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Flashcards in Lec 7 Pneumonia Deck (78):
1

What is definition of pneumonia?

infection of pulmonary parenchyma

2

What 3 general routes to lower respiratory tract?

- inhalation of particles
- aspiration
- blood stream [less common]

3

What virulence factor for chlamydophila pneumonia?

ciliostatic factor

4

What virulence factor for mycoplasma pneumoniae?

shear off cilia

5

What virulence factor for influenza virus?

reduces tracheal mucus velocity

6

What virulence factor for strep pneumoniae?

- produces proteases that split secretory IgA
- has capsule that inhibits phagocytosis

7

Which 2 types of bugs are resistance to microbicidal activity of phagocytes?

mycobacterium
legionella

8

What things might cause increase volume of inoculum?

- laryngeal dysfunction
- gastric dysfunction = stomach really full + you vomit

9

What things can increase concentration of pathogen?

- gingival or sinus disease = source of bacteria in you

- achlorhydria [less acid in stomach that kills bacteria]

- prolonged critical illness

- breathing tube

10

What is morphology of strep pneumoniae?

gram positive cocci in pairs or diplococci

has polysaccharide capsule

11

Where does strep pneumo come from?

normally inhabits oropharynx in adults

12

What kind of pneumonia do you get with S. pneumonia?

step1

- mostly lobar
- also bronchopneumonia

13

What is morphology of staph aureus?

gram positive cocci in clusters

14

What settings do you usually get staph aureus pneumonia?

- secondary complication of resp tract infection with influenza
- hospitalized immune compromised pt
- widespread dissemination through blood stream

15

What kind of pneumonia do you get from staph aureus?

step1

bronchopneumonia

16

What is morphology of hemophilus influenzae?

small coccobacillary gram negative organism

17

What kind of setting do you usally get H influenza pneumonia?

often colonizes nasopharynx of normal people and lower airway of pts with COPD

18

What is morphology of klebsiella pneumoniae?

large gram-negative bacillus

19

What is setting of klebsiella pneumonaie pneumonia?

often in alcoholics
found in GI tract

20

What bug should you think if you hear "thick blood mucoid sputum" = currant jelly sputum?

klebsiella pneumoniae

21

What is morphology of pseudomona aeruginosa?

gram negative bacillus

22

What is setting of pseudomonas aeruginosa pneumonia?

- found in environmental sources
- big problem in pts who are debilitated, hospitalized and previously treated with antibiotics

23

What is setting of legionella pneumophila infection?

- affects previously healthy and those with prior resp impairments

24

What is morphology of legionella pneumophila?

gram negative bacillus
stains very poorly so can't use conventional stani methods

25

What are some signs of legionella pneumophila pneumonia?

may have lots of nonrespiratory manifestations

-- GI, CNS, hepatic, renal

26

What is morphology of chlamydophila pneumoniae?

obligate intracellular parasite

note readily cultured

27

What is morphology of mycoplasma pneumoniae?

- intermediate between virus and bacteria
- no rigid cell walls
- do not need host cell to replicate

28

Who gets mycoplasma pneumoniae? how does it present?

happens in young adults

get walking pneumonia = chest radiograph looks much worse than clinical presentation

29

What is most common predisposing factor for anaerobic pneumonia?

aspiration of secretions by:
-- impaire consciousness --> coma, alcohol, seizure

-- difficulty swallowing [neuromuscular disease]


also at higher risk if poor dentition or gum disease = larger burden of organisms

30

Who mostly gets viral pneumonia?

kids

31

What is pathology of pneumonia?

infection and inflammation of distal pulmonary parenchyma

have influx neutrophils, edema, erythrocytes,etc

32

What is bronchopneumonia?

step1

distal airway inflammation and alveolar disease

spread of infection/inflammation occurs through airways

patchy distribution

involves > 1 lobe

33

What are 4 major causes of bronchopneumonia?

step1

- staph aureus [+ cluster]

- strep pneumo [+ diploccoci]

- Klebsiella [- large rod, currant]

- H influenza [- small coccobacilli]

34

What is lobar pneumonia?

step1

infectious process through entire lobe of lung

appears as dense consolidation

spread from alveolus to alveolus through interalveolar pores of Kohn

35

What are 3 major causes of lobar pneumonia?

step1

s. pneumoniae = most frequent [+ diplococci]

legionella [- rod poor stain]

klebsiella [- large rod, currant]

36

What is interstitial pneumonia?

- inflammatory process within interstitial walls rather than alveolar spaces

- diffuse patchy inflammation

- distribution > 1 lobe

37

What major causes for interstitial pneumonia?

- viruses [influenza, RSV, adenovirus]
- mycoplasma
- legionella
- chlamydia

38

What symptoms of pneumonia?

- generalized system response: fever, cough, SOB, high WBC, chest pain, tachycardia, can get hypotension/shock

- affects of lung function: decreased ventilation in affected areas, can lead to V/Q mismatch == shunt --> hypoxemia

39

What does pneumonia due to CO2?

don't usually have CO2 retention unless you already have limited reserve [bad COPD]

most pts with pneumonia usually have primary respiratory alkalosis = hyperventilate

40

What does type of cough [productive vs nonproductive] tell you about etiology?

productive = probably viral

non-productive = probably viral or mycoplasma

41

What info do you see on physical exam?

- tachycardia
- tachypnea
- fever

- rales
- egophony
- tactile fremitus
- dullness to percussion

42

What findings on lung exam suggest opening/closing of distal air spaces

- rales

43

What findings on lung exam suggest consolidation?

- tactile fremitus
- egophony
- dullness to percussion

44

What is typical pneumonia? How does it present?

