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Pathology ICSM COPY > Microbiology 14 - Respiratory Tract Infection > Flashcards

Microbiology 14 - Respiratory Tract Infection Flashcards

(52 cards)

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1
Q

organism responsible for pneumonia

A

Gram-positive cocci (chains and pairs) - S pneumoniae

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2
Q

What pattern of pneumonia is usually produced by streptococcus pneumoniae?

A

Neatly lobar pneumonia

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3
Q

What pattern of haemolyisis does S. pneumonia show?

A

Alpha haemolysis

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4
Q

What are the top 2 organisms that can cause CAP?

A

S. pneumoniae
H. influenzae

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5
Q

What are the 3 most likely organisms to cause CAP in neonates?

A

E coli
Group B strep
Listeria

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6
Q

What are the 3 most likely organisms to cause CAP in 1-6 month olds?

A

Chlamydia
S. aureus
RSV

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7
Q

What are the 2 most likely organisms to cause CAP in 6 month - 5 year olds?

A

Mycoplasma
Influenza

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8
Q

What are the 2 most likely organisms to cause CAP in 16-30y/o?

A

Mycoplasma pneumoniae, Streptococcus pneumoniae

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9
Q

Which atypical organism is responsible pneumonia if exposure to farm animals and birds?

A

farm animals - Coxiella burnetii (Q fever) - hepatitis

birds - Chlamydia psittaci (Psittacosis) - Splenomegaly, rash, haemolytic anaemia

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10
Q

Recall the CURB 65 criteria

A

Confusion
Urea > 7
Resp rate > 30
BP <90 systolic/ <60 diastolic
Age > 65

2 = consider admitting, 2-5 = manage as severe / consider ITU

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11
Q

How will a CXR appear in bronchitis?

A

Normal

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12
Q

In which patient group does bronchitis usually occur ?

A

smokers

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13
Q

How should bronchitis be managed?

A

Bronchodilators and antibiotics IF bacterial cause (usually viral)

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14
Q

Which organisms are usually responsible for bronchiits

A

Viruses

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

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15
Q

Which organism is most likely to cause lung cavitation?

A

Haemophilus influenzae

Gram-negative cocco-bacilli (stain on chocolate agar)

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16
Q

In which patient group is H. influenzae most likely to cause CAP?

A

Those with a pre-existing lung condition

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17
Q

Which cause of CAP is associated with confusion?

A

Legionella

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18
Q

How would you investigate Legionella pneumophila

A

urinary antigens

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19
Q

Why are penicillins ineffective in atypical pneumonia and what should you use instead?

A

Organisms that can cause atypical pneumonia don’t have a cell wall

Macrolides (clarithromycin/erythromycin)

Tetracyclines (doxycycline)

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20
Q

What are the typical symptoms and signs of legionella pneumonia?

A

Confusion
Abdominal pain
Diarrhoea
Hyponatraemia

Lymphopoenia

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21
Q

What are the possible extrapulmonary features of atypical pneumonia?

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A

Hepatitis
Hyponatraemia

22
Q

Legionella treatment

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A

sensitive to macrolides

23
Q

What is the biggest risk factor for coxiella burnetti pneumonia?

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A

Exposure to domestic/ farm animals

Transmitted by aerosol or milk

24
Q

How is coxiella pneumonia diagnosed?

25
Which type of atypial pneumonia is spread by birds?
Chlamydia psittaci
26
What imaging is needed to diagnose empyema?
CT
27
How can empyema be treated?
Large chest drain difficult to treat - wall around them, pus itself very acidotic - inactivates antibiotics → spike fevers even on ABx
28
Which type of pneumonia might cause a mild anaemia?
M. tuberculosis
29
What is the classic CXR pattern in TB?
classically upper lobe cavitation (but can vary)
30
What stain is used to detect TB?
auramine (screen) and a Ziehl-Neelsen (diagnostic)
31
What is a hospital-acquired pneumonia?
Pneumonia that develops within 48 hours of being in hospital
32
How can upper and lower respiratory flora be identified and distinguished in HAP?
Bronchial lavage
33
Which organism is the most common cause of HAP?
Enterobacteriaciae (e.g. E. coli, K. pneumoniae) – 31% Staphylococcus aureus – 19% Pseudomonas spp – 17% Haemophilus influenzae – 5% Acinetobacter baumanii – 4% Fungi (Candida spp) – 7%
34
What is the typical CXR appearance of PCP pneumonia?
Bat wing - bilateral ground-glass shadowing
35
What are the s/s of PCP?
Insidious onset Dry cough Weight loss SOB Malaise
36
37
What antibiotic is used to treat PCP pneumonia?
co-trimoxazole (septrin)
38
Which patient population is most at-risk of aspergillus pneumonia?
Immunosuppressed (eg prolonged chemo/ HIV)
39
what are the features of Allergic bronchopulmonary aspergillosis
Chronic wheeze Eosinophilia Bronchiectasis
40
What is the treatment for aspergillus pneumonia?
Amphotericin B
41
Which 2 pneumonia-causing organisms can be tested for in urine?
S. pneumoniae Legionella urine Ag tests
42
What is the antibiotic of choice to treat MRSA pneumonia?
Vancomycin
43
What is the antibiotic of choice to treat pseudomonas pneumonia?
Piperacillin/tazobactam OR ciprofloxacin ± gentamicin
44
What are the 1st and 2nd line antibiotic therapies for HAP?
1st line: Ceftazidine/ciprofloxacin +/- vancomycin 2nd line: Piptazobactam and vancomycin
45
What is the empirical therapy for CAP?
**Mild-Moderate:** Amoxicillin [OR erythromycin/clarithromycin] **Moderate-Severe** Needing hospital admission: Co-amoxiclav (augmentin) AND clarithromycin Allergic: Cefuroxime AND clarithromycin
46
investigations for PCP
bronchoalveolar lavage - immunofluorescence NOTE: the walk test (attaching an oxygen saturation probe and asking the patient to walk) will show desaturation on exertion
47
Which LRTI organisms are you at risk of in HIV?
PCP, TB, Atypical mycobacteria
48
Which LRTI organisms are you at risk of in neutropoenia?
Fungi (e.g. Aspergillus spp)
49
Which LRTI organisms are you at risk of in BM transplant?
CMV
50
Which LRTI organisms are you at risk of insplenectomy?
Encapsulated organisms (S. pneumoniae, H. influenzae, malaria)
51
When would you do an antibody test in LRTIs?
difficult to culture - Chlamydia, Legionella ## Footnote Only useful on paired serum samples (one acutely unwell and another when getting better) Usually collected on presentation and 10-14 days later Looks for a rise in antibody level over time
52
which LRTI is silver stain used to detect?
PCP

Pathology ICSM COPY (90 decks)

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