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93 Cards in this Set
- Front
- Back
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what are the URI and what is the most common cause?
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common cold, pharyngitis, laryngitis, sinusitis, otitis media; usually caused by viruses
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what are the lower respiratory tract infections?
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tracheobronchitis, bronchiolitis, croup, pneumonia
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pneumonia is usally caused by bacteria or viruses?
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viruses
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the most common cause of cold in adults and children?
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rhinoviruses in adults, parainfluenza or corona viruses in children
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pharyngitis in children under 3 and adults is usually caused by what organisms?
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rhinoviruses, coronaviruses, adenoviruses, or infulenza
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pharyngitis in older children (5-15) and young adults is often related to what organisms?
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S. pyogenes (most common in older children), influenza, EBV, M. pneumonia, or enteroviruses (older children)
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rare bacterial causes of laryngitis:
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Moraxella catarrhalis, M. tuberculosis
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most common cause of otitis media:
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S. pneumoniae and H. influenzae secondary to viral URI
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most common cause of tracheobronchitis in adults and children with normal lung function
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adults: adenovirus, parainfluenza virus, influenza virus; children: RSV
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occasional cause of tracheobronchitis in older adults
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B. pertussis
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tracheobronchitis in COPD pts is often caused by:
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H. influenzae or M. catarrhalis
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most common cause of community aquired pneumonia
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S. pneumoniae
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major causes of atypical pneumonia
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M. pneumoniae, C. pneumoniae, Legionella
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common cause of pneumonia in alcoholics
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K. pneumoniae, S. pneumoniae
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common cause of pneumonia in IV drug users
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S. aureus
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common cause of pneumoniae in neutropenic pts
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Aspergillus spp
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common cause of pneumoniae in pts who use steroids
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Nocardia
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usual cause of acute exacerbation of chronic bronchitis (AECB)
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H. influenzae and S. pneumoniae
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H. influenzae is isolated on what media?
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chocolate agar
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what is the pathogenomic feature of nontypable H. influenzae?
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it is an unencapsulated strain
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Hemophilus has the species influenzae, parainfluenzae, haemolytica, and parahemolytica; what is the difference between the para- species and the others?
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para- species only require factor V(nicotinamide adenine dinucleotide) where the others requre factor X (heme) only or factor X and factor V
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virulence factor of NTHi
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IgA protease
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antimicrobial Tx for Hib or NTHi bronchitis vs Tx for invasive disease
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bronchitis: newer macrolides (clarythromycin, azithromycin) or a cephalosporin; invasive disease: 3rd generation cephalosporin (cefotaxime or ceftriaxone)
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almost exclusive cause of epiglottitis
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Hib (in non-immunized children)
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gram positive lancet-shaped diplococci
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S. pneumoniae (pneumococcal pneumonia)
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similarity and differences between S. pneumoniae and viridans group strep identifiers
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both are a -hemolytic and catalase negative (anaerobic?) but viridans are Optochin resistant where S.pneumoniae are Optochin sensitive
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virulence factors for S. pneumoniae
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IgA protease, polysaccharide capsule, pneumolysin (in more severe infections)
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pathological stages of lobar pneumonia
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congestion, red hepatization, grey hepatization, resolution
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DOC for S. pneumoniae
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penicillin
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empirical therapy for community accuired pneumonia
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third generation cephalosporin (cefotexime or ceftriaxone) + a macrolide or a newer quinolone (levofloxacin or gatafloxacin)
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most common cause of menengitis in adults
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S. pneumonae
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"rust-colored" or purulent sputum
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S. pneumonae
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"currant jelly" sputum
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K. pneumoniae (or abcess?)
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short, plump, gram negative bacilli, lactose fermenter, urease positive, indole negative
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K. pneumonia
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K.pneumoniae virulence factor
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K antigen (polysaccharide capsule)
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Drugs used for K. pneumoniae
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extended-spectrum penicillins (piperacillin and ticarcillin), aminoglycosides, quinolones
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mechanism of drug resistance in K. pneumoniae
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extended-spectrum beta-lactamases
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unique feature of mycobacteria
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cell wall contains 60% lipids (mycolic acids)
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M. tuberculosis growth media
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slowly on selective (eg Lowenstein-Jensen) agar
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M. tuberculosis virulence factors
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cord factor, phenolic glycolipids (lipoarabinomannan (LAM))
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obligate aerobe, facultative intercellular bacteria
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M. tuberculosis
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method of active phagocytosis employed by M. tuberculosis
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LAM is recognized by macrophage mannose receptors and M. tb expresses C3 convertase which forms C3b on it's surface which is recognized by macrophages (CR4)
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what virulence factor induces the typical 'tubercle' of M. tuberculosis infection?
