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CPR II Exam 2 > Chapter 15: Pulmonary Infections > Flashcards

Chapter 15: Pulmonary Infections Flashcards

1
Q

What is the most common cause of death in viral influenza epidemics?

A

Superimposed bacterial pneumonia

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2
Q

What are 2 acute phase markers made in the liver that are specific for bacterial infection and can be useful in pneumonia diagnosis?

A
  • CRP
  • Procalcitonin
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3
Q

Which serotype of the encapsulated H. influenzae is most virulent?

A

Type B

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4
Q

What will the sputum culture of a patient with community-acquired bacterial pneumonia caused by Streptococcus pneumoniae show morphologically?

A

Lancet-shaped gram (+) diplococci in pairs and chains

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5
Q

Which patient population is at a high risk for development of invasive infection by H. influenzae?

A

Neonates and children w/ comorbidities

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6
Q

What is the 1st and 2nd most common bacterial cause of acute exacerbation of COPD?

A

- Most common = H. influenzae

- 2nd = M. catarrhalis

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7
Q

Pneumonia caused by what bacteria is a pediatric emergency due risk of acute epiglottitis w/ high mortality rate?

A

H. influenzae

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8
Q

What is the pulmonary consolidation associated w/ H. influenzae typically like?

A

Lobular and Patchy

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9
Q

Which patient population is especially susceptible to bacterial pneumonia by Moraxella Catarrhalis?

A

Elderly

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10
Q

S. aureus pneumonia is associated with a high incidence of which 2 complications?

A
  • Lung abscess
  • Empyema (aka pus in the pleural space)
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11
Q

What is the most frequent cause of gram-negative bacterial pneumonia and who does it most commonly afflict?

A
  • Klebsiella pneumoniae
  • Debilitated and malnourished people, particularly chronic alcoholics
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12
Q

What type of sputum is characteristic of Klebsiella pneumoniae?

A

Thick, mucoid (blood-tinged) –> “currant jelly”

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13
Q

Pseudomonas aeruginosa is a common cause of pneumonia in whom and in what setting?

A
  • Hospital acquired
  • Cystic Fibrosis and Immunocompromised
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14
Q

Which bacteria cause of pneumonia flourished in warm freshwater (i.e., AC units, misters, hot tubs); what does it live inside?

A
  • Legionella pneumophila
  • Lives in amoebas
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15
Q

What are the 2 common modes of transmission for Legionella pneumophilia?

A
  • Inhalation of aerosolized organisms
  • Aspiration of contaminated drinking water
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16
Q

What is the gram stain and morphology of Legionella pneumophila?

A

Gram NEGATIVE bacillus

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17
Q

Pt’s with what predisposing conditions are most at risk for Legionella pneumonia?

A
  • Pt’s w/ cardiac, renal, immunologic, or hematologic diseases
  • Organ transplant recipients****
  • Elderly smokers
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18
Q

How is rapid diagnosis of Legionella pneumophila done and what is the gold standard?

A
  • Legionella Ags in the urine
  • (+) fluorescent Ab test on sputum samples
  • CULTURE = gold standard
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19
Q

Which bacterial cause of pneumonia is associated with hypokalemia, elevated CPK, and lobar infiltrates?

A

Legionella pneumophila

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20
Q

What is the gram stain, shape, and O2 dependency of Pseudomonas aeruginosa?

A

AEROBIC Gram NEGATIVE; bacillus

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21
Q

Mycoplasma pneumoniae infections are common in which age groups and occur most often how?

A
  • Children and young adults
  • Sporadically or as local epidemics (i.e., schools, military camps, prisons)
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22
Q

Patchy consolidation of the lung is the dominant characteristic of what type of bacterial pneumonia?

A

Bronchopneumonia

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23
Q

Air-fluid level within cystic space seen on CXR associated with pneumonia suggests what?

A

Lung abscess

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24
Q

What are the 4 stages of the inflammatory response which have been classically described for lobar pneumonia?

