Term
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Definition
| an infoamatory reacion int he lungs caused by a variety of isnults. could be bacteria, vursus, toxins, radiation |
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Term
| 3 groups of infectious penumonia |
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Definition
1) bacerial s.pneumonia, staplococcyl
2) atypical pneumonia (mycoplasma, vruses)
3) granulatomous pneumoniae |
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Term
| signs and symptoms of bacterial pneumoniae |
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Definition
| fever, chills, cough, pleurisy, headache, cyanosis, dyspnea, cardiac arrhythmias, shocl. limitation fo chest expansion, dullness to percuissions, bronchial breath sounds, frictionr ubs due to pleural inflammation. |
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Term
| lab findings of bacterial pneumonia |
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Definition
| neutrophilic leukocytosis with left shift, purulent sputum with bacteria stainable by Gram stain. sputum cultures for organisms, bloo cultures |
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Term
| radiographic fidnings on bacterial pneumoniae |
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Definition
| depends on pathologic pattern, but in general there is increased radiographic density where fluiod and cells have caused consolidation of pulmonary tissue. |
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Term
| In necrotizing pneumonias and pulmonary abscesses_____________. |
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Definition
| air fluid levels may be pbserved. Abscesses infvariably communicate with bronchi and allow air into space and pus to be coughed up. |
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Term
| pathologic patterns of bacterial pneumonia |
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Definition
1) lobar pneumonia (one or more lobes of a lung become consolidated caused by encapsulated bacteria pneumoccous and kleibsiella
2Bronchopneumonia, patchy nodules of lung become consolidated These nodulres are centered on airways (because that is how the bugs get there) spread of the organizim is contained by hose inflamatory response before the enire lobe becomes consolidated.
3) embolic pneumonia, in contrast to lobar and bronchopneumonia which are airborne, the organsism responsivle for emboolic pneumonia reach the lung via the bloodstrem from other infected sites- abscesses, cellulitism osteomyelitis)nodular pathcy areas of consildation by not necesarily ont he airways. accompanied by necorso or cavitation. |
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Term
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Definition
| one or more lungs becomes consolidated (the alveolar air spaces are cfilled with fluid fibri, inflamatory cells, and vacteria) causd by encapsulated bacteria ie pneumococcus kliebsiella. Spread of the organism is limited by interlobuklar septae of lung and not the host inflamatory response to teh bacteria. |
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Term
| Pathologic sequence of lobar and bronchopneumoniae |
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Definition
4-24 hours itraalveolar edema
early neutrophil inflammation
2) 1-3 days red haptization exudation of fludi, blood and white cells into airspaces
3) 3 to 8 days gray hepatization acculation fo fibrin lysis of red cells, lysis of neutrophils influx of macrophages
4) 8-10 days onset of resolution often elaving normla parenhyma int he case of pneumococcal pneumoni; however other mroe sever forms of peneumonia will result in organzation by scarrugn and loss of normal pulmonary architecture. |
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Term
| Patchy nodultes of lung becoem cnsolidated. Therese nodules are centered on airways. Spread of organism is stopped by host immune defemnse |
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Definition
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Term
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Definition
as opposed to lobar and bronchopenumonia which are airborne infections. embolic comes tot he lung via the blood stream from other infected sites. Nodular pathce so fconsolidation that are nto bronchocentric.
