SS pulm infections

what are the three pulmonary infections we are going to go over

• pneumonia

• covid-19

• tuberculosis

what are the two modes of transmission you can get pneumonia

• community acquired

• hospital acquired (nosocomial pneumonia)

is community acquired or hospital acquired pneumonia more common

community acquired- especially in chronic disease and smoking

what are the most common causative organisms of community acquired pneumonia

• strep pneumoniae

• influenza virus

• SARS-CoV-2

hospital acquired pneumonia is often _____-______ resistant

multi-drug resistant

there is a sub-category of healthcare acquired pneumonia, in what locations can pts acquire these

nursing homes, dialysis centers, etc

are pts at higher risk of acquiring pneumonia through hospitals or in healthcare

hospital is higher risk

what symptoms would a pt present w community acquired pneumonia

cough, dyspnea, fever, chest pain, and often anorexia

strep pneumonia often has what appearance on a chest x-ray

consolidated lobar- lung has some grey/white in it

what is tx for community acquired pneumonia

• 30% require hospitalization

• sputum culture sent but doesn’t always identify organism

• antiviral and/or antibiotics based on presentation (S. pneumonia is usually targeted)

prognosis for community acquired pneumonia if hospitalization is required

mortality rate is up to 35%

prognosis for community acquired pneumonia if mild

antibiotics/antiviral are usually successful; recovery can be long (even in young/healthy people)

prevention for community acquired pneumonia

• pneumococcal vaccine (<2 yrs and >65 yrs or immunocompromised)

• influenza vaccine

• don’t smoke

what is aspiration

refers to the entry of gastric or oropharyngeal substances into the lower airways

what is aspiration pneumonitis

if the substance aspirated is a chemical or gastric acid; inflammation of the lung

what is aspiration pneumonia

if the substance aspirated results in an infection

what are risk factors for aspiration

older age, reduced consciousness, neurological impairment, pharyngeal anesthesia, people w poor dental hygiene

COVID-19 was caused by

coronavirus, SARS-CoV- 2

what is SARS-CoV-2

an enveloped RNA virus; has receptor-binding region on its spike protein and the receptor is the angiotensin-converting enzyme 2

how prevalent is tuberculosis

in 33% of the world population

how is TB caused

mycobacterium tuberculosis that are acid fast bacilli

how is TB transmitted

by infectious aerosolized droplets

what are the 4 possible outcomes after inhalation of M. tuberculosis

• immediate clearance

• primary disease w immediate onset of active disease

• latent infection w minimal or no primary symptoms

• reactivation of disease after latent infection

of the 4 possible outcomes after inhalation of M. tuberculosis, what is the most common

latent infection

is primary infection of TB be asymptomatic or symptomatic

both!

what is happening to the TB bacteria in a latent infection

bacilli proliferate in the alveoli→ granulomas called tubercles form to isolate the bacilli → hangs out until it wants to reactivate

symptomatic primary infection presentations of TB

recurring fever, night sweats, chest pain, dyspnea, cough, weight loss, fatigue, can have painful mouth ulcerations, and often presents like cancer

untreated symptomatic TB disease- primary or reactive- has a mortality rate around…

50%

if a person has latent TB, are they infectious

no

what are the screening tests for TB

skin test and blood tests

the screening tests screen for the bacilli infection but DO NOT identify…

noninfectious vs active TB disease

how do we determine if a person has noninfectious vs infectious TB

examination, sputum samples, and chest x-ray

the time of highest risk reactivation to active TB disease is during what period of latency

the first 2 years

why is it important to treat latent TB

tx while latent greatly reduces the likelihood of reactivation in the future and thus dec the spreading and dec morbidity for that person

what is the tx for latent TB

multiple daily doses for 3 mo or 24 mo

people w what medical conditions are at v high risk of TB reactivation

people w HIV, are immunocompromised or chronic diseases

if you encounter someone and you are suspicious of TB, what is the first thing you do

call the public health office to arrange for text steps- including contact tracing

if you encounter someone and you are suspicious of TB, what do you do after you contact the public health office

mask the suspected person immediately and isolate them

what are the most common meds for tx of TB

RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol