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Respiratory II > Micro: Lower Respiratory Tract Infections > Flashcards

Micro: Lower Respiratory Tract Infections Flashcards

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1
Q

What are the organisms that make up the normal flora of the Lower Respiratory Tract ?

A

PSYCH ! Trick question, the LRT is a sterile environment and should not have a colonization by bacteria.

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2
Q

Infections in the LRT are cause by Virus, Fungi and Bacteria. Where do bacteria that cause infections usually come from ?

A 
Typically from upper respiratory tract infections --> LRT
Ear Infections/ URT
S.pneumoniae
H. Influenzae
Moraella

Mycoplasma pneumoniae

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3
Q

In acute brochitis, what kind of fever will you see ?

A

Either none or a very low grade. If it is high grade, most likely pneumonia not bronchitis.

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4
Q

What must be excluded in order to come to a diagnosis of Acute Bronchitis

A

COPD

Pneumonia

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5
Q

Define pneumonia

A

Inflammation of the lungs accompanied by fluid filled alveoli and bronchioles

Most common cause of death due to infection in the elderly

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6
Q

How are pneumonias classified ? (3)

A

Causitive agent
Where acquired (Community, Nosocomial)
Typical v. Atypical (Productive cough)

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7
Q

What is the #1 cause of typical pneumonia ?

A

S. pneumoniae

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8
Q

Describe the signs and symptoms of an Typical Pneumonia

A

abrupt onset
Fever, chills, Congestion SOB
PRODUCTIVE COUGH (the hallmark)

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9
Q

Describe the Lab diagnostics for S.pneumoniae

A 
Gram +
Catalase -
Pairs of chains
Alpha Hemolytic
Optochin Sensitive
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10
Q

What is the most important virulence factor for S.pneumoniae ?

A

The Capsule (allows for adhesion)

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11
Q

List other virulence factors for S.pneumoniae besides the capsule

A

Adhesin (for adhesion)
IgA protease (Breaks down IgA. This is very important in the lungs
Pneumolysin (lyses ciliated epithelial cells)

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12
Q

What may predispose someone to pneumococcal pneumonia ?

A 
Previous Viral infection
Alcoholism (this is not specific, more telling for Kleb)
Children
Elderly 
SPLENECTOMY 
NON_IMMUNIZED !
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13
Q

How would you describe the productive cough associated with S.pneumoniae ?

A

Rust Colored Sputum

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14
Q

What would you see in microscopy with S.pneumo ?

A

Gram + cocci, and NUMEROUS PMN’s (neutrophils)

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15
Q

PPSV23

A

AKA Pneumovax, 23 most common capsule serotypes –> Adult !!

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16
Q

PCV13

A

Pneumococcal conjugate vaccine

Children 2 moths - 59 months

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17
Q

What is the most important virulence factor for Klebsiella pneumonia >

A

Capsule

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18
Q

Describe the productive cough associated with Kleb Pneumoniae ?

A

Current Jelly Sputum (due to blood and capsule)

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19
Q

Is Klebsiella CAP or HAP ?

A

BOTH !

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20
Q

Is S.pneumos CAP or HAP ?

A

CAP

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21
Q

Being hospitalized and on a ventilator are big risk factors for Kleb pneumoniae . What is the another huge risk factor ?

A

Alcoholism

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22
Q

Why is Kleb pneumoniae associated with higher mortality than pneumococcal pneumonia ?

A

Causes necrosis of the lung tissue.

LPS can be released (Gram -) leading to shock.

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23
Q

Describe the Lab diagnostics for K. pneumonia

A

Gram- rod
Lactose fermenter ( Lac + leads to purlple discoloration of agar due to acid)
Indole - ( not e.coli)
Grows on MacKonkey Agar

