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49 Cards in this Set

  • Front
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PNA in immunocomp host:
1. cause
1. genetic: t-cell def -> prone to mycobacT, herpes, listeria
-b-cell def -> prone to S. aureus & E. coli
- combined def
2. acquired: immunosupp (ie transplant pt or pt w/ leukemia)
- or AIDS: prone to pneumocystic jirovecci
PNA in immunocomp host:
morphology
-alveoli filled w/ cell debris, foamy exudates & organisms appearing as small bubbles
- interstitium filled w/ plasma cells and lymphocytes
PNA in immunocomp host:
1. dx
- silver stain of trans-trach aspiration, and trans-bronch lung biopsy and culture
- will demonstrate fungus as round 5 micro m structure w/ central dimple
PNA in immunocomp host:
mucormycosis, zygomycosis, phycomycosis
widespread distribution in plants, soil, food, bread mold
the types of infxns caused by the parasites (mucomycosis, zygomycosis, phycomycosis)
1. subQ
2. rhino-cerebral
3. fungal arteritis which causes thrombosis
4. pulm mucormycosis - often in neutropenic (can cause sepsis)
5. fungus invasion of arterial wall - demonstration of non-septate hyphae in tissue biopsy
nosocomial infxns
- acquired while in hosp
- # is continuously growing, important to remind pt who want to be admitted longer that its not always beneficial due to infxns
atypical PNA:
typical v atypical
1. alveolar involvement - edema, fibrin, PMNs, bacT = TYPICAL
2. interstitial involvement - edema, mononuc cells, fibroblasts = ATYPICAL
viral interstitial PNA:
1. bugs
2. CXR
1. CMV, HSV, measles, RSV, flu and coronavirus (SARS)
2. interstitial opacities starting from hilus
viral interstitial PNA:
morphology
- bronchiolitis and interstitial inflamm
- interstitial pna: inflam rxn is mainly in interstitium while alveoli remain clear
- severe cases may be a/w formation of hyaline memb lining the alveoli
--type I cells damaged & generate intra-alveolar edema
- plugs of mucus, fibrin & dead cells determine focal lung atelectasis
atypical influenza PNA
- acute self limiting infxn
- necrosis in ciliated epi & extension into lungs
- 1-2% mortality rate - should get vaccine
atypical SARS pna
1. what
2. who
3. when
4. CXR
1. 30% URT infxn, "cold-like" type
2. infants or young children
3. winter/spring outbreaks
--can progress to PNA or hemorr
--diffuse alveolar damage, multinuc giant cells = **why so many people die
--5% mortality
4. interstitial opacities starting from hilus - rarely patchy and confluent
atypical PNA - mycoplasma (walking PNA)
1. bug
2. labs
1. M. pneumonia
2. rising titer of cold agglutinins (causes agglutination of RBC at 4-6* C)
atypical PNA - mycoplasma (walking PNA)
1. transmission
2. morphology
1. aerosols & droplet - mostly in close quarters like dorms & ships
2. bronchiolitis & erosion of bronchial epi w/ interstitial PNA
- empty alveolar space
- inflamm infiltration is thickening the alv walls -> intra-septal accumulation of lympho and plasma cells (mononuc)
atypical PNA - mycoplasma (walking PNA)
1. s/sx
2. complications
1. fev/ha/malaise/sore throat/ nasal symp/chestp/ear ache
--may cause false + for syph
2. myocarditis, miringitis (eardrum infxn)
--also stevens johnson synd: peri-orificial ecto-dermatitis
chronic PNA includes what bacT infxns?
1. histoplasma capsulatum - Histoplasmosis
2. cryptococcus neoformans - cryptococcosis
3. coccidiioides immitis - coccidiomycosis
4. blastomyces dermatiditis - N. american blastomycosis
5. paracoccidioides brasiliensis - S. american blastomycosis (paracoccidiomycosis)
6. aspergillus niger or aspergillus fumigatus - Aspergillosis
histoplasmosis capsulatum:
1. general
2. where
1. dimorphic fungus (yeast & mold)
2. grows on soil contaminated w/. bird or bat droppings
--dangerous for kids who play in soil near birds
--found: ohio-mississippi valley, W mexico, S. america
histoplasmosis capsulatum:
1. micro
2. complications
1. lung granuloma w/ epithelioid cells & other organs have focal accumulations of macrophages filled w/ histoplasmosis
2. disseminated histoplasmosis, or more aggressive clinical forms resemble TB
histoplasmosis capsulatum:
1. gross
2. dx
1. encapsulated fibro-caseous nodule
2. demonstration of H. capsulatum in smears or lymph node biopsy b/c the skin tests for histoplasmosis is often false
cryptococcosis:
1. bug
2. morphology
1. cryptococcus neoformans - encapsulated yeast that live in both plants & animals
- ds results from human inhalation of spores from pigeon droppings
2. lung lesions range from small to large granulomatous nodules, or consolidation or cavitation
cryptococcosis:
1. complications
1. fungal meningitis
coccidiomycosis
