Buxton 10-2-07 Bacterial Pneumonia

Front 1

Bacteria causing community acquired pneumonia

Back 1

S. pneumoniae
H. influenza b
M. catarrhalis
Legionella spp
Mycobacteria pneumoniae
Chlamydophila pneumoniae
others

Front 2

Bacteria causing hopital-acquired pneumonia

Back 2

Pseudomonas aeruginosa
Klebsiella pneumoniae
Legionella spp
Acinetobacter
Staph. aureus

Front 3

What type of pneumonia is this?

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

Back 3

typical


note- this classification system is not reliable, although you may still encounter it

Front 4

What type of pneumonia is this?

Slower onset, non-productive cough, frequent extra-pulmonary symptoms

Back 4

atypical

Front 5

pathogens causing typical pneumonia

Back 5

S. pneumo, H. influenzae, M. catarrhalis

Front 6

pathogens causing atypical pneumonia

Back 6

Legionella sp, Mycoplasma pneumoniae, Chlamydophila pneumoniae

Front 7

Immune Compromised pts get pneumonia from the previously listed bugs plus what viruses?

Back 7

CMV, HSV, VZV, measles, others

Front 8

CF pts get pneumonia with what uncommon bug?

Back 8

Pseudomonas-

Front 9

alcoholics get pneumonia with what uncommon bug?

Back 9

Klebsiella-

Front 10

AIDS pts get pneumonia with what uncommon bug?

Back 10

Pneumocystis-

Front 11

outpatient treatment of pneumonia (pt has had no previous antibiotitics)

Back 11

Macrolide or doxycyclin




Previous antibiotics
Respiratory fluoroquniolone
Advanced macrolide

Front 12

In-patient treatment of pneumonia

Back 12

Respiratory fluoroquniolone
Advanced macrolide plus b-lactam

Front 13

Most common cause of CAP requiring hospitalization

Back 13

Streptococcus pneumoniae

Front 14

Classic symptoms of Pneumococcal Pneumonia

Back 14

High fever
Tachycardia
Hypoxia
Respiratory distress
CRX often shows consolidation

Front 15

What immune cells account for the consolidation in pneumonia?

Back 15

PMNs

Front 16

__?-valent vaccine
Recommended for 65 and older or >2yr with chronic disease, lack of functional spleen, institutionalized, immune suppressed

Back 16

23

Front 17

__? valent congugate vaccine
Recommended for Infants and toddlers

Back 17

7

Front 18

Where do legionella pneumophilia live?

Back 18

Grow in amoebae in the water

Front 19

Are legionella pneumophilia resistant to chlorine?

Back 19

yes

Front 20

Legionella sp.- Associated Diseases

_____ Fever- mild self-limiting febrile illness
Fever, chills, myalgia, malaise

Back 20

Pontiac

Front 21

Legionella pneumonia
Virulence factors-

Back 21

1) Facultative intracellular pathogen
replicates in alveolar macrophages and monocytes
2) Endotoxin

Front 22

Legionellosis has two forms: Pontiac fever, a mild respiratory infection, and ________' disease, a serious and potentially fatal form of pneumonia

Back 22

Legionnaires

Front 23

Symptoms of legionnaires disease

Back 23

Abrupt onset of fever, chills, non-productive cough, headache
Involves more than lung- multisystem disease involving GI tract (diarrhea), liver, kidneys, CNS

Front 24

Clues that you might have legionnaires disease

Back 24

Non-pulmonary symptoms
Negative sputum gram stain (small very faintly staining, gm – bacilli, hard to see)

Front 25

Legionnella:
Culture sample from bronchoalveolar lavage on _________ agar

Back 25

BCYE-buffered charcoal yeast extract

Front 26

Other ways to diagnose legionnaires disease

Back 26

1) DFA (fluoro) of sputum
2) Urine antigen test
3) PCR
4) Serology

Front 27

DOC for legionnaires disease

Back 27

is newer macrolides- azithromycin- or respiratory fluoroquinolones (levofloxacin, others)

Front 28

DOC for pontiac fever

Back 28

no treatment (don't need it)

Front 29

How do you treat the source of legionnella? (eg, wet A/C unit)

Back 29

Superheating of water to 70-80C
Install copper-silver ionization units
Produce metallic ions that kill microbes

Front 30

Why can't you use B-lactam antibiotics or vancomycin to treat mycoplasma pneumoniae?

Back 30

no cell wall

membrane made of sterols

Front 31

Symptoms of walking pneumonia

Back 31

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

Front 32

WBC count in walking pneumonia

Back 32

WNL


w/i normal limits

Front 33

CXR of walking pneumonia

Back 33

CXR: Diffuse unilateral or bilateral infiltrates usually involving lower lung; rarely shows consolidation

Front 34

Pathogenesis of M. pneumoniae:
P1 adhesion protein mediates attachment to ____ on epithelial cells

Back 34

cilia

Cilia stop moving and epithelial cells die

Front 35

Mycoplasma pneumoniae culture

Back 35

What's this?