A

1) Congestion: vascular engorgement; intra-alveolar fluid
2) Red hepatization: massive exudation of alveolar spaces w/ lots of neutrophils; red, firm, airless lobe; liver-like consistency
3) Gray hepatization: disintegration of red cells w/ fibrinosuppurative exudate
4) Resolution: fibrosis and macrophage clean-up

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25
Q

Congested septal capillaries due to massive confluent exudation w/ numerous intra-alveolar neutrophils is characteristic of what stage of lobar pneumonia?

A

Red Hepatization

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26
Q

Which inflammatory stage of lobar pneumonia is characterized by progressive disintegration of red cells and the persistence of a fibrinosuppurative exudate?

A

Grey Hepatization

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27
Q

Exudates within alveolar spaces converted into fibromyxoid masses rich in macrophages is characteristic of which inflammatory stage of lobar pneumonia?

A

Resolution/Organization

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28
Q

Which pattern of bacterial pneumonia is often multilobular and frequently bilateral and basal?

A

Bronchopneumonia

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29
Q

Which cause of bacterial pneumonia is classically seen in military recruits or college student i.e., those living in close quarters?

A

Mycoplasma pneumonia

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30
Q

Histologically, the rxn associated with bronchopneumonia shows areas of acute suppurative inflammation rich in what type of immune cell?

A

Neutrophilic exudate filling bronchi, bronchioles, and adjacent alveolar spaces

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31
Q

Tissue destruction and abscess formation as a complication of pneumonia are most common associated w/ what 3 organisms?

A

- Type 3 pneumococci

- Klebsiella

- S. aureus

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32
Q

Bacteremic dissemination as a complication of pneumonia can spread where and cause what?

A
  • Heart valves, pericardium, brain, kidneys, spleen, or joints
  • Metastatic abscesses, endocarditis, meningitis, or suppurative arthritis
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33
Q

What are the major sx’s of acute bacterial pneumonia?

A
  • Abrupt onset of high fever + shaking chills + cough
  • Mucopurulent sputum and occasionally hemoptysis
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34
Q

What are the 2 most important components in term of virulence for Influenza virus allowing it to cause infections; function of each?

A
  • Hemagglutinin: allows for attachment to cells; via sialic acid residues
  • Neuraminidase: allows release of replicated virus from cells; cleaves sialic acid residues
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35
Q

What is antigenic drift in regards to Influenza virus and what changes occur; leads to what type of outbreak?

A
  • Spontaneous mutation that alter antigenic epitopes on the vial Hemagglutinin and Neuraminidase proteins
  • Result in new viral strains, leading to epidemics
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36
Q

What is antigenic shift in regards to Influenza virus and what changes occur; leads to what type of outbreak?

A
  • Both hemagglutinin and neuraminidase genes are replaced through recombination w/ animal influenza viruses
  • Leads to pandemics
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37
Q

If influenza virus gains entry into pneumocytes what are the cytopathic changes that it can elicit which contribute to its pathogenesis?

A
  • Inhibits Na+ channels –> electrolyte + H2O shifts = fluid accumulation in alveolar lumen
  • Inhibits host cells mRNA translation and activates caspases –> cell death via apoptosis
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38
Q

What complications may arise with viral pneumonia as a result of activation of the nearby pulmonary endothelium causing lung injury?

A
  • ARDS
  • Fatal pulmonary disease from superimposed bacterial infection
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39
Q

Which bacteria is most commonly found as cause of superimposed bacterial infection on a viral pneumonia?

A

Staphylococcus aureus

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40
Q

Which family of viruses does Human Metapneumovirus (MPV) belong to?

A

Paramyxovirus

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41
Q

What is the only antiviral tx that is currently available for human MPV infections and is most commonly used for immunocompromised pt’s w/ severe disease?

A

Ribavirin

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42
Q

Which family of viruses does SARS belong to?

A

Coronavirus

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43
Q

Why is SARS a distinct coronavirus in terms of infection?

A
  • Many upper respiratory infections are caused by coronavirus
  • SARS differs in that it can infect the lower respiratory tract and spread throughout the body
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44
Q

Respiratory syncytial virus (RSV) belongs to what family of viruses?

