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70 Cards in this Set

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Bacteria causing community acquired pneumonia
S. pneumoniae
H. influenza b
M. catarrhalis
Legionella spp
Mycobacteria pneumoniae
Chlamydophila pneumoniae
others
Bacteria causing hopital-acquired pneumonia
Pseudomonas aeruginosa
Klebsiella pneumoniae
Legionella spp
Acinetobacter
Staph. aureus
What type of pneumonia is this?

Presentation often acute with shaking chills, productive cough, CXR showing consolidation, no extra-pulmonary symptoms
typical


note- this classification system is not reliable, although you may still encounter it
What type of pneumonia is this?

Slower onset, non-productive cough, frequent extra-pulmonary symptoms
atypical
pathogens causing typical pneumonia
S. pneumo, H. influenzae, M. catarrhalis
pathogens causing atypical pneumonia
Legionella sp, Mycoplasma pneumoniae, Chlamydophila pneumoniae
Immune Compromised pts get pneumonia from the previously listed bugs plus what viruses?
CMV, HSV, VZV, measles, others
CF pts get pneumonia with what uncommon bug?
Pseudomonas-
alcoholics get pneumonia with what uncommon bug?
Klebsiella-
AIDS pts get pneumonia with what uncommon bug?
Pneumocystis-
outpatient treatment of pneumonia (pt has had no previous antibiotitics)
Macrolide or doxycyclin




Previous antibiotics
Respiratory fluoroquniolone
Advanced macrolide
In-patient treatment of pneumonia
Respiratory fluoroquniolone
Advanced macrolide plus b-lactam
Most common cause of CAP requiring hospitalization
Streptococcus pneumoniae
Classic symptoms of Pneumococcal Pneumonia
High fever
Tachycardia
Hypoxia
Respiratory distress
CRX often shows consolidation
What immune cells account for the consolidation in pneumonia?
PMNs
__?-valent vaccine
Recommended for 65 and older or >2yr with chronic disease, lack of functional spleen, institutionalized, immune suppressed
23
__? valent congugate vaccine
Recommended for Infants and toddlers
7
Where do legionella pneumophilia live?
Grow in amoebae in the water
Are legionella pneumophilia resistant to chlorine?
yes
Legionella sp.- Associated Diseases

_____ Fever- mild self-limiting febrile illness
Fever, chills, myalgia, malaise
Pontiac
Legionella pneumonia
Virulence factors-
1) Facultative intracellular pathogen
replicates in alveolar macrophages and monocytes
2) Endotoxin
Legionellosis has two forms: Pontiac fever, a mild respiratory infection, and ________' disease, a serious and potentially fatal form of pneumonia
Legionnaires
Symptoms of legionnaires disease
Abrupt onset of fever, chills, non-productive cough, headache
Involves more than lung- multisystem disease involving GI tract (diarrhea), liver, kidneys, CNS
Clues that you might have legionnaires disease
Non-pulmonary symptoms
Negative sputum gram stain (small very faintly staining, gm – bacilli, hard to see)
Legionnella:
Culture sample from bronchoalveolar lavage on _________ agar
BCYE-buffered charcoal yeast extract
Other ways to diagnose legionnaires disease
1) DFA (fluoro) of sputum
2) Urine antigen test
3) PCR
4) Serology
DOC for legionnaires disease
is newer macrolides- azithromycin- or respiratory fluoroquinolones (levofloxacin, others)
DOC for pontiac fever
no treatment (don't need it)
How do you treat the source of legionnella? (eg, wet A/C unit)
Superheating of water to 70-80C
Install copper-silver ionization units
Produce metallic ions that kill microbes
Why can't you use B-lactam antibiotics or vancomycin to treat mycoplasma pneumoniae?
no cell wall

membrane made of sterols
Symptoms of walking pneumonia
Slow onset (weeks) beginning with URT symptoms, flu-like illness
Body aches, sore throat, headache, chills, malaise
Fever
Non-productive cough
Rales and rhonchi, +/- wheezing on auscultation
WBC count in walking pneumonia
WNL


w/i normal limits
CXR of walking pneumonia
CXR: Diffuse unilateral or bilateral infiltrates usually involving lower lung; rarely shows consolidation
Pathogenesis of M. pneumoniae:
P1 adhesion protein mediates attachment to ____ on epithelial cells
cilia

Cilia stop moving and epithelial cells die
Mycoplasma pneumoniae culture
What's this?
Treatment of M. pneumoniae
Most often empiric
macrolides or respiratory fluoroquinolones


sensitivity testing not necessary
Culture of Chlamydophila penumoniae, Chlamydia trachomatis, Chlamydia psittaci
no culture


(Obligate intracellular pathogens)
Chlamydophila Exist as elementary and ______ bodies
reticulate
Which are infectious, elementary or reticulate bodies?
elementary (metabolically inactive)



(reticulate bodies are opposite)
Which Chlamydia?

