Respiratory System Flashcards

Question

PNEUMONIA what is it

Answer 1

infection of LRT that involves bronchioles, lungs & alveoli -can be caused by bacteria, virus or fungus -alveoli get filled with pus and fluid leaving them unable to oxygenate blood Infection by 1. Breathing in normal flora from URT 2. Upper airway infection that spreads into lungs 3. Seeding of lung via blood from a distant site of infection 4. Inhalation of airborne droplets containing organism Manifests as fever chill chest pain Productive cough → yellow/green mucous may be bloody with many WBC

Answer 2

Community-acquired pneumonia (CAP) - most common outside of healthcare settings -s. pneuomo, H flu -Mycoplasma pneu - walking pneumonia Hospital-acquired pneumonia (HAP) - after admission into hospital -increased risk due to ventilators or intubation MRSA, Pseudo, Enterobac, Serratia

Answer 3

Bacterial, Viral, Mycoplasma, Fungal Aspiration Pneumonia - Inflammation minus bacteria - due to inhalation of food, liquid, gases, dust

Answer 4

Lobar, bilateral etc

Answer 5

-chronic inflammatory lung diseasewith obstructed airflow -caused by smoking or pollution -genetic - decrease in Alpha 1 antitrypsin Emphysema - alveoli are destroyed by cigarette smoke Chronic bronchitis -inflammation of lining or bronchial tube Emphysema & chronic bronchitis usually occur together

Answer 6

genetic - mutation of CFTR gene -cftr protein can move CL and H2O to the cell surface -over production of thick mucus on organs like lung, pancreas and liver -lung infections due to breathing problems -liver disease -fatal Diagnosis Positive NB screen Sweat test - saltier sweat Genetic testing Work up any amount of Burkholderia cepacia, P. aeruginosa, & S. aureus B. cepacia is also phoned to physician

Answer 7

lining of brochial tubes is inflammed Acute - productive cough that lasts for more than 3 weeks -worse due to virus or bacteria even worse if you smoke chronic - sputum in cough for 3 months or over 2 years -bacterial infection, smoking, dust

Answer 8

Colonizes resp tract of CF patients Strict aerobe, slow grower, GNB, non-motile, NLF Oxidase weak + ve , Lysine - and Arginine +, DNAse: negative MALDI/Vitek Transmission p/p in medical solutions , disinfectant , med devices in contaminated food or on resp equipment Virulence factors -intrinsic resistance to ABtics -binds to mucin from patients with Cystic Fibrosis -invades epithelial cells -Opportunistic - causes pneumonia in immunocom with lung disease -fatal lung disease and bacteremia

Answer 9

Routine media "BA (CO2), HSA agar (CO2), MAC (O2) at 35C special media 1. Pseudomonas cepacia agar (PC) 2. Oxidation-fermentation base-polymyxin B-bacitracin-lactose (OFPBL) 3. BCSA (B cepacia selective agar – has polymyxin B, gentamicin, ticarcillin) Selective media all prevent/slow growth of NF which may overgrow slower growing B cepacia. Media also inhibits P. aeruginosa & S. maltophilia

Answer 10

- found in aquatic environments -nosocomial because it colonizes fluids used in hospital settings like irrigation solution or IV fluid -found in pt secretions - resp, urine, -dont cause disease in healthy unless a device is inserted - intubation ppl at risk immunosupp. CF, ppl on broad spectrum ABtics

Answer 11

Strict aerobe GNB , straight, or curved Motile on BA, CHOC, HSA -large, shiny, uneven edges -lavender- green - light purple -green discoloration -smells like ammonia NLF Oxidase: neg DNAse: positive OF maltose: oxidative Lysine decarboxylase pos MALDI/Vitek intrinsic resistance to beta lactams treat with SXT or levofloxacin

Answer 12

- NF of urt -spread by p/p contact Typeable (encapsulated) non typeable (no capsule) -typed based on capsule characteristics -Type B is most common - immunization reduced incidence Virulence Encapsulated strains - capsule is anti phagocytic can cause pneumonia Non encapsulated - pili causes localized infections

Answer 13

Faculative anaerobe -Small GNB/GNCB Requires X & V factor for growth Grows on CHOC or HSA – lysed RBC provides X & V Only grows on BA around certain organisms (S. aureus streak) No growth on MAC CF patients use Horse blood-bacitracin agar-prevents overgrowth of H. influenzae by mucoid P. aeruginosa Unencapsulated - smooth encapsulated - mucoid