A

Paramyxovirus

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45
Q

How does respiratory syncytial virus (RSV) spread from the nasopharynx to lower respiratory tract; what is the effect of viral replication on this process?

A
  • Attaches to and infects host epithelial cells in nasopharynx
  • Cells are sloughed and aspirated, carrying RSV to lower respiratory tract cells
  • Viral replication leads to abnormal sloughing of epithelial cells, inflammatory cell infiltration, ↑ mucus secretion and impaired ciliary action
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46
Q

Which virus is associated w/ sx’s of rhinorrhea, cough, wheezing, dyspnea, tachypnea, and cyanosis in an infant?

A

RSV

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47
Q

What are the 3 major bacterial causes of pneumonia in neonates?

A
  • Group B strep
  • Gram negative bacilli
  • Listeria
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48
Q

What are 5 major viral causes of pneumonia in children >1 month?

A
  • RSV**
  • Parainfluenza virus, Influenza A and B, Adenovirus, Rhinovirus
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49
Q

What are 4 major bacterial causes of pneumonia in children >1 month?

A
  • S. pneumoniae
  • M. catarrhalis
  • H. influenzae
  • S. aureus
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50
Q

Viral-induced tonsillitis causing hyperplasia of the lymphoid tissue within what is common in children?

A

Waldeyer ring

51
Q

What are the 3 major morphological changes seen in upper respiratory viral infections?

A
  • Mucosal hyperemia
  • Lymphomonocytic and plasmacytic infiltration of submucosa
  • Overproduction of mucus secretions
52
Q

How does the inflammatory rxn (location and immune cells) differ between bacterial vs. viral causes of pneumonia?

A
  • Bacterial = INTRA-alveolar neutrophilic inflammation
  • Viral = INTERSTITIAL lymphocytic inflammatory rxn; walls of alveoli
53
Q

When viral pneumonia is complicated by ARDS what is seen lining the alveolar walls?

A

Pink hyaline membranes

54
Q

Which 3 viruses may be associated with necrosis of bronchial and alveolar epithelium and acute inflammation?

A
  • Herpes simplex
  • Varicella
  • Adenovirus
55
Q

What is the onset, fever, and infiltration seen on CXR like for bacterial vs. viral causes of pneumonia?

A
  • Bacterial has abrupt onset w/ high fever; and lobar/consolidated appearance
  • Viral has gradual onset w/ absent or low-grade fever; and diffuse infiltrates on CXR
56
Q

Bacterial causes of pneumonia are not typically associated w/ epidemics, except those caused by what 2 types?

A
  • Legionella
  • Pertussis
57
Q

A red, flat to slightly bumpy (maculopapular) rash that starts on the forehead and spreads to the face, neck, torso, and finally the feet is associated with what virus?

A

Measles (paramyxovirus)

58
Q

What is the gram stain and shape of Bordatella pertussis?

A

Gram negative bacillus

59
Q

What are the 4 major virulence factors of Bordetella pertussis?

A
  • Pertussis toxin: activates G proteins –> ↑cAMP
  • Extracytoplasmic adenylate cyclase: “weakens” immune cells
  • Filamentous hemagglutinin: binding to ciliated epithelial cells
  • Tracheal cytotoxin: kills ciliated epithelial cells
60
Q

While working the pediatric ED, you see a child with a sore throat and fever. There is a dark exudate on the child’s pharynx, which appears darker and thicker than that of strep throat; which bacteria is most likely responsible and what its gram stain/shape?

A
  • -* Corynebacterium diptheriae
  • Gram positive rods - very pleomorphic and club-shaped
61
Q

If Corynebacterium diptheriae is suspected why must you NOT scrape the pseudomembranes formed on the pharynx; may lead to what?

A
  • May bleed and systemic absorption of lethal EXOTOXIN will be enhanced
  • Can cause: myocarditis and neural involvement (peripheral nerve palsies, Guillan Barre-like syndrome, and palatal paralysis/cranial neuropathies
62
Q

What is the gram stain and shape of Listeria monocytogenes?

A

Gram POSITIVE rod

63
Q

What are the 2 most common organisms isolated in association with Health Care-Associated Pneumonia?

