SUPER BUG
Anatomy of lungs & pleura
Pneumonia management
control of respiration
Pneumonia
B- cell responses
Causality in Medicine
Risk factors of LRTI
is defined as
an event that plays an important role, or regular/ predictable change in occurrence of the outcome.
has two types
necessary cause
component cause
which means that
removing this cause won't diminish the effect
Epidemiological triad
represents
the interaction between the agent, the host, and the environment with a specific time
Epidemiology of CAP
in Qatar
Worldwide
Strep. pneumoniae and mycoplasma pneumoniae are the most common pathogens causing CAP
It caused 3M deaths each year
The estimated incidence is 1.5-14 cases per 1000 persons-years
It affect mostly countries with aging population and poor access to health care
Epidemiology of COVID-19
includes
475M confirmed cases
58.5M active cases
6M deaths
411M recoveries
10.9B vaccine doses administered
5B people one-dose vaccinated
4B people fully vaccinated
is caused by
Infectious typical bacteria
Strep pneumonia
Characteristics are
Non-motile
Capsule
grow in pairs or chains
Gram (+)
Non-spore forming
Catalase (-)
Virulence Factors
1- CPS
4- CBPs
3- Lyt
2- PLY
Important for:
1- Resistance to phagocytosis and antibiotics
2- Adhesion
3- Highly immunogenic
4- protection
5- Vaccine development
Exotoxin
pore forming
Hemolysis activity
partial hemolysis of RBCs
Inhibit ciliary beating
Required for transmission
Stationary phase
Lyt A + Lyt C
Bacteria cell wall autolysis
release of
DNA
RNA
Ply
PsPA
PspC
Bind to factor H
Resist complement activation
bind to lactoferrin
allow the growth of bacteria
Chronic diseases
Smoking
Hospitalization
Recent viral infection
Age
< 2 , > 65
Weakened immune system
Such as
Asthma
Heart disease
COPD
Caused by
Organ transplant
Drugs (Chemotherapy - steroids)
HIV/AIDS
Incomplete vaccination
Investigations for pneumonia
Bronchoalveolar lavage
PCR - rapid tests
ABG (acidosis/respiratory failure)
Pulse oximetry
Urine antigen test (S.pneumoniae - legionella)
Sputum microscopy & culture
Blood microscopy & culture
CBC and serum test
Chest Xray
Resulting in
Leukocytosis (especially PMNs)
Elevated Urea/creatinine
Elevated lactic acid
Elevated procalcitonin
Elevated CRP
Normal D-dimer and ferritin
cap
hap
CURB 0-1
CURB ≥3
CURB=2
antibiotics + send patient
home
admit into the hospital for
observation
admit into the ICU
microlides
or
Tetracyclines
e.g,
e.g,
Doxycycline
ezithromycin
microlides/ tetracyclines + A/B
plura
Trachea and bronchi
A
B
penicillin
3rd generation cephalosporin
e.g,
e.g,
ampicillin
ceftriaxone
3rd generation cephalosporin + A/B
penicillin-b lactamase + A/B
A/B = microlides/ respiratory floroquinolone
HAP Early Onset
HAP Late Onset
respiratory fluoroquinolone
carbapenems
Amino-glycoside + microlides
penicillin-b lactamase
Amino-glycoside OR respiratory fluoroquinolone +A/B/C
Primary B cell response
B
C
A
Secondary B cell response
Exposure to the Ag for the first time
B-lactamase inhibitor - B-lactam
carbapenem
3rd generation cephalosporin 4rd generation cephalosporin
Naive B cell are activated
IgM production
Peaks one week after infection
Has weak potency
e.g,
The exposure of the Ag for the second time
e.g,
e.g,
Memory B cells are activated
IgG production
Peaks hours after infection
Has high potency
tazobactam -piperacillin
NOT ertapenem. imipenem doripenem meropenem
Herd immunity
ceftazidime cefepime
Defined as
It is when most of the population is immune to an infectious disease
can be achieved
Naturally exposed to the disease
Vaccines
defensive mecahnisms
Barriers
Mucocillary escalator
Innate cellular defenses
Type one alveolar cells
Type 2 alveolar cells
Alveolar macrophages
Interstitial macrophages
Humoral immunity through
consist of
viceral pleura
pleural cavity
parietal pleura
that divides by location into
costal
diaphragmatic
cervical
mediastinal
histology
consist of
simple squamous epithelium
subserous fascia
made of
loose areolar CT
pleural recess
include
costomediastinal recess
costodiaphragmatic recess
Trachea
is a
Fibrocartilaginous tube from C6 to T4/T5
bronchi
Anterolateral
U-shaped bars of hyaline cartilage
Posterior
Smooth muscle (trachealis)
consist of
primary (main) bronchi
seprated into
Right bronchus
Wider
Secondary bronchi
more vertical
shorter
left bronchus
Narrower
longer
horizontal
Right
Left
Superior
inferior
middle
SARS-Cov-2
Superior
inferior
Tertiary (segmental) bronchi
Supply bronchopulmonary segment
has
.
Structural proteins
COVID-19
important for
Causing infection
includes
S protein
E protein
M protein
N protein
diagnosed by
RT-PCR
Immune response
can detect
Viral RNA
looking for
IgM
IgG
medulla oblongata
the primary respiratory control center.
composed of
the dorsal respiratory group (DRG)
the ventral respiratory group (VRG)
contains
inspiratory neurons
Contain
both inspiratory and expiratory neurons
inputs
the peripheral (arterial) chemoreceptors
the central chemoreceptors
stimulated by
1- Significantly decreased Po
2- Increased H concentration
3-Increased Pco
stimulated by
increased Pco, via associated changes in H concentration.
CURB-65
is
Severity Score estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
Hospital-Acquired Infection
types
Pneumonia
Surgical site infections
Urinary tract infections
Bloodstream infections
causes
Surgical procedures
Mechanical ventilation
Urinary catheters
Risk factors
Long hospital stay
Immunosuppression
Elderly
often
More serious than CAP
because
patients are immunosuppressed
Microbes are more virulent & might have antibiotic resistance