a) the site fo inflammation and necrosis int eh lung is important. If teh alveolar air spaces are teh site, then complete respolutiont otnormal lung may ensue. If there is necrosis of the lalveolar septal and intersitital tissue then healing occurs with fibrosis and some of the lung will be non functional. |
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Term
| pulmonary defense systems 4 methods |
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Definition
1) innate immunte system
2) secondary immune response-sensitized lymphocytsm specific antibodies
3) inflammatory reaction can be a two edged sword
a phagocytosis and elimnnation forganism or non sepcific damage to lung parenchyma escalator damag, bronchial epithelial damage
excess muous secretion
impaired reffuicact of immunoglobulins
neutrpil elastsase mediated tissue destruction
neutrophil response is proportional to teh number of inoculums |
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Term
| typical resolution of pneumonia |
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Definition
1) first few days
defervescence, diminished symptoms resolution of leukocytosis
2) delayed respoluton absence of any early clinical improvemnets
absence of CXR clearance at 4-6 weeks
3) causes of poor rsponses to initial therapy
inappropriate therapy antibiotic resistance, unusual pathogen, complicated pneumonia, complications of treament
non ifectious mimic of pneumonia |
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Term
| Complications of Bacterial pneumonia |
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Definition
spread of infection-
pericarditis
pleural empyema
2) invasion of blood stream ifnection at distal sites, meningitis, edocarditis, arthritis (septic) abscesses)
local complications-bronchiectasis, bronchopleural fistula, lung abscess |
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Term
| Aspiration pneumonia in the 1970s and today |
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Definition
1970s ot was noted that patients with clincal aspiration penumoia were found to be infected with anaerobic organizsims in most cases
in teh 1990s it was found that community acquired aspiration penumona was most commonly associated iwth streptocooccus pneumo, staph aureus, h. influenza and enterobacter
in 1970s found late in course of illness
in 70s patients had abscensses
early folks had alcoholism |
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Term
| prediscposing factors to aspiration pneumonia |
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Definition
| altered CNS status, particularly unconscious dysphagia and disordes in swallowing mechanism, mechanical bariers protracted vomiting |
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Term
| Is aspiration pneumonia more commonly caused by anerobes or aerobes? |
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Definition
| More commonly caused by anaerobes-often times it is mixed flora which necessitates aerobic and anaerobic cultures. |
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Term
| aspiration of a foreign body |
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Definition
| comnmon in toddlers chronically developrecurrent pneumonia distal to and bronchiestasis around the asoirated foreign body. |
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Term
| chronic aspiration of inert fluid |
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Definition
leads to lipoid pneumonia
lipoid pneumonia is distinct from a lipid pneumonia or "golden neumonia" which occurs as teh result of acuumulaton of lipid- filled macrophages |
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Term
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Definition
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Term
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Definition
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Term
| Chronic recurrent pulmonary infections |
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Definition
anatomic abnormalities:
TE fistula
vascular rings
sequestration
cyanotic congenital heart disease
chest wall deformities |
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Term
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Definition
cystic fibrosis
immunogloulin deficiences
ciliary dyskinesias
asthma |
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Term
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Definition
usual presentationa nd clinical course of disease differed from typical pneumococcla pneumonia
etiologic organizsims did not grow on routine cultures
teh disease did not respond to penicillint herapy
maybe caused bty obligate intracellualar parasitic organisms like legionella chlamydia and mycoplasma |
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Term
| clinical manifestations of a typial pneumonia |
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Definition
insidious rather than abruupt. non productive cough. fever. headache malaise myalgias.
1. physical exam-rhochi rales/no consolidation. |
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Term
| radiography of atypical pneumonia |
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Definition
| interstitial infiltrates+- patchy bronchopneumonia. frequently bilateral. |
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Term
| labaroatory in atypical pneumonia |
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Definition
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Term
| Atypical pneumonia sputum sample |
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Definition
| mixture of mononuclear inflamatory cells and neutrophils without a predominant organism on gram stain routine sputum cultures are negative. |
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Term
| mycoplasma or viral pneumonias as opposed to bacterial pneumonia |
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Definition
| mononuclear cells characerize the pulmonary infiltrates in most |
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Term
| pathologic patterns laryngotracheobronchitis in atypical pneumonia |
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Definition
| laryngotrachebronchitis-infection of large airways characterized by submucosal lymphocytic infiltrates with epithelial lining cell injury and sloughing |
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Term
| bronchiolitis in atypical pneumonia |
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Definition
| infection of small airways again with submucosal lymphocytic infiltrates. admixed neutrophils common. |
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Term
| cellular interstitial pneumonia |
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Definition
| usually an extension of bronchiolitis into the alveolar interstitium. Alveolar septae are widened by lymphocytes, admixed neutrophils, mild edema. |
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Term
| bronchopneumonia-atypical pneumonia |
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Definition
| groussly and microscopically looks just like bacterial bronchopneumonia with neutrophils. Causative organisms may be identified by routine H and E stains or special stains, cutlure or serology. |
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Term
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Definition
| viral acute intersitital penumonia- results in ARDS |
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Term
| clincial aspects of influenza |
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Definition
| abrupt onset of systemic illness |
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Term
| Legionairres disease clinic |
