Pulmonary Sepsis and Respiratory Infections

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Questions and Answers

What is the initial event that leads to the pathogenesis of bronchiectasis?

  • Mucus accumulation
  • Airway obstruction (correct)
  • Chronic bronchitis
  • Persistent infection

Under which condition can bronchiectasis become irreversible?

  • Temporary obstruction
  • Atelectasis resolution
  • Acute viral infection
  • Persistent obstruction and infection (correct)

Which of the following conditions is commonly associated with bronchiectasis?

  • Asthma
  • Cystic fibrosis (correct)
  • Pneumothorax
  • Atherosclerosis

What is a potential complication of bronchiectasis?

<p>Cor pulmonale (B)</p> Signup and view all the answers

Which organism is NOT commonly linked to the development of bronchiectasis?

<p>Escherichia coli (D)</p> Signup and view all the answers

What is NOT a characteristic of upper respiratory tract infections (URTI)?

<p>Severe (A)</p> Signup and view all the answers

Which organism is commonly responsible for the viral sore throat known as pharyngitis?

<p>Adenovirus (B)</p> Signup and view all the answers

Which of the following conditions is likely to lead to bacterial infections in healthy individuals?

<p>Viral infections (C)</p> Signup and view all the answers

Acute laryngitis, which can lead to mechanical inability to breathe, is commonly caused by which bacterium?

<p>Haemophilus influenzae Type B (B)</p> Signup and view all the answers

What is a common complication of influenza?

<p>Pneumococcal pneumonia (C)</p> Signup and view all the answers

Which of the following is a primary viral cause of laryngotracheobronchitis, particularly in children?

<p>Respiratory Syncytial Virus (RSV) (C)</p> Signup and view all the answers

What can result from the suppression of the cough reflex in respiratory infections?

<p>Reflux of gastric contents into the airway (A)</p> Signup and view all the answers

Which of the following structures is affected by lower respiratory tract infections?

<p>Bronchi (C)</p> Signup and view all the answers

Which organism is commonly associated with community-acquired atypical pneumonia?

<p>Mycoplasma (D)</p> Signup and view all the answers

What type of pneumonia is characterized by Gram-negative rods like Klebsiella and E. coli?

<p>Hospital-acquired pneumonia (A)</p> Signup and view all the answers

Which population is particularly at risk for pneumococcal infections?

<p>Patients with splenectomies (A)</p> Signup and view all the answers

What is a common feature of aspiration pneumonia?

<p>Presence of anaerobes (A)</p> Signup and view all the answers

Which of the following describes a potential complication of pneumonia?

<p>Pulmonary edema (B)</p> Signup and view all the answers

Which factor may impair defense mechanisms in pneumonia patients?

<p>Cough suppressants (C)</p> Signup and view all the answers

Which organism is primarily associated with pneumonia in immunocompromised hosts?

<p>Mycobacterium avium-intracellulare (A)</p> Signup and view all the answers

Which of the following statements is true regarding blood cultures in pneumonia?

<p>May be positive in 20-30% of cases (C)</p> Signup and view all the answers

What is the most common cause of lung abscesses?

<p>Aspiration of infected material (D)</p> Signup and view all the answers

Which type of pneumonia is characterized by interstitial infiltrate and typically does not have alveolar exudate?

<p>Viral pneumonia (B)</p> Signup and view all the answers

What complication is more common with lobar pneumonia?

<p>Pleurisy and pleural adhesions (C)</p> Signup and view all the answers

Which treatment is typically recommended for lung abscesses?

<p>Drainage and antibiotics (B)</p> Signup and view all the answers

In which situation is viral pneumonia most likely to become severe?

<p>In immunocompromised patients (D)</p> Signup and view all the answers

What characteristic differentiates bacterial pneumonia from viral pneumonia?

<p>Bacterial pneumonia has alveolar exudate (D)</p> Signup and view all the answers

Which of the following is a rare complication of pneumonia?

<p>Alveolar fibrosis (D)</p> Signup and view all the answers

What type of pneumonia initially presents as atypical pneumonia?

<p>Viral pneumonia (B)</p> Signup and view all the answers

Which mechanism is NOT considered a defense of the respiratory tract?

<p>Increased respiratory rate (D)</p> Signup and view all the answers

What is the primary function of the mucociliary apparatus?

<p>To trap and move particles towards the mouth (D)</p> Signup and view all the answers

How does the respiratory tract defend against pathogens?

<p>Cell-mediated immunity (D)</p> Signup and view all the answers

Which of the following conditions could impair the cough reflex?

