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Respiratory Block: Microbiology > Respiratory Infections in Special Populations > Flashcards

Respiratory Infections in Special Populations Flashcards

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Biology 101 flashcards
1
Q

What is bronchiectasis?

A

A condition where the bronchi are permanently damaged, widened and thickened.

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2
Q

What is the consequence of bronchiectasis?

A

Damaged airways allow mucous build-up and bacteria to accumulate
= Multiple infections

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3
Q

How is bronchiectasis cured?

A

Cannot be cured, but can be managed

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4
Q

What mutation causes cystic fibrosis?

A

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutation

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5
Q

What is the function of CFTR?

A
  • channel that transports chloride into and out of cells
  • regulates the passage of other ions and chemicals
  • found in the epithelial cells of: lung, digestive system, sweat glands
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6
Q

What is the mode of inheritance of cystic fibrosis?

A

Autosomal recessive

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7
Q

What does a CFTR mutation result in?

A

Inappropriate movement of chloride through cells

- result = thick and sticky mucous in the lungs and digestive system

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8
Q

Why do cystic fibrosis patients have chronic lung infections?

A
  • thick and dehydrated mucus is produced throughout the respiratory tract, especially in the small airways
  • the mucus is difficult to clear from the airways
  • the extra mucus leads to symptoms such as chronic cough
  • the abnormal mucus results in bacteria adhering to it
    = Ultimately causes chronic lung infection
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9
Q

What organisms are associated with colonization and infection in cystic fibrosis patients?

A
  1. Staphylococcus Aureus
  2. Pseudomonas Aeruginosa
  3. Haemophilus Influenzae
  4. Stenotrophomonas Maltophilia
  5. Burkholderia Cepacia Complex
  6. Non-tuberculosis Mycobacteria
  7. Candida spp.
  8. Aspergillus spp.
    and other bacteria…
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10
Q

What is significant about colonization and infection with Staphylococcus Aureus in the CF population?

A
  • GPC clusters
  • one of the most common pathogens at any stage
  • difficult to eradicate
  • develops resistance to Beta-lactams… MRSA
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11
Q

What is significant about colonization and infection with Pseudomonas Aeruginosa in the CF population?

A
  • GNB = common cause of chronic infections
  • FORMS BIOFILMS!
  • difficult to eradicate
  • prone to multi-drug resistance (MDR)
  • patients receive multiple courses of antibiotics
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12
Q

What is significant about colonization and infection with Haemophilus Influenzae in the CF population?

A
  • GNB
  • more common in younger patients
  • often not a chronic pathogen
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13
Q

What is significant about colonization and infection with Stenotrophomonas Maltophilia in the CF population?

A
  • GNB
  • less common
  • intrinsically MDR
  • few treatment options
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14
Q

What is significant about colonization and infection with Burkholderia Cepacia Complex in the CF population?

A
  • GNB
  • less common
  • usually occurs in older patients
  • prone to chronic colonization
  • certain species and genotypes associated with poor outcomes and are even a CONTRAINDICATION TO LUNG TRANSPLANTATION
  • intrinsically MDR
  • few treatment options
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15
Q

What is significant about colonization and infection with Non-Tuberculosis Mycobacteria in the CF population? Which species are associated?

A

Species: M. Avium Intracellulare

  • significance unknown
  • long duration of treatment
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16
Q

What is significant about colonization and infection with Candida spp. in the CF population?

A
  • a known commensal of the mouth

- can become pathogenic in certain patients

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17
Q

What is significant about colonization and infection with Aspergillus spp. in the CF population?

A
  • ubiquitous organism
  • spores found widely in the environment
  • can cause ABPA of carying severities
18
Q

What are some of the other bacteria that cause infections in cystic fibrosis patients?

A

Any other bacterial pathogen can infect these patients:

  • A. Xylosoxidans
  • TB
  • E. coli
  • Klebsiella Pneumoniae
19
Q

Cystic Fibrosis patients usually have what symptoms in colonization and infection?

