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Lower Respiratory Tract Infections
Downstate > MS2 Respiratory Block > LRI Lecture 9
72
Medical
Graduate
01/30/2011

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Term
bugs that cause viral tracheitis (3)
Definition
parainfluenza, influenza, enterovirus
Term
bugs that cause secondary bacterial tracheitis (5)
Definition
Staph aureus, GAS, Strep viridans, Hib, Gram- enterics
Term
site of infection of tracheitis
Definition
subglottic area, upper trachea
Term
gross presentation of tracheitis
Definition
pseudomembranes that do not hemorrhage with removal
Term
child with croup, stridor, no bacteremia, pneumonia (50%); physical exam shows pseudomembranes; dx?
Definition
tracheitis
Term
most common bugs that cause bronchitis (5)
Definition
M. pneumoniae, parainfluenza, adenovirus, influenza, RSV
Term
What immunodeficiencies are associated with chronic cough (5)?
Definition
IgA deficiency, IgG deficiency, hypogammaglobulinemia, ataxia-telangectasia, GVHD
Term
bacterial causes of typical community-acquired pneumonia (5)
Definition
Strep pneumonia, GAS, M. catarrhalis, Staph.aureus, Klebsiella pneumoniae
Term
bacterial causes of atypical community acquired pneumoniae (3)
Definition
Mycobacterium pneumoniae, Chlamydia pneumoniae, Coxiella burnetti
Term
viral causes of community acquired pneumonia
Definition
A CRRIPE: adenovirus, coronavirus, RSV, rhinovirus, influenza, parainfluenza, enterovirus + new bugs bocavirus and hMNV
Term
causes of nosocomial pneumonia (4)
Definition

 

 Pseudomonas (most common), Enterobacteriaceae (i.e. Klebsiella), Staph aureus, Legionella, (Acinetobacter, RSV, SARS)

Term
S. pneumoniae is _-hemolytic. Staph aureus is _-hemolytic.
Definition
S. pneumoniae: alpha-hemolytic; Staph aureus is beta-hemolytic
Term
How does S. pneumoniae escape the immune system?
Definition
thick capsule prevents phagocytosis
Term
Which vaccine is recommended for pts<2yo?
Definition
PCV-13
Term
Who is Pneumovax recommended for?
Definition
adults>65yo, children>2yo at risk of developing pneumococcus, children>2yo with asplenia or sickle cell
Term
transmission of S. pneumoniae is ___
Definition
autoinfection and seasonal, NO outbreaks
Term
risk factors for developing S. pneumoniae (6)
Definition
young, day care, functional/anatomical asplenia, HIV; African American, Native American/Alaskan
Term
high mortality, necrotizing abscesses, pneumonia, toxic shock; dx?
Definition
Staph aureus
Term
Staph aureus: Gram, motility, anaerobic/aerobic, fastidious?
Definition
Gram+, nonmotile, aerobic or facultative anaerobic, not fastidious
Term
Staph aureus is coagulase __; Staph epidermis is coagulase __
Definition
Staph aureus: coagulase+; Staph epidermis: coagulase-
Term
How does Staph aureus evade the immune system?
Definition
protein A inhibits phagocytosis and binds Fc
Term
pneumatoceles, abscesses, consolidation, empyema; dx?
Definition
Staph aureus
Term
CA-MRSA is resistant to ___ and sensitive to ___
Definition
resistant to beta-lactams; sensitive to clindamycin and vancomycin
Term
hospital acquired MRSA is resistant to ___ and sensitive to ___
Definition
resistant to beta-lactams, clindamycin; sensitive to vancomycin
Term
PVL
Definition
Panton-Valentine leukocidin; pore-forming protein assc'd with necrotizing abscesses formed by Staph aureus
Term
Legionella: aerobic/anaerobic, fastidious, Gram?
Definition
aerobic, fastidious, Gram- bacilli
Term
what 2 diseases are caused by Legionella?
Definition
Legionnaires' disease, Pontiac fever
Term
transmission of Legionella
Definition
ingested water or inhaled aerosolized water
Term
lives in amoebas
Definition
Legionella
Term
assc'd with schools, military, nursing homes, etc. (4)
Definition
M. pneumoniae, C. pneumoniae, Legionella, adenovirus
Term
no cell wall, no PBPs; tx with macrolide, tetracycline, or fluoroquinolones
Definition
Mycoplasma pneumoniae
Term
pathogenesis: peroxide causes hemolysis, oxygen radicals cause ciliostasis, ciliolysis, and exfoliation
Definition
Mycoplasma pneumoniae
Term
P1 protein used to attach to cilia; causes dry, hacking cough; bug?
Definition
Mycoplasma pneumoniae
Term
cons of serology diagnostics for M. pneumoniae
Definition
negative in early infection; IgM levels are variable
Term
pt presents with pneumoniae that has persisted for 3 wks; serology shows cold agglutination; bug?
Definition
M. pneumoniae
Term
no protective immunity despite previous exposure (2)
Definition
M. pneumonia, RSV
Term
Gram- rod, oxidase negative, and lactose fermenting; bug?
Definition
Klebsiella pneumonia
Term
protein A => bug?
M protein =>
P1 protein =>
PVL =>
MBL =>
Definition
protein A = Staph aureus
M protein = Strep pneumo
P1 protein = M. pneumo
PVL = Staph aureus
MBL = SARS
Term
intracytoplasmic inclusions fuse to form 1 large inclusion body; bug?
Definition
C. pneumonia or C. trachomatis
Term
C. pneumoniae vs. C. psittaci: transmission?
Definition