<p>Alcohol intoxication (D)</p> Signup and view all the answers

What type of antibodies are primarily secreted in the lamina propria of the respiratory tract?

<p>IgA (A)</p> Signup and view all the answers

Which of the following statements correctly distinguishes between bronchopneumonia and lobar pneumonia?

<p>Bronchopneumonia is characterized by patchy infiltrates, while lobar pneumonia shows consolidation. (A)</p> Signup and view all the answers

What type of infections can the respiratory tract's local lymphoreticular system help prevent?

<p>Both bacterial and viral infections (A)</p> Signup and view all the answers

Which component of the respiratory tract is primarily responsible for the secretion of surfactant?

<p>Type II alveolar cells (A)</p> Signup and view all the answers

What is the primary type of epithelium found in the bronchi and bronchioles up until the terminal bronchioles?

<p>Ciliated epithelium designed to produce mucus (C)</p> Signup and view all the answers

Which type of pneumonia is primarily caused by Strep pneumoniae and affects the entire lobe of the lung?

<p>Lobar pneumonia (B)</p> Signup and view all the answers

What is a common feature of bronchopneumonia?

<p>Infection starts in the bronchi and can affect alveoli (B)</p> Signup and view all the answers

What type of organism is typically responsible for causing lobar pneumonia in healthy individuals?

<p>Streptococcus pneumoniae (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of lobar pneumonia?

<p>Patchy foci coalescence (D)</p> Signup and view all the answers

Which bacterial organism is known to cause aspiration pneumonia, particularly in hospitalized ill patients?

<p>Klebsiella pneumoniae (A)</p> Signup and view all the answers

Which factors can typically lead to lower respiratory tract infections (LRTIs)?

<p>Exposure to irritants and pathogens (A)</p> Signup and view all the answers

Which type of viral infection is particularly associated with the development of pneumonia?

<p>Influenza virus (C)</p> Signup and view all the answers

What is the main characteristic of pulmonary sepsis?

<p>Systemic response to severe lung infection (A)</p> Signup and view all the answers

Which of the following organisms is known for causing pneumonia in immunosuppressed individuals?

<p>Pneumocystis jirovecii (B)</p> Signup and view all the answers

Flashcards

Respiratory Tract Defences

The body's natural barriers that protect the respiratory system from infection.

Nasal Hair

Small hairs in the nose that trap inhaled particles.

Turbinates

Bony structures in the nose that create air turbulence, trapping particles.

Saliva

A natural body fluid containing enzymes and antibodies that help fight infection.

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Cough Reflex

The process of clearing the airways by coughing and expelling mucus.

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Mucociliary Apparatus

A layer of mucus and cilia that move to trap and remove foreign particles from the airways.

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Alveolar Macrophages

Specialized immune cells that engulf and destroy bacteria and other invaders.

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Lymphoreticular System

A network of lymphatic vessels that helps to drain infection and prevent its spread.

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Upper Respiratory Tract Infections (URTI)

Infections caused by viruses, bacteria, or atypical bacteria (mycoplasma) that affect the nose, sinuses, larynx, and trachea.

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Viral URTI: Common Cold

A common cold, caused by rhinovirus, usually mild and transient.

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Viral URTI: Viral Sore Throat

An infection of the throat caused by adenovirus, commonly associated with pharyngitis and conjunctivitis.

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Viral URTI: Influenza

Caused by influenza virus, can progress to pneumonia. Symptoms include fever, lassitude, and depression.

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Viral URTI: Laryngotracheobronchitis (RSV)

An infection of the trachea and larynx caused by RSV, common in children, leads to breathing difficulty.

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Bacterial URTI

Infections caused by bacteria such as Strep pyogenes. They can occur in healthy individuals or those with weakened immune systems.

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Bacterial URTI: Acute Sinusitis & Nasopharyngitis

Acute inflammation and swelling of the sinuses caused by Strep pyogenes, can be serious in young people.

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Bacterial URTI: Acute Laryngitis

Inflammation of the larynx caused by Haemophilus influenzae or Strep pyogenes. Symptoms include swelling and difficulty breathing.

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Aspiration Pneumonia

A type of pneumonia caused by aspiration of bacteria from the pharynx, often affecting the lower lobes or right middle lobe.

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Atypical Pneumonia

Pneumonia caused by organisms like Mycoplasma, Chlamydia, Coxiella, or viruses. Typically milder than bacterial pneumonia.

