Respiratory System Module: Pneumonia Basics

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Questions and Answers

What type of infection is Pneumonia considered?

An inflammation of the lungs affecting the alveoli.

What does VAP stand for?

Ventilator-Associated Pneumonia

What is the Gold Standard for diagnosing Pneumonia?

  • Blood tests
  • Infiltrate on a plain chest radiograph (correct)
  • A CT scan
  • Sputum analysis

What is the name of the university where this lecture was presented?

<p>Modern University for Technology and Information</p> Signup and view all the answers

Which faculty is this lecture a part of?

<p>Faculty of Medicine</p> Signup and view all the answers

What is the name of the module this lecture belongs to?

<p>Respiratory System Module</p> Signup and view all the answers

Pneumonia is defined as an inflammation of the lung affecting the bronchi.

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

How is pneumonia classified according to the source of infection?

<p>Hospital-acquired (C), Community acquired (D)</p> Signup and view all the answers

What is the definition of healthcare-associated pneumonia?

<p>Pneumonia that occurs 48 hours or more after admission to the hospital and was not present nor incubated at the time of admission.</p> Signup and view all the answers

Which of the following is NOT a common causative agent of healthcare-associated pneumonia?

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

Which of the following is considered an uncommon causative agent of HA-pneumonia in immunocompetent patients?

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

What are the main sources of infection for HA-pneumonia?

<p>Environment, other patients, staff, and devices (A)</p> Signup and view all the answers

Which of the following is NOT a route of pathogen entry into the lower respiratory tract causing pneumonia?

<p>Direct contact with infected skin (A)</p> Signup and view all the answers

What are the common clinical manifestations of HA-pneumonia? List at least 3.

<p>High fever, increased respiratory secretions, and increased oxygen requirements.</p> Signup and view all the answers

Which of the following IS NOT a common complication of HA-pneumonia?

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

What is the gold standard for diagnosing HA-pneumonia?

<p>Plain chest radiograph showing an infiltrate (inflammation) on the lungs.</p> Signup and view all the answers

Blood cultures are not useful in diagnosing HA-pneumonia in hospitalized patients.

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

Prompt initiation of antibiotics for HA-pneumonia is not critical, as it has no impact on patient outcomes.

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

What is the primary treatment strategy for HA-pneumonia?

<p>Broad-spectrum antibiotics depending on the local epidemiology, with prompt initiation being crucial.</p> Signup and view all the answers

What is VAP, and when does it usually occur?

<p>Ventilator-associated pneumonia; it typically occurs 48-72 hours after endotracheal intubation.</p> Signup and view all the answers

Why is VAP more common in patients requiring mechanical ventilation?

<p>The artificial airway increases the risk of aspiration and colonization. (A)</p> Signup and view all the answers

The incidence of VAP decreases with the duration of mechanical ventilation.

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

Which of the following is a common cause of early onset VAP?

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

What is the main characteristic of late-onset VAP compared to early onset VAP?

<p>Higher mortality and morbidity (D)</p> Signup and view all the answers

Emergence of viral diseases always involves a completely new unknown virus.

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

Which of the following is NOT a common factor contributing to the emergence of new viral diseases?

<p>Lack of genetic diversity (D)</p> Signup and view all the answers

What are the main categories of factors that contribute to the emergence of new viral diseases?

<p>Environmental changes, human behavior, socioeconomic and demographic phenomena, travel and commerce, food production, health care, microbial adaptation, and public health measures.</p> Signup and view all the answers

Which of the following is an example of an emerging viral agent?

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

Which type of virus is responsible for causing COVID-19?

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

What is the name of the virus that causes the severe acute respiratory syndrome (SARS)?

<p>CoV-SARS</p> Signup and view all the answers

What is the name of the virus that causes the Middle East Respiratory Syndrome (MERS)?

<p>MERS-CoV</p> Signup and view all the answers

Coronaviruses are the most common cause of the common cold.

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

The genetic material in coronaviruses is single-stranded, positive-sense RNA.

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

What is the most important characteristic of the envelope of coronaviruses?

<p>Presence of prominent club-shaped spikes (C)</p> Signup and view all the answers

What is the natural reservoir for the SARS virus(CoV-SARS)?

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

How are humans infected with MERS virus (MERS-CoV)?

<p>Close contact with infected camels (D)</p> Signup and view all the answers

Where is the virus that causes COVID-19 (SARS-CoV-2) suspected to have originated?

<p>Bats</p> Signup and view all the answers

The incubation period for COVID-19 is always exactly 14 days?

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

Which of the following is NOT a common symptom of COVID-19?

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

The novel coronavirus, SARS-CoV-2, is spread by respiratory droplets.

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

What is the primary diagnostic test used to detect the presence of viral RNA in respiratory specimens?

<p>PCR assay</p> Signup and view all the answers

What is the target receptor of MERS-CoV in the respiratory tract?

<p>CD26 (B)</p> Signup and view all the answers

What is the primary mode of transmission of Hantavirus?

<p>Inhalation of aerosols from rodent's feces and urine (B)</p> Signup and view all the answers

Hantavirus is known to have a very high mortality rate.

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

Hantavirus is spread through direct human-to-human transmission.

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

What is the primary method of preventing Hantavirus infection?

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

Flashcards

Healthcare-associated pneumonia

Pneumonia that develops 48+ hours after hospital admission and wasn't present or incubating at the time of admission.

Causative Agents (HAP)

Bacteria (Gram-negative bacilli like E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter; and Gram-positive cocci, especially S. aureus), viruses (influenza, parainfluenza, adenovirus, RSV), and fungi (Aspergillus fumigatus, Candida) can cause healthcare-associated pneumonia.

Sources of infection (HAP)

HAP can arise from the environment (air, water, equipment), devices (respiratory devices), other patients, or staff.

Routes of Pathogen Entry

Pathogens enter the lower respiratory tract by aspiration of oropharyngeal organisms, inhalation of contaminated aerosols, or direct inoculation (less common).

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Clinical Manifestations (HAP)

Symptoms may include high fever, increased respiratory secretions, and increased oxygen requirements.

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Complications (HAP)

Potential complications include pleural effusion and pleural empyema.

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Diagnosis (HAP)

Diagnosis involves a chest X-ray to spot lung inflammation, clinical assessment, and tests (swab cultures, blood cultures) to identify the pathogen.

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Treatment (HAP)

Treatment often involves broad-spectrum antibiotics (e.g., carbapenems) depending on local resistance patterns, which is important because many hospital-acquired infections are multidrug-resistant.

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Healthcare-associated pneumonia (HAP)

Pneumonia developing 48+ hours after hospital admission, not present or incubating at admission.

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Causative agents of HAP

Bacteria (Gram-negative, Gram-positive), viruses (influenza, RSV), and fungi (e.g., Aspergillus) can cause HAP.

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Sources of HAP infection

HAP sources include hospital environment, devices (e.g., ventilators), other patients, staff, and patient's underlying condition.

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Routes of pathogen entry (HAP)

Pathogens enter the lungs via aspiration, inhalation, or direct inoculation.

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HAP clinical signs

Symptoms include high fever, increased mucus, needing more oxygen.

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HAP complications

Complications include fluid buildup around the lungs (pleural effusion) and pus in the lung lining (pleural empyema).

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HAP diagnosis

Diagnosis involves a chest X-ray, clinical information, and tests to identify the germ causing HAP.

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HAP treatment

Treatment often includes broad-spectrum antibiotics, depending on local microbial resistance.

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Study Notes

Faculty of Medicine

  • Modern University for Technology & Information
  • Focuses on technology and medicine
  • Offers a Faculty of Medicine

Respiratory System Module

  • Healthcare associated pneumonia
  • Emerging viral diseases
  • Medical Microbiology & Immunology Department
  • Focuses on healthcare-associated pneumonia, emerging viruses, and related medical disciplines

Learning Objectives (ILOs)

  • Define healthcare-associated pneumonia
  • List causative agents of healthcare-associated pneumonia and VAP
  • Outline healthcare-associated pneumonia
  • Outline management of healthcare-associated pneumonia
  • Outline emerging viral diseases
  • Explain management of emerging viral diseases

Pneumonia

  • Inflammation of the lung alveoli
  • Classified based on source of infection
    • Community-acquired (outside hospital)
    • Hospital-acquired (>48 hours after admission)
      • Further classified as typical or atypical pneumonia based on presenting symptoms and causative organism

Healthcare-Associated Pneumonia

  • Occurs 48 hours or more after hospital admission
  • Not present or incubated at the time of admission
  • Often more severe due to the presence of antibiotic resistant organisms

Causative Agents of Healthcare-Associated Pneumonia

  • Bacteria
    • Gram-negative bacilli (e.g., E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter species)
    • Gram-positive cocci (e.g., Staphylococcus aureus)
  • Viruses
    • Influenza, parainfluenza, adenovirus, respiratory syncytial virus (RSV)
      • RSV outbreaks often cause bronchiolitis and pneumonia in children
      • Influenza A is a common viral cause in adults
  • Fungi
    • Aspergillus fumigatus, Candida species
      • Less common in immunocompetent patients

Sources of Infection

  • Environment (air, water, equipment, fomites)
  • Other patients
  • Staff
  • Devices (e.g., respiratory devices)

Routes of Pathogens Entry

  • Aspiration of oropharyngeal pathogens
  • Inhalation of pathogens from contaminated aerosols
  • Direct inoculation; hematogenous spread from distant body sites (less common)

Clinical Manifestations & Complications

  • High fever (potentially only symptom)
  • Increased respiratory secretions
  • Increased oxygen requirements
  • Complications: pleural effusion, pleural empyema

