Bacterial Diseases Of The Respiratory System

Front 1

What are the most common bacterial infections?

Back 1

Upper Respiratory Infections (URI's)

Front 2

Is there normal flora in upper respiratory system?

Back 2

Yes, quite a bit.

Front 3

Is there normal flora in the lower respiratory system?

Back 3

No, healthy individuals will be sterile in the lower respiratory system.

Front 4

Diptheria caused by?

Back 4

Corynebacterium diptheriae

Front 5

Corynebacterium diptheriae gram designation and morphology?

Back 5

• Gram +
• Bacillus (pleomorphic some bacilli some bent)

Front 6

What occurs when bacterium causes Diptheria?

Back 6

• Bacterium undergoes lysogenic conversion

Front 7

Lysogenic conversion

Back 7

• Happens when Corynebacterium becomes infected with a virus, then the virus provides Corynebacterium with genetic information that teaches the bacterium how to produce a toxin
• This toxin causes the symptoms of diptheria

Front 8

Diptheria transmission?

Back 8

• Typically through inhalation of cough droplets or sneeze droplets
• Can occur from symptomatic or asymptomatic individual
• Fomites may also aid in transmission
• In some tropical parts of the world there is a cutaneous form of disease caused by corynebacterium

Front 9

Diptheria incubation period?

Back 9

• 1-10 days (2-5 average)

Front 10

Diptheria symptoms?

Back 10

• Initially slight fever, fatigue, malase, sore throat
• Neck will become very swollen called bull neck
• Develop thick whitish grey membrane over tonsils and soft pallet called a pseudomembrane

Front 11

Diagnosis of diptheria?

Back 11

• Must diagnose as soon as possible because toxin is very virulent
• The identification of pseudomembrane and bull neck enable diagnosis of diptheria
• If not treated within a few days patient could die of progressive organ failure

Front 12

Treatment for diptheria?

Back 12

• Penicillin, sepholisporin, urithomycin, tetracycline (depending on age of patient)
• Also treat patient with an anti-toxin which can be produced in horses similarly to production of snake bite anti venom

Front 13

Vaccine for Diptheria?

Back 13

• DPT vaccine covers diptheria, tetnis, and whooping cough

Front 14

Streptococcal pharyngitis (strep throat) caused by?

Back 14

• Streptococcus pyogenes

Front 15

Streptococcus pyogenes gram designation and morphology?

Back 15

• Gram +
• coccus

Front 16

This strep is sometimes called?

Back 16

• Group A beta hemolytic strep
  

Front 17

Group A beta homolytic strep means?

Back 17

• Group A refers to a set of molecules that serve as markers on the surface of the cell which can be used to identify the organism causing infection
• beta hemolytic refers to the complete breakdown of blood cells when grown on blood agar

Front 18

Streptococcus pyogenes also can cause?

Back 18

• Empatigo (common in children)

Front 19

Transmission of strep pharyngitis?

Back 19

• Typically inhalation of respiratory secretions

Front 20

Incubation period of strep pharyngitis?

Back 20

• 2-5 days

Front 21

Symptoms of strep pharyngitis?

Back 21

• Inflamation of the mucus membranes of the throat
• Fever
• Lymph nodes of neck become swollen and tender
• Otitis media is a common complication

Front 22

Otitis media?

Back 22

• Middle ear infection
• Common complication in patients with strep pharyngitis

Front 23

How long are you contagious after taking antibiotics when you have strep pharyngitis?

Back 23

• 24 hours

Front 24

With strep pharyngitis, how long are you contagious without antibiotic treatment?

Back 24

• Up to 3 weeks
• Can be a self limiting infection but not worth the risk

Front 25

Diagnosis of Streptococcal pharyngitis?

Back 25

• View patients throat
• Take swab of patients throat, swab on blood agar plate, incubate for 24 hours, check for evidence of beta hemolysis
• Instant test similar to home pregnancy tests are also available, and can give definitive results in 15 minutes to an hour

Front 26

Treatment of Streptococcal pharyngitis?

Back 26

• Penicillin
• Urithomycin (if penicillin intoerant)
• Tetracylcine not a good choice due to blackening of teeth in children and development of resistance to tetracycline

Front 27

How many serologic strains of S. pyogenes?

Back 27

• Over 55

Front 28

Scarlet fever caused by? (not technically a respiratory disease, but can be a complication)

Back 28

• Streptococcus pyogenes

Front 29

Streptococcus pyogenes gram designation and morphology?

Back 29

• Gram +
• Coccus

Front 30

S. pyogenes strains that cause scarlet fever?

Back 30

• have been viraly infected and produce erythogenic toxin

Front 31

erythogenc toxin?

Back 31

• Means red causing toxin

Front 32

Transmission of Scarlet fever?

Back 32

• Inhalation of respiratory secretions

Front 33

Scarlet fever incubation period?

Back 33

• 2-5 days

Front 34

Scarlet Fever symptoms?

