Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardio > Microbiology Lower Resp Tract infections > Flashcards

Microbiology Lower Resp Tract infections Flashcards

(102 cards)

Start Studying
1
Q

Definition of LRTI:

A
  • Any Infection of the respiratory tract from the vocal cords downwards
  • Includes bronchi, bronchioles, alveoli, parenchyma, pleura and pleural cavities.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Normal flora of the LRT

A
  • The NORMAL LRT is bacteriologically strile
  • Inhaled particles including micro-organisms are trapped by mucus and moved to the URT by epithelial cilia (mucociliary excalator)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Abnormal flora of LRT

A
  • Paralysis of cilia
  • Excessive volume and/or viscosity of mucus
  • Macro-ventiliation: LOC, Paralysis, ventilation, failure to protect LRT
  • Failure to cough/loss of swallowing reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common colonisers of the LRT and origin

A

• “Colonisers” of LRT are often from URT such as Haemophilus influenza and Streptococcus pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Iatrogenic causes of change of antibiotics

A

• Antibiotic therapy will effect URT colonisation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Types od LRTI

A 
•	Bronchiolitis (not covered) - viral
•	Bronchitis (acute and chronic)
•	Pneumonia
→ Community-acquired
→ Hospital-acquired
→ Aspiration
→ Immunocomprimised host
  • Bronchiectasis
  • Lung abscess/Emypema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute Bronchitis causes

A 
Most are Viral:
•	Influenza
•	RSV
•	Rhinovirus
•	Adenovirus
•	Parainfluenza virus

Pertusis (bacterial cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Manifestations with % frequency

A
  • Cough (98%)
  • Trouble sleeping (60%)
  • Dyspnoea (50%)
  • Nasal congestations (50%)
  • Rhinorrhoea (50%)
  • Sore throat (50%)
  • Inability to work (33%)
  • Fever (10-20%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chronic obstructive airway disease – chronic bronchitis clinical definition

A

• Productive cough for more than 3 months per year for at least 2 years
• Wheezing
• Dyspnoea (shortness of breath)
COPD = chronic bronchitis with airflow limitation. Most chronic bronchitis develops COPD or time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Infective exacerbations of chronic bronchitis common

A

• 1-3 exacerbations per year in COPD patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Criteria used

A 
Anthonisen criteria – used to optimising antibiotic selection in COPD patients
Antibiotic therapy indicated if two if:
•	Increased breathlessness
•	Increased sputum volume
•	Increased sputum purulence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Infective exacerbations of chronic bronchitis % viral/Bacteria

A

40% of acute exacerbations are viral
→ Patients with COPD may have colonisation of the LRT with organisms normally found in the URT such as H. influenza, M. cattarhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Infective exacerbations of chronic bronchitis treatment

A

Amoxicillin

Tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Community Acquired required length of stay and causative organisms

A

< 48 hours in hospital or in community (definition)

Usually bacterial Due to S. Pneumonia and sometimes-other organisms. Sometimes viral in children (always consider TB).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Community Acquired treatment

A

Narrow spectrum therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hospital Acquired stay in hospital and causative organisms

A

> 48 hours in hospital and not intubated on admission (definition)
Due to multi-resistant “hospital flora”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hospital Acquired treatment

A

Broad spectrum agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pneumonia general clinical features

A

Fever/rigors/sweats
Headache
Confusion (esp. elderly)
Vomiting/diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pneumonia localised clinical features

A

Breathlessness
Cough (may be productive)
Haemoptysis
Pleuritic chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical Syndromes – Aspiration

A

(Macro aspiration) Inhalation of material, about 10% of community cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Predisposition to aspiration

A

Neurological deficit and commonly affects the posterior segment of right upper lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Aspiration complication

A

Abscess formation

Can be associated with chemical pneumonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Aspiration prevention

A

Protection of the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aspiration treatment