A

These patients normally have chronic cough (productive, may be purulent), wheeze, signs of respiratory impairment, bronchiectasis

20
Q

What is seen in colonization of cystic fibrosis patients?

A

The normal symptoms + isolation of typical bacteria (no deterioration of lung function)

21
Q

What is seen in infection of cystic fibrosis patients?

A

Increased volume of purulent sputum, dyspnoea, wheeze, chest pain, CXR may be normal, fever is unusual

22
Q

How is diagnosis of infection made in cystic fibrosis patients?

A

Most respiratory sample types are accepted for MC&S (including throat swabs)

  • additional culture media is used for testing to improve likelihood of isolating a pathogen
  • important to let the laboratory know that the sample has been taken from a patient with CF
23
Q

How are cystic fibrosis patients managed?

A

Once diagnosed with CF, patients must be referred to a Pulmonologist (Paediatric or Adult Physician)
- specialist CF treatment centers in SA

24
Q

Nocardia epidemiology

A

Environmental saprophytes

25
Q

What is the structure of Nocardia?

A

Branching gram positive bacilli

26
Q

What does Nocardia cause?

A

Causes granulomatous infection in humans who are immuno-compromised

27
Q

What is the prototype granulomatous infection?

A

TB

28
Q

What are some of the types of infections caused by Nocardia spp?

A
  1. Pulmonary
  2. Cutaneous
  3. Disseminated or CNS
29
Q

How does pulmonary infection with Nocardia occur?

A

Pulmonary infection occurs as a result of inhalation of bacilli

30
Q

What conditions predispose to infection with Nocardia spp?

A
  1. DM
  2. Cancer
  3. HIV
  4. Pulmonary alveolar proteinosis
  5. Connective tissue disorder
  6. Alcoholism
  7. Bone marrow or solid organ transplant
  8. High dose corticosteroids
31
Q

What is pulmonary alveolar proteinosis?

A

An illness that causes the air sacs of the lungs to become plugged

32
Q

What is a connective tissue disorder?

A

A disease that affects the tissue that connects and supports different parts of the body

33
Q

What does Pulmonary Nocardiosis look a lot like?

A

Tuberculosis

34
Q

What are the clinical features of Pulmonary Nocardiosis?

A

Presentation and clinical features are variable, may have acute / chronic symptoms

  • Fever
  • Weight loss
  • Night sweats
  • Cough
  • Chest pain
  • Pneumonia
  • Multiple lung abscesses - complicated by secondary abscesses to the brain in one third of patients
35
Q

What is the differential diagnosis of Pulmonary Nocardiosis?

A
  1. TB, TB, TB!!
  2. Aspergillosis
  3. CAP
  4. Fungal pneumonia
  5. Histoplasmosis
  6. Kaposi Sarcoma
  7. Lung abscess
  8. Mycobacterium Avium-Intracellulare
  9. Non-Hodgkin Lymphoma
  10. Pneumocystis Jiroveci Pneumonia
36
Q

How is Pulmonary Nocardiosis diagnosed?

A

Respiratory sample for MC&S:

  • sputum, tracheal aspirate, broncho-alveolar lavage fluid
  • tell the lab that you suspect Nocardia!!
  • special stains
37
Q

What does Nocardia look like?

A

Beaded branching gram positive bacilli

38
Q

What is important about culturing Nocardia?

A

Grows more slowly than a typical bacteria (3-5 days)

- need to keep plates longer than usual

39
Q

How is the presence of Nocardia confirmed?

A

Requires molecular testing to confirm identification (only done at a few referral labs)

40
Q

How is Nocardia managed?

A

Refer to a Pulmonologist or Infectious Diseases specialist!

  • long duration of treatment (>6 months)
  • Examples of antibiotics used for treatment include: Trimethoprim-Sulfamethoxazole (Co-Trimoxazole)

Respiratory Block: Microbiology (7 decks)

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