Back 34

• red skin rash
• deep peel about 10 days in
• high fever
• tongue will become spotted and swollen
• deafness is a possible complication

Front 35

Scarlet Fever treatment?

Back 35

• Penicillin

Front 36

Pertussis (Whooping Cough) caused by?

Back 36

• Bordetella pertusis

Front 37

Bordetella pertusis gram designation and morphology?

Back 37

• Gram -
• cocco bacillus

Front 38

Is Bordetella pertusis aerobic or anaerobic?

Back 38

• anaerobic

Front 39

Transmission of Pertussis?

Back 39

• Airborne, inhalation of cough or sneeze droplets

Front 40

Pertussis incubation period?

Back 40

• Approximately 10 days

Front 41

Pertussis typically seen in?

Back 41

• Infants less than a year old, especially un-immunized infants

Front 42

Pertussis symptoms?

Back 42

• Initially includes mild cough, sneezing, and inflamed throat
• Over next 10-14 days infection makes it's way down to the lower respiratory system and symptoms worsen
• Then sever cough, patient makes whooping sound when coughing
• Vomiting is common do to severe coughing
• Coughing may cause the breakage of ribs
• May experience fluid accumulation in lungs, causing convulsions

Front 43

Pertussis symptoms last?

Back 43

• 2-3 weeks, and typically taper off

Front 44

Treatment of Pertussis?

Back 44

• Urythomycin
• Amphocylin
• If not a young patient, then tetracycline

Front 45

Recovery from pertussis provides?

Back 45

• patient with partial immunity

Front 46

Tuberculosis caused by?

Back 46

• Mycobacterium tuberculosis

Front 47

Mycobacterium tuberculosis gram designation and morphology?

Back 47

• Gram +
• Bacillus

Front 48

Mycobacterium tuberculosis acid fast or not acid fast?

Back 48

• Acid-fast

Front 49

How many new cases of TB in U.S. per year?

Back 49

• Approximately 22,000
  

Front 50

How many U.S. residents currently infected with TB?

Back 50

• 10-15 million (Most latent infections)

Front 51

MDR-TB?

Back 51

• Stands for multi drug resistant tuberculosis
• Which is present in virtually all countries worldwide

Front 52

Transmission of TB?

Back 52

• 75% acquired through respiratory route
• Can become infected by ingestion of contaminated milk or direct contact with infection

Front 53

How to find evidence of TB in individuals with latent infections?

Back 53

• Only way is with TB skin testing

Front 54

TB skin testing?

Back 54

• Use of PPD (Purified Protein Derivative)
• Filtrate from micobacterium that has been grown in a liquid media, and is injected under upper layers of skin
• Patient returns 48-72 hours later, injection site is examined
• If there is swelling and redness, then positive skin test

Front 56

Process of TB Primary Infection?

Back 56

• Bacterium inhaled
• Engulfed by macrophages in the lungs
• Patent may be asymptomatic or may experience mild flu like symptoms
• 2-6 weeks after initial infection, the infection becomes systemic
• Patient then will develop a hyper sensitive (allergic) response to infection
• Nodules called tubercules form in the lung, which are the sites of active multiplication of Mycobacterium
• If patient was healthy prior to infection, the primary infection is usually handled pretty well
• Eventually bacteria will stop multiplying, and tubercules will calcify
• Patient will then either become latent, or develop into active symptoms

Front 57

Macrophages role in TB infection?

Back 57

• Usually macrophages digest invaders, but in TB case, Mycobacterium has evolved to survive in macrophages and multiply there
• Macrophages can travel all over the body, so infection could show up at other body sites

Front 58

Reactivation phase of TB?

Back 58

• Most frequently occurs in men over 50 years of age
• Associated with alcoholism, diabetes, and poor nutrition
• Usually occurs in the lungs
• Reactivated cases are quite aggressive
• As bacterium breaks open tubercules and continues to multiply, it will cause necrosis of the lung tissue

Front 59

Active symptoms of TB?

Back 59

• Chronic blood tinged cough
• Weight loss
• night sweats
• chronic fever
• old fashion name for this disease was consumption

Front 60

Screening for TB?

Back 60

• Skin test using PPD
• If positive, then we do chest x-ray
• If calcified nodules found, then use acid fast test to differentiate between latent and active TB
• If positive for Acid-fast then its an active case of tuberculosis

Front 61

Tuberculosis treatment?

Back 61

• Because organism is so highly drug resistant the patient is treated with 2 or 3 antibiotics simultaneously (called synergism)
• May take anywhere from 6-9 months, can be as long as 2 years
• Many patients don't want to take medication because it makes them feel terrible
• Drugs used: Soniazid, rifampicin, others
• Specific cocktail of drugs is dependant on the specific persons bacteria

Front 62

MDR-TB?

Back 62

• Multi Drug Resistant TB
• Doesn't respond to traditional first line anti TB drugs

Front 63

XDR-TB?

