Flashcards in Lower Respiratory Tract Infections Deck (57):
1
Which 3 fungi are common in LRTIs?
Aspergillus
Candida
Pneumocystistis Jroveci
2
Definition of chronic bronchitis
Cough productive of sputum on most days during more than 3 months of 2 successive years
3
Chronic bronchitis is associated with what risk factor?
Smoking
4
Bronchiolitis occurs in which age group?
Paediatrics
5
Causative organism for bronchiolitis
RSV
6
Infection affecting the most distal airways and alveoli- formation of inflammatory exudate
Pneumonia
7
What are the 2 anatomical patterns of pneumonia
Bronchopneumonia
Lobar pneumonia
8
Patchy distribution of pneumonia centred on inflamed bronchioles and bronchi then subsequent spread to surrounding alveoli
Bronchopneumonia
9
Pneumonia affecting a large part, or entire lobe
Lobar Pneumonia
10
Causative organism of lobar pneumonia
S. Pneumoniae
11
4 types of pneumonia based on where it is acquired
Community acquired
Hosptial acquired
-Ventilator acquired
-Aspiration
12
Hospital acquired pneumonia devleops how soon after hospital admission
>48 hrs
13
Organisms that cause pneumonia but are difficult to grow, not sensitive to penicillin and clinical presentation and treatment is different
Atypical organisms
14
Typical organisms causing pneumonia
Streptococcus pneumoniae
Hamophilus influenzae
Moraxella Catarrhalis
S.Aureus
Klebsiella penumoniae
15
Atypical organisms causing pneumonia
Mycoplasms pneumonia
Legionella pneuomphilia
Chlamydophilia pneuomoniae
Chlamydophilia psittaci
Coxiella burnetii
16
Atypical organism causing pneumonia:
Autumn epidemics every 4-8 yrs. Children and young adults. Rare complications include pericarditis, arthritis, ghuillian barre ascending polyneuropathy, peripheral neuropathy
Mycoplasma pneumoniae
17
Atypical organism causing pneumonia:
Mild pneumonia or bronchitis in adolescents and young adults.
Chlamydophila pneumonia
18
Atypical organism causing pneumonia:
Associated with exposure to birds- splenomegaly, rash, hepatitis, haemolytic anaemia and reactive arthritis on presentation.
Chlamydophilia psittaci
19
Atypical organism causing pneumonia:
Colonises water pipes. High fevers, rigors, cough, dyspnoea, vomiting, diarrhoea, confusion
Legionella pneumophilia
20
What are the 2 types of pneumonia that develop from influenza?
Primary viral pneumonia: rare- occurs in patients with pre-existing cardiac and lung disorders.
Secondary bacterial pneumonia: may develop after initial influenza (flu) presentation
21
What is the assessment for disease severity used in pneumonia?
CURB65
Confusion, urea, resp. rate >30, blood pressure 65
22
Antibiotic used to treat typical pneumonia
Amoxicillin or co-amoxiclav
23
Antibiotic used to treat atypical pneumonia
Clarithromycin (lincosamide)
24
Pneumococcal vaccination is what organisms?
Streptococcus pneumoniae
25
Describe the shape of mycobacteria
Slender, bacilli
26
Why are mycobacteria different to all other bacterial genera?
Unusual waxy cell wall (high lipid content)
Slower growing
27
What stains are used to identify mycobacteria?
Ziehl Neelson, phenol auramine
28
Another name for mycobacteria
Acid fast bacilli
29
Mycobacteria:
Intra/extracellular pathogens?
Chronic infections or latent infections?
Longer or shorter course of treatment?
Intra
Latent
Longer
30
What types of mycobateria cause TB?
M.tuberculosis
M.bovis
31
What atypical mycobacteria are associated with HIV?
M avium complex
32
Atypical mycobacteria
M.avium
M.kansasii
M.marium
33
How does M.marium infections present
Fish tank granuloma
34
Common site of primary TB infections?
Periphery of lung midzone
35
Name of the collection of macrophages in the hilar lymph nodes in primary TB where intracellular muliplication takes place
Ghon focus
36
Describe the structure of the tubercles in primary lymph nodes
Granuloma
Cell-mediated immune response
Central area of epitheloid cells and giant cells surrounded by lymphocytes
Central area is caseous encrosis
Fibrosis/calcification of lesions
37
In the acquisition of TB, when will you have a positive tuberculin skin test?
3 months after primary acquisition
38
When is TB reactivated
immunosuppressed
39
Pathogenesis of reactivating TB
Coalescing tubercles, central caseous encrosis and cavity develops in centre- increases organism load- increases risk of tranmission
40
Where does TB classically reactive?
Lung apices (mycobacteria require O2)
41
extra-pulmonary manifestations of TB
-necrotic tubercle erodes into blood vessel. e.g. meningitis. Disseminates to pleura, lymph nodes, kidneys, epididymis, bone, intestines, brain,pericardium etc
42
Diagnosis of TB meningitis
Chest X-ray, Skin testing, interferon y release assay:IGRA
43
Sputum samples for TB diagnosis
3 early morning specimens
44
When is a direct microscopy for acid fast bacilli smear positive?
>5000 organisms per ml sputum
45
Standard treatment for TB
2 months: rifampicin, isoniazid and 2 others
next 4 months: rifampicin, isoniazid
46
Treatment for meningitis TB
12 months therapy
47
Name of the standard treatment for TB
Directly observed therapy short course (DOTS)
48
Multi-drug resistant TB is resistant to what?
Rifampicin and izoniazid
49
Extensive drug resistant TB is resistant to what?
Rifampicin, izoniazind and fluorquinolones
50
Name of the TB skin test
Mantoux tes- tuberculin skin test- positive test if skin indurates (bubble and fibrosed patch develops)- person has acquired TB if >5mm
51
Diagnostic test to look for T cells that recognise TB specific antigens and release gamma interferon
Interferon-gamma release assays
52
What does BCG stand for?
Bacille Calmette Guerin
53
What mycobacteria is given in BCG vaccine?
Strain of M.Bovis
54
What disease is caused by M.leprae?
Leprosy-Hansen's disease
55
Where is M.leprae cultivated?
On the nine banded armadillo
56
2 clinical forms of M. leprae
Tuberculoid- macules/plaques develop on nerves
Lepromatous- subcutaneous tissue accumulation
57