LRT II & III Flashcards by tcarlso 3

What are the bacteria that fall into the walking or atypical pneumonia category?

Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella pneumophila

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Is the onset abrupt or gradual for atypical pneumonia? What are the associated symptoms?

Gradual

fever, HA, fatigue, myalgias, dry cough

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What is the treatment for atypical pneumonia?

Tetracycline and erythromcin

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True or false: you treat atypical pneumonia empirically?

True

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What is the smallest living bacteria?

Mycoplasma pneumoniae

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What is mycoplasma pneumoniae’s morpholoy? What is the colony morphology?

Morph = pelomorphic

Fried egg appearing colonies

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What is in the membrane of mycoplasma pneumoniae that it robs from humans, since it cannot produce it on its own?

Sterols

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Does mycoplasma pneumoniae have a peptidoglycan layer? What is the significance of this?

No, thus cannot use beta lactams or abx that target cell wall

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How does mycoplasma pneumoniae spread? How much bacteria is needed to cause disease?

Through large droplets, with small number of bacteria needed

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What is the other major disease that mycoplasma pneumoniae causes, besides pneumonia?

Tracheobronchitis

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What is the major virulence factor that mycoplasma pneumoniae produces? What is its function?

P1 adhesin–binds to base of cilia, allowing ciliary stasis and cell death

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What is the MOA of how mycoplasma causes anemia?

IgM produced against mycoplasma is cross reactive with RBCs

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What is the best way to diagnose mycoplasma pneumoniae? Which way would you not use?

PCR or serology

NOT culture

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What is the treatment for mycoplasma pneumoniae?

Tetracycline and macrolide

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What is the agglutination test?

Test to see at what temp RBCs aggutinize at. Normal = 37 C, abnormal = 4 C

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Which type of abx do you never use against mycoplasma pneumoniae? Why?

Beta lactams, because they do not have a cell wall

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What is the prognosis for mycoplasma pneumoniae?

Self -limiting in 2 weeks

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What can be done to prevent infx with mycoplasma pneumoniae?

avoiding it, no vaccine

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What is the gram stain, metabolic, and morphology of chlamydophila pneumoniae?

Small, gram negaviet obligate intracellular pathogen

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What type of pneumoniae does chlamydophila pneumoniae cause (typical or not)?

Atypical

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How do you diagnose chlamydophila pneumonaie?

PCR or ELISA

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What is the treatment for chlamydophila pnuemoniae?

Tetracyline and a macrolide (same as mycoplasma pneumoniae)

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What is significant about the infection process of chlamydophila pneumoniae?

Reticulate bodies (non-infx) and elementary bodies (infx)

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What is the causative agent of legionnaires disease?

Legionella pneumonophila

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What are the two diseases that legionella causes?

Legionnaires disease, and pontiac fever

What is pontiac fever?

Mild, self limiting disease caused by legionella pneumonphila. Much more common.

What is the gram stain and morphology of legionella?

Gram negative coccobacilli (inside of cell). Pleomorphic outside cell

Where does legionella pneumophila usually exist?

Freshwater lakes, streams, ground water.

How is legionella pneumopha transmitted to humans?

Aersols from manmade water supplies, ACs etc

How does legionella infect the body? (What is the cell target?)

Targets and attaches to alveolar macrophages, and prevents fusion with lysosome

What is the unique histological characteristic to legionella?

Coiling phenomenon inside macrophages

What is the pathogenesis of legionella?

Hjacks cell by injecting a ton of toxins. Recruits macrophages to produce itself. Lyses the macrophage

What causes the lung necrosis seen in an infx with legionella?

Lysis of macrophage, and emission of bacterial toxins

What are the clinical manifestations of legionnaries disease?

Severe, toxic pneumonia Myalgias HA/confusion Rapid fever

Diagnosis of legionella is done how?

Leukocytosis with L shift Direct fluorescent antibody nucleic acid synthesis

What is the treatment foe Legionnaires disease? What is the abx type that is not effective in treatment?

Macrolide or fluoquinolone NOT beta lactams

What is the gram stain of mycoplasma TB?

Weakly gram positive

What is in the cell wall of mycoplasma TB, that is distinct?

tons of lipids

What is the stain that can identify TB? How does this work?

