) Bronchocentric granulomatosis (cell-mediated rxn)

4) Invasive

75
Q

Which fungi can produce a yellow-green mucus?

A

aspergillosis

76
Q

What is mucormycosis?

A
  • It is a fungus
  • Found in the soil with leaves and animal dung
  • It invades the arterial wall and causes necrosis
  • It is an opportunistic infection in neutropenic patients and diabetics
77
Q

Which fungi are neutropenic and diabetics at risk?

A

Mucormycosis

78
Q

What is the relation between cytomegalo virus and pneumonia?

A
  • It is found in the breast milk, blood, saliva, etc
  • It causes infection in immunocompromised patients, it is the most common viral pathogen in AIDS (CD4 <50), other than pneumonia it can cause retinitis (the most common organ to be infected)
78
Q

Which pathogens cause pneumonia in immunocompromised patients?

A
  • CD4+

1) < 500 Bacterial pneumonia

2) < 200 Pneumocystis jiroveci

2) < 100, toxoplasmosis, cryptococcosis, Avium complex

3) < 50 toxoplasmosis, Cytomegalovirus (most common virus)

79
Q

Describe the microscopic photo of CMV

A
  • Marked cellular enlargement (due to viral replication)
  • Large intranuclear basophilic inclusion surrounded by a halo
80
Q

What are the different investigations for CMV?

A

1) Viral culture

  • Anti-viral antibody titer
  • PCR

Y2S1-CVS-Pathology (12 decks)

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