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Block 5 > Lower respiratory tract infections > Flashcards

Lower respiratory tract infections Flashcards

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1
Q

cause of CAP

A

strep pneumo

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2
Q

types of acute pneumonia

A

CAP

nosicomial

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3
Q

types of subacute/chronic pneumonia

A

tuberculosis
fungal
lung abscesses

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4
Q

major diseases caused by strep pneumo

A 
pneumonia
meningitis
sinusitis
otitis media
bacteremia
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5
Q

less frequent diseases caused by strep pneumo

A

endocardiits
spetic arthritis
peritonitis

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6
Q

strep pneumo identifier

A 
gram positive
cocci in pairs or chains
alpha hemolytic
catalase negative
optochin sensitive
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7
Q

main mech of strep pneuma pathogenicity

A

immune evasion

doesn’t release toxins

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8
Q

mechanisms of immune evasion for strep pneumo

A

capsule prevents phagocytosis

induces inflammation which activates complement and attracts neutrophils

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9
Q

what stimulates strep pneumo cytokine production

A

peptidoglycan

teichoic acid

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10
Q

virulence factors of strep pneumo

A 
adhesive cell surface components
neuramidase and hyaluronidase
capsule
autolysin
pneumolysin
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11
Q

adhesive cell surface components of strep pneumo

A

teichoic acid
choline binding proteins
protein A

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12
Q

neuramidase and hyluronidase do what

A

change ECM

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13
Q

capsule

A

prevents phagocytosis

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14
Q

autolysin

A

lyses cells which releases peptidoglycan and pneumolysin

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15
Q

pneumolysin

A

inhibits cillia and neutrophils
promotes inflammation
activates complement system

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16
Q

how is a capsule stained

A

antibody in Quelling rxn

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17
Q

anti capsule antibodies

A

appear 5-8 days post infection- marker of immunity

1/3 of adults make them, rest do not

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18
Q

capsular based strep pen vaccine

A

stimulates IgM and IgG production via capsular polysaccharides from 23 strains

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19
Q

protein conjugated strep pneumo vaccine

A

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

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20
Q

what vaccine do you give to

A

protein conjugated

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21
Q

what vaccine do you give to >4

A

capsular based

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22
Q

pathogenesis of strep pneumo

A

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

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23
Q

CXR of pneumococcal pneumonia

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A

fluid accumulation in a lobe with no abscess

24
Q

stage 1 pneumococcal pneumonia

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A

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

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