Back 63

• Exstensively drug-resistant TB
• Form of TB that is resistant to front-line and second-line forms of treatment

Front 64

Pneumonia caused by Streptococcus pneumoniae?

Back 64

• Is a gram + alpha hemolytic bacterium
• Causes about 70% bacterial pneumonias
• S. pneumoniae is normal flora of the upper respiratory system in some individuals

Front 65

Transmission of S. pneumoniae?

Back 65

• Normal flora of individual takes over when patient becomes immunocompromised

Front 66

S. pneumoniae Symptoms?

Back 66

• Fever
• Dema of lungs (swelling)
• fluid accumulates in lungs which severely limits gas exchange
• 70% with this pneumoniae will see spontaneous recovery
• Some will die from this disease (mostly elderly)
• Is a pneumococcal vaccine given to the elderly

Front 67

Treatment for Streptococcus pneumoniae?

Back 67

• Penicillin
• Urithomycin

Front 68

Atypical (walking) pneumonia caused by?

Back 68

• Mycoplasma pneumoniae

Front 69

Mycoplasma pneumoniae additional facts?

Back 69

• Is a very tiny bacterium
• Naturally lacks a cell wall
• Common contaminant of tissue cultures
• Very slow grower
• Doesn't grow well on artificial media

Front 70

Atypical pneumonia outbreaks happen in?

Back 70

• close social groups like day care facilities or families
• Most frequently seen in young people between 5-15 years of age

Front 71

Transmission of atypical pneumonia?

Back 71

• Respiratory droplets from cough or sneeze

Front 72

Incubation period of atypical pneumonia?

Back 72

• 1-4 weeks

Front 73

Symptoms of atypical pneumonia?

Back 73

• may last for 3 weeks or longer
• Low grade fever
• cough
• headache
• some cases require hospitalization

Front 74

Diagnosis of atypical pneumonia?

Back 74

• Tricky because organism doesn't grow well on artificial media
• Grown on complex media that contains horse serum and yeast extract
• Might take as long as 3 weeks to grow and even then needs to be examined with a microscope to see colonies
• Can also diagnose with polymerase chain reaction (pcr) which allows for diagnosis within a few days

Front 75

Treatment of atypical pneumonia?

Back 75

• Tetracycline tops the list, but not a good choice for patients 5-15 years of age

Front 76

Pneumonia caused by Klebsiella pneumoniae Facts?

Back 76

• Gram -
• bacillus
• Forms capsules
• Non-motile
• Relatively common in nature
• Normal flora of the upper respiratory system in some individuals
• CDC says 5-10% of American population harbors this organism
• Imuno-compromised patient is ideal candidate for this form of pneumonia

Front 77

Transmission of Klebsiella pneumoniae caused pneumonia?

Back 77

• Normal flora that becomes opportunistic

Front 78

Incubation period of Klebsiella pneumoniae?

Back 78

• Variable

Front 79

Symptoms of pneumonia caused by K. pneumoniae?

Back 79

• High fever/chills
• flu like symptoms
• productive cough
• sputum is referred to as current jelly sputum

Front 80

Treatment for K. pneumoniae caused pneumonia?

Back 80

• Every case treated differently due to super bug status of K. pneumoniae
• Susceptibility testing must be done to find out which antibiotic to use

Front 81

Legionella (Legionaire's Disease) caused by?

Back 81

• Legionella pneumophila

Front 82

Legionella pneumophila gram designation and morphology?

Back 82

• Gram -
• bacillus

Front 83

Legionella pneumophila also causes?

Back 83

• Pontiac fever (mild respiratory symptoms)

Front 84

First outbreak of legionare's disease happened?

Back 84

• 1977 in Philidelphia after a Legionare's convention
• The air conditioning was infected with Legionella pneumophila, and was spread through the air to all participants
• 221 sick, 34 died
• Couldn't isolate bacterium, inoculated samples into guinea pigs, and found the previously unknown bacterium
• Research showed the bug is common in aquatic environments

Front 85

Transmission of Legionare's disease?

Back 85

• Through the air conditioning in initial outbreak
• Not contagious from person to person

Front 86

Incubation of Legionare's disease?

Back 86

• 2-10 days

Front 87

Symptoms of Legionare's disease?

Back 87

• High fever (105F)
• Headache, muscle pain, chills
• Confusion or other mental changes
• cough malaise
• abdominal pain
• nausea, diarrhea
• acute kidney failure

Front 88

If legionare's disease is left untreated?

Back 88

• 15-30% will die from pneumonia followed by shock
• Even with treatment, 1-2 weeks hospitalization required

Front 89

Diagnosis of Legionare's disease?

Back 89

• Chest x-ray which doesn't confirm but shows presence of a lung infection
• Test sputum sample or lung tissue
• CT scan of brain and or spinal tap if mental changes

Front 90

Treatment for Legionare's disease?

Back 90

• Hospitalization
• Urythomycin