Answer 14

Oxi - weak pos XV required -satelliting around S aureaus -porphyrin negative - no fluoresce this test detects enzyme that converts aminolaevulinic acid (ALA) to porphyrins or protoporphyrin’s (fluoresce) -use MALDI, Vitek NH, Rapid NH, or API NH AG detection test for H Flu serotype B done directly on CSF or Blood Culture Susceptibility testing Beta Lactamase

Answer 15

H. influenzae needs X (hemin) & V (NAD- nicotinamide adenine dinucleotide) -while both factors are found in RBC, factor V is only available if RBC is lysed -choc has lysed blood so both X and V are available grows satellite colonies on BA around BH that make NAD like staph, strep pneu, neisseria

Answer 16

strict aerobe Gram: GNB small Colonial Morph good growth at 42C in O2 BA - flat fuzzy edge can be BH , metallic sheen, smells like grape or rotting fruit MAC- NLF can have a green pigment Id- Oxi- pos O/F- oxidative Maldi/Vitek Susceptibility-Intrinsic resistance to many antibiotics

Answer 17

Pathogenesis in human nasopharynx -p/p by contaminated resp secretions -virulence due to capsule and pneumolysin -leading cause of meningitis & pneumonia Gram - GPDC, lancet shaped, can be in short chains -can look gram neg if culture is old or pt on ABtics Culture BA: Small, gray, glistening, checkered with age; AH -mucoid if encapsulated HSA, MAC: No growth

Answer 18

ID Optochin (ethylhydrocupreine hydrochloride) is ≥14mm Bile solubility = soluble ( tests the ability of bile salts to induce the autolytic enzyme Direct specimen testing capsular polysacc AG detected directly from CSF susceptibility testing Pen from KB with oxacillin disc Ox<20mm = Pen R Pen MIC to confirm before reporting Pen R

Answer 19

Epidemiology - NF of URT Pathogenesis and disease -cause of otitis media, sinusitis, pneumonia and chronic bronchitis -ppl with COPD or emphysema at risk gram - GNDC- strict aerobe likes 5% CO2 culture BA: med to large NH, white/grey dry– slides on agar like hockey puck CHOC: med to large gray, opaque, dry MAC: NG

Answer 20

identification Oxidase: positive Tributyrin: positive DNAse: positive Bacticard = IB pos Glucose, Maltose, Lactose, Sucrose utilization tests: negative Susceptibility testing Pen R because it makes Beta Lactamase No AST because its S to other AB

Answer 21

GNB grows on BA, CHOC, MAC will NOT grow on HSA Ox Neg, Nit Pos follow up with vitek or Maldi API20E if necessary

Answer 22

Fusobacterium Species-GN non-sporing fusiform bacillus. F. nucleatum most common Peptostreptococcus species: GPC P/C SPS disk added to aerotolerance – Sensitive Bacteroides species: Small GNB pleomorphic Bile disk added to Aerotolerance- resistant AnIdent to ID

Answer 23

-Candida albicans or other candida spp -Yeast is NF but it can over grow if immunocom or on ABtics -common in babies -seen as white patches on inside of cheek, tongue and throat Take throat swab, put on BA and SAB Germ tube pos Urea neg Chlamydospore pos

Answer 24

-Caused by Fusobacterium necrophorum (rods with tapered ends) + Borrelia vincentii (spirochetes) -causes bleeding between gums -Acute necrotizing ulcerative gingivitis -TRENCH MOUTH -seen in third world countries due to poor oral hygiene -do gram of mouth swab to look for orgs above

Answer 25

-infection of epiglottitis and tissues above vocal cords -in adults caused by h flu, strep pneumo, BHS, S aureus -in kids H flu type B Take throat swab or blood culture

Answer 26

-caused by Corynebacterium diphtheriae -droplet transmisson infects resp tract -Only Corynebacterium infected with bacteriophage with tox- gene can make cytotoxic exotoxin that causes Diphtheria : C. diptheriae is not the same as diphtheroid diphtheroid are any Corynebacterium that don’t make toxins or are non-pathogenic

Answer 27

C. ulcerans & C. pseudotuberculosis –both zoonotic – don’t spread human - human C. ulcerans may cause Diphtheria-like illness & skin infections C. pseudotuberculosis may cause infection of lymph nodes – very rare

Answer 28

-cytotoxic exotoxin damages epithelial cell -forms pseudo membrane -makes it hard to breathe take throat, tonsil, or nasopharynx swab or piece of the pseudomembrane -Amies or stuarts -keep in fridge or deliver on ice

