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Microbiology > Respiratory tract infections > Flashcards

Respiratory tract infections Flashcards

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1
Q

Which part of the lung is inflamed in pneumonia?

A

Alveoli, usually in one lobe. Can also be bronchopneumonia.

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2
Q

How does pneumonia present?

A

Fever, cough, pleuritic chest pain, SOB

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3
Q

What are the signs of pneumonia on CXR?

A

Airspace opacity, lobar consolidation, or interstitial opacities. No loss of volume.

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4
Q

How is pneumonia severity assessed? (scoring system)

A

CURB 65

C: confusion of new onset (defined as an AMTS of 8 or less)
U: Blood Urea nitrogen greater than 7 mmol/l (19 mg/dL)
R: Respiratory rate of 30 breaths per minute or greater
B: Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less

Age 65 or older

Each scores 1 point to give a total score /5. Used to predict severity, mortality, whether treatment should be oral or IV and whether to admit: -
0-1: Treat as an outpatient
2: Consider a short stay in hospital or watch very closely as an outpatient
3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit

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5
Q

What is the treatment for pneumonia?

A

Supportive (O2, fluids etc) and antibiotics

Abx
Community: Amoxicillin (or, if penicillin allergy, clarithromycin or doxycycline)

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6
Q

What is bronchitis?

A

Inflammation of the medium sized airways, usually in smokers.

Criteria for diagnosis: cough with sputum most days for 3 months, for 2 or more consecutive years.

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7
Q

How does an acute exacerbation of chronic bronchitis (AECB) present?

A

Cough, fever, increased sputum production, increased SOB

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8
Q

What are the signs of bronchitis on CXR?

A

None - it will look normal

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9
Q

Which organisms are most commonly implicated in an acute exacerbation of chronic bronchitis (AECB)?

A

Viruses
S. pneumoniae
H. influenzae
M. catarrhalis

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10
Q

What is the treatment for bronchitis/AECB?

A

Bronchodilation
Physiotherapy
+/- Abx if clinically indicated (eg worsening presentation)

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11
Q

Which 5 pathogens are most likely to cause a classical pneumonia? (Signs present on both chest exam and CXR)

A 
S. pneumoniae
H. influenzae
M. catarrhalis
S. aureus
K. pneumoniae
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12
Q

Which pneumonia-causing pathogen can be vaccinated against?

A

S. pneumonia

Vaccination given to at-risk groups incl babies and >65

NB Hib also vaccinated against, not in path guide

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13
Q

Which pneumonia-causing pathogen causes rust-coloured sputum?

A

S. pneumonia

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14
Q

Which pneumonia-causing pathogens are associated with smoking?

A

H. influenza and M.catarrhalis

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15
Q

Which pneumonia-causing pathogen is associated with a recent viral infection (eg post influenza) and cavitation on CXR?

A

S. aureus

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16
Q

Name 4 atypical pneumonia-causing pathogens. (NB, these cause a pneumonia with no signs on chest exam or not in keeping with CXR)

A

Legionella pneumophilia
Mycoplasma pneumonia
Chlamydia pneumonia
Chamydia psittaci

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17
Q

In atypical pneumonias, what feature do the “atypical” pathogens have in common?

A

All lack a cell wall

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18
Q

As the atypicals lack a cell wall, what problem does this pose for their treatment?

A

Don’t respond to penicillin abx, therefore require macrolides and tetracyclines

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19
Q

Which atypical should you consider if a hx includes: travel, air conditioning or water towers?

A

Legionella pneumophilia

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20
Q

Which 3 autoimmune conditions can be triggered by the atypical Mycoplasma pneumophilia?

A

Cold agglutinin disease
Stevens Johnson Syndrome (SJS)
Autoimmune haemolytic anaemia (AIHA)

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21
Q

What are the extrapulmonary features in Legionella pneumophilia?

A

Hepatitis and low Na

22
Q

Due to its autoimmune sequelae, which systemic features may occur in Mycoplasma pneumophilia infection?

A

Joint pain and erythema multiforme. Cold agglutinin test should be performed.

23
Q

What is the TWAR agent?

A

Former name of Chlamydia pneumoniae (Taiwan acute respiratory agent). Very difficult to diagnose.

24
Q

Which atyptical pneumonia-causing pathogen is associated with birds?

A

Chlamydia psittaci

25
Q

When should you worry about Bordatella pertussis?

A

Whooping cough in someone unvaccinated, eg travellers

26
Q

What might suggest that a pneumonia is actually TB?

A

Poor response to antibiotics

27
Q

Which pathogens are associated with resp tract infection in immunosuppression due to HIV?

A 
Pneumocystis jiroveci (pneumocystis pneumonia/PCP) (fungus)
TB
Cryptococcus neoformans (encapsulated yeast)
28
Q

Which pathogens are associated with resp tract infection in immunosuppression due to neutropaenia?

A

Fungi - several Aspergillus species

29
Q

Which pathogens are associated with resp tract infection in immunosuppression due to bone marrow transplant?

A

Aspergillus

CMV

30
Q

Which pathogens are associated with resp tract infection in immunosuppression due to splenectomy?

A

Encapsulated organisms: H. influenzae, S. pneumoniae, N. meningitidis

31
Q

Which pathogens are associated with resp tract infection in immunosuppression due to cystic fibrosis?

A 
Pesudomonas aeruginosa
Burkholderia cepacia (v high mortality)
32
Q

Aside from blood culture, name 3 methods of diagnosing the specific pathogen in pneumonia.

A

Urine antigen tests
Antibody tests
Immunofluorescence

33
Q

When is urine antigen testing used and what can it test for?

A

Used in severe community acquired pneumonia (CAP) which is not responding to treatment.

Can be used to test for Legionella and Strep. pneumoniae.

34
Q

How are antibody tests performed and what do they test for?

A

Used for difficult-to-culture organisms. Serum antibodies measured at presentation and 10-14 days later. Rise over time indicates infection.

Used for Chlamydia and Legionella

35
Q

Name two methods of testing for pneumocystis pneumonia (PCP - fungus - associated w/HIV)

A
  • Immunofluorescence - antibody labelled w/ fluorescent dye, normally used in virology
  • Silver stain in cytology lab - “boat shaped organisms”
36
Q

Which pathogen has a “boat shaped” appearance with silver staining?

A

Pneumocystis (PCP) - yeast, common in HIV

37
Q

What are the criteria to define a pneumonia as hospital acquired (HAP)?

A

> 48hr hospital stay with no previous infection

38
Q

When would you use bronchoalveolar lavage (BAL) in pneumonia?

A

To differentiate between URT and LRT microbes.

39
Q

Name two sub-types (sites) of URTI

A

Sinusitis

Tonsilitis

40
Q

Name five sub-types (sites) of LRTI

A 
Bronchitis
Pneumonia
Empyema
Bronchiectasis
Lung abscess
41
Q

What are the standard antibiotics for a mild-moderate community acquired pneumonia?

A

Amoxicillin or macrolide for 5-7 days

42
Q

What are the standard antibiotics for a moderate-severe community acquired pneumonia?

A

Claritromycin + Co-amoxiclav/cefuroxime for 2-3 weeks

43
Q

What are the standard antibiotics for an atypical community acquired pneumonia?

A

Depends on local policy, but must be an antibiotic that targets protein synthesis, ie macrolide (eg clarythromycin) or tetracycline

44
Q

What are the 1st line antibiotics for hospital acquired pneumonia (HAP)?

A

Ciprofloxacin +/- vancomycin

45
Q

What are the 2nd line antibiotics for hospital acquired pneumonia (HAP)?

A

Piptazobactam +/- vancomycin

46
Q

What are the standard antibiotics for aspiration pneumonia?

A

Cefuroxime +/- metronidazole

47
Q

Which antibiotics are indicated for community acquired legionella pneumonia?

A

Macrolide + rifampicin

48
Q

Which antibiotics are indicated for community acquired staph aureus pneumonia?

A

Flucloxacillin

49
Q

Which antibiotics are indicated for hospital acquired pseudomonas pneumonia?

A

Piperacillin + tazobactam (tazocin) or ciprofloxacin +/- gentamicin

50
Q

Which antibiotics are indicated for hospital acquired MRSA pneumonia?

A

Vancomycin

Microbiology (27 decks)

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