- acute presentation
- productive cough
- lung exam shows consolidation
- leukocytosis with neutrophils
- lobar consolidation with air bronchograms

45

What bugs cause typical consolidation?

- strep pneumo
- H. influenza
- klebsiella
- stap aureus
- anaerobes

46

What is atypical pneumonia? how does it present?

- gradual presentation
- non-productive cough
- normal WBC
- systemic complaints more prominent than respiratory ones

47

What bugs cause atypical pneumonia?

- mycoplasma
- chalmidophyla pneumoniae
- legionella
- viruses

48

What is morphology of histoplasma capsulatum?

- dimorphic fungus = branching hyphae in soil; round or oval yeast in the body

49

What is setting of histoplasmosis?

step1

- Mississipi and Ohio River valleys
- inhale spores from bird/bat droppings --> organism converts to years --> delayed hypersensitivity and granulomatous inflammation

causes pneumonia

50

What happens with histoplamosis in immune competent vs compromised?

competent = self-limited infection

compromised = progressive disseminated histoplasmosis

51

What is chronic pulmonary histoplasmosis?

chronic lung disease in pt with preexisting structural lung abnormality [ie COPD]

resembles TB

52

What is setting of coccidiodomyocosis?

step1

"san joaquin valley fever" in california, utah, SW US

granulomatous inflammatory response

causes pneumonia and meningitis; can disseminate to bone + skin

increase rate after earthquakes b/c spores in dust thrown into air

53

What is morphology of coccidodes immitis?

dimorphic fungus = mycelia in soil; spherules in tissue

54

How does size of histoplama vs coccidioides compare to RBC

step1

histoplama = smaller than RBC

coccidioides = much larger than RBC

55

What happens to coccidioidomycosis in immune competent vs compromised?

competent = self limited
compromised = hematogenous spread and disseminated disease

chronic pulm involvement can look like TB

56

What is setting of blastomycosis infection?

- primarily midewester + SE US and central america

- causes inflammatory lung disease; can disseminate to skin and bone

granulomatous nodules + pyogenic response

combo of macrophages and T lymphocytes and neutrophils

resembles bacterial pneumonia

57

What is morphology of blastomyces?

broad based budding yeast

58

What signs/symptoms in blastomycosis?

acute infection resembles bacterial pneumonia --> abrupt onset fever, cihlls, cough, purulent sputum

may be self limited

if impaired cellular immunity --> at risk for more severe disease

59

What setting of asperigullus infection?

- widespread = no specific geography

pretty much everyone is exposed; it depends on your immune system

60

What is morphology of aspergillus

always appears as mycelia
branching hyphy

not dimorphic

61

What is most pathologic type of aspergillus?

aspergillus fumigatus

62

What is allergic bronchopulmonary aspergillosis? who gets it?

step1

associated w/ asthma and cystic fibrosis

organism stays in airways and is an antigen rather than invasive

causes bronchiectasis and eosinophilia

63

What is aspergilloma? who gets it?

step1

seen in people with preexisting lung cavity from TB or sarcoidosis

orgniasm colonizes cavity wtih little tissue invasion

clinically = hemoptysis or no symptoms

64

What is invasive aspergillosis? who gets it?

step1

seen in immunocompromised and neutropenic
--> post transplant, radiation, cancer, etc


invades and spreads through lung tissue

65

What is chronic necrotizing pulmonary aspergillosis? who gets it?

seen in pts with underlying lung disease or mild impairment of pulmonary or systemic host defense mech [DM, corticosteroids]

indolent, localized invasion

necrosis of tissue --> cavity formation

66

What kind of aspergillus colonization happens in each time of persion:

- normal host
- asthmatic
- person with previous TB
- person with chronic lung disease
-


- normal host --> nothing

- asthmatic or CF --> allergic bronchopulmonary aspergillosis [ABPA]

- person with previous TB --> aspergilloma

- person with chronic lung disease --> chronic necrotizing aspergillosis


- immune compromised --> invasive pulmonary aspergillosis

67

Who gets pneumocystis jiroveci pneumonia?

step1

immune compromised particular cellullar immune compromised = AIDS (esp CD4 < 200)

in pt with AIDS, cancer, organ transplant, immunosuppression

68

What happens in pneumocystis pneumonia?

inhale it; get diffuse interstitial pneumonia

present with insidious onset fever, dyspnea
hypoxemia due to alveolar filling

69

What is morpholgoy of pneumocytsis jiroveci?

disc shaped yeast on methenamine silver stain

70

What is lung abscess?

- localized collection of pus within parenchyma

- abscess contents = primarily neutrophils

71

What are some complications of pneumonia?

- lung abcess

72

What type of bugs cause lung abscess from pneumonia?

- those that cause significant tissue necrosis

== anaerobes, staph aureus, gram negatives

73

What is an empyema?

pus in pleural space from pneumonia extending to pleural surface

thick/creamy or yellow fluid within plueral space and lots of leukocytes [neutrophils]

74

What is treatment for empyema?

drain b/c antibiotics can't reach

if dont drain can develop pleural scarring and fibrothorax

75

You have diagnosed an ill-appearing patient with pneumonia based on history, physical exam and chest radiograph.

Do you:

A. perform bronchoscopy with biopsy and wait a few days for culture results and antibiotic sensitivity before administering antibiotics

B. empirically administer antibiotics

B!

if you do A this process will continue and pt will get worse

76

What types of bugs usually hospital acquired pneumonia?

- gram negative organisms [pseudomonas, klebsiella], MRSA

77

What are most common community acquired causes of pneumonia?

- strep pneumo
- staph aureus
- H influenzae
- chlamidophyla
- legionella
- influenza

78

How do you treat community acquired pneumonia?

- macrolide or doxycycline
OR
- fluoroquinolone or B lactam plus macrolide