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58 Cards in this Set
- Front
- Back
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4 ways to get pneumonia
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aerosolized
aspiration hematogenous spread (bacteremia --> lungs) contiguous spread (injury to chest wall) |
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normal host defenses against pneumonia
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cough
mucociliary clearance alveolar macrophages complement, AB, etc |
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impairment of mucocialary clearance
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smoking
COPD influenza-denuded resp epi |
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how long do sx last if they are from bacterial pneumonia?
fungal, anaerobic, mycobacterial, etc? |
hrs - days
days - weeks |
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extrapulm sx of legionella pneumonia
influenza? |
MS changes and diarrhea
severe malaise |
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what are rhinitis and pharyngitis associated with
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viruses
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is tactile fremitus increased or decreased in pneumonia
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increased
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when is lobar pneum usually seen?
infiltrative |
bacterial infx
CMV, legionella, P. carinii, C. neoformans, asergilus, VZV |
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which pneumonias --> pulmonary infarct
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aspergillus
mucormycosis pseudomonas |
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what are some of the viral causes of pneumonia
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CMV
VZV measles |
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sx of viral pneumonia
CXR? |
dry cough
dyspnea constitutional sx nterstitial infiltrates |
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which viral pneumonias can be treated?
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VZV
measles |
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when is s. pneumo --> pneumonia
what sx usually preceeds it |
usually follows viral URI
coryza and URT sx usually precede |
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where is s. pneumo found
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normal colinizer of nasopharynx
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sx of s pneumo
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cough
fever sputum production pleuritic CP dyspnea |
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complications of s. pneumo
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meningitis
endocarditis pericarditis arthritis |
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increased risk factors for s pneumo infx
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asplenia
AIDS post-influenza MM smokers, alcoholics, extreme ages |
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who should get pneumococcal vaccine
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<65 yo
comorbid illnesses HIV sickle cell MM asplenia CSF leak (b/c of meningitis risk) |
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morph of HiB
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Gm - coccobacillus
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who get HiB
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those with COPD, bronchitis and infants
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when to suspect Hib
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increase in cough and change in sputum porduction
fever new infiltrate on CXR |
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who gets infected with gm - bacilli --> pneumonia
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chonic alcoholics
cystic fibrosis neutropenia dm malignancy comorbid dz of kidney, heart, lungs hospitalized |
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who gets klebsiella pneumonia
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alcoholics
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who gets e. coli pneumonia
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those with UTI
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who gets pseudomonas infx
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cf
nosocomial |
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who are the msot likely to get pneumonia from staph
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persistent nasal colonization
post-viral infx nosocomial |
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which is the most common bacteria --> pneumo following viral illness?
2nd most common? |
strep pneumo
staph |
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how does pneumo from staph spread
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hematogenously, from seeding of thrombophlebitis, endocarditis, infected IV device
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extrapulm sx of staph pneumonia
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skin lesions (boils, abscesses)
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what are the primary atypical pneumonias?
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mycoplasma pneumoniae
legionella pneumoniae chlamydia pneumoniae |
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who get m. pneumoniae?
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young adults (5-30 yo)
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where does m. pneumo normally occur?
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usually a URT infx, but 10% --> lower tract
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clinical sx of m. pneumo
extrapulm? |
dry cough
myalgias, arthralgias, skin lesions, neuro probs |
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what kind of skin lesions are seen in m. pneumo
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e. nodosum
e. multiforme stevens-johnson |
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what neuro probs are in m. pneumo
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meningitis
myelitis CN or peripheral neuritis |
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morph of legionalla
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gm - bacilli
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incubation of legionella
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2-10 day s
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sx of legionella
incl extrapulm sx |
dry cough
dyspnea fever, rigors, constitutional sx HA confusion diarrhea |
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lab findings of legionella
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no organsisms seen
lots of neutrophils though leukocytosis |
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radiologic findings of legionella
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lobar
patchy pleural effusions |
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dx of legionella
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indirect fluorescen AB takes 8 wks
direct fluoresence AB on resp secretions, very high specificity legionnal ag in urine in certain types |
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presentation of clamydia pneumoniae
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sx are gradual
URI sx preceed infx fever CP nonproductive cough HA bronchitis sinnusitis pharyngitis |
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radiologic findings of chlamydia pneumoniae
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50% bilateral infiltrates
sometimes pleural effusions can be normal looking |
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why do foreign bodies get seeded?
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there is no vascular supply to foreign objects
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why does general anesthesia --> infx
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dries out respiratory surfaces
reduces ciliary and cough activity compromises the airway |
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Which organisms are ppl with T cell impairment at risk for getting?
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mycobacteria
DNA viruses fungi |
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Which organisms are ppl with Bcell impairment at risk for getting?
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encapsulated organsism
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what can cause reticulendotelial system defects
what results |
splencectomy
iron storage dz streptococcus clearance impaired |
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what are ppl with IgA deficiency susceptible to?
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giardiasis
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what are ppl with complement probs susceptible to
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pyogenic cocci
esp neisseria (get neisseria recurrently) |
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what are most infx from BMT or stem cell transplants caused by?
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endogenous flora
latent DNA viruses |
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what immunologic defect do BMT and stem cell transplant recipients have btwn 0-50 days?
50+ days? |
neutropenia and mucositis
CMI (and humoral immunity starting by day 100) and GVHD |
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Who is extremely susceptible to a strongyloides stercoralis infection? what results?
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those wiht skin adn T cell deficiency
w t cell deficiency, it can invade the bloodstream and CNS, carrying intestinal flora w it --> polymicrobial meningitis |
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what shoud you think about in an unexplaned gram negative rod meningitis (esp in a t cell deficient pt)
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s. stercoralis
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how do pts with neutropenic fever present
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with fever, but other sx and si of systemic infx are absent
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physical finding in pts with fever and neutropenia (as well as those with severe sepsis)
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ecthyma gangrenosum
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what is ecthyma gangrenosum
what can be assoc with it |
infarctive process fo skin
can also have perirectal infx |
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who is likely to have perirectal infx
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pt w leukemia
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