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Microbiology- Bacteriology
Pneumonia (T Pierce)
51
Medical
Professional
09/11/2009

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Cards

Term
Pneumonia syndromes
Definition
  • acute community acquired
  • atypical
  • aspiration
  • nosocomial
  • immunosuppresed host
  • chronic
Term
Pathophysiology of pneumonia
Definition
  1. lungs parenchyma infected by an organism
  2. neutrophils migrate out of pulmonary capillaries into the air spaces
  3. after phagocytosis, neutrophils kill injested microbes
  4. inflammation results in neutrophilic exudate in alveolar spaces

 

Term
Causes of acute pneumonia
Definition
  • most common- apsiration of oropharyngeal bacteria
  • other causes
    • inhale aerosolized microbes
    • metastatic seeding of microbes from blood
    • invasion of infection in contiguous structures
    • direct inoculation of microbes
    • reactivate latent infection (ex: TB)
Term
Major host defense against upper resp. tract infections
Definition
  • nasopharynx- turbinates, filtration, impaction, mucociliary epithelium
  • oropharynx- flow of salivea, sloughing of epithelium, bacterial interference of resident flora, produce complement
  • trachea, bronchi
    • epiglotical reflex during swallowing (major)
    • cough reflex
    • mucociliary reflex
    • production of Ig's
Term
Development of acute pneumonia signifies what?
Definition
  • Aka, you have either exposure to particularly virulent organism
  • defect in host defense
  • overwhelming inoculum of low virulence organism
Term
defense mech from lower resp. tract infection
Definition
  • cough
  • resp. tract structure
    • alveolar macrophages that produce cytokines that lead to neutrophil recruitement
    • alveolar lining in resp. zone- surfactant, fibronectin, complement, IgG, macrophages
  • epithelial cells in conducting airways produce surface liquid w/:
    • lactoferrin
    • lysozyme
    • secretory leukocyte proteinase inhibitor
Term
Function of fibronectin
Definition
glycoprotein covering cell R's that prevents microbial adherance
Term
Function of lysozyme
Definition
bactericidal for gram positive bacteria
Term
Function of surfactant in host defense
Definition
increase macrophage microbicidal activity
Term
Function of lactoferrin
Definition
rotein that is bateriostatic for gram negative bacteria
Term
What could impair the cough reflex?
Definition
  • stroke
  • neuromusc. disease
  • sedatives
  • alterations in consciousness
  • poor nutrition
Term
What could depress mucociliary transport
Definition
  • smoking
  • aging
  • dehydration
  • morphine
  • atropine
  • Mycoplasma infections
  • chronic bronchitis
Term
What anatomic changes facilitate pneumonia infection
Definition
  • emphysema
  • bronchiestasis
  • obstructive mass lesions
Term
Role of inflammatory cells in impairing host defense
Definition
  • release proteolytic enzymes
    • alters bronchial epithelium
    • alter ciliary clearance
    • produce excess mucus
Term
What could blunt the cellular and humoral immune responses
Definition
  • HIV/AIDS
  • CGD
Term
What could cause reduced granulocyte chemotaxis?
Definition
  • aging
  • DM
  • malnutrition
  • hypothermia
  • corticosteroids
Term
what could cause reduced neutrophil number (neutropenia)
Definition
chemotherapy
Term
What could cause dysfunctional alveolra macrophages
Definition
  • coricosteroids
  • cytokines
  • viral illnesses
  • malnutrition
Term
What could cause diminshed Ab production or function
Definition
  • chronic lymphocytic leukemia
  • multiple myeloma
Term
What type of Iatrogenic manipulations could influence spread of pneumonia?
Definition
  • endotracheal tubes
  • nasogastric tubes
Term
How does tobacco cause pneumonia
Definition
  • disrupt mucociliary function
  • distrupt macrophage activity
Term
How can alcohol influence spread of bacteria?
Definition
  • impair cough
  • impair epiglottic reflexes
  • colonize gram negative bacteria
  • block TNF and neutrophil activation
Term
Role of aging in development of pneumonia
Definition
  • less effective mucociliary clearance and coughing
  • changes in humoral and cell mediated immunity
Term
Causes of recurrent pneumonia
Definition
  • anatomic abnormality
    • tumor
    • compressed bronchus
    • pum. sequestration
    • foreign body
    • bronchiectasis
  • Ig deficiencies (CVID)
  • depressed neutrophil function (CGD)
  • cystic fibrosis
  • abnormal ciliary activity
    • immotile cilia syndrome
    • Kartagener's syndrome
    • Young's syndrome
Term
Symptoms upon taking history of pneumonia with typical pathogens
Definition
  • high fever
  • chills
  • productive cough
  • dyspnea
  • pleuritic chest pain
Term
Symptoms upon taking medical history with atypical pathogens
Definition
  • low grade fever
  • nonproductive cough
Term
Lobar pneumonia X ray findings
Definition
focal pneumonia (bacterial cause)
Term
Diagnosis of pneumonia
Definition
  • epidemiology considerations
    • age
    • environment
    • underlying conditions
    • season
  • blood cultures
  • gram stain of sputum
  • characteristic X ray appearance
  • antigen tests (S. pneumonia, Legionella)
Term
Most common cause of community acquired pneumonia
Definition
Streptococcus pneumoniae
Term
symptoms of Streptococcus pneumonia
Definition
  • shaking chills
  • pleuritic chest pain
  • rusty sputum
  • suppurative complications
    • sinusitis
    • otitis media
    • endocarditis
    • meningitis
    • parapneumonic effusion/empyema
Term
Pneumococcal vaccine (describe, who should get it, how often)
Definition
  • structure
    • capsular polysaccharide from 23 serotypes
  • who should git it
    • age 65 and over
    • chronic cardiac, pulm., renal disease
    • DM
    • alcoholics
    • cirrhosis
    • age
    • splenic dysfunction
    • HIV
    • transplant patients
    • military recrutis
  • revaccinate after 5 years
Term
Hemophils influenza pneumonia (associated with what conditions?, symptoms)
Definition
  • Char
    • penicillin resistant due to beta lactamase production being common
    • encapsulate strains more virulent
  • associated w/:
    • COPD
    • alcoholism
  • symptoms
    • fevers
    • chills
    • cough w/purulent sputum
    • pleural effusion
Term
Hib vaccine (type of vaccine, success)
Definition
  • conjugate vaccine containing type b polysaccharide
  • incidence of invasive disease remarkably reduced among children
Term
Klebsiella pneumoniae (associated with what, symptoms/signs, can lead to what type of pneumonia)
Definition
  • associated with:
    • alcohol
    • cancer
    • DM
    • COPD
  • signs/symptoms
    • sudden onset of prostration and toxemia
    • fever
    • chest pain
    • dyspnea
    • hemoptysis
    • thick purulent sputum
  • chronic necrotizing pneumonia
Term
Major causes of community acquired pneumonia
Definition
  • Streptococcus pneumonia
  • Hemophils influenza
  • Klebsiella pneumonia
  • Staph aureus
Term
S. aureus (symptoms, MRSA pneumonia)
Definition
  • symptoms
    • fever
    • multiple rigors
    • dyspnea
    • cough
    • purulent sputum
  • CaMRSA
    • contains Panto-Valentine Leukocidin
      • frequently see abscesses or lung cavities due to this enzyme
Term
S aureus (prim vs secondary pneumonia)
Definition
  • primary
    • follow viral infection esp. influenza or hospital acquired infection
  • secondary
    • hematogenous dissemination with multiple pulmonary nodules
Term
Bacterial causes of atypical pneumonia
Definition
  • Legionella
  • Mycoplamsa
  • Chlamydophila
  • Psittacosis
  • Tularemia
  • Q fever
Term
 Common symptoms of atypical pneumona
Definition
cough most prominant symptom with a fever often absent
Term
Symptoms, diagnosis of Legionella pneumophilia
Definition
  • symptoms
    • high fevers
    • Gi symptoms
    • multilobar, rapid progression
  • diagnosis by:
    • serology
    • culture of bronchial specimens (on charcoal yeast extract)
    • PCR
    • urinary Legionella Ag test, but only for serogroup 1 (but this is 90% of all Legionella pneumonias)
Term
Myocplasma pneumoniae (prevalence, symptoms, diagnosis)
Definition
  • most common of lower RT infection in young adults
  • symptoms
    • sore throat
    • nonproductive cough
    • headaches are prominent symptoms
    • bullous myringitis (in children)
    • extrapulm. manifestation
      • rash
      • DIC
      • hemolysis
      • meningoencephalitis
      • myocarditis
      • hepatitis
  • diagnosis
    • X rays often worse than clinical findings
    • made clinically and confiremd by serology (cold agglutininis) or culture
Term
Chylamydophilia pneumoniae (demographic most effective, prominent symptoms)
Definition
  • mainly effects college students
  • hoarseness prominent
Term
Chlamydophilia psittaci (psittacosis) is associated with what in the patient history
Definition
  • associated with bird exposure
Term
Coxiella burnetti (Q fever) associated with exposure to what and what complications?
Definition
  • associated with exposure to sheep, goats, cattle
  • complications
    • endocarditis
    • hepatitis
    • osteomyelitis
    • meningitis
Term
Franciella tularensis (tularemia) associated with what in the patient history
Definition
  • exposure to infected tissue of rabis or bite from infected tick
  • requires Cys-enriched media for growth
Term
Pathology of aspiration/anaerobic pneumonia along with predisposing conditions
Definition
  • at risk in patients with
    • impaired gag/cough reflex
    • CNS disease
    • alcohol accompanied by severe periodontal disease
    • tonsillectomy
    • tooth extraction
    • esophageal dysfunction
    • altered consciousness
      • alcohol, anesthesia, drug OD
  • leads to chemical pneumonitis, bronchial obstruction, and bacterial aspiration
Term
Nosocomial pneumonia pathogenesis and risk factors
Definition
  • colonization of oropharynx with pathogenic organism followed by aspiration
  • risk factors
    • age over 70
    • severe underlying disease
    • malnutrition
    • comorbid conditions
    • acidosis
    • ventilator support
    • sedatives
    • narcotics
    • steroids
Term
microbiology and treatment of nosocomial pneumonia
Definition
  • microbiology
    • majority due to aerobic gram negative bacteria (Klebsiella, Enterobacter, Serratia, Pseudomonas)
    • S aureus increasingly common
  • treatment
    • antibiotics should included anti-pseudomonal therapy
    • therapy directed against aerobic gram negative bacilli and MRSA
Term
define empyema
Definition
pus in a pleural space
Term
Microbiology of emyemas and comp. of fluid within them
Definition
  • microbiology- mainly anaerobics
  • Pleural fluid comp.
    • low pH
    • low glucose
    • high LDH
    • positive gram stain
Term
treatment of empyema
Definition
  • never let the sun go down on parapneumonic effusion
  • requires chest tube if
    • organisms on gram stain
    • culture positive
    • pH < 7.2
    • glucose <20
  • four weeks of antibiotics directed at pathogen cultured
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