A
  • P. aeruginosa
  • MRSA
64
Q

How is health care-associated pneumonia different from hospital-acquired pneumonia?

A
  • Health care = recent hospitalization, presenting from nursing/long-term care facility; attending hospital or hemodialysis clinic; recent IV abx, chemotherapy, or wound care
  • Hospital-acquired = acquired while in the hospital
65
Q

Patients on what are at particularly high-risk of hospital-acquired pneumonia?

A

Mechanical ventilation

66
Q

What are the most common gram positive and gram negative organisms responsible for hospital-acquired pneumonia?

A
  • Gram (+) cocci –> S. aureus and S. pneumonia
  • Gram (-) rods –> Enterobacteriaceae (i.e., Klebsiella spp., Serratia, and E. coli) and Pseudomonas species
67
Q

Which bacteria is a common cause of bacteria in pt’s with CF, burn victims, and those with neutropenia?

A

P. aerugionosa (Gram negative rod)

68
Q

Which bacterial cause of pneumonia is especially common in organ transplant recipients?

A

Legionella pneumophila

69
Q

What are the 4 anaerobic oral bacteria commonly recovered in the culture of pt with aspiration pneumonia?

A
  • Bacteroides
  • Prevotella
  • Fusobacterium
  • Peptostreptococcus
70
Q

What are 3 atypical (aka not detectable on gram stain or with culture) bacteria associated with pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Coxiella burnetii
71
Q

Aspiration pneumonia occurs most frequently in whom; what are the risk factors?

A

- Markedly debilitated pt’s + pt’s who aspirate gastric contents while unconcious or during repeated vomiting

  • Acute/chronic alcoholism, COMA, stroke, anesthesia, sinusitis, gingivodental sepsis
72
Q

What type of damage is seen with aspiration pneumonia and what is its typical course?

A
  • Often necrotizing and pursues fulminant clinical course
  • Frequent cause of death
73
Q

In those who survive aspiration pneumonia what is a frequent complication that arises?

A

Lung abscesses

74
Q

Microaspiration is commonly seen in pt’s with what condition?

What type of immune rxn/damage does it result in?

A
  • Pts w/ GERD
  • Results in small, poorly formed NON-caseating granulomas w/ multinucleated foreign body giant cell rxn
75
Q

What is a common cause of postobstructive pneumonia which may lead to abscess formation?

A

Neoplasia causing obstruction

76
Q

What is a cause of lung abscess which may originate in systemic venous circulation or the right side of the heart?

A

Septic embolism

77
Q

When all the causes have been exluded and in which there is no discernible basis for lung abscess formation, what is this referred to as?

A

Primary cryptogenic lung abscesses

78
Q

Lung abscesses due to aspiration are more common on which side of the lung and are most often (single/mutliple)?

A

Right side of lung; most often single

79
Q

What is the cardinal histologic change in all lung abscesses?

A

Suppurative destruction of the lung parenchyma within the central area of cavitation

80
Q

Clinical signs/sx’s of lung abscess?

A
  • Cough + fever + copious amounts of foul-smelling purulent or bloody sputum
  • Fever + chest pain + weight loss = common
  • Clubbing of digits may appear within a few weeks
81
Q

If a lung abscess is discovered in an elderly pt, what must be ruled out?

A

Underlying carcinoma

82
Q

Complications which may arise from a lung abscess?

A
  • Extension into pleural cavity
  • Hemorrhage
  • Brain abscesses or meningitis from septic emboli
  • Rarely, secondary amyloidosis (AA)
83
Q

What type of pneumonia is most often a localized lesion in the immunocompetent pt, with or without LN involvement; typically featuring a granulomatous inflammatory rxn?

A

Chronic pneumonia

84
Q

Which chronic lung disease puts people at a particularly high risk for tuberculosis?

A

Silicosis

85
Q

Which critical mediator released from TH1 cells both in LN’s and the lung enables macrophages to contain M. tuberculosis infection?

A

IFN-γ

86
Q

Which immune cells orchestrate the formation of granulomas and caseous necrosis seen in M. tuberculosis infection?

