Pneumonia

Transmission Contact droplet 100+ organisms cause

Pathogenesis

Incidence

Symptoms -rattling in chest -shortness of breath -fever -chest pain -wet, thick mucus on coughing -white stuff on X-ray

Other 20% are viral

Mycobacterium tuberculosis Acid fast

Contact, aerosol -Mycolic acid gives exceptionally long stability on surfaces, can be transmitted through air ducts. Airborne precautions

Mycolic Acid: protects from many Abx, drying -Lives in macrophages, slow growing survives phagocytosis and lives in phagosome, dividing only occasionally. Tubercles in lungs = masses of infected macrophages, some of which may die and calcify (obvious in Xray). Tubercles may obstruct airways

1/3 of world! -Was declining, but 2 factors caused the comeback: 1) HIV/AIDS 2) USSR collapseunderfunded Russian prisons were riddled with TB and couldnt afford drugs, so they cut pills in half for prisoners MDR strains

-Bloody cough -trouble breathing -May disseminate to GI, brain, or fetus Asymptomatic: 95% symptoms usually only develop in immunocompromised, but transmission may still occur

TB test: Inject TB Ag just under the skin. If person has antibodies, inflammation will occur within a couple days. Its like an ELISA in the skin! But cant distinguish reliably between past and present infections. Chest X-ray needed for that.

Diseases Community Acquired (CA)- most common: Streptococcus pneumonia (pneumococcus) Atypical pneumonia: walking pneumonia common & less serious Mild, no sputum, caused by obligate intracellular pathogens, hide inside alveolar cells. Chlamydophila pneumonia- survives phagocytosis by alveolar macrophages and replicate in phagosome & Mycoplasma pneumoniae children, lacks a cell wall and is tiny. Lives in bronchial/alveolar epithelia Hospital-Acquired (HA) Pneumonia nosocomial Can be any of the above: pneumococcus, chlamydophila, but often bacteria in wrong place. GI residents and Skin residents Primary TB: initial exposure: bacteria set up tubercles and infection may progress if immunity is weak Secondary TB: reactivation of tubercles due to immune compromise

Vaccine? Yes

Effect of Rx consistent Abx treatment for 6-24 months required to eradicate. Tx very unlikely during treatment. TB vaccine: exists, but low efficacy, and not given because would guarantee positive TB tests. Directly Observed Therapy : (DOT) the gold standard. Required that treatment be administered directly by trained health care workers so as to prevent more MDR.

Transmission Influenza Contact droplet

Pathogenesis Viral receptors: the main recipients of shift, since they are exposed to Abs: 1) Hemagglutinin (HA) 2) Neuramidinase (NA)

Incidence Host range is very broad-many mammals and birds. Key species for human problems= pigs, chickens, humans. Factory farm here and close living quarters in other countries create opportunities for Ag shift.

Symptoms Not vomiting & diarrhea (though that may happen in ~10% of cases) Mainly: -Fever -Achiness -Fatigue -Cough

Other A,B,C Serotypes: A-pandemics B-regional epidemic C-very mild, usually not a problem.

Diseases Pandemics frequent because of high antigenic shift frequency-herd immunity never possible to achieve. 1918- worst by far, but probably wouldnt be as bad today. Transported in it WW1 Avian flu (H5N1)- 50% + mortality in humans, but so far can only spread chickens humans. H1N1 flu (2009)- recent pandemic traced back to pig factory farms, where high population density favors development of virulent disease Hypoxia & retention of CO2 difficulty breathing, death

Vaccine? On Feb 23, 2012 The WHO recommended that the Northern Hemispheres 20122013 seasonal influenza vaccine contain the following 3 vaccine viruses: -an A/California/7/2009 (H1N1)pdm09-like virus -and A/Victoria/361/2011 (H3N2)-like virus -a B/Wisconsin/1/2010like virus

Respiratory Syncytial Virus (RSV)

Contact droplet

Whooping Cough Bortetella pertusis bacterium causes it

Contact droplet

Causes alveolar and bronchial cells to fuse and form syncytia, which results in lower gas exchange abilities, alveolar collapse Pertussis toxin: destroys cilia of respiratory tract. Mucus collects in lungs

SIDS link likely responsible for some cases of SIDS, especially with secondary factors like tobacco smoke exposure Rare, but rising -congestion -sneezing progresses over 1-2 weeks to paroxysmal coughing and apnea (inability to breathe) -exhaustion -death possible Usually only in immunocompromised people. Severe pneumonia with a high fever high mortality rate (15-50% of those with symptoms)

DTaP, Tdap

Legionnaires Disease Legionella pneumophila: lung bacterium

Aerosol Airborne precautions

Obligate intracellular. Very difficult to culture, fastidious . Amoebas in the environment, freeliving, harmless amoebas act as a reservoir. They must be inhaled for infection to occur. You must inhale in spray to become infected. Air conditioning units, showerheads, and produce sprays at groceries have all been implicated

Transmission Hantavirus Pulmonary Syndrome (HPS) Aerosol Specifically, aerosolized urine or feces from infected rodents (reservoir)

Pathogenesis

Incidence Epidemiology tends to arise at newly dispersed suburban edges, especially with those storing food

Symptoms Sudden flu-like symptoms -lungs fill with fluid -high mortality rate

Other

Diseases Sin Nombre Virus- Asia, prior to 1990s, hantaviruses only found in East Asia. Outbreak in Navajo Nation in 1994 led to discovery of new hantavirus, now called Sin Nombre. Cases are sporadic today, mainly in W/SW US.

Vaccine?

Q Fever Coxiella burnetii endospores, so can survive long after remains have decayed Obligate intracellular bacteria hard to culture Inhalation Anthrax Bacillus anthraciscommon in soil, but has high ID50, plus must be inhaled for serious disease. Thus, very rare

Aerosol From aerosolized sheep placenta/fetuses. Causes spontaneous abortion to facilitate its transmission among herd animals Aerosol inhaled endospores. Human to Human transmission not demonstrated, but droplet precautions still recommended Aerosol (at least) Maybe also droplet

Goats, sheep are most common in those with frequent contact with these animals

-chills -cough -fever-like symptoms -abortion can cause fetal death in humans

-mild, until anthrax toxin accumulates sufficiently to kill many alveolar cells cyanosis, death.

Fungal Infections Pneumocystits carinii pneumonia (PCP) very common in AIDS patients

Primarily immunecompromised LRTIs-can see hyphae on X-ray

-mild pneumonitis -dry cough, put progressive inability to breath (dyspnea) and pneumonia. -Hypoxia -Death

Bioterrorism: endospores and nonobvious pathology make it attractive, but would require high degree of training and production facility for significant dispersal. Still, big deal on the NCLEX. HIV-most patients with PCP have HIV. Significant decline now that HAART is available

Prophylactic Abx recommended for possible exposure

Others: -Histoplasmosis -Coccidiomycosis -Aspergillosis