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60 Cards in this Set
- Front
- Back
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What is Pneumonia?
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An infection of the lung parenchyma
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4 microbes that can cause pneumonia:
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-Bacteria
-Viruses -Mycoplasma -Fungi |
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Does "pneumonia" always refer to infection?
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No; it can also refer to ILD which is noninfectious
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-% of hospitalizations due to pneumonia
-Where does it fall in causes of death? -% of nosocomial pneumonias |
3% of all hospitalizations
6th leading COD with flu 13% of nosocomial pneumonia |
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-Main mechanism for host immunity in the lungs
-What size organisms can get to alveoli -How small microbes are cleared |
-Mucociliary system clears upper resp tract/large airspaces
-Microbes <5um can reach alveoli -Immune system (both) clear small microbes |
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5 ways that Host Defenses in lungs can be impaired:
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1. Loss of cough reflex
2. Injury of mucociliary system 3. Macrophage phagocytosis or bactericidal function impairment 4. Pulmonary congestion/edema 5. Secretion accumulation (CF) |
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4 things that cause Loss of Cough Reflex:
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1. Anesthesia
2. Coma 3. Neuromuscular disorders - Guillain-Barre 4. Drugs (EToH) |
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4 things that injury the Mucociliary system:
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GIVS
-Genetic (inmotile cilia syndrome) -Intubation -Viral infections -Smoking |
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What 2 bugs evade the immune system by producing toxins that paralyze cilia?
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-Haemophilus influenza
-Bordetella |
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What 2 bugs are Ciliostatic?
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-Pseudomonas
-Mycoplasma |
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How does Influenza evade the immune system?
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-Hemagglutinin
-Neuraminidase |
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How does M. tb evade the immune system?
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Escapes phagocytic killing
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What are 2 ways by which patients can have increased susceptibility to lung infection?
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1. Predisposing primary infection
2. Chronic illness |
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What are 2 organisms that predispose patients to a secondary infection?
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-Influenza
-Strep pneumo |
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What is typical pneumonia?
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Community acquired
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What are some key signs of CAP?
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-Fever/chills
-Productive cough (yellow/green) -Blood in sputum -Confusion/headache/fatigue -Chest pain/tachypnic/SOB |
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Can CAP be diagnosed or excluded based on symptoms?
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No; need ancillary testing and culture!
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What are the 2 patterns of gross morphology seen in CAP?
What is involved in each pattern? |
1. Lobar pneumonia - involves entire lung lobe
2. Lobular pneumonia - involves patchy areas around bronchioles |
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What is another name for lobular pneumonia?
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Bronchopneumonia
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4 Stages of Lobar Pneumonia:
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1. Congestion
2. Red hepatization 3. Gray hepatization 4. Resolution |
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What happens in the Congestion stage of lobar pneumonia?
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Vascular engorgement
Capillary leak Neutrophil migration Intra-alveolar fluid accumulation |
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What occurs in Red Hepatization?
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RBCs enter into exudate
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What is the lung tissue like in the Red hepatization stage of lobar pneumonia?
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-Red firm and airless
-Livery |
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What are the 2 features seen in the Gray Hepatization stage of lobar pneumonia?
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-Fibrinosuppurative exudation
-Disintegration of red cells |
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What is the main feature of the Resolution stage of lobar pneumonia??
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Enzymatic degradation - resorption, expectoration, and macrophage ingestion
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What is the end result of the Resolution phase of lobar pneumonia?
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Fibroblastic organization
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What is a pleural fibrinous reaction to underlying inflammation called? What causes it?
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-Pleuritis
-Caused by resolution and fibrinous organization forming PLAQUES in the pleura |
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What are 4 complications from lobar pneumonia?
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ABOE
-Abscess -Bacteremic dissemination -Organization -Empyema |
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What is empyema?
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Spreading of pneumonia into the pleural space
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What is organization?