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24
Q

DOC for K.pneumoniae

A

Gentamicin

Ciprofloxacin

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25
Why may K.pneumo be difficult to treat ?
Carbapenem resistence (contains a carbapenamase)
26
Describe the lab finding for H.influenzae
G- coccobacillus Grows on Chocolate Agar (Factor V(NAD)and X) Although G-, it will not grow on MacKonkey. Often a normal fluora of the URT.
27
List the main virulence factors for H.influenzae
CAPSULE LPS (endotoxin, can cause shock) Adhesisn
28
Who is at risk for H.influenzae ?
Elderly Smokers COPD
29
Describe the lab diagnostics for S.aureus
G+ coccus | Catalase and Coagulase +
30
Describe the productive cough caused by S.aureus
"Salmon Pink" sputum
31
How is S.aureus typically disseminated to the LRT ?
``` Aspiration Hematogenous (bacteremia or endocarditis ```
32
What is a typical area of the lung for S.aureus to infect ?
``` Pleural cavity (Empyema = pus filled pleural cavity) Abscesses (causes or inhabits ?) ```
33
Suppose you encounter a patient with severe hemoptysis and shock. You notice Gram + cocci on microscopy. What organism do you suspect
CA- MRSA
34
What will you see on gram stain with organisms that cause atypical pneumonia ?
NOTHING ! | Most eitehr do not have a gram reaction or they are intracellular pathogens.
35
mycoplasma pneumoniae is CAP or HAP ?
CAP
36
Pneumonia due to mycoplasma pneumonia is also known as ..
Walking pneumonia (#1 cause)
37
Why does mycoplasma not show on gram stain ?
No cell wally !
38
T or F: Mycoplasma is encapsulated
True !
39
what virulence factor allows mycoplasma to bind to ciliated epithelial cells ?
Adhesin
40
What will you see on microscopy of aspirate from a lung with mycoplasma infection ?
large # of PMN's w/o organisms !
41
What are the characteristics associated with mycoplasma 'walking pneumonia' ?
Non- productive, persistent cough. | Excessive sweating !*
42
Igm for Mycoplasma and RBC's that are diagnostic for the organism are also known as..
Cold Agglutinins
43
Why will you not see Chlamydophila pneumonias on gram stain ?
It is an intracellular pathogen ! | It is gram - however, so if it were to be out of the host organism, you would see it as a pink blot.
44
What is the infectious stage of Chlamydophila ?
Elementary body
45
What is the replicative form of Chlamydophila ?
Reticulate body
46
What would you see upon microscopy of a patient suspected of having chlamydophila ?
Large amount of PMN's but no organisms
47
What is treatment for Chlamydophila ?
Azythromycin Arythromycin Doxycycline (Treatment for G-)
48
Chlamydophila psittaci cause what disease ?
Parrot fever
49
Although it does not show up on gram stain, how could we classify Legionella ?
Gram - (does not gram stain well however)
50
What two building structures are associated with legionella ?
water cooling towers and air conditioning units.
51
Besides, not gram staining well. Why would yu not see legionella on gram stain ?
Intracellular bacteria
52
What cells does legionella infect within the body ?
Alveolar macrophages
53
how is legionella transmitted ?
Aerosolized droplets (really likes h20)
54
Describe the signs and symptoms of legionella infection
``` ABRUPT ONSET of fever Pleurisy Chills Myalgia Dry Cough --> Hyponatremia ``` Complications with liver or kidneys are common
55
Patients at risk for legionella include:
Smokers COPD Elderly RENAL TRANSPLANT or DIALYSIS !
56
What media will Legionella grow on ?
Buffered Charcoal Yeast Extract. (Iron and cysteine salts)
57
In What body fluid can you detect legionella antigen with fluorescence ?
Urine.
58
What are the common causes of nosocomial pneumonia ?
``` Pseudomonas aeruginosa S.aureus H.influenzae Enterics (due to aspiration) Enterobacter Kleb E.coli Serratia ```
59
In cystic fibrosis, what bacteria colonizes the lung prior to pseudomonas ?
S. aureus | Pseudomonas colonizes by 5 yo
60
What are some key signs of pseudomonas infection
copious green sputum , grape smell Hot tub folliculitis also caused by pseudomonas.
61
Why is pseudomonas difficult to treat ?
resistant to many antimicrobials
62
How do most anaerobes get into the lungs to cause pneumonia ?
Aspiration of gastric material into the respiratory tract.
63
What are the major classes of anaerobes that are found in aspiration pneumonia ?
Bacteriodes and Fusobacterium
64
What do bactericides and fusobacterium typically cause within the lung ?
Necrotizing lung disease Lung abscess and empyema (pyothorax)
65
Describe the productive cough associated with anaerobes
Copious amounts of foul smelling sputum.
66
What is the DOC for anaerobic bacteria ?
Metronidozole for 2-4 months.
67
Bacillus anthrax is gram + or gram - ?
Gram +
68
describe the shape of bacillus anthrax
Boxcar shaped
69
How is anthrax transmitted ?
Inhalation of endospores
70
what is the most important virulence factor associated with anthrax ?
Anthrax toxin
71
Describe the course of inhalation anthrax infection
Early: Sore throat, mild fever, myalgia and cough | After a few days : Severe coughing, NV, Lethargy, Shock and Death.
72
How would you treat inhalation anthrax
Penicillin, Ciprofloxacin, doxycycline. Prayer.
73
Yersinia pestis is less affectionatel known as ..
PLAGUE !
74
What kind of gram stain organism is yersinia pests
Gram -, Coccobacillus.
75
Describe the productive cough seen in Yersinia infection ?
Frothy bloody sputum Fever, chills, cough, difficulty breathing.
76
What would you seen on microscopy with stained Yersinia samples ?
Bi-polar coccobacilli (Safety pin staining, darker at the ends)
77
What is the treatment for yersinia pestis?
Streptomycin/Gentimycin Tetracycline/Doxycycline Chloramphenicol
78
What organism is responsible for Q fever ?
Coxiella burnetti
79
Why will you not see Coxiella on gram stain ?
Although it is gram - , you will not see it since it is an intracellular parasite.
80
What are the primary carriers of Coxiella ?
Cattle, Sheep and goats.
81
How is Coxiella transmitted ?
Inhalation of contaminated dust Ingestion of unpasteurized milk Working in a slaughterhouse farm or vet office
82
Describe the symptoms associated with coxiella
acute onset, severe headache, non-productive cough, muscle pain and fever.
83
What animal is Francisella tularensis associated with ?
Rabbitts --> Tularemia
84
Will you see Francisella on gram stain ?
No, it is an intracellular pathogen (although, it is gram -coccobacillus)
85
What culture media will Francisella grow on ?
BCYE and Cysteine Glucose blood agar !
86
TOC for francisella ?
Streptomycin

Respiratory II (8 decks)

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