A

TH1

87
Q

Macrophages activated by IFN-γ in M. tuberculosis infection differentiate into what?

A

“Epithelioid histiocytes” that aggregate to form granulomas; some may aggregate to form giant cells

88
Q

Pt’s with RA treated with what type of drugs are at an increased risk for tuberculosis reactivation?

A

TNF antagonist

89
Q

Which pattern of tuberculosis arises in a nonimmune host vs. previously sensitized host?

A
  • Non-immune = primary TB
  • Previously sensitized = secondary TB
90
Q

Secondary pulmonary tuberculosis classically involves which area of the lungs?

A

APEX of one or both lungs

91
Q

What are the systemic and pulmonary signs/sx’s associated with secondary tuberculosis?

A
  • Remittent/low-grade FEVER + WEIGHT LOSS + Night sweats
  • Fever appears late each afternoon and then subsides
  • Sputum that at first is mucoid and later purulent; variable degree of hemoptysis
92
Q

Which laboratory diagnostic test allows for more rapid diagnosis of M. tuberculosis?

A

PCR amplification of M. tuberculosis DNA

93
Q

What remains the gold standard for confirming diagnosis of M. tuberculosis?

A

Culture

94
Q

What is a risk factor in HIV infected pt’s before starting HAART which increases risk for developing tuberculosis?

A

Low CD4 count

95
Q

Primary tuberculosis almost always begins in which organ and what is seen morphologically as sensitization develops?

A
  • Lungs –> bacilli implant in the distal airspaces of lower part of upper lobe or upper part of lower lobe
  • Gray-white inflammation w/ consolidation, know as Ghon focus –> center of focus undergoes caseous necrosis
96
Q

Ghon complex seen in primary TB is a combination of what?

A

Parenchymal lung lesion (Ghon focus)+LN involvement

97
Q

Cell-mediated immunity typically controls the primary TB infection leading to what morphological change in the Ghon complex, which is often followed by what radiologically detectable change?

A

Ghon complex undergoes progressive fibrosis, followed by radiologically detectable calcification (Ranke complex)

98
Q

Which subset of pt’s do NOT form the characteristic granulomas associated with primary TB and instead have macrophages loaded with many bacilli?

A

Immunocompromised

99
Q

With progressive pulmonary tuberculosis, the pleural cavity is almost invariably involved, and what 3 complications may be seen here?

A
  • Pleural effusions
  • Tuberculous empyema
  • Obliterative fibrous pleuritis
100
Q

Systemic miliary tuberculosis is most prominent in which organs/structures?

A
  • Liver
  • Bone marrow (osteomyelitis)
  • Spleen
  • Adrenals (Addison diseas)
  • Meninges (tuberculous meningitis)
  • Kidneys (renal tuberculosis)
  • Fallopian tubes (salpingitis) and Epididymis
101
Q

When the vertebrae are affected by isolated tuberculosis this is known as what?

Parapsinal “cold” abscesses in these pt’s may track along tissue planes and present how clinically?

A
  • Pott disease
  • Present as abdominal or pelvic mass
102
Q

What is the most frequent presentation of extra-pulmonary tuberculosis (aka what is most often affected)?

A

Lymphadenitis

103
Q

How does lymphadenitis and the presentation differ in HIV-negative vs. HIV-positive pt’s with active tuberculosis?

A
  • HIV-negative = lymphadenitis tends to be unifocal and localized
  • HIV-positive = tends to be multifocal disease w/ systemic sx’s, and either pulmonary or other organ involvement
104
Q

Granulomatous inflammation leading to ulceration of the overlying mucosa and eventually healing strictures associated with intestinal tuberculosis is most often seen in which segment of the intestine?

A

Ileum

105
Q

Histoplasma capsulatum infection is acquired via inhalation of what?

A

Dust particles from soil contaminated with bird or bat droppings containing small spores (microconidia)

106
Q

Histoplasma capsulatum is endemic where; where else is it seen?

A
  • Endemic –> Ohio and Mississippi rivers and Caribbean
  • Also found in Mexico, Central and S.A., parts of Europe, Africa, east Asia, and Australia
107
Q

Histoplasma capsulatum typically causes what type of infection with what type of immune response; what is seen on CXR?