1. bug
2. where
1. coccidiodes immitis - dimorphic fungus; endospores called arthroconidia
2. mold in soil of SW and W US - "valley fever" b/c dry, windy weather
coccidiomycosis
1. affects
1. lungs - focal pneumonitis or scattered focus of consolidation (resemble tubercles)
-- rarely disseminated via blood stream to skin, meninges, bone, liver and sleep
coccidiomycosis
1. who
2. dx
1. certain racial groups (Filipinos), immunocomp
2. organism found in sputum
N. American blastomycosis
1. bug
2. where
3. affects
1. blastomyces dermatiditis - dimorphis fungus; round/oval yeast w/ thick contoured wall
- mold in warm moist soil w/ decaying
2. US, mississippi, ohio rivers, great lakes
3. pulm and skin
S. American blastomycosis = paracoccidiomycosis
1. bug
2. affects
1. paracoccidiodes brasiliensis - dimorphic fungus, external buds from soil
2. lungs, skin, lymph nodes
aspergillus niger or A. fumigates
Aspergillosis
invasive aspergillosis
1. general
2. gross
3. fulminant course
1. opportunistic infxn in immunocompromised
2. multifocal areas of consolidation, occasionally cavities, occlusion & thrombosis
3. death
aspergilloma
1. general
2. CXR
1. "fungus balls" - fungus grows in pre-existing cavities
2. large mass separated from wall by air w/in a cavity
allergic bronchomulmonary aspergillosis (ABPA):
1. general
- immunologic rxn to Aspergillus
- transient pulm infiltrates on CXR
- eosinophilia of blood and sputum
- skin sensitivity & serum precipitins, inc serum IgE
ABPA:
1. gross
2. micro
3. clinical
4. tx
1. central bronchiectasis, involving segmental bronchi
2. mucous plugs & infiltrates of eosinophils, Charcot-Leyden crystals
3. similar to asthma - wheeze, cough, chestp, mucous plugs
4. cortisone
1* pulm TB
- why is it coming back?
- patho of tubercle formation
- prevalence of AIDS
- tuberculous bacilli (bacilli of Koch = BK) are phagocytozed by macrophages
1* pulm TB
- what do macrophages secrete to produce a response in TB
1. IL-6: acute phase protein response
2. MHC class 11: Ag presentation to T-cell
3. proteinases & cathepsins - tissue destruction
4. IL-10: limits inflamm response
5. proinflamm cytokine secretion (eg TNF) and adhesion molecule expressions: granuloma formation
Ghon focus
subpleural lesion found in middle zone of lung, about 1 cm gray-white granuloma
in 1* pulm TB, hilar lymph nodes are
enlarged and caseous
Ghon 1* complex =
ghon focus + lymphadenopathy
tubercle
infective granuloma of TB - different from sarcoidosis
different types of tubercles
1. central: BK and cessation
2. pericentral: epithelioid cells, multi-nuc langhans giant cells, lymphocytic infiltration
3. peripheral: fibroblasts
what are epitheloid ang iant cells formed from?
histiocytes or macrophages
1* pulm TB:
1. clinical course
2. CXR
3. special test
4. evolution
1. asymp or fever w/ nonprod cough
2. patchy infiltrate; hilar adenopathy
3. PPD test +
4. most cases heals w/ fibrosis and calcification
2* TB
- infxn in previously sensitized individuals which can be from
1. reactivation in 1* ds
2. reinfxn w/ exogenous BK
2* TB:
1. gross
2. clinical
3. cxr
4. healing
1. Simon's foci
2. cough, malaise, fatigue, night sweats, hemoptysis
3. coin lesions & tuverculous PNA
4. variable w/ possible cavitation, fibro-calcific scar and pleural adhesions
Simon's foci
dense spherical nodules or excavated, cavitary lesions in apical regions of 1 or both lobes
how are Simon foci seen on CXR
coin lesions
patterns of TB spread
1. cavitary fibro-caseous TB
2. direct extension to pleura-pleurisy
3. through bronchial lumen & trachea to other parts of lungs - also along natural passages (gut, ureter)
4. endobronchial & endotrach TB -> laryngeal TB -> intestinal TB (may lead to each of these)
5. through blood stream -> miliary TB (whole body or isolated organ TB), can also cause TB meningitis
6. miliary TB
cavitary fibro-caseous TB
caseous focus can erode into bronchiole which is evacuated through cough (hemoptysis), but the fibrous wall remins to form a cavity
miliary TB
- tubercules scattered throughout all parenchyma of lung or other
miliary TB:
1. spread via
2. causes
3. can also spread to
1. lymphatics
2. causes focal eroding into pulm artery which localizes miliary TB in lung
3. pulm vein which disseminates TB throughout body
miliary TB:
1. morphology
2. complications
1. yellow-white consolidated foci showing typical structure of tubercle
2. interstitial lung fibrosis, pachipleuritis, mayloidosis
dx of TB
- isolation of acid fast staining bacilli from body fluids (sputum is most imp)
- biopsy - in order to identify acid fast bacilli
- TB skin test: may test + if born or raised in diff country or if you've had vaccine