A

Antibiotics to cover URT flora e.g. penicillin or cephalosporin plus metronidazole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Acute community acquired pneumonia x-ray and the differentials for x-ray findings:
Lots of acute CXR shadowing | Sometimes non-infective e.g. Cardiac failure, chemical (smoke infection), severe infection elsewhere (ARDS)
26
Acute-community acquired
Ilness progresses over days to a few weeks
27
Chronic-community acquired
Illness progresses over weeks to a months
28
Differentials for chronic community acquired pneumonaie
TB is the most important cause Differential is wide including Vasculitides (non infectious) Specialist assessment is needed.
29
CAP epi
``` More common in water Male/Female ratio 2:1 More common in older people 750,000 cases/year in UK 150,000 consult GP 50,000 hospitalised 10% mortality among hospitalised patients Up to 50% mortality if severe ```
30
Assessing severity of CAP
``` CURB-65 Confusion (AMT of 8 or less) Urea raised >7mmol/l Resp rate >30/min Blood pressure: • Systolid <60 mmhg 65 + ```
31
Additional adverse features of CAP
Hypoxaemia Pa 02 <8 kPa, SaO2, 92% | Bilateral or multilobar involvement on CXR
32
CURB65 score assessment
>3 Severe pneumonia (mortality) =2 Non-severe, (mortality 9-2%, consider admission) 0 of 1 Non severe (mortality 1.5%, treat at home)
33
In the community assessment of CAP
CRB-66 scores >3 Urgent hospital admission 1 or 2 Hospital referral and assessment 0 Treat in community
34
Possible organisms related to occupation Health Care worker
MTB | Acute HIV seroconversino with pneumonia (needle sticks)
35
Possible organisms related to occupation Veterinarian, farmer, abattoir worker
Coxiella burnetti
36
Possible organisms related to occupation DKA
S. pneumonia | S. aureus
37
Possible organisms related to occupation Alcoholism
S. pneumonia L. pnuemonaie S. aureus
38
Possible organisms related to occupation COPD
S. pneumonia H. influenza M. catarrhalis
39
Possible organisms related to occupation Solid organ transplant recipient (>3 months)
``` S. pneumonia H. influenza Legionella spp. Pneumocyctis jiroveci CMV Stronglyoides Sterocoracils ```
40
Possible organisms related to occupation Sickle cell disease
S. pneumonia
41
Possible organisms related to occupation HIV (CD4+ T – cells <200/ ul)
``` S.penuomaie P.jirovci H. influenza H. influenza Cryptococcus neoforms MTB Rhodococcus equi ```
42
Possible organisms related to occupation Air-conditioning
Legioella penumophilia
43
Possible organisms related to occupation After windstorm in area of endermnicity
Coccidioides inmitis
44
Possible organisms related to occupation Outbreak in shlter or jail
S. pneumonia, MTB
45
Possible organisms related to occupation Exposure to turkeys, psittacine birds
Chlamydia psittici
46
Possible organisms related to occupation Exposure ro rabbits
Francisella turalensis
47
Possible organisms related to occupation Travel to Southeast Asia
Burkolderia pseudomallei
48
Immigrants from high endemic from high prevalence of tuberculosis
MTB
49
Investigations
``` Saturation Arterial blood gases FBC; U + E Cr CRP (shows progression) CXR ```
50
Microbiological
* Serum: stored; use retrospectively to diagnose * Blood cultures: + ve in 15% of severe cases * Sputum: shown to be of no clinical value except for TB of legionella * BAL: Bronchio-alveolar lavage. Optimal sample but only in severe cases since invasive * Urine: antigen for Legionella/ S. pneumonaie
51
Grouping of pneumonia
Atypical and Typical (typical doesn’t mean common) | So much overlap that distinguishing is difficult – related to their response to treatment
52
Typical pathogens
Often lobar | Streptococcus pneumonaie
53
Typical pathogen treatments
Amoxycillin sensitive | Sometimes macrolide sensitive
54
Atypical
Often multisystem, multilobar → Mycoplasma, Chlamydia. Coiella, Legionella Amoxicillin resistant (different to typical) Macrolide sensitive
55
Streptococcus pneumonaie can invade and causes
Can invade(although commensual) and cause : Pneumoniae Meningitis Endocarditis Bacteraemia (may be only manifestations in toddlers) – viral prodrome Triad → (rare) Austrins triad primary pneumonia, cholangitis, meningitis
56
Streptococcus pneumonaie colonises and transmission
Colonises the nose and transmitted person to person
57
Streptococcus pneumonaie sensitive to
Amoxycillin and doxycycline levofloxacin/ noxifloxacin Penicillin resistance rising although rare in the UK
58
Streptococcus pneumonaie significant mortality in which groups
Elderly Renal Failure Splenectomy
59
Streptococcus pneumonaie vaccination
Is available against 23 serogroups plus new heptavalent conjugate vaccine. → Pneumovax → Kednav vaccine (recheck name)
60
Haemophilus infleunzae: Presence
Several serovars resident in the nose
61
Haemophilus infleunzae: Transmission and associated with which types of infections
