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YR5 Microbiology > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What does the term URTI cover?

A

Sinusitis
Tonsilitis

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2
Q

What does the term LRTI cover?

A

Bronchitis
Pneumonia
Empyema
Bronchiectasis
Lung abscess

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3
Q

Give 5 ways in which respiratory defences can be compromised

A

Poor swallow: CVA, muscle weakness
Abnormal ciliary function: Smoking, Kartagener’s
Abnormal mucous: CF
Dilated airways: Bronchiectasis
Defects in host immunity: HIV, Drugs

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4
Q

What is the abnormality seen here?

A

Double heart border “Sail sign”
Left lower lobe collapse

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5
Q

What is seen on CT here?

A

Densely consolidated + collapsed left lower lobe

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6
Q

18F
Left lower lobe pneumonia
Unwell
Raised WCC + CRP
What is the likely organism?
A. Pseudomonas aeruginosa
B. Mycobacterium tuberculosis
C. Legionella pneumophilia
D. Streptococcus pneumoniae
E. Staphylococcus aureus

A

D. Streptococcus pneumoniae

30-50% of CAP

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7
Q

Give 3 features of streptococcus pneumoniae under microscope

A

Gram +ve cocci (pairs + chains)
Alpha haemolytic
Optochin sensitive

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8
Q

List 4 symptoms/ signs of S. pneumoniae

A

Acute onset
Severe pneumonia
Fever, rigors
Lobar consolidation

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9
Q

What is S. pneumoniae almost always sensitive to?

A

Penicillin

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10
Q

What is pneumonia? How sick are patients generally?

A

Inflammation of lung alveoli
Community acquired or Hospital acquired
5-10% Mortality
20-40% admitted to hospital

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11
Q

Give 5 common signs/ symptoms of pneumonia

A

Fever
Cough +/- sputum
SOB
Pleuritic chest pain
Often localising signs + abnormal CXR

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12
Q

List 4 factors to consider when assessing possibility of pneumonia

A

Pre-existing lung disease
Immunocompromised
Travel, seasons, epidemics
Exposure to animals

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13
Q

List the 5 main causative organisms of CAP

A

Streptococcus pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Moraxella catarrhalis
Klebsiella pneumoniae

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14
Q

How does age influence susceptibility to different causative organisms for CAP?

A

0-1m: E. coli, GBS, Listeria monocytogenes
1-6m: Chlamydia trachomatis, S aureus, RSV
6m-5y: M pneumoniae, Influenza
16-30: M pneumoniae, S pneumoniae

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15
Q

What are the typical causes of CAP? How many cases do they account for?

A

S pneumoniae
H influenza
85%

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16
Q

What 4 atypical organisms must be accounted for when treating CAP? Give a feature or exposure associated with each

A

Legionella: water exposure, A/C
Mycoplasma: barking cough, normal CXR
Coxiella burnetii (Q-fever): farm animals
Chlamydia psittaci: bird exposure

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17
Q

Give 7 signs that may be found on examination in a patient with CAP

A

Pyrexia
Tachycardia
Tachypnoea
Cyanosis
Dullness to percussion, tactile vocal fremitus
Bronchial breathing
Crackles

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18
Q

What investigations should be sent when suspecting CAP?

A

FBC, U+Es, CRP
BC, Sputum MC+S
ABG
CXR
Urinary antigen: legionella + s aureus

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19
Q

What is the CURB-65 score designed for?

A

Predicting mortality of CAP
Score 2: ?Admit
Score 2-5: Manage as severe

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20
Q

What are the elements of the CURB-65 score?

A

Confusion
Urea >7 mmol/l
RR >30
BP <90 sys, <60 dia
>65y

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21
Q

What is bronchitis? Which patients is it mostly seen in?

A

Inflammation of medium sized airways
Smokers

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22
Q

List 4 signs/ symptoms of bronchitis

A

Cough
Fever
Increased sputum production
Increased SOB

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23
Q

How does bronchitis appear on CXR?

A

Normal

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24
Q

List 4 organisms causative of bronchitis

A

Viruses
S pneumoniae
H influenzae
M catarrhalis

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25
Q

What is the treatment for bronchitis?

A

Bronchodilation
Physiotherapy
+/- Abx

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26
Q

What can be seen here?

A

Cavitation on LHS

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27
Q

56M
Left lower lobe pneumonia
Haemoptysis
Cavitation on CXR
What organism would you suspect?
A. S pneumoniae
B. H influenzae
C. S aureus
D. Klebsiella pneumoniae

A

B. H influenzae

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28
Q

Give 3 features of H influenzae under the microscope

A

Gram -ve Cocco-bacilli
Stain on Chocolate agar
May produce B-lactamase

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29
Q

Give 2 epidemiological features of H influenzae

A

15-35% CAP
More common with pre-existing lung disease

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30
Q

What is seen here?

A

Bilateral interstitial change

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31
Q

62M smoker
SOB
Confused
Bilateral interstitial change
Hyponatraemic
What is the likely organism?
A. Moraxella catarrhalis
B. Mycobacterium tuberculosis
C. Legionella pneumophilia
D. Cytomegalovirus
E. Staphylococcus aureus

A

C. Legionella pneumophilia

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32
Q

What similarity to atypical organisms share?

A

No cell wall
thus cell-wall active abx e.g. penicillin ineffective
Often extra pulmonary features e.g. hepatitis, low Na

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33
Q

How is legionella transmitted? What culture is required to grow it on?

A

Inhalation of infected water droplets e.g. A/C, fountain
Buffered charcoal yeast extract agar

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34
Q

What agents are required to treat atypical pneumonias?

A

Targeting protein synthesis:
Macrolides e.g. Clarithromycin, Erythromycin
Tetracyclines e.g. Doxycycline

35
Q

Atypical organisms account for … CAP? How do they usually arise?

A

20%
Flu-like prodrome before fever + pneumonia

36
Q

Give 4 symptoms/ manifestations of legionella pneumophila pneumonia

A

Confusion
Abdo pain
Diarrhoea
Multi-organ failure

37
Q

What blood results are associated with legionella pneumophila pneumonia?

A

Hyponatraemia
Lymphopenia

38
Q

What investigations should be sent for legionella pneumophila pneumonia?

A

Legionella urinary antigen
Sputum/ blood sample

39
Q

In which organisms is Coxiella burnetii common? How is Coxiella burnetii transmitted?

A

Domestic/ farm animals

Aerosol/ milk transmission

40
Q

How is Coxiella burnetii pneumonia and Chlamydia psittaci pneumonia diagnosed?

A

Serology

41
Q

In which organisms is Chlamydia psittaci common? How is Chlamydia psittaci transmitted?

A

Birds
Inhalation

42
Q

What can be seen here?

A

Homogenous shadowing/ shadowing with meniscus level on RHS

43
Q

74F
SOB, fever, right sided pleuritic chest pain
Reduced percussion note + decreased air entry right base
Right lower lobe pneumonia
On standard abx
Not improving
What is the probable diagnosis?
A. TB
B. Empyema
C. Mesothelioma
D. MRSA pneumonia
E. Aspiration pneumonia

A

B. Empyema

44
Q

What can be seen here?

A

Large empyema with collapsed lung underneath

45
Q

Why are empyemas difficult to treat?

A

Wall around them + pus itself is very acidotic which inactivates abx

46
Q

What 7 reasons may explain why a pneumonia is failing to improve with treatment?

A

Empyema/ abscess
Proximal obstruction: tumour
Resistant organism, inc. TB
Not receiving/ absorbing abx
Immunosuppression
Lung cancer
Cryptogenic organising pneumonia

47
Q

Describe the radiograph. What is this characteristic of?

A

Patchy to speckled infiltration
Ground glass appearances
SARS-CoV-2

48
Q

What can be seen here?

A

RHS apical shadowing

49
Q

21M from Ecuador
Cough and weight loss
RUZ shadowing on CXR
What is the causative organism?
A. S aureus
B. Aspergillus fumigatus
C. Mycobacterium tuberculosis
D. H influenzae
E. Pneumocystis jiroveci

A

C. Mycobacterium tuberculosis

50
Q

Why is TB sometimes referred to as “the White Plague”?

A

Sometimes there is a complete “white out” of chest on CXR

51
Q

Give 5 clues that suggest TB

A

Ethnicity
Prolonged prodrome
Fevers +/- Night sweats
Weight loss
Haemopytsis

52
Q

What is commonly found on CXR in TB?

A

Upper lobe cavitation
(can vary- abscess, miliary seeding pattern)

53
Q

What staining is used to identify TB?

A

Auramine stain
Ziehl-Neelsen stain

54
Q

What can be seen here?

A

Smear +ve ZN stain
TB = red rods
Acid fast bacilli

55
Q

What is hospital acquired pneumonia? What investigation is desirable?

A

Pneumonia onset >48h in hospital
Often previous abx +/- ventilator
Bronchial lavage to differentiate upper respiratory from lower respiratory flora

56
Q

List 3 main causes of HAP

A

31%: Enterobacteriaciae e.g. E. coli, K. pneumoniae
19%: S. aureus
17%: Pseudomonas spp

57
Q

64M
Treated for LN TB
Increasing SOB over 1m
Non-productive cough
Bilateral ground-glass shadowing

What is the likely organism?
A. Aspergillus fumigatus
B. H1N1 Swine flu
C. Mycoplasma pneumoniae
D. Cytomegalovirus (CMV)
E. Pneumocystis jiroveci

A

E. Pneumocystis jiroveci

58
Q

What can be seen here?

A

Bilateral ground glass shadowing

59
Q

Give 2 facts about Pneumocystis jirovecii

A

Protozoan
Ubiquitous in environment

60
Q

Give 5 features of Pneumocystis jirovecii presentation

A

Insidious onset
Dry cough
Weight loss
SOB
Malaise

61
Q

What is the classic CXR finding of Pneumocystis jirovecii?

A

“Bat’s wing”
Bilateral ground glass shadowing

62
Q

What investigation and treatment is needed for Pneumocystis jirovecii?

A

Ix: Immunofluorescnece on BAL
Rx: Septrin (Co-trimoxazole)

63
Q

What is the walking test suggestive of Pneumocystis jirovecii?

A

attaching O2 sats probe + asking patient to walk will show desaturation on exertion

64
Q

What prophylaxis should those on immunosuppressants take against Pneumocystis jirovecii?

A

Septrin

65
Q

22M
Chemo for leukaemia
Prolonged neutropenia <1.0
Ongoing fevers
Abx failed
Interstitial change on CT

What is the likely organism?
A. MRSA
B. Aspergillus
C. Tuberculosis
D. CMV
E. Drug reaction

A

B. Aspergillus

66
Q

What can be seen on this CT?

A

Interstitial changes

67
Q

What are the 3 types of aspergillus?

A

Allergic bronchopulmonary aspergillosis
Aspergilloma
Invasive aspergillosis

68
Q

Give 3 features of allergic bronchopulmonary aspergillosis

A

Chronic wheeze
Bronchiectasis
Eosinophilia

69
Q

Give 2 features of Aspergilloma

A

Aspergilloma fungal ball in pre-existing cavity (often from TB)
May cause Haemoptysis

70
Q

Which patients are susceptible to invasive aspergillosis? What treatment is required?

A

Immunocompromised
Rx: Amphotericin B

71
Q

Which LRTIs are HIV patients particularly susceptible to?

A

PCP
TB
Atypical mycobacteria

72
Q

Which LRTIs are neutropenic patients particularly susceptible to?

A

Fungi e.g. Aspergillus spp

73
Q

Which LRTIs are bone marrow transplant patients particularly susceptible to?

A

CMV

74
Q

Which LRTIs are splenectomy patients particularly susceptible to?

A

Encapsulated organisms:
S. pneumoniae
H. influenzae
Malaria

75
Q

What samples should ideally be sent prior to antibiotics administration?

A

Sputum/ induced sputum
Blood cultures

76
Q

For which species are urine antigen tests available?

A

S. pneumoniae
Legionella pneumophila

77
Q

When are antibody tests useful in respiratory tract infections?

A

In organisms difficult to culture e.g. Chlamydia + Legionella
Only useful in paired serum samples e.g. at presentation + 14d later
Look for rise in antibody over time

78
Q

What is the empirical therapy for mild-moderate CAP?

A

Amoxicillin
Or erythromycin/ clarithromycin

79
Q

What is the empirical therapy for moderate-severe CAP?

A

Needing admission: Augmentin (co-amoxiclav) + Clarithromycin
Allergic: Cefuroxime + Clarithromycin

80
Q

What is the empirical therapy for HAP?

A

1st: Ciprofloxacin +/- Vancomycin
2nd/ ITU: Piptazobactam + Vancomycin

81
Q

What specific therapy is used for MRSA HAP?

A

Vancomycin

82
Q

What specific therapy is used for pseudomonas HAP?

A

Piptazobactam or Ciprofloxacin
+/- Gentamicin

83
Q

What can be recommended to prevent pneumonia?

A

Smoking cessation
Vaccination: Flu, pneumovax, COVID-19

YR5 Microbiology (23 decks)

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