Answer 29

in BSL -2 so sent to PHL -they do culture and test for toxin -facultative anaerobe and grows well in agar with blood or serum at 37 -BA - smll white Loeffler’s horse serum slant: look for clubbed ends and Metachromatic granules Catalase: positive Gram: small GPB in club forms C dipth is urease neg

Answer 30

Plate to BA, Loeffler’s + selective differential media like Hoyles or Tinsdale

Answer 31

blood and tellurite K tellurite is selective and inhibits NF and GNB also differential because Coryne grows, and reduces the tellurite to tellurite salt = black colonies Tinsdale - tellurite reduced to the sale = black colonies -some coyrne make cystinase that makes H2S which reacts with the Tellurite salt = brown halo Only C. diphtheriae, C. ulcerans & C. pseudotuberculosis are black colonies w brown halo –Other Coryne, reduce tellurite but won’t have halos

Answer 32

-part of ID ing C dipth is demonstrating the toxin; most important to diagnose -do by ELEK or PCR -issue with PCR is that it only tests for PRESENCE of tox gene = therefore screen test = if negative STOP if positive then do ELEK - shows toxin actively being produced

Answer 33

-filter paper with disptheria antitoxin put in middle of agar -streak org 90 degrees to antitoxin -lines of precipitin = toxin positive for C dipth

Answer 34

Vaccine -Schick test- tests for pt susceptibility to Dipth; needle under skin and read in 1-4 days . One arm control and other is test -if person has NO ABs = red swollen (5-10mm) POSITIVE and person is susceptible -No reaction = negative result = pt not susceptible -Reaction in both arms = person has Ab’s to another substance in vaccine sera & cannot be interpreted

Answer 35

-spread by aerosol droplets -can cause CAP - walking pneumonia -dry cough -can make Community Acquired Respiratory Distress Syndrome toxin(CARDS) -affects liver, joints take Nasopharyngeal/Oropharyngeal Dacron, nylon or rayon swabs (plastic shaft) in UTM or any LRT sample

Answer 36

-people are carriers and transmitted through aerosols -common cause of community acquired pneumonia -Walking pneumonia with dry cough -cause URT infections lead to bronchitis or contribute to COPD take Nasopharyngeal/Oropharyngeal Dacron, nylon or rayon swabs (plastic shaft) in UTM or LRT sample in sterile container must be delivered to lab in <48hrs , refrigerate and transport on cold packs

Answer 37

only in specialty labs DFA, ELISA qPCR or multiplex

Answer 38

-found in aquatic environments like plumbing or AC -not NF and is NEVER spread P/P -transmitted by inhalation of infectious aerosols BSL-2 Two disease forms Pontiac fever- mild walking pneumonia Legionnaires -multi lobar pneumonia can cause septic disease Facultative intracellular parasite that uses pili to attach to macrophages in lungs, they get taken up by the macros and live in the lysozomes and multiply -bacteria produces a cytotoxin as inflammatory response which can cause lung damage

Answer 39

Specimens: Lower resp specimens + urine for antigen testing -if systemic = blood culture /tissue -need L cysteine to grow so cultured on Buffered Charcoal Yeast Extract agar (BCYE) -Plated to BCYE with L-cysteine & BCYE without L-cysteine -if growth with JUST BCYE with L-cysteine = presumptive Legionella however if growth on both then it isnt legionella Gray-white to blue, convex, ground glass colonies in 3-5 days GNB, can be pleomorphic, Motile, Cat: pos

Answer 40

BSL-2 organism Growth on only selective BCYE w cysteine & MALDI Legionella urinary antigen test: detects Legionella pneumophila serogroup 1 antigen from urine -DFA directly from specimen qPCR: 2 targets, Legionella spp, & L. pneumophila. Serology: Done only for outbreaks Organism phoned to MOH, Dr., ICP

Answer 41

Whooping cough -used to be fatal Transmission: aerosol droplet Virulence: produces many toxins 3 stages of disease infants are highest at risk

Answer 42

2 Nasopharyngeal specimens taken with Rayon or Dacron on flexible wire shaft -1 for culture and 1 for PCR -take in first 2-3 weeks of illness -swab for culture in Regan-Lowe transport media -store samples at 2-8 and send to PHL on ice packs =PCR swab in pcr specific media

Answer 43

BSL-2 Sent to PHL because needs special media and testing -PCR is most sensitive but also has false positives so must be confirmed with culture and test only ppl with symptoms Bordet-Gengou agar: Potato infusion- shiny domed white colony BH/NH Regan Lowe Charcoal agar- charcoal with or w/o cephalexin -colonies look like mercury drops -37 O2 high humidity for 7 days Must be phoned to MOH, Dr. & IC -DPT vaccine Non-motile oxidase: pos No growth on Mac or CHOC MALDI Gram neg coccobacilli

Answer 44

Branching GPB in Actinomycetes group -soil, water, and decaying plant -causes disseminated infection = high mortality rate Specimens: Sputum, BW, BAL, abscess fluid – all in sterile container Swabs are not acceptable

Answer 45

Presumptive ID microscopy & culture morphology BSL-2 Micro: Branching GPB & modified Acid –Fast positive Culture : Strict aerobe, Grows on BA, BHI & Sab (w/o antibiotics) -grows at RT -hold for 14 days -breadcrumb and chalky -definitive ID by MALDI or PCR

Answer 46

-sputum, BW, BAL in sterile container or nasopharyngeal swabs in UTM if for culture or PCR transport media DFA - use a Fluorescent labeled AB to detect AG = RSV , hflu , adenovirus Virus cell culture -grow on cell lines and look for CPE -test infected cells with pool of fluorescent ABs and if positive then test with specific monoclonal Ab Molecular - multiplex

Answer 47

-fungus -Airborne transmission by 3 yrs old you have the AB -many are carriers -ppl that are immunocomp get PCP -primary oppurtunistic infection in ppl with AIDS- DIAGNOSTIC FOR AIDS -3 stages Cyst is infective stage – trophozoite stage attacks alveoli -can spread to brain PCP (Pneumocystis carinii pneumonia)

Answer 48

Sputum, BAL or lung tissue in sterile container -cant be cultured -DFA with monoclonal AB or histological stains like Giemsa -qPCR

Answer 49

-C. neoformans spores in bird droppings -spread by inhalation BSL-2 -will cause pneumonia in ppl with AIDS and can spread to the brain -samples can be taken from ANY part of the body including blood or CSF Germ tube -neg Mucoid colonies due to capsule India ink pos Urea posi Chlamy - neg MALDI , PCR -Cryptococcal capsular antigen latex agglutination test to detect Ag in CSF for diagnosing patients with cryptococcal meningitis

Answer 50

Dimorphism: Exist in 2 forms Yeast at 30 or mold at 25 -start as lung infections and skin infections -in immunocomps it can become systemic

Answer 51

Inhalation of fungus in bat & bird feces

Answer 52

Inhalation of arthroconidia in soil -produces spherules in host tissue

Answer 53

Inhalation of fungus in soil around decaying wood

Answer 54

Inhalation fungus in soil in which coffee is grown-9 banded armadillo)

Answer 55

Inhalation of fungus in soil around roses, may also be on rose plants

Answer 56

Risk level 3 organisms -process and culture in CL2 lab and test in CL3 lab like PHL Specimens: tissue, blood culture, sputum, BW, BAL Ag or Ab detection: serological methods (EIA) Molecular testing: PCR Histological staining: find yeast or spherule in tissue Culture: on fungal media one at 25 and other at 35 - keep for 28 days examine daily for growth -examine microscopically by LPCB for conversion from mold to yeast

Answer 57

-found everywhere even in lab BSL 2 -If isolated from 1 specimen not sure if contaminant or not -True infection = repeat isolation from multiple specimens or if organism seen directly in tissue -transmission by spore inhalation -cause acute or chronic lung infection Specimens: Sputum, BAL, tissue or blood for serology Lab diagnosis: Direct microscopic exam from specimen Cultured then LPCB microscopic exam of growth PCR asp = hyphae & spores mucor = lid lifter

Answer 58

Hookworm Ascaris Strongyloides larvae travel from blood stream to lungs, get coughed up & swallowed again into the intestine

Answer 59

Strict aerobe, non-motile, bacilli -cell wall has mycolic acids which is a virulence factor making cell wall less permeable. Protects the org -cant be grammed -mycolic acid makes org acid fast

Answer 60

-found in environment -trasmitted by showers or hot tubs -non pathogenic -can be opportunistic in immunocomp or ppl with underlying lung disease -cause disease like TB in lungs or skin infection -NTM are further classified into 4 groups called Runyon Classification based on how fast or slow they grow and if they produce pigment in light/dark or not at all