Acid fast-stains the mycolic acids

What are the 6 components of TB's cell wall?

``` Membrane Peptidoglycan arabingalactan Lipoarabinomannin Plasma membrane Mycolic acid ```

True or false: TB has many reservoirs in the environment

False--only humans

How is TB spread?

Person to person contact

What are the four disease states of TB?

Primary Active Latent Reactivation

What is the pathogenesis of TB?

Taken up by alveolar macrophages, but macrophages cannot degrade them. This causes granuloma formation

What is the latent immunity of TB?

When TB is effectively walled off in a granuloma

What is primary TB? How symptomatic is it?

Initial infection, usually asymptomatic

What causes TB to reactivate?

Immunosuppression for some reason

What is the primary cause of damage that TB causes?

The immune response

What is miliary TB?

Disseminated TB infection that looks like millet seeds in tissues

What are the symptoms of active TB? Gradual or sudden?

Gradual onset of wieght loss, night sweats, hemoptysis

What is the major reasons that TB is so widespread?

Carriers can be asymptomatic for 2-3 years

What are the symptoms of reactivation TB?

Similar to primary TB

What is a Gohn focus?

Calcified granuloma from TB in the lung as seen on CXR

What is the Ghon complex?

Ghon focus + hilar lymph node calcification

What might a CXR show in active TB?

CXR may show lobar pneumonia as granuloma falls apart

True or false: TB requires reporting

True

What is the lab diagnosis for TB?

Mantoux test (PPDs injected into skin) IFN-gamma release assay

What is the vaccine that causes a Mantoux to be positive?

BCG vaccine

For a pt with a h/o the BCG vaccine, how do you test for TB? What is involved in this test?

IFN-gamma release assay Measure T cell reaction to MTB proteins

What is the stain that can be helpful for identifying TB?

Acid fast stain

Why is culturing TB not as useful as other techniques?

Takes 10-21 days

What is the treatment for TB?

Isoniazid, ethambutol pyrazinamide and rifampin for 2 months, follows by 26 months

What is the issue with TB treatment?

Hepatotoxic drugs taken for 28 months causes low compliance

What is the BCG vaccine? Is it effective against TB?

vaccine against mycobacterium bovis. Not effective against TB.

What is the consequence of having AIDS and being exposed to TB?

Primary infx much more likely, and will progress to secondary faster

The nontuberculous mycobateria are (Typical or atypical mycobateria)

Atypical

What is mycobacterium avium intracellulare, and what is the disease it causes?

A complex of several mycobacteria that cause infx similar to TB

What is mycobacterium kansasii? What is the population that this disease usually infects?

Similar to TB. Seen in elderly and COPD pts

How do you diagnose mycobacterium kansasii or avium? What is the difference in these two bacterial infx compared to TB?

Same diagnosis as TB, but less severe

What are the symptoms of laryngitis, tracheitis, and epiglotitis?

Hoarseness | Retrosternal burning pain

What are the possible complications that can result from laryngitis, tracheitis, and epiglotitis?

Airway obstruction, especially in children

What is the most likely etiology of laryngitis, tracheitis, and epiglotitis? Which bacteria constitute less common causes?

Viral, Group A Strep, haemophilus influenzae or staph aureus

What is the gram stain and morphology of Haemophilus influenzae type B?

Gram negative coccobacilli

What is the bacteria that requires chocolate agar? What does the agar have that the bacteria needs?

Haemophilus influenzae type B, NAD and hemin

Haemophilus influenzae is type based on what?

Capsule

What is the capsule that Haemophilus influenzae type B has made of?

polyribosylribitol phosphate (PRP)

What is the capsule that nontypable Haemophilus influenzae made of?

Nothing-- nontypable do not have a capsule

Haemophilus influenzae type B usually infects whom?

Unvaccinated children

What are the three virulence factors that Haemophilus influenzae type B has?

LPS IgA protease PRP

How do you diagnose Haemophilus influenzae type B?

Gram stain and culture

What is the mortality rate of Haemophilus influenzae type B?

>90%

What is the treatment for severe cases of Haemophilus influenzae type B? Less severe?

Severe = broad spectrum | Not severe = amoxicillin

What is the vaccine against Haemophilus influenzae type B made from?

Conjugate vaccine to PRP

What is the common bacteria that causes acute bronchitis? What is a complication that can arise from this?

Mycoplasma pneumoniae Pneumonia

What is the causative agent of whooping cough?

Bordetella pertussis

What is the gram stain and morphology of pertussis?

Gram negative coccobacilli

What causes the whooping part of pertussis?

Increase respiratory secretions and impaired clearance

What is the MOA of pertussis?

Adhere to cilia, produce toxins

What is the bacteria that require Bordet-Gengou agar?

Pertussis

How is pertussis spread?

Aersols. Human only.

What is the incubation period for pertussis? What are the symptoms during this time?

7-10 days, asymptomatic

What is the progress of symptoms of pertussis?

Nothing to general cold, then whooping cough

What are the major adhesion factors that bordatella pertussis produces?

Filamentous hemagglutinin Peractin Fimbrae

What is the MOA of filamentous hemagglutinin that pertussis produces?

Binds to epithelial cells

What is MOA of the pertusis toxin? What type of toxin is it?

AB toxin that activated adenylate cyclase to increase respiratory secretions

What are the three major toxins that pertussis has/produces?

LPS Pertussis toxin Adenylate cyclase activator

What are the lab tests available to diagnose pertussis?

Culture on bordet-gengou agar Nucleic acid amp

What is the treatment for whooping cough?

Supportive + macrolides

What are the three active part of the pertussis toxin?

Detoxified pertussis toxin Peractin Filamentous hemagglutinin

Purulent sputum is associated with what infection?

Typical pneumonia

Scant, watery/mucoid sputum is associated with what infection?

Interstitial pneumonia

Rust colored sputum is associated with what infection?

Strep pneumoniae

Thick, currant jelly-like sputum is associated with what infection?

Klebsiella pneumoniae

Hemoptysis is associated with what infection?

TB or lung abscess

Foul smelling sputum is associated with what infection?

Anaerobic bacterial pneumonia