STD and perinatal infection
Can cause pneumonia in perinatally infected infants
Chlamydia trachomatis
Which Chlamydia ?

Exposure to organism shed from psittacine birds (parrots, parakeets)
Causes pneumonia or FUO
Chlamydia psittaci
Which Chlamyda(-ophila)

Causes mild pneumonia, bronchitis, sinusitis
3-10% of CAP
300,000 pneumonia cases/yr
Usually affects adolescents and young adults
Chlamydophila pneumoniae
How does Chlamydophila pneumoniae survive in a cell?
Prevents fusion of phagosome with lysosomes
Most of Chlamydophila pneumoniae disease's manifestations are due to inflammatory response to ____
LPS
Diagnosis of C. pneumoniae- associated pneumonia
Diagnosis difficult
Organism is hard to culture, must be grown in cells; identifiied by immunoassay or immunofluorescence
Serology requires acute and convalescent antibody titers;
PCR is rapid and sensitive,
Hospital-Acquired Pneumonias
Most frequently in ______ patients (VAP)
ventilated
Hospital-Acquired Pneumonias

some pathogens
Pseudomonas aeruginosa
Acinetobacter baumannii
MRSA
Klebsiella pneumoniae
Enterobacteriaceae
Pseudomonas aeruginosa

Aerobic, catalase-positive, Gm ____ rod
neg
Pseudomonas aeruginosa is resistant to some ______ disinfectants
common
What kind of person gets infected with Pseudomonas aeruginosa
Swimmers- otitis externa
CF- pneumonia
Catheterized patients- UTI, septisemia
Burn patients- wound infections, septisemia
Intubated patients- pneumonia, septicemia
P. aeruginosa:
Found in soil and water
Frequently isolated from water sources in hospitals- sinks, faucets, ______ solutions
disinfectant
Virulence Factors in Pathogenesis of Pseudomonas:

Bacterial attachment and colonization
Pili (attachment)
Virulence Factors in Pathogenesis of Pseudomonas:

Obstruction of host defenses
Pyocyanin (blue-green pigment, impairs cilia)
Capsule (antiphagocytic)
Exotoxins A and S are suppressive
Cytotoxin
Virulence Factors in Pathogenesis of Pseudomonas:


Induce inflammation
LPS, pyocyanin, phosphlipase C
Virulence Factors in Pathogenesis of Pseudomonas:


Tissue destruction, local invasion and dissemination
Elastase, toxins, pyocyanin, other secreted enzymes
Diagnosis of Pseudomonas
Gram stain, culture and sensitivity of:
Biopsied lung tissue is best sample
Most common sample is bronchoscopic or BAL
Sputum cultures not reliable
Growth on blood agar or MacConkey agar
Produce fruity odor
Treatment of Pseudomonas pneumonia
Anti-pseudomonal penicillins along with an aminoglycoside
Ie, ticarcillin-clavulanate or piperacillin-tazobactam with tobramycin
Other drug choices- imipenem-cilastatin, aztreonam, quinolones, ceftazidime, cefepime,
Klebsiella pneumoniae
Gram ____. rods, ,
neg
Klebsiella pneumoniae
catalase ________
positive
Klebsiella pneumoniae
oxidase negative, ferments _____
lactose
Klebsiella pneumoniae
Colonizes _______
mucosal surfaces (especially gut) and skin
Who are at greatest risk for pneumonia due to K. pneumoniae
Intubated patients and alcoholics
Klebsiella pneumoniae:
Causes inflammation, necrosis and _______ in lung
hemorrhage
Klebsiella pneumoniae:
May produce thick, bloody, mucoid sputum "_______ sputum”
“currant jelly
Klebsiella pneumoniae:
Many hospital strains produce extended spectrum ______ (ESBL)
b-lactamses
Extended spectrum cephalosporins, such as the third generation cephalosporins, were originally thought to be resistant to hydrolysis by ________!
beta-lactamases
mid 1980's it became evident that a new type of beta-lactamase was being produced by Klebsiella & E coli that could hydrolyze the ______ ______ cephalosporins.
extended spectrum

These are collectively termed the
•'extended spectrum beta-lactamases'(ESBL's)
Diagnosis of Klebsiella pneumoniae:
Growth on _____ Agar and Blood agar
MacConkey
Why the slimey appearance of Klebsiella on agar?
due to capsule
Treatment of Klebsiella pneumonia
Non-ESBL strains
Third generation cephalosporins with or without aminoglycosides
Susceptible to wide range of b-lactams, aminoglycosides, quinolones, aztreonam
ESBL strains
imipenem