Diagnosis

  • Gold standard: infiltrate on a plain chest radiograph
  • Clinical data is helpful
  • Sputum analysis for Gram stain and culture, plus blood cultures (for hospitalized patients)
  • PCR tests for respiratory pathogens (e.g., influenza virus, RSV)

Treatment

  • Broad-spectrum agents (e.g., carbapenems)
  • Prompt initiation of antibiotics is critical (morbidity and mortality increase after >8 hours)
  • Drainage of empyema or infected pleural fluid
  • Hospital-acquired infections are often multidrug resistant

Ventilator-Associated Pneumonia (VAP)

  • Pneumonia occurring 48-72 hours after endotracheal intubation
  • Artificial airways increase risk of aspiration and colonization
  • Incidence increases with duration of ventilation
  • Early onset VAP (<4 days) carries better prognosis, with antibiotic-sensitive bacteria, more frequently involved.
  • Late onset VAP (≥5 days) with more virulent, multi-drug resistant (MDR) bacteria.

Emerging Viral Diseases

  • Emerge via:
    • Recognition of a new agent
    • Abrupt increase in illnesses caused by an endemic agent
    • Invasion of a new host population

Factors Contributing to Disease Emergence

  • Environmental changes (deforestation, floods, drought)
  • Human behavior (sexual behavior, drug use, outdoor recreation)
  • Socioeconomic & demographic phenomena (population growth, migration)
  • Travel & commerce (international air travel)
  • Food production (globalization of food supplies, changes in processing/packaging)
  • Healthcare (new medical devices, blood transfusions, immunosuppressant drugs, organ transplantation)
  • Microbial adaptation (mutations, reassortment, drug resistance)
  • Public health (inadequate sanitation, vector control, limited prevention programs)

Examples of Emerging Viral Agents

  • SARS-CoV
  • MERS-CoV
  • SARS-CoV-2 (COVID-19)
  • Hantavirus
  • Ebola virus

Coronaviruses

  • Second to rhinoviruses as a common cold cause
  • New coronavirus strains have emerged

Coronavirus Structure

  • Non-segmented, single-stranded, positive-sense RNA genome
  • Helical nucleocapsid
  • Prominent spikes on envelope (appearance of a corona)

SARS-CoV Background

  • Originated in China (2002)
  • Rapid spread to other countries
  • Bats are the natural reservoir
  • Civet cats act as intermediate hosts
  • Human-to-human transmission occurs

MERS-CoV Background

  • Outbreak in Saudi Arabia (2012)
  • Serious, often fatal pneumonia
  • Bats are the reservoir
  • Humans contract through close contact with infected camels
  • Human-to-human transmission is limited

SARS-CoV-2 Background / COVID-19

  • Identified in Wuhan, China (2019)
  • Initially linked to an animal market
  • Declared a global pandemic by WHO (March 2020)
  • Originated in bats

Pathogenesis

  • Transmitted via respiratory droplets
  • Limited to respiratory tract mucosal cells
  • 50% of infections are asymptomatic
  • CoV-SARS: diffuse edema, hypoxia
    • Angiotensin-converting enzyme 2 (ACE-2) on respiratory cells is a target
  • MERS-CoV binds to CD-26

Clinical Manifestations of Coronaviruses

  • Common cold: runny nose, scratchy throat, low-grade fever
  • Incubation period (2-10 days, SARS; 2-14 days, COVID)
  • SARS/MERS: fever, nonproductive cough, dyspnea, hypoxia, chills, malaise, headache, acute respiratory distress syndrome (ARDS).
    • Chest x-ray shows interstitial "ground-glass" infiltrates, leukopenia and thrombocytopenia

Laboratory Diagnosis

  • PCR assay to detect viral RNA in respiratory tract specimens
  • Antibody-based tests to detect a rise in antibody titer

Prevention

  • Vaccination (mRNA and viral vector vaccines)
  • Public health measures (isolation, quarantine, contact tracing, wearing masks)
  • Hygiene measures (frequent handwashing, cough/sneeze etiquette)
  • Personal protective equipment (PPE) for medical personnel
  • Antiviral medications, monoclonal antibodies (for treatment and prevention)

Hantavirus

  • Bunyavirus family
  • Enveloped, single-stranded, segmented, negative sense RNA
  • Rodent-borne (directly transmitted)
  • Causes hemorrhagic fever with renal syndrome (e.g., Korean hemorrhagic fever)

Hantavirus Pulmonary Syndrome

  • New disease, acquired by inhalation of rodent urine/feces aerosols
  • Influenza-like symptoms, rapidly progressing to severe respiratory failure
  • High mortality rate
  • Prevention depends on rodent control and avoiding contact

Additional Information

  • Possible target receptors and mode of transmission for different viruses.
  • Notes on the different types of vaccines are also present

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