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The solidification of areas of the lung - BOOP
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3 possible diseases resulting from bacteremic dissemination:
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-Septic embolism
-Endocarditis -Arthritis |
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What is the most common etiologic agent to cause CAP?
How is it identified? |
Streptococcus pneumoniae
ID: gpdc, lancet shaped, w/in PMNs |
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What leads to false pos pneumoslide latex tests?
What is a more specific test? How is it treated? What is used for high risk patients? |
-Strep pneumo is normal flora in 20% of adults
-Blood culture is more specific -Penicillin -Vaccine for hi-risk patients |
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What is another common cause of CAP in adults and children?
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Haemophilus influenza
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What type of H. flu is most usual cause of severe/invasive disease? Why?
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Hib - capsule increases the virulence by increasing survival in the host
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What has significantly impacted the incidence of H. flu? What is the result we're seeing?
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-Vaccine
-So other serotypes and nonencapsulated forms are increasing |
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What are 2 ways that H. flu can cause emergency in children?
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-Laryngotracheobronchitis causing airway obstruction
-Meningitis |
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What is H. flu the most common cause of in older patients?
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Acute exacerbation of COPD
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What gram neg dc is an increasing cause of bacterial pneumonia?
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Moraxella catarrhalis
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What is M. Catarrhalis the 2nd most common cause of?
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Acute exacerbation of COPD
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What causes <5% of CAP? In what patients is it most commonly seen? Which species?
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Staphylococcus - in IV drug abusers
S. aureus |
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What is seen in high incidence with Staphylococcal pneumonia?
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Complications - abscesses
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In what type of infection is Staphyloccus more likely to cause complications?
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Nosocomial pneumonia
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What is the most common cause of gram negative bacterial pneumonia?
In what patients? |
Klebsiella pneumoniae
-in chronic alcoholics |
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Why is K. pneumoniae a common cause of pneumonia?
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Because of its viscous capsular polysaccharide which causes thick gelatinous sputum
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What do we call the sputum in patients with Klebsiella pneumonia?
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Current jelly sputum
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What patients often get Pseudomonas aeruginosa caused pneumonia?
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Cystic fibrosis
Nosocomial infection patients |
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What is a rare bacteria that causes pneumonia?
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Legionella pneumophilia
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What 2 infections are caused by L. pneumophila? How do they compare?
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-Legionnaire's - pneumonia
-Pontiac fever - upper resp infection w/o pneumonia |
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How does Atypical pneumonia present? What makes it different from CAP?
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-Presents like a severe upper resp infection or chest cold
-Cough may be ABSENT |
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What are 4 things that make atypical pneumonia atypical?
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1. Moderate to no sputum
2. No physical findings of lung consolidation 3. Moderate to no WBC elevation 4. Lack alveolar exudate |
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What are the 4 agents that cause atypical pneumonia?
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1. Mycoplasma pneumoniae
2. Viruses 3. Chlamydia pneumoniae 4. Coxiella burnetii |
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What are the 2 results of M. pneumonia not having a cell wall?
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1. No gram staining
2. No antibiotics can inhibit cell wall synthesis/structure |
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What %age of pneumonia is caused by M. pneumonia? In what patient populations?
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10-20% of all pneumonia
50% in children/young adults |
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What type of infection does M. pneumonia cause initially in 75% of cases, and in how many does it progress to pneumonia?
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75% get Tracheobronchitis
5% progress to pneumonia |
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What is a common finding in atypical pneumonia?
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Extrapulmonary manifestations
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What extrapulmonary manifestations can be found in 10-20% of atypical pneumonia?
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Rashes on the trunk and extremities
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What are 2 other common extrapulmonary manifestations of atypical pneumonia?
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1. Hemolytic anemia
2. Cold agglutinins |
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Why do patients with M. pneumoniae infections have cold agglutinins?
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Because at 2 weeks IgM antibodies are produced that cross-react with I antigen on RBCs
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When do cold agglutins
-Initially appear -Peak -Clear |
Initial: 2 weeks
Peak: 4 weeks Cleared: 2 months |