A
  • Subclinical infection with granulomas, which usually undergo caseation necrosis and coalesce to produce large areas of consolidation
  • Calcifications (“tree-bark appearance) or coin lesions on CXR
108
Q

What is the morphology (aka shape) of the yeast forms seen with Histoplasma capsulatum?

A

Thin-walled yeast w/ “pumpkin seed” morphology

109
Q

How is the diagnosis of Histoplasma capsulatum established; when are serological tests for Abs and Ags most useful?

A
  • Via culture or identification of fungus in tissue lesions
  • Ag detection most useful in the early stages
110
Q

Granulomas in the lungs associated with Histoplasma capsulatum may liquefy and form cavities in pt’s with what underlying disease?

A

COPD

111
Q

What are the 4 clinical presentations/morphological lesions which may be associated with Histoplasma capsulatum?

A
  1. Self-limited and often latent primary pulmoanry involvement; coin-lesions on CXR
  2. Chronic, progressive lung disease, localized to apices and causes cough, fever, and night sweats
  3. Extrapulmonary spread –> mediastinum, adrenals, liver, or meninges
  4. Widely disseminated disease in immunocompromised
112
Q

How is the morphology of the disease caused by Histoplasma capsulatum different in immunosuppressed individuals?

A
  • Causes fulminant disseminated histoplasmosis
  • Granulomas do NOT form
  • Instead there are focal accumulations of mononuclear phagocytes FILLED w/ fungal yeasts throughout the body
113
Q

Blastomyces dermatitidis is a soil-inhabiting dimorphic fungi that is endemic where in the US and also seen in what other countries?

A
  • Central (Ohio and Mississippi river valleys) and SE United States
  • Also seen in Canada, Mexico, the Middle East, Africa, and India
114
Q

How does pulmonary Blastomyces dermatitidis infection typically present clinically (signs/sx’s)?

A
  • ABRUPT onset w/ productive cough + HA + chest pain
  • Weight loss + fever + night sweats + chills
115
Q

How do the lung lesions of Blastomyces dermatitidis appear morphologically in a normal host?

Which immune cells are seen in high numbers?

A
  • Suppurative granulomas
  • Macrophages have limited ability to ingest and kill this organism; persistence of this yeast leads to ↑↑ neutrophils
116
Q

What is the characteristic morphology of Blastomyces dermatitidis that distinguishes it from other fungi?

A
  • Round w/ BROAD-BASED BUDDING
  • THICK, double-contoured cell-wall
117
Q

Involvement of the skin and larynx by Blastomyces Dermatitidis caused what change to epithelial cells and may be mistaken for what?

A
  • Marked epithelial hyperplasia
  • May be mistaken for SCC
118
Q

Where is Coccidioides immitis endemic and in the lungs what does the infection cause?

A
  • Endemic in SW United States and Mexico
  • Causes granulomatous response w/ eosinophils
119
Q

What are the signs/sx’s of pulmonary and cutaneous infection with Coccidioides immitis?

A
  • Fever + cough + pleuritic chest pain
  • Erythema nodosum or erythema multiforme (the San Joaquin Valley fever complex)
120
Q

Which pt population and ethnic groups are at the highest risk for the rare disseminated infection caused by Coccidioides immitis?

What type of lesions dominate in the disseminated disease?

A
  • Filipino and African Americans
  • Immunosuppressed
  • Purulent lesions dominate
121
Q

What is the characterisitc morphology of Coccidioides immitis that distinguishes it from other fungi?

A
  • THICK-walled, NON-budding SPHERULES
  • Often filled w/ small endospores
122
Q

A pt with known lung disease presents with recurrent hemoptysis, a tissue sample from the lungs shows this; what is the diagnosis and how do you know?

A
  • Aspergillosis
  • Septate hyphae w/ acute-angle branching (40 degrees)
123
Q

A tissue biopsy of a pt with granulomatous lung disease shows this; what oganism is this most consistent with?

A

Coccidioides immitis

CPR II Exam 2 (23 decks)

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