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RHS Lecture 18: Respiratory Infections VI

Terms in this set (33)

Roadmap
RHS Algorithm
Mini-Vignette 6
- think Lobar Pneumonia - Strep pneumoniae
The Most Common Bacterial Cause of Community Acquired Pneumonia is .....-........?
Strep pneumoniae
What are the Virulence factors involved in the Pathogenesis of Strep pneumoniae? 1- ...... which causes localized destruction, 2- ...... - allows for Immune evasion and 3- Resistance to ..... drugs is becoming more common? Infection with "Typical" Gram-Positive and Gram-Negative bacteria result in massive influx of ...... , due to TLR signaling and release of ...... and ......?
Pneumolysin

Capsule

Beta-Lactams

Neutrophils

TNF-alpha and IL-8
What are are the Risk factors for acquiring Bacterial Pneumonia? 1- A Preceding ..... infection causes an increased risk for Secondary Superinfection, 2- Underlying Lung disease or compromised ....-.... function leads to increased risk of Broncho-pneumonia eg: in ....... , patients with ........, Alcoholics and Ventilation, 3- People with a Suppressed ...... system- -> risk of bacteremia and meningitis with encapsulated bacteria especially Asplenic individuals? Risk of ..... with S. pneumoniae is is about 500x higher in children with sickle cell compared to healthy children?
Viral infection

Muco-Ciliary

Smokers, COPD

Immune

Sepsis
What are the Clinical Features associated with Typical Pneumonia/Lobar Bronchopneumonia? 1- Occurrence of a ..... Fever, 2- .... cough with often .... sputum due to high ..... influx, 3- ..... (breathing), 4- Occurrence of ....... ie ..... colored sputum, 5- Signs of ...... - such as Tachycardia, Hypotension and Edema?
High Fever

Productive Cough with Thick Sputum

High Neutrophil influx

Dyspnea

Hemoptysis- Rust Colored Sputum

Sepsis
Typical Pneumonia/Lobar Bronchopneumonia (bacterial) has a .... onset of ..... to .....?
Rapid onset

Hours to Days
Practice Q1
Ans: E
What is a common cause of Bacterial Typical Pneumoniae after Strep pneumoniae? - ..... pneumoniae?
Klebsiella pneumoniae
Klebsiella pneumoniae is a Gram .....-..... that it is a Lactose ..... (fermenter/nonfermenter), has a prominent ....... and a ..... appearance? Klebsiella pneumoniae is part of the ..... family?
Gram Negative Bacillus

Lactose Fermenter

Prominent Capsule- Mucoid appearance

Enterobacteriaeceae
Klebsiella pneumoniae is part of the Microbial flora of the .... cavity and ......? Risk of Klebsiella pneumoniae infection are: 1- ..... acquired , 2- ..... acquired and 3- Multiple Drug ..... is a Major threat?
Community Acquired- eg: Alcoholics, Diabetes, COPD

Hospital Acquired- eg: COVID + Ventilators, IV catheters, etc

Multiple Drug Resistance
What are the Virulence factors involved in the Pathogenesis of Klebsiella pneumoniae infection? 1- Presence of Pili (Fimbriae), Biofilm, 2- Polysaccharide ...... -specially ... antigen - Anti-phagocytic, protects bacteria from uptake by neutrophils, 2- .... Polysaccharide Triggers robust inflammatory response via TLR4 signing, 3- Presence of .... plasmids - allows Horizontal gene transfer, 4- Extended Spectrum .....-....... and 5-Presence of the ...... enzyme?
Capsule: K- antigen

Lipopolysaccharide (LPS)

MDR plasmids

Beta-Lactamase

Carbapenemase (enzyme that degrades antibiotics)
Klebsiella infection can lead to the occurrence of ..... pneumonia aka .... pneumonia?- in this Greater than one area of the Lung parenchyma is replaced by cavities filled with .....?- is characterized by the production of a Red currant .... like Sputum and Putrid odor to .... and .....?A Large % of cases are polymicrobial (>1 species) and progress to Lung .... formation? Complications include bacteremia, septicemia, meningitis
Red Colored Jelly like Sputum

Breath and Sputum

Abscess
Acute Exacerbated Chronic Bronchitis (ACEB) aka Complicated Bronchopneumonia- People with ...... and/or ....-.... are at high risk for Bacterial Lower Respiratory Tract Infections? Bacterial agents are Chronic Endogenous ..... colonizers of oropharynx and bronchi? Exacerbation of symptoms are often triggered by .... infection? Patients should get routine ..... vaccinations?
COPD

Cystic Fibrosis

Biofilm

Viral infection

Pneumococcal vaccinations
The Most common cause of Acute Exacerbated Chronic Bronchitis (ACEB) aka Complicated Bronchopneumonia is .....-......?
Pseudomonas aeruginosa
Pseudomonas spp are Gram ....-..... , Lactose ...... (fermenter/non-fermenter), Strictly ...... , .... (Motile/Non-motile) and .... positive?
Gram Negative Rods