Person to Person (capsule vs non capsular) → Capsular strain (a-f) – associated with invasive infection including, meningitis, epiglottis (HiB vaccine effective) → Non-capsular strains (generally non invasive disease) → Associated with mucosal infections including, otitis media, sinusitis and exacerbations of COPD (HiB vaccine ineffective)
62
Haemophilus infleunzae: Can invade and causes which disease
Pneumonaie Meningitis Bacteraemia, Epiglottis Other (septic arthritis)
63
Haemophilus infleunzae: Sensitive to
Amoxicillin 20% are Beta-lactamase positive Sensitive to cefuroxime and co-amoxiclav
64
Haemophilus infleunzae: Requires what for growth
Needs special factors to grow: Haem (X) and NAD (V)
65
Mycoplasma pneumonaie:Structure
Lacks classical peptidoglycan cell wall
66
Mycoplasma pneumonaie: Resistant to
Beta lactam antibiotics
67
Mycoplasma pneumonaie: Sensitive to
Macrolides Tetracyclines Quinolones
68
Mycoplasma pneumonaie:Cause of
Atypical penumoniae
69
Mycoplasma pneumonaie: Epi
Occurs in epidemics every 3-4 years Transmission human to human Most common in children and young adults
70
Mycoplasma pneumonaie: Rare complications
Myringitis (middle ear infection) and encephalitis
71
Mycoplasma pneumonaie: Diagnosis via
Serology -more likely with PCR
72
Legionella pneumophilia Survival
Can survive and multiply inside macrophages
73
Legionella pneumophilia Presentation
Legionella can cause mild disease (Pontiac fever) or severe pneumonia with multi-organ failure (legionnaires disease)
74
Legionella pneumophilia Epi
>50% of cases associated with travel Cooling towers Air conditioning systems
75
Legionella pneumophilia Diagnosis via
Antigen detection and serology and culture
76
Legionella pneumophilia Treatment
Macrolides/quinolones +/- nifampicin
77
Chlamydophilia pneumonaie and Chlamydophilia psittaccii Description
Obligate intracellular parasites
78
Chlamydophilia pneumonaie and Chlamydophilia psittaccii Sensitive to
Macrolides Tetracyclines Quinolones
79
Chlamydophilia pneumonaie and Chlamydophilia psittaccii C.pneumoniae prognosis
Self-limiting and mild. Human to human transmission
80
Chlamydophilia pneumonaie and Chlamydophilia psittaccii C.psittacii can cause
Severe pneumonia associated with birds of all sorts. | Occupational disease of poultry processing industry
81
Coxiella burnetti: Causes
Q fever – contact with animals
82
Coxiella burnetti: Spread by
Airbourne, through infected milk, faeces and urine of farm animals
83
Coxiella burnetti:Can causes
Severe pneumonia
84
Coxiella burnetti:Diagnosis is by
Serology (Phase 1 and 2 antibodies)
85
Coxiella burnetti: Treatment
Best with tetracyclines
86
Management of Pneumonaies: CAP non severe
Amoxicillin 500 mg-1.0gs (home treated)
87
Management of Pneumonaies: CAP non sever and alternative HAP
``` Amoxicillin 500 mg-1.0gs Oral: Amoxicillin 500 mg-1.0gs Erythromycin 500 mg Clarithromycin 500mg ``` IV: Ampicillin or nezylpenicillin
88
Management of HAP alternative
Fluoroquinolone with some enhanced pneumococcal activity e.g. levofloxacin IV: Levofloxacin
89
Management of | CAP alternative
Erythromycin 500 mg | Clarithromycin 500mg
90
Ventilatory associated pneumonia →
* Gram negatives more common * Similar paths to hospital acquired pneumonia * Broad spectrums use
91
Pneumonia in immunocompromised: Description
1. Different groups vary in susceptibility to micro-organisms e.g. neutropenia, HIV, Organ transplantation, steroid treatment. 2. Lack of neutrophils predisposes to Gram negatives e.g. Coliforms, Pseudomonas and Gram positive eg. staph and virdidans streptococci. 3. Lack of appropriate T-cells predisposes to intracellular pathogens (e.g. Mycobacterium spp.)
92
Pneumonia in immunocompromised: Treatment:
* Can be difficult * Strenous attempts should be made to help identify offending pathogens e.g. use of CT scan, bronchoscopy, BAL, needle biopsy * Treatment may have to cover a wide range of pathogens * Recovery of neutrophil function/T-cell defect will improve prognosis * Prophylaxis required in selected patients
93
Pnenumocysitis jiroveci
* HIV related illness * Occurs with CD4<200 * Fungus: Pneumocysitis * Pneumonia, onset over several days → weeks * Important cases of deaths in AIDS
94
Pnenumocysitis jiroveci treatment
* Refractory to normal antibiotics * Responds to co-triamoxole (Septrin) + steroids * Prophylaxis given CD4<200
95
Pnenumocysitis jiroveci Diagnosis requires
* Sputum sputa or BAL sample * Analysed by Cytology * Pneumocysitis
96
Complications of pneumonia
Parapneumonic effusion Empyema Lung abcessess
97
Parpneumonic effusion
Reactive, not infected pH>7.2 Manage conservatively
98
Empyema
Infected pH <7.2 Needs drainage and surgery
99
Lung abscesses
May be due to aspiration, pneumonia, haematogenous spread (IV drug users) or malignancy
100
Aspiration organisms
Polymicrobial
101
Haematogenous abscess usually due to
Staph
102
Rare causes of lung abscess
Klebsiella pneumonia | Pseudomonas aeruginosa and fungi

Cardio (108 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions