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Infection Flashcards

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1
Q

Definition of pneumonia

A

An inflammation of the substance of the lungs/parenchyma in which the air sacs fill with pus and may become solid

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2
Q

What is protection against pathogenic bacteria provided by?

A

Colonisation
- commensal flora and colonisation resistance

Swallowing
- enruological + anatomical factors

Lung anatomy

  • mucociliary escalator
  • cough reflex

Immunity (innate and adaptive)

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3
Q

Symptoms of pneumonia

A

pyrexia (fever)

Resp symptoms:
cough
sputum
chest pain (pleurisy)
dyspnoea
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4
Q

Precipitating factors for pneumonia

A 
infants + elderly
underlying lung disease
immunocompromised
impaired swallow
congestive HF
alcoholics + drug users
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5
Q

Epidemiology of legionella pneumophila (a cause of CAP)

A

summer, water tanks, travel related (50%)

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6
Q

Epidemiology of chlamydophila pneumoniae

A

often older adults, sometimes closed outbreaks, longer duration of symptoms

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7
Q

If someone had contact with sick birds, what would you suspect?

A

chlamydophila psittaci

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8
Q

If someone had had contact with farm animals, esp sheep, what would you predict

A

Coxiella burnetti

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9
Q

Pathogenesis of pneumonia

A

Bacteria ‘translocate’ to the normally sterile distal airway

‘overwhelm’ resident host defence

‘develop and inflammatory response’

‘resolution phase’ when bacteria cleared

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10
Q

When would severe disease occur? (pathogenesis of pneumonia)

A

excessive inflammation
lung injury
and/or failure to resolve without lung damage

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11
Q

What does rusty sputum suggest?

A

S. pneumoniae

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12
Q

Pneumonia signs

A

Abnormal vital signs
Signs of lung consolidation on percussion + auscultation

+/- hypoxia + signs of resp failure

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13
Q

Investigations for pneumonia

A

WCC - aids Dx and is a marker for severity

CXR

Sputum - Gram stain, culture + sensitivity tests

Serology - for viruses + atypical organisms

Pulse oximetry (severity) +/- ABG (define RF)

CRP

Urinary antigen - legionella +pneumococcal antigens

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14
Q

What would CXR with upper lobe cavity suggest?

A

K. pneumoniae

but must exclude TB

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15
Q

What would a CXR with multilobal consolidated area suggest?

A

S. pneumoniae,
S. aureus
Legionella sp.

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16
Q

Assessment of severity in pneumonia

A

CURB65
Predicts mortality

confusion, urea, resp rate, BP, age

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17
Q

Tx for mild severity pneumonia in community

A

amoxicillin

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18
Q

Tx for moderate severity pneumonia

A

amoxicillin + clarithromycin

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19
Q

Antibiotic Tx severe pneumonia

A

co-amoxiclav + clarithromycin
or
cefuroxime + clarithromycin

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20
Q

Whats the duration to classify as severe pneumonia?

A

7-10 days

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21
Q

Specific Tx for severe legionella sp pneumonia?

A

Ensure fluoroquinolone in regimen either alone or with clarithromycin

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22
Q

Prevention of pneumonia

A

Polysaccharide pneumococcal vaccine

Influenza vaccine to those >65 yrs, Immunocompromised or with co-morbidities

Smoking cessation

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23
Q

Complications of pneumonia

A

lung abscess

empyema (presence of pus in the pleural cavity)

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24
Q

What can cause pus in the pleural cavity? and whats the presentation?