C. pneumoniae: droplets, person to person

C. psittaci: aerosolized bird feces to person

Term
newborn presents with rales and hyperinflation on CXR, but is afebrile with no wheezing, no pleural effusion, no consolidation; eosinophilia but no leukocytosis; dx?
Definition
C. trachomatis
Term
multiple, separate intracytoplasmic inclusion bodies; bug?
Definition
C. psittaci
Term
What tests are used to diagnose C. psittaci?
Definition
complement fixation test, microimmunofluorescence (MIF)
Term
SARS: transmission?
Definition
droplet, person to person
Term
SARS: genome? family?
Definition
+ssRNA, coronavirus
Term
what molecular proteins are protective against SARS?
Definition
MBL, ACE2
Term
biphasic illness with a prodrome; dx?
Definition
SARS
Term
myalgia, headache, mild respiratory symptoms, possible rigors; then dyspnea, nonproductive cough, and respiratory failure; dx?
Definition
SARS
Term
histological pathogenesis of SARS
Definition
diffuse alveolar damage with varying degrees of organization; early phase: hyaline membranes, edema, congestion; late phase: fibrosis
Term
RSV: genome? family?
Definition
-ssRNA, paramyxoviridae
Term
what populations does RSV target?
Definition
can cause infection in all ages but has a bimodal distribution, and is primarily a pediatric LRI
Term
how does RSV present in infants?
Definition
LRI, bronchiolitis, pneumonia: hyperinflation, flat diaphragm, tachypnea, wheezing, dyspnea
Term
how does RSV present in older children and adults?
Definition
URI, tracheobronchitis
Term
how does RSV present in immunocompromised and elderly?
Definition
pneumonia
Term
infectious agent for reactive asthma
Definition
RSV
Term
adenovirus: genome? family? structure?
Definition
dsDNA, adenoviridae, non-enveloped icosahedral
Term
what adenovirus types cause LRI?
Definition
types 3, 4, 7, 21
Term
endemic throughout the year, affects all age groups, most are asymptomatic; bug?
Definition
adenovirus
Term
in addition to pneumonia, this can cause URIs, fatal infections in immunocompromised, and keratoconjunctivitis
Definition
adenovirus
Term
high incidence sequelae of adenovirus
Definition
bronchiectasis
Term
transplant pts that contract this bug cannot be treated and have 100% mortality
Definition
adenovirus
Term
how do group B adenoviruses enter the cell?
Definition
binding to CD46
Term
hMNV: genome? family? structure?
Definition
-ssRNA, paramyxoviridae, enveloped
Term
new virus that causes 10% of LRIs in children and cannot be distinguished from RSV
Definition
hMNV
Term
2 parvoviruses that are pathogenic in humans
Definition
bocavirus, parvovirus B19
Term
cause of Fifth Disease in children and aplastic crisis in sickle cell anemia pts
Definition
parvovirus B19
Term
human bocavirus: genome? family?
Definition
ssDNA, parvoviridae
Term
what causes Chlamydia to transition into a persistent state?
Definition
IFN-g, antibiotics, glucose or iron restriction
Term
genes to generate ATP are turned off; bug?
Definition
Chlamydia
Term
what antigen is used for the complement fixation test to diagnose Chlamydia?
Definition
LPS
Term
no cell wall, some PBPs; bug?
Definition
Chlamydia
Term
RB = ?; EB = ?
Definition
reticulate body (replicative); elementary body (infectious) // part of Chlamydia life cycle
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