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Hospital-Acquired (Nosocomial) Pneumonia

Pneumonia that develops in a hospital setting, often caused by resistant bacteria.

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Pneumonia in Immunocompromised Hosts

Pneumonia in individuals with weakened immune systems, often caused by opportunistic pathogens.

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Pulmonary Sepsis

Infection of the lungs that spreads to the bloodstream, potentially leading to life-threatening complications.

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Pneumonia

Inflammation of the lung parenchyma caused by various microorganisms. Characterized by cough, fever, shortness of breath, and chest pain.

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Factors that Increase Risk of Pneumonia

Factors that increase the risk of pneumonia: suppressed cough reflex, impaired ciliary function, weakened immune system, alcohol consumption, cigarette smoking, etc.

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Complications of Pneumonia

Complications of pneumonia include respiratory failure, abscess formation, sepsis, and death.

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Bronchopneumonia

A type of pneumonia where the infection starts in the bronchi and spreads to the alveoli, creating patchy inflammation and consolidation.

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Lobar Pneumonia

A severe form of pneumonia where the infection spreads throughout an entire lobe of the lung, often caused by Streptococcus pneumoniae.

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Streptococcus pneumoniae Pneumonia

A type of bacterial pneumonia caused by Streptococcus pneumoniae, often seen in smokers and after viral infections.

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Haemophilus influenzae Pneumonia

A type of bacterial pneumonia caused by Haemophilus influenzae, often seen in smokers and those with COPD.

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Moraxella catarrhalis Pneumonia

A type of bacterial pneumonia caused by Moraxella catarrhalis, often seen in smokers, those with COPD, and the elderly.

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Staphylococcus aureus Pneumonia

A type of bacterial pneumonia caused by Staphylococcus aureus, often seen in IV drug users, infants, and those with skin infections.

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Klebsiella Pneumonia

A type of bacterial pneumonia caused by Klebsiella, often seen in hospitalized patients and those with aspiration pneumonia.

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Pseudomonas aeruginosa Pneumonia

A type of bacterial pneumonia caused by Pseudomonas aeruginosa, often seen in hospitalized patients and those with aspiration pneumonia.

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Mycoplasma pneumoniae Pneumonia

A type of bacterial pneumonia caused by Mycoplasma pneumoniae, often seen in young adults and those with milder symptoms.

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Lung Abscess

A type of lung infection characterized by pus-filled cavities (abscesses) that form in the lung tissue.

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Pleurisy

Inflammation of the lining of the lungs (pleura), causing sharp pain, often worse with breathing.

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Bronchiectasis

An abnormal widening of the airways (bronchi) due to inflammation and infection, leading to chronic coughing and mucus production.

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Bacterial Pneumonia

Bacterial pneumonia is an infection that affects the small air sacs in the lungs, causing inflammation and fluid buildup.

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Viral Pneumonia

Viral pneumonia is an infection that affects the lung tissue, causing inflammation and swelling.

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Empyema

A serious complication of pneumonia characterized by a buildup of pus in the space between the lungs and chest wall.

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Alveolar Fibrosis

A complication that can occur after pneumonia, causing scarring and thickening of the lung tissue.

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Bacteraemia

A condition characterized by the presence of bacteria in the bloodstream, often a complication of pneumonia.

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How does obstruction lead to bronchiectasis?

Obstruction of the airways, leading to air trapped in the distal bronchi (small airways). The blockage can be caused by things like tumors, foreign bodies, or excessive mucus. This causes the airways to collapse, leading to inflammation and scarring, ultimately resulting in larger, permanently dilated airways.

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What role does infection play in bronchiectasis?

Long-term infection in the airways causes further damage to the bronchial walls, leading to more inflammation and ultimately permanent dilatation.

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What are some complications of bronchiectasis?

Bronchiectasis can lead to lung abscesses, blood clots in the lungs (cor pulmonale), and even brain abscesses.

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Study Notes

Pulmonary Sepsis Objectives

  • Outline the normal defense mechanisms of the respiratory tract
  • Distinguish between upper and lower respiratory infections
  • Describe the etiology and pathogenesis of upper and lower respiratory infections, including the organisms and individuals at risk
  • Discuss methods of pneumonia classification
  • Mention common pneumonia-causing organisms
  • Distinguish between bronchopneumonia and lobar pneumonia based on morphology and clinical course, including gross and microscopic differences
  • Discuss pneumonia complications
  • Explain the pathogenesis of lung abscess and bronchiectasis
  • Briefly outline pneumonia investigation methods
  • Understand how to choose the correct antibiotic