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cord factor
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histological characteristics of M. tuberculosis granuloma/tubercle
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central multinucleated giant cells (coalesced epithelioid cells (macrophages w/epithelial characteristics)) containing bacilli, midzone of epithelioid cells, and peripheral zone of fibroblasts, lymphocytes, and monocytes
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characteristics of primary and secondary/post-primary TB
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primary: lower lobe involvement, granulomas visable on CXR (Ghon focus), secondary: cavitary lesion usually in upper lobes
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what immune factors are required for effective TB killing
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TH1 induction of nitric oxide production in macrophages
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complications of TB in HIV pts
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meningitis
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CT scan showspulmonary nodules w/ a "halo sign" and ground glass attenuation
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Aspergillus spp
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most common mold to cause disease in humans
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Aspergillus spp
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stain reveals thin hyphae, that branch at 45 degree angle
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Aspergillus spp
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aspergillosis is associated with what risk factors?
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neutropenia, chronic granulomatous disease, and building projects (release of condia from decaying vegitation)
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DOC for pulmonary aspergillosis
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voriconazole (+ GCSF for neutropenic pts)
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"fungus ball" seen on CXR
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Aspergillus growing in tuberculosis cavity
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associated with bats, blackbird, pigeons, and demolition
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histoplasmosis
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oval thin walled yeast found in tissues
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histoplasma capsulatum
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growth on mycologic agar, after up to 4 weeks, shows thick walled finger-like conidia
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histoplasma capsulatum
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endemic region of H. capsulatum
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Ohio and Mississippi river valleys
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DOC for histoplasmosis in immunocompetent pts and in immunocompromised pts
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itraconazole; amphotericin B respectively
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broad based budding seen on biopsy
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blastomyces
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white fluffy mold on sabourad agar or brown wrinkled colonies on blood agar
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blastomyces dermatitidis
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endemic region of Blastomycosis
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SE united states
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pulmonary infection associated with spread to skin and bones; skin lesion which become verrucous, crusted, or ulcerated and slowly spread
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blastomycosis
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DOC for blastomycosis
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itraconazole; amphotericin B in immunocompromised pts
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mycoses w/ thick-walled nonbudding spherules
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Coccidioides immitis
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epidemic area of C. immitis "valley fever"
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SW united states
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mycoses causing characteristic erythema nodosum after pulmonary infection
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Coccidioides immitis
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DOC for Coccidiodes immitis
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fluconazole or itraconazole; amphotericin B in immunocompromised pts
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pulmonary mycoses infection associated with disemination to skin, bones, and meningies
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Coccidioides immitis
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filamentous, aerobic, weakly gram positive, and weakly acid-fast bacterium found on culture after up to 4 weeks incubation
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Nocardia
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bacterial infection which may disseminate to any organ including CNS (usually brain abscesses) especially in immunocompromised pts
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Nocardia
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DOC for nocardiosis
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sulfonamides (usually TMP/SMX)
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foul smelling sputum is associated with what
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anaerobic lung abcess and/or actinomyces
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"sulfer granules" found on gram or tissue stain of draining lesion
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actinomyces israelii
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filamentous, strict aerobe (non-fermenting), gram positive, non-acid fast bacterium found on culture after up to a month of incubation
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actinomyces
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"molar teeth" colonies found on agar plate
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actinomyces
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risks for infection by A. israelii
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poor oral hygeine and IUDs
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DOC for Actinomyces
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penicillin G usually followed by amoxicillin for 6 to 12 months
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3 common causes of nosocomial pneumonia
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K. pneumoniae, Pseudomonas aeruginosa, and S. aureus
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aerobic, gram negative rod, which is oxidase positive
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P. aeruginosa
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pneumonia with green sputum production
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P. aeruginosa (pyocyanin)
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common cause of ventilator-associated-pneumonia and pneumonia in CF pts
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P. aeruginosa
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agar plate found to have mucoid appearance and fruity odor
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P. aeruginosa
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virulence factors for P. aeruginosa
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alginate capsule (biofilm), pili (bind to N-acetylneuraminic acid), flagella, exoenzyme S adhesin, LPS (increases mucin production), elastase, exotoxin A, and phospholipases
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common modes of transmission of P. aeruginosa
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contaminated water, liquids, or foods
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bacteria associated with infections including otitis externa (swimmer's ear) which may be invase in diabetics, "hot tub" folliculitis, sepsis w/ecthyma gangrenosum, osteomyelitis, UTI (especially w/ foley catheter), and pneumonia
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P. aeruginosa
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comon cause of post viral pneumonia
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usually S. aureus or S. pneumoniae
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gram positive cocci in clusters, catalase positive
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Staphylococcus
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staphylococcus which is coagulase positive
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S. aureus
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staphylococcus which is coagulase negative, and sensitive to novobiocin
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S. epidermidis
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staphlococcus which is coagulase negative and resistant to novobiocin
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S. saprophyticus
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creamy-yellow to orange colored colonies on agar
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S. aureus
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halmark of S. aureus infection on CXR
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abcess (fibrin wall containing pus) within the alveoli?
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DOC for S. pneumoniae
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IV antistaphlococcal penicillin (eg nafcillin)
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