A
  1. rupture of lung access
  2. bacterial spread of severe pneumonia

Px: very ill, high fever and neutrophil leucocytosis

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25
What's a lung abscess?
From localised suppuration of the lung with cavity formation, often with a fluid level on CXR
26
What causes a lung abscess?
Complicating pneumonia Secondary to bronchial obstruction From septic emboli from a focus elsewhere Secondary to infarction
27
What needs to happen promptly to an empyema?
Drainage by catheter insertion or chest tube placement
28
Antibiotics for empyema?
co-amoxicalv
29
Who are lung abscesses seen in and whats the Tx?
aspiration, alcoholics and those with poor dentition prolonged antibiotics for up to 6 wks may need surgical drainage
30
What would you suspect an elderly in patient with new fever, purulent secretions, radiological infiltrates, leukocytosis and increasing O2 requirements to have?
HAP (acquired at least 2 days after admission) could be Staph. aureus including methicillin resistant
31
What's the m. tuberculosis complex?
m. tuberculosis and m. bovis aerobic, non-spore forming non-motile bacteria with high content of high MW lipids in its cell wall
32
what is post-primary Tb?
all forms of tb that develop after the 1st few weeks of the primary infection when immunity to the mycobacterium has developed
33
What is in the primary focus in TB characterised by?
exudation + infiltration with neutrophil granulocytes
34
What's a Gohn complex in TB?
In primary infection | The gohn focus (typical granulotamous lesions formed by macrophages), as well as caseous lesions in regional lymph nodes
35
what is maxillary tb as a result of?
acute dissemination of tubercle bacilli via the bloodstream
36
how is tb spread?
in aerosol from infected individual's lung to another lung or via spitting or sneezing on plates or hands
37
Whats the natural history for most cases of TB?
the immune response enables the primary complex to encapsulate + contain the organism forever lesions become fibrosic + calcify but may continue to house viable but dormant organisms for decades
38
What factors would favour Tb disease (not infection) to develop?
age immunosuppression malnutrition intensity of exposure reinfection/new exposure
39
Post-primary TB - whats this due to?
usually endogenous reactivation but also reinfection
40
Where do secondary TB lesions develop?
in the regional lymph nodes
41
What forms the primary complex?
granuloma (formed by macrophages) + lymphatics + lymph nodes
42
If primary disease isn't contained, what happens (TB)?
there is haematogenous dissemination, often leads to serious pulmonary disease
43
what is post primary disease?
reactivation after a dormant phase
44
systemic features of active TB
``` weight loss* low grade fever anorexia night sweats* malaise ```
45
Symptoms of pulmonary TB
chest pain, dyspnoea upper lobe consolidation: dull apex with bronchial breathing compression by LN: collapse, cough etc.
46
Ix TB
CXR: patchy or nodular shadows in the upper zones Sputum/bronchoscopy with washings LP: to examine CSF for evidence of infection in all cases of military TB
47
contact tracing for tb?
report all cases to the local Public Health Authority
48
Drug treatment for TB
DOT (directly observed therapy) rifampicin isoniazid pyrazinamide ethambutol
49
what tb drug has a possible side effect of optic neuritis?
ethambutol
50
what drug stains body secretions and urine pink (TB)
rifampicin
51
whats the BCG vaccine?
a bovine strain of M. tuberculosis which has lost its virulence after growth in the lab for many years immunisation produces cellular immunity and a positive mantoux test
52
rifampicin mechanism of action
inhibits bacterial DNA-dependent RNA synthesis by inhibiting bacterial DNA-dependent RNA polymerase.
53
Pharyngitis aetiology
**viral**: rhinovirus, adenovirus glandular fever EBV Acute HIV infection streptococcus pyogenes,
54
what viruses cause croup?
parainfluenza viruses
55
what is sinusitis usually caused by?
viral infection
56
what do rhinoviruses cause?
rhinoviruses: common cold, bronchitis, sinusitis
57
what do coronaviruses cause?
colds but occasionally severe respiratory illnesses
58
what do adenoviruses cause?
URT infection, pharyngitis, bronchitis, occasional pneumonia
59
emerging respiratory virus infections
SARS Middle East Respiratory Syndrome novel Coronavirus Avian influenze
60
What URT infection does haemophilus influenza type B (Hib) cause?
acute epiglottitis
61
Whats another name for acute laryngo-treacheobronchitis?
croup! mainly due to parainfluenza viruses
62
what does respiratory syncytial virus cause?
bronchiolitis

Respiratory (16 decks)

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