Answer 61

NTM THAT CAUSE LUNG INFECTION -part of Mycobacteria avium complex (MAC) -M. avium-intracellularae & M. avium-paratuberculosis -causes same lung disease as TB and can disseminate through the body -more resistant to anti –TB drugs & have a high prevalence in AIDs patients

Answer 62

NTM THAT CAUSE LUNG INFECTION M. abscessus -causes lung infection in ppl with cystic fibrosis -can infect wound

Answer 63

cause tuberculosis in humans & animals. Slow growers & Non pigmented -M. tuberculosis: most common cause of TB in humans can also infect animals -M. bovis: causes bovine TB –used in BCG vaccine -M. africanum- ONLY in humans

Answer 64

-caused by Mycobacterium tuberculosis -multidrug resistant -co infections with TB-HIV -known as Consumption & Pott's disease (TB in spine) -site for TB is pulmonary tract – can become systemic -opportunistic -found in overcrowded places or areas with famine -3 stages : Primary active, Latent or Secondary/Reactivated

Answer 65

Transmitted via aerosol droplet- only need to inhale 10 bacilli to get infected look at slide Primary/initial infection = goes right to active TB 2ndary TB= latent dormant infection seen as Bacilli confined with granuloma

Answer 66

Two types skin & blood test - used to identify individuals previously exposed to TB Mantoux tuberculin skin test (TST): -inject PPD of TB in arm -examine injection site after 48-72 hrs for hive Interferon gamma (IFN-γ) Blood test (IGRA): -Mix blood with specific TB protein antigens –incubate for 16-24 hrs -If person has sensitized/activated T-lymphs to TB antigens, T-lymphs will secrete IFN- γ cytokine -test plasma for IFN-y with ELISA

Answer 67

-mycobacteria tuberculosis are BSL3 pathogens -transmitted by aerosol to laboratory personnel -process specimen in CL2 lab with Class II type A BSC with additional PPE & respirators if aerosol risk high -culture and test in CL3 lab

Answer 68

3 sputum specimens of 5-10 mL, BAL, BW, TTA Gastric lavage, body fluids, tissue biopsy, urine (40ml) -collect in plastic sterile container -liquid sample spun and sediment is place on media and tissue ground up -Don’t screen sputum specimens for acceptability -blood culture vials or blood for interferon gamma assays -culture must be processed in an hour everything BUT blood or CSF can be kept at 4 degrees up to 24 hours if there is a delay -molecular detection of MTB or NTM with sputum or biopsy

Answer 69

Homogenize (liquify) with N-acetyl-L-cysteine -Decontaminate with NaOH to remove normal flora (not done on sterile specimens)

Answer 70

-symptoms swollen lymph nodes, chest xray to look for granulomas, TB test Microscopy for AFB Culture (media or automation) Phenotypic immunological Id tests Molecular testing AST -TB becoming highly resistant

Answer 71

Acid fast bacilli – all stains use higher conc’n of acid alcohol decolorizer (3%) stain with AFS Ziehl Neelsen (ZN)- Hot stain - uses heat to get primary stain of carbol fuchsin into the cell wall Kinyoun Cold stain uses Carbol with higher conc’n of basic fuchsin and phenol . Counterstain both with methylene blue AFB are pink and other orgs are blue Auramine Rhodamine fluorescent stain + potassium permanganate quencher (removes non-specific fluorescence) Auramine O (read at 40X) Kinyoun/ZN (read with oil 100x)

Answer 72

solid media either egg based, or agar based + broth media Lowenstein-Jensen(LJ) (egg-based solid media): selective -malachite green -inhibits respiratory flora . Media cloudy because of egg Middlebrook 7H10 or 7H11 (agar- based solid media): Selective = antibiotics + malachite green -inhibits respiratory flora. Media is clear to make it easier to count Middlebrook 7H9 broth: (example of liquid media) some fastidious mycobacteria grow only in liquid BACTEC 960 MGIT - own broth 7H9 broth

Answer 73

-Broth & solid media incubated in CO2 at 35-37ºC for 6-8 weeks – (usually in dark) -look at 2X a week for first 2 weeks & then weekly for 8 weeks. -look at Rate of growth, colonial morphology and pigmentation -wait 8 week before reported negative -on egg media MTB looks like breadcrumbs

Answer 74

Positive for Niacin , nitrate reduction, peroxidase, pyrazinamide test , growth on tch

Answer 75

BCG (Bacille Calmette-Guérin): live attenuated (weakened) strain of M. bovis