Respiratory Tract Defenses

  • Nasal hairs, turbinates, and saliva filter
  • Nasopharyngeal filtering
  • Cough reflex prevents aspiration, especially important in those under anesthesia or with head injuries
  • Mucociliary apparatus moves mucus toward the mouth
  • IgA antibodies secreted in the lamina propria
  • Phagocytic activity of alveolar macrophages
  • Alveolar fluid with surfactant, immunoglobulin, and complement
  • Cell-mediated immunity
  • Lymphoreticular system in airways prevents spread

Upper Respiratory Tract Infections (URTIs)

  • URTIs are not prioritized for antibiotic treatment
  • Affected structures: nose, sinuses, larynx, and trachea
  • Common characteristics: common, trivial or mild, and transient
  • Viral URTIs: common cold (rhinovirus), viral sore throat (adenovirus), influenza, and laryngotracheobronchitis (RSV)
  • Secondary bacterial infections can result from viral infections
  • Bacterial URTIs: strep pyogenes and other bacteria colonizing the nose and throat

Lower Respiratory Tract Infections (LRTIs)

  • Affected structures: bronchi, bronchioles, and lung parenchyma (alveolar spaces)
  • Epithelium of the bronchi to bronchioles produces mucus to trap microbes
  • Infections are serious and can complicate pre-existing conditions (bacteria, viruses, atypical organisms, and fungi)
  • Pneumonia involves infection of alveolar spaces (broncho and lobar varieties)
    • Host reaction can result in consolidation (whitish appearance on X-ray)
    • Classification: based on morphology (bronchopneumonia and lobar pneumonia), cause, and clinical setting

Bronchopneumonia

  • Caused by Strep pneumoniae, Haem influenzae, Moraxella catarrhalis, Staph pneumonia, Klebsiella, and Pseudomonas aeruginosa
  • Starts in bronchi, then affects alveoli
  • Polymorphs, fibrin, patchy foci, coalesce, consolidation, widespread or bilateral, and rarely heals with fibrosis

Lobar Pneumonia

  • Typically caused by Strep pneumoniae (90-95% cases)
  • Starts in alveoli, spreads luminally to bronchioles and alveoli
  • High virulence, host vulnerability, polymorphs, fibrin, edema fluid, affects most or all lobes, consolidation, and resolution is common

Pneumonia Causes (Bacterial)

  • Atypical: mycoplasma, legionella, chlamydia, coxiella
  • Streptococcus pneumoniae (often follows viral infections in smokers)
  • Haemophilus influenzae (in smokers and COPD patients)
  • Moraxella catarrhalis (in smokers and COPD patients)
  • Staphylococcus aureus (in IV drug users, infants, and usually related to skin infections)
  • Klebsiella (aspiration pneumonia, in hospitalized patients)
  • Pseudomonas aeruginosa (aspiration pneumonia, in hospitalized patients)
  • Coliform bacteria (in hospitalized patients)
  • Chlamydia
  • Legionella pneumophilia (from contaminated water systems)
  • Tuberculosis (TB)
  • Mycobacterium avium-intracellulare (immunosuppressed patients)

Pneumonia Causes (Fungal)

  • Pneumocystis jirovecii/carinii (immunosuppressed, HIV patients)
  • Aspergillus fumigatus (immunosuppressed patients)

Pneumonia Etiology (Viral, Aspiration, Radiation, Allergic)

  • Viral: community-acquired pneumonia (strep, haem influenza, moraxella, staph, legionella, klebsiella, pseudomonas) characteristics, sputum, gram stain, blood cultures
  • Aspiration: pneumonia caused by aspiration of infected material (gastric contents, anaerobic bacteria, mixed with S. aureus, or beta-hemolytic streptococci, Klebsiella, Pseudomonas)
  • Radiation-induced
  • Allergic mechanisms

Pneumonia Complications

  • Pleurisy and pleural adhesions
  • Lung abscesses
  • Resolution with correct antibiotic is most common

Bronchiectasis Characteristics

  • Abnormal permanent dilation of distal bronchi and bronchioles
  • Associated chronic infection
  • Pathogenesis: obstruction → atelectasis → loss of elastic tissue → fibrosis → irreversible airway dilation
  • Causes: congenital defects, cystic fibrosis, immunodeficiency, immotile cilia, necrotizing or suppurative pneumonia, virulent organisms (Staph aureus, Klebsiella, tuberculosis)

Bronchiectasis Complications

  • Lung abscesses
  • Cor pulmonale
  • Metastatic brain abscesses

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