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Infectious Pneumonias
Downstate > MS2 Respiratory Block > Lecture 5 Respiratory Tract Infections
63
Medical
Graduate
02/05/2011

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Term
5 impaired host defenses
Definition
ciliary defect, excess mucus, macrophage dysfunction, loss of cough reflex, pulmonary edema
Term
4 gross stages of lobar pneumonia
Definition
congestion, red hepatization, grey hepatization, resolution/fibrosis
Term
fibrinous pleuritis
Definition
inflammation of pleura creates adhesions -> friction rub
Term
lobar vs. lobular pneumonia: gross
Definition
lobar: dark, solid lung lobe; lobular: dry, granular, red/white/yellow spots (around bronchioles)
Term
lobar vs. lobular pneumonia: CXR
Definition
lobar: radioopaque consolidation of a lobe with clear margins; lobular: patchy, diffuse infiltrate without clear margins
Term
viral pneumonia: histology
Definition
pink hyaline membrane, interstitial inflammation, little exudate
Term
viral pneumonia: red spots in giant cells; bug?
Definition
measles
Term
viral pneumonia: smudgy nucleus; bug?
Definition
adenovirus
Term
viral pneumonia: "owl's eye"--dark nuclear inclusion with a clearing rim; bug?
Definition
CMV
Term
7 bugs that cause community acquired typical pneumonia
Definition
Strep pneumonia (most common), Klebsiella pneumonia, M. catarrhalis, Staph aureus, Legionella, Hib, Pseudomonas spp.
Term
Strep pneumoniae on a smear?
Definition
Gram+ diplococci inside neutrophils
Term
risk factors for Strep pneumonia
Definition
functional or anatomical spleen deficiency
Term
Klebsiella pneumoniae on a smear?
Definition
Gram- extracelullar rod
Term
red currant jelly sputum -> bug? // rusty colored sputum -> bug?
Definition
red currant jelly -> Klebsiella // rusty colored -> Strep pneumoniae
Term
Klebsiella pneumoniae risk factors
Definition
alcoholics, aspiration pneumonia, hospitalization, diabetes
Term
Klebsiella pneumoniae: gross
Definition
mucus strands hanging off of lung
Term
2 bugs that cause vasculites
Definition
Klebsiella pneumonia, Pseudomonas aeruginosa
Term
smears for Hib, M. catarrhalis, Staph aureus, and Legionella
Definition
Hib: Gram- rod, M. catarrhalis: Gram- diplococci, Staph aureus: Gram+ grape clusters; Legionella: Gram- rod
Term
top 2 most common causes of pneumonia in COPD pts
Definition
1. H. influenza 2. M. catarrhalis
Term
3 bacteria that cause community acquired atypical pneumonia
Definition
Mycoplasma pneumonia, Chlamydia pneumonia, Coxiella burnetti
Term
community acquired atypical pneumonia: clinical presentation
Definition
dry cough, walking pneumonia, <1% mortality
Term
community acquired atypical pneumonia: histology
Definition
little PMN, mostly mononuclear infiltrates, little exudate, interstitial inflammation, pink hyaline membranes
Term
community acquired atypical pneumonia: CXR
Definition
patchy, diffuse infiltrates
Term
common complication of community acquired atypical pneumonia
Definition
bronchiolitis
Term
smear of M. pneumoniae vs. C. pneumoniae vs. Coxiella burnetti
Definition
M. pneumoniae = extracellular; C. pneumoniae, Coxiella = intracellular
Term
4 bugs that cause nosocomial pneumonia
Definition
Staph aureus, Pseudomonas aeruginosa, Enterobacteriaceae, Klebsiella
Term
Gram+ cocci that is 1) novobiocin sensitive or 2) novobiocin resistant
Definition
1) Staph epidermis novobiocin sensitive 2) Staph saprophyticus novobiocin resistant [First Aid]
Term
Gram+ cocci that is 1) coagulase+ or 2) coagulase-
Definition
1) Staph aureus coagulase+ 2) Staph epidermis coagulase-
Term
2 bugs that cause lung abscesses
Definition
Klebsiella pneumonia, Staph aureus
Term
aspiration pneumonia: clinical presentation
Definition
foul-smelling sputum, chest pain, weight loss, cough; inflammation of right lobe > lower lobe (standing) or upper lobes (supine)
Term
aspiration pneumoniae: complications
Definition
lung abscesses, necrotizing pneumonia, empyema, hemorrhage, brain abscess, meningitis, secondary amyloidosis, septic embolism
Term
what gene whose polymorphism may affect TB diseae progression?
Definition
NRAMP1
Term
effects of IFN-g produced by Th1 cells in TB pathogenesis (3)
Definition
activate macrophages into epithelioid histiocytes, produce NO, induce phagolysosome fusion
Term
middle/lower lobe pneumonia, Ghon complex, lymphadenopathy, no bacteremia, no cavitations; dx?
Definition
primary TB
Term
middle/lower lobe pneumonia, Ghon complex, lymphadenopathy, diffuse seeding of other lung segments, bacteremia, no cavitations; dx?
Definition
progressive primary TB
Term
pleural effusions are found in what kind of TB? pleuritis?
Definition
progressive primary TB has pleural effusions; secondary TB has pleuritis
Term
galloping consumption; dx?
Definition
secondary TB
Term
complications of secondary TB (4)
Definition
Pott's disease, scrofula, Addison's, fungus ball from Aspergillus coinfection
Term
what organs does MAI target?
Definition
mononuclear system: lymph nodes, spleen, liver, lungs, GI
Term
Mississippi and Ohio R. valleys
Definition
Histoplasmosis, Blastomycosis
Term
bird or bat droppings; bug?
Definition
Histoplasmosis
Term
coin lesions on CXR; spreads to adrenals and meninges; dx?
Definition
Histoplasmosis
Term
how does Histoplasmosis enter macrophages?
Definition
HSP60 on fungus binds to beta-integrin on macrophages
Term
central and SE US; bug?
Definition
Blastomycosis
Term
Mexico, India, Africa, Canada, Middle East; bug?
Definition
Blastomycosis
Term
broad based buds with double contour wall
Definition
Blastomycosis
Term
intracellular in giant cells; bug?
Definition
Coccidioidomycosis
Term
desert SW; bug?
Definition
Coccidioidomycosis
Term
San Joaquin Valley fever; bug?
Definition
Coccidioidomycosis
Term
spherules; bug?
Definition
Coccidioidomycosis
Term
causes of bacterial pneumonia in HIV pt (4)
Definition
Pseudomonas, Mycobacteria, Listeria, Legionella
Term
causes of viral pneumonia in HIV pt (2)
Definition
CMV, HSV
Term
causes of fungal pneumonia in HIV pt (5)
Definition
PCP, Candida, Aspergillus, Cryptococcus, Mucormycosis
Term
encapsulated yeast, positive for mucicarmine stain (bright pink wall)
Definition
Cryptococcus
Term
CD4>200 --> risk for which bugs?
Definition
bacteria, mycobacteria
Term
CD4<200 --> risk for which bugs?
Definition
PCP
Term
CD4<50 --> risk for which bugs?
Definition
CMV, MAI
Term
mutations of HA and NA antigens allows host evasion
Definition
antigenic drift
Term
RNA recombination among different species strains creates a new strain
Definition
antigenic shift
Term
which influenza strain has ubiquitous tissue tropism?
Definition
H5N1
Term
<40yo, 60% mortality; most mortality in 10-19yo
Definition
H5N1
Term
child with acute encephalitis but no respiratory symptoms
Definition
H5N1
Term
presentations vary: pulmonary, cutaneous, or disseminated; acute flu-like; CXR: upper lobe involvement; suppurative granulomas on biopsy; bug?
Definition
Blastomycosis
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