Front 36

Treatment of M. pneumoniae

Back 36

Most often empiric
macrolides or respiratory fluoroquinolones


sensitivity testing not necessary

Front 37

Culture of Chlamydophila penumoniae, Chlamydia trachomatis, Chlamydia psittaci

Back 37

no culture


(Obligate intracellular pathogens)

Front 38

Chlamydophila Exist as elementary and ______ bodies

Back 38

reticulate

Front 39

Which are infectious, elementary or reticulate bodies?

Back 39

elementary (metabolically inactive)



(reticulate bodies are opposite)

Front 40

Which Chlamydia?

STD and perinatal infection
Can cause pneumonia in perinatally infected infants

Back 40

Chlamydia trachomatis

Front 41

Which Chlamydia ?

Exposure to organism shed from psittacine birds (parrots, parakeets)
Causes pneumonia or FUO

Back 41

Chlamydia psittaci

Front 42

Which Chlamyda(-ophila)

Causes mild pneumonia, bronchitis, sinusitis
3-10% of CAP
300,000 pneumonia cases/yr
Usually affects adolescents and young adults

Back 42

Chlamydophila pneumoniae

Front 43

How does Chlamydophila pneumoniae survive in a cell?

Back 43

Prevents fusion of phagosome with lysosomes

Front 44

Most of Chlamydophila pneumoniae disease's manifestations are due to inflammatory response to ____

Back 44

LPS

Front 45

Diagnosis of C. pneumoniae- associated pneumonia

Back 45

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,

Front 46

Hospital-Acquired Pneumonias
Most frequently in ______ patients (VAP)

Back 46

ventilated

Front 47

Hospital-Acquired Pneumonias

some pathogens

Back 47

Pseudomonas aeruginosa
Acinetobacter baumannii
MRSA
Klebsiella pneumoniae
Enterobacteriaceae

Front 48

Pseudomonas aeruginosa

Aerobic, catalase-positive, Gm ____ rod

Back 48

neg

Front 49

Pseudomonas aeruginosa is resistant to some ______ disinfectants

Back 49

common

Front 50

What kind of person gets infected with Pseudomonas aeruginosa

Back 50

Swimmers- otitis externa
CF- pneumonia
Catheterized patients- UTI, septisemia
Burn patients- wound infections, septisemia
Intubated patients- pneumonia, septicemia

Front 51

P. aeruginosa:
Found in soil and water
Frequently isolated from water sources in hospitals- sinks, faucets, ______ solutions

Back 51

disinfectant

Front 52

Virulence Factors in Pathogenesis of Pseudomonas:

Bacterial attachment and colonization

Back 52

Pili (attachment)

Front 53

Virulence Factors in Pathogenesis of Pseudomonas:

Obstruction of host defenses

Back 53

Pyocyanin (blue-green pigment, impairs cilia)
Capsule (antiphagocytic)
Exotoxins A and S are suppressive
Cytotoxin

Front 54

Virulence Factors in Pathogenesis of Pseudomonas:


Induce inflammation

Back 54

LPS, pyocyanin, phosphlipase C

Front 55

Virulence Factors in Pathogenesis of Pseudomonas:


Tissue destruction, local invasion and dissemination

Back 55

Elastase, toxins, pyocyanin, other secreted enzymes

Front 56

Diagnosis of Pseudomonas

Back 56

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

Front 57

Treatment of Pseudomonas pneumonia

Back 57

Anti-pseudomonal penicillins along with an aminoglycoside
Ie, ticarcillin-clavulanate or piperacillin-tazobactam with tobramycin
Other drug choices- imipenem-cilastatin, aztreonam, quinolones, ceftazidime, cefepime,

Front 58

Klebsiella pneumoniae
Gram ____. rods, ,

Back 58

neg

Front 59

Klebsiella pneumoniae
catalase ________

Back 59

positive

Front 60

Klebsiella pneumoniae
oxidase negative, ferments _____

Back 60

lactose

Front 61

Klebsiella pneumoniae
Colonizes _______

Back 61

mucosal surfaces (especially gut) and skin

Front 62

Who are at greatest risk for pneumonia due to K. pneumoniae

Back 62

Intubated patients and alcoholics

Front 63

Klebsiella pneumoniae:
Causes inflammation, necrosis and _______ in lung

Back 63

hemorrhage

Front 64

Klebsiella pneumoniae:
May produce thick, bloody, mucoid sputum "_______ sputum”

Back 64

“currant jelly

Front 65

Klebsiella pneumoniae:
Many hospital strains produce extended spectrum ______ (ESBL)

Back 65

b-lactamses

Front 66

Extended spectrum cephalosporins, such as the third generation cephalosporins, were originally thought to be resistant to hydrolysis by ________!

Back 66

beta-lactamases

Front 67

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.

Back 67

extended spectrum

These are collectively termed the
•'extended spectrum beta-lactamases'(ESBL's)

Front 68

Diagnosis of Klebsiella pneumoniae:
Growth on _____ Agar and Blood agar

Back 68

MacConkey

Front 69

Why the slimey appearance of Klebsiella on agar?

Back 69

due to capsule

Front 70

Treatment of Klebsiella pneumonia

Back 70

Non-ESBL strains
Third generation cephalosporins with or without aminoglycosides
Susceptible to wide range of b-lactams, aminoglycosides, quinolones, aztreonam
ESBL strains
imipenem