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Definition
asymptomatic seroconversion
mild slef0limited febrile illness
severe progressive pneumonia |
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Term
| symptoms of legionairres disease |
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Definition
high fver, dry cough, pleuresy
diahrrhea, relative bradycardia
focal neurologic signs, elevated liver and renal function |
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Term
| Chest xray of legionella's disease |
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Definition
alveolar infiltrates
abscess formation
interstitial infiltrates
ARDS |
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Term
| epidemiology of legionella disease |
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Definition
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Term
| legionella is associated with |
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Definition
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Term
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Definition
atypical pneumona-small organism-limited biosyntehtic capabilities
mucosal pathogen |
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Term
| 25 percent o pneumonias in ambularotry patients are caused by |
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Definition
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Term
| transmission of mycoplasma pneumonia |
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Definition
| is aerosolized with an incubation of 1-3 weeks |
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Term
| CXR for mycoplasma pneumoniae |
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Definition
| looks worse thant he patient diffuse reticular infiltrates in the perihilar region/lower lobes. 20 percent are bilateral infiltrates. |
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Term
| diagnosis of mycoplasma pneumonia |
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Definition
| specific antibody tst, cold agluttinins |
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Term
| Treatment of mycoplasma pneumonia |
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Definition
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Term
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Definition
| obligate intracellular parastie organizm without a known zoonotic rservoir. |
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Term
| 5-20 percent of community aquired pneumona |
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Definition
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Term
| pathology in animal models of chlamydia |
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Definition
early neutrophilic inflammation followed by chronic intersitital inflamatory infiltrate
relationship to atheroscolrosiis |
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Term
| treatment of chlamydia pneumonia |
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Definition
| macrolides, tetracycline, fluoroquinolones |
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Term
| bacterial pneumonia lab findings |
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Definition
neutrophilic leukocytosis
left shift in neutrophilic series
purulent sputum
bacteria phns on sputum gram stain
sputum |
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Term
| 12-24 hours after bacterial pneumonia infection |
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Definition
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Term
| 1-3 days after bacterial pneumonia infection |
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Definition
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Term
| 3-8 days after bacterial pneumonia infection |
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Definition
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Term
| weeks after a bacterial pneumonia infection |
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Definition
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Term
| 2 edged sword of inflammatory reaction |
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Definition
phagocytosis elimates organism
you can also get snons pecific damage to pulmonary tissues-escalator, epitheliakl damage, mucus hyper secretion
neutrophil elastase |
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Term
| 3 clinical settigns way of getting pneumonia |
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Definition
1) nosocomial
2) community acuired
3) immunocompromised |
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Term
| etiology of bacterial pneumonia: community acquired |
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Definition
| pneumococcal, staphylococal,s teptococcal, h. influenzae, klebsiella |
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Term
| etiology of bacterial pneumonia: nosocomial |
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Definition
gram negative organisms
e coli
staph aureus
serratia
pseudonomas |
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Term
| 70 percent of community acquired bacterial pneumoniae |
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Definition
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Term
| natural course of s.pneumoniae infetion |
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Definition
5-10 days uncomplicated course
protracted illness with compl;ications leads to 30 percent death in untreated cases |
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Term
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Definition
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Term
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Definition
capsular poly saccharide
pneumolysin-intracytoplasmic toxin released only on lysis of cell wall toxic
pneumococcal surface protein A
Autolysin
cell wall polysaccharide |
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Term
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Definition
present on pneumooccus essential for virulence antiphagocytic not toxic itself
antibody to this is the best aprotection to the s.pneumonia |
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Term
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Definition
intracytoplasmic toxin released on lysis of the s. pneumonia cell wall.
activates complement. |
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Term
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Definition
upon growth stop, lyses cell wall.
essential for release of pneumolysin |
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Term
| pneumococcal surface protien |
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Definition
immunogenic surface proetien
unclear function |
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Term
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Definition
causes inflammation with s pneumonia
attaches to PAF on endothelium |
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Term
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Definition
s.pneumonia
capsular color
can also see asheen in the lungs |
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Term
| Poor prognosticators for s.pneumonia |
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Definition
splenic dysfunction
alcoholism
old age
multilobar
leukopenia |
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Term
| Atypical pneumonia-viruses with recognizable inclusions |
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Definition
Adenovirus-
CMV inclusions-huge
measles- giant multinucleated
herpes simplex virus-condense nucleus eosinophilia. |
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