Lactose Non-Fermenter

Strictly Aerobic

Motile

Oxidase Positive
Pseudomonas spp produce Mucoid ..... colored colonies ie ..... on Conventional agar? Pseudomonas Lung infections produce a ..... smelling odor and ....-.... colored sputum?
Green --> Pyocyanin

Fruity smelling

Yellow-Green Sputum
Pseudomonas is the leading cause of Mortality in .....-.... patients?
Cystic Fibrosis
What are the Virulence factors involved in the Pseudomonas infection? 1- Formation of Persistent ..... in Lungs - often co-colonized with NTHi and Moraxella, 2- Produces .....-.... which inactivates EF-2 and 3- Has Multiple Drug ......?
Biofilm

Exotoxin A

Multiple Drug Resistance
What are the Clinical Features associated with Acute Exacerbated Chronic Bronchitis (ACEB) aka Complicated Bronchopneumonia? 1- Sudden onset ..... of Symptoms, 2- Occurrence of ..... Fever, 3- ...... (breathing), 4- Formation of ...... sputum with abundant ......?- Sputum cultures are often .... -microbial?
Worsening

High Fever

Dyspnea

Productive Sputum with Abundant Neutrophils

Poly-Microbial

- patchy areas of Consolidation
Practice Q2
Ans: C

- Mumps
What is the Most common cause of Atypical Bacterial Pneumonia?
Mycoplasma pneumoniae
Mycoplasma pneumoniae is a Pleiomorphic bacteria that lacks a ......-......? Its Cell membrane requires .......? Mycoplasma pneumoniae has a ....-.... appearance on Eaton's agar?
Cell wall

Sterols

Fried-Egg

•Class: Mollicutes, the smallest free-living microorganisms
Due to the Fact that Mycoplasma pneumoniae lack a Cell wall: 1- They are unreactive to .... stains and 2- Are Extremely susceptible to desiccation and intrinsically
resistant to ..... antibiotics? The ....-..... test is a screening tool for Mycoplasma pneumoniae?
Gram stains

Beta-Lactam

Cold Agglutinin test
Mycoplasma pneumoniae is the 1st MCC ..... Bacterial Community Acquired pneumonia (CAP) (2nd overall- strep pneum is the 1st)? Under .... years of age it is Symptomatic - adult most often present with Mild ..... like symptoms? Outbreaks lasting months tend to occur in ..... institutional settings?
Atypical Bacterial CAP

Symptomatic: < 20 years

Cold like symptoms

Crowded Institutional Settings

eg: •Colleges, Schools, Nursing homes, Military, Prisons, etc.
What are the Virulence factors that play a role in the Pathogenesis of Mycoplasma pneumoniae? 1- ..... adhesion- is an attachment organelle, 2- Ability to produce ...-...... and ......, 3- Attaches to and damages the respiratory ...... cells at the base of cilia (red arrow) activating the innate immune response and producing local cytotoxic effects and 4- Molecular ...... induces production of cross-reactive antibodies (ie. Cold agglutinin reaction) , associated with extrapulmonary complications?
P1 Adhesin

Hydrogen Peroxide and Cytotoxin

Epithelial cells

Molecular Mimicry
Atypical Pneumonia ie Walking Pneumonia has a ...... and .... onset of Several days to Weeks?
Gradual

Insidious (proceeding in a gradual, subtle way, but with harmful effects)
What are the Clinical Features associated with Atypical Pneumonia ie Walking Pneumonia? 1- ..... and ..... cough, 2- .... chest pain, 3- ...... (breathing), 4- Usually a ..... Fever, 5- Occurrence of ...... , Myalgia(muscle pain) and Arthralgia (joint pain) , 6- Loss of ...... , Low .... and general feelings of ..... , 8- Occurrence of a ...... and 9- Inflammation of the .... membrane ie .....?
Dry and Persistent Cough

Pleuritic chest pain

Dyspnea

Low Fever

Headaches, Myalgia and Arthralgia

Loss of Appetite, Low Energy and Fatigue

Rash

Mucous membrane ie Mucositis
The Biological Warfare Agent- Bacillus Anthracis is a Gram ....-.....? Its method of spread is via Inhalation of ......? Bacillus Anthracis can cause Pulmonary ....... which is characterized on X-ray by .....-......?
Gram Positive Rod

Inhalation of Spores

Pulmonary Anthrax

Mediastinal Widening
The Biological Warfare Agent- Bacillus Anthracis: 52-year-old male postal worker with progressively widened mediastinum (B, arrowheads)
- Note time and rapid progression of disease
Bacteria Pneumonia: Outcome & Prevention
Practice Q3
Ans: A

- Typical Bacterial Pneumonia
B- Strep pyro
C- pseduomonas
D- Haemop influenza
E- Diphtheria
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