Lower respiratory tract infections Flashcards Preview

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Flashcards in Lower respiratory tract infections Deck (56):
1

cause of CAP

strep pneumo

2

types of acute pneumonia

CAP
nosicomial

3

types of subacute/chronic pneumonia

tuberculosis
fungal
lung abscesses

4

major diseases caused by strep pneumo

pneumonia
meningitis
sinusitis
otitis media
bacteremia

5

less frequent diseases caused by strep pneumo

endocardiits
spetic arthritis
peritonitis

6

strep pneumo identifier

gram positive
cocci in pairs or chains
alpha hemolytic
catalase negative
optochin sensitive

7

main mech of strep pneuma pathogenicity

immune evasion
doesn't release toxins

8

mechanisms of immune evasion for strep pneumo

capsule prevents phagocytosis
induces inflammation which activates complement and attracts neutrophils

9

what stimulates strep pneumo cytokine production

peptidoglycan
teichoic acid

10

virulence factors of strep pneumo

adhesive cell surface components
neuramidase and hyaluronidase
capsule
autolysin
pneumolysin

11

adhesive cell surface components of strep pneumo

teichoic acid
choline binding proteins
protein A

12

neuramidase and hyluronidase do what

change ECM

13

capsule

prevents phagocytosis

14

autolysin

lyses cells which releases peptidoglycan and pneumolysin

15

pneumolysin

inhibits cillia and neutrophils
promotes inflammation
activates complement system

16

how is a capsule stained

antibody in Quelling rxn

17

anti capsule antibodies

appear 5-8 days post infection- marker of immunity
1/3 of adults make them, rest do not

18

capsular based strep pen vaccine

stimulates IgM and IgG production via capsular polysaccharides from 23 strains

19

protein conjugated strep pneumo vaccine

capsular polysaccharide conjugated to a protein (tetanus or diphtheria)
induces T cell memory

20

what vaccine do you give to

protein conjugated

21

what vaccine do you give to >4

capsular based

22

pathogenesis of strep pneumo

bacteria grow into alveolar spaces which activates complement and vasoactive factors
bacteria accumulate
exudate and WBC migrate into alveolar spaces

23

CXR of pneumococcal pneumonia

fluid accumulation in a lobe with no abscess

24

stage 1 pneumococcal pneumonia

alveoli fill with clear serous fluid and bacteria cells which proliferate

25

early consolidation phase of pneumococcal pneumonia

neutrophils and bugs infiltrate
antibodies produced OR innate immunity kicks in
CRP increases which activates complement system

26

late consolidation in pneumococcal pneumonia

alveoli fill with cellular infiltrate and bacteria--looks like liver

27

resolution in pneumococcal pneumonia

macrophages replace neutrophils and clear exudate
lung architecture restored

28

complications to pneumococcal pneumonia

pleural effusion
empyema

29

symptoms of pneumococcal pneumonia

sudden onset chills and sweats
high fever
chest pain
cough, fatigue
tachy,
gray, anxious appearance

30

labs associated with pneomoccal pneumonia

low Hg
leukocytosis
capular detection in urine
PCR

31

common carriers of strep pneumo

preschool kids

32

transmisison of strep pneumo

person to person in close contact
NOT school or work

33

predisposing factors to strep pneumo

defective antibody production
defective complement
neutrophil deficiency
defective bacteria clearance
previous viral infection

34

treatment of strep pneumo

penicillin
macrolides
quinolones
vancomcin

35

ermB

high level of resistance to ALL macrolides

36

mefA

low level resistance to some macrocodes

37

causes of atypical pneumonia

mycoplasma pneumoniae
leginella pneumonae

38

mycoplasma pneumonaia features

no cell wall
small
slow growing
special media

39

myocplasma pneumoniae causes

bronchopneumonia

40

transmission of mycoplasma pneumoniae

spread via respiratory droplets

41

symptoms of mycoplasma pneumoniae

sore throat
cough
fever

42

diagnosis of mycoplasma pneumoniae

clinical presentation- no sputum production

43

CXR of mycoplasma pneumoniae

uni/bilateral patchy infiltrate in lower lobes

44

treatment of mycoplasma pneumoniae

macrolides
tetracyclines
fluoroquinolones

45

features of leginella pneunominphilia

gram neg bacillus
thermophilic
grows on special media
found in ponds

46

transmission of legionella

inhalation of infected aerosoles

47

symptoms of legionella pneumonia

flu
watery diarrea
vomitting
diarrhea
low O2--> lethargy, confusion

48

life cycle of legionella

infects the macrophage
type 4 secretion system inserts proteins that block formation of phagolysosomes
bacteria replicate in the vesicle
ppGpp increases as nutrients decrease which triggers transcription of genes for release

49

diagnosis of legionella

antibody staining or ELISA on urine- misses cases
culture- slow
CXR- patchy dsitribution

50

treatment of legionella

macrolides
tetracyclines
quinolones

51

nosocomial early onset

52

nosicomial late onset

>4 days
gram neg bacilli
staph aureus

53

VAP risk factors

prolonged hospitalization
repeated intubations
endotracheal or NG tube
prior antibiotic therapy
stress, ulcer prophylaxis
supine position

54

microaspiration

most common
colonized secretions from upper airways get into lower lung areas
gram neg bacilli
staph aureus

55

macroaspiration

infection with esophageal or gastric material
bacteria condenses in tube and forms biofilm
pieces break off and get into lung

56

symptoms of VAP

fever
leukocytosis
purulent sputum
new lobar filtrate