Lower Respiratory Tract Infections

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Gram positive diplocci grown on blood agar that is alpha-hemolytic/catalase negative, bile soluble, virulent for mice with a capsule, no lancefield grouping

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Strep Pneumoniae

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Bacteria with Polysaccharide capsule (antiphagocytic), IgA protease, Pneumolysin (aids in spread)?

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Strep Pneumoniae

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Two Alpha Hemolytic Streptococci?

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Strep Pneumo/Viridians

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Bacteria found in respiratory secretions, infection is usually endogenous with more then 80 serotypes

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Strep Pneumo

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Bacteria with only human reservoir (increased incidence in <6 and >60 yo)

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Strep Pneumo

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#1 community acquired pneumonia?

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Strep Pneumo (aspiration of resp secretions --> alveoli --> multiply --> inflamm response --> increased PMNS, edema, pus)

Front 7

Pt with shaking chills, high fever, SOB, productive cough --> pink/rusty sputum, pleuritic chest pain, decreased breath sounds, rales, CXR: lobar consolidation, increased WBC -----> complete resolution

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Strep pneumo

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#1 cause for bacterial meningitis in adults?

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Strep Pneumo

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#1 cause for OM, Sinusitis in Children?

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Strep Pneumo

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Can cause bacteremia if decreased spleen function following community acquired bacterial pneumo?

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Strep Pneumo

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Pt with pink/rusty sputum and lobar consolidation, what diagnostic tests to do?

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Smear (sputum, exudates, spinal fluid), Culture, Pneumococcal capsular Ag detection in CSF, latex agglutination, Quellung reaction (specific Ab causes capular swelling)

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How to treat Strep Pneumo pt?

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Penicillin (may have beta-lactam target, transpeptidate mutated), Floroquinolones/Vancomycin (for serious dz)

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How does the body fight off Strep Pneumo infection?

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Early stages: Phagocytosis, complement
Later: Production of anticapsule igG, IgM Ab --> Obsonization, increased phago, complement
Long lasting: Strain/type specific

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Strep Pneumo prevention?

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1st gen vaccinee: Capsule polysacch of 23 serotypes (not effective in less then 2 yrs old)
2nd gen vaccine: Multi-valent polysacch conjugated to protein carrier (mostly for infants)

Front 15

Gram negative rod, motile, aerobic, oxidase positive, pycoyanin, pyoverdin, fruity odor

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Pseudomonas Aeruginosa

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Virulence factors such as proteolytic enzymes, capsular slime, exotoxin A (similar to diptheria, inhibits protein synth), endotoxin

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Pseudomonas Aeruginosa

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Ubiquitous, hardy requires minimal nutrients, grows in any enviroment, disease in man, plants, animals

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Pseudomans Aeruginosa

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Opportunistic pathogen, infects almost any body tissue but normal flora of small intestine/skin

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Pseudomonas Aeruginosa

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Predisposed to these infections due to extensive burns, patients being ventilated, CF patients (from childhood most are chronically infected by mucoid/capsular strains --> necrotizing bronchopneumonia)

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Pseudomonas Aeruginosa

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These bacteria are highly resistant to most bacteria.. must perform sensitivity test (usually with beta lactam and aminoglycoside)

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Pseudomonas Aeruginosa

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This bacteria is difficult to prevent (cases associated with contaminated hot water/avoid excess broad spectrum Ab) and immunity is via anti-exotoxin A Ab

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Pseudomonas Aeruginosa

Front 22

Lactose fermenting, gram negative rod, pink colonies, grown on MacConkey, EMB agar

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Klebsiella Pneumoniae

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Has a thick mucoid capsule and endotoxin. Is part of the normal flora of respiratory & GI tracts

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Klebsiella Pneumoniae

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Can cause community acquired lobar pneumonia (usually due to aspiration), can cause necrotizing pneumo with thick viscous bloody sputum "currant jelly" --> scar tissue

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Klebsiella Pneumoniae

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Which bacteria cause Typical(acute) Pneumonia?

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Strep Pneumo
Legionella Aeruginosa
Klebsiella Pneumo

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What are the traits of Typical Pneumo

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Productive cough, lobar consolidation

Front 27

Bacteria is small, highly pleomorphic, stains poorly and only grows on complex media (lipoprotieins/sterols/etc).

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Mycoplasma Pneumo

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No cell wall (triple-layered w/ sterols), not an L form and remains extracellular

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Mycoplasma Pneumo

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Virulence factors include P1 (cytoadhesion to resp epith cells) and secretes ROS

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Mycoplasma Pneumo

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Trasmitted P2P via respiratory secretions (need close contact)

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Mycoplasma Pneumo

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May persist in throad several weeks prior to recovery (can still be transmitted)

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Mycoplasma Pneumo

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Causes all types of pneumos but known for primary atypical pneumo

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Mycoplasma Pneumo

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Remains extracellular by decreasing ciliary action, secreting ROS --> damaging resp epith and causing inflammation

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Mycoplasma Pneumo

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Incubation time 1-3 weeks & self limiting (slow resolution 1-4 weeks)

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Mycoplasma Pneumo

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Insidious onset (fever, headache, soar throat, malaise, non-prod cough)
CXR shows non-defined infiltrates & rare consolidation
Complications are uncommon and low mortality rate

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Mycoplasma Pneumo

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Sputum @ acute phase shows increased PMNs, take culture, Ag specific tests (complement fixation, H inhibition, indiret immunofluorescense, growth inhibition), Increased cold agglutinin titer for type O RBCs

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Mycoplasma Pneumo

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How to treat Mycoplasma Pneumo?

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Tetracycline, Erythromycin, Doxycycline (effective for all typical pneumos), completely resistant to penicillin b/c no cell wall

Front 38

Gram negative rod (coccobaccilli), stains poorly with gram, stain with dieterle's silver impregnantion, fastidious (needs Fe)

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Legionella Pneumophila

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Needs complex media (Buffered charcoal yeast extract, slow growth), cat +, oxidase +

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Legionella Pneumophila

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Facultative intracellular parasite (inhibits phagosome-lysosome fusion)

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Legionella Pneumohpila

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Ubiquitious in warm, moist environments, infects a water-borne protozoa, prepares it to live in macros of human hosts. Lives as biofilms, aerosauls/dust (not p2p, airborne), inhale from contaminated water

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Legionella Pneumophila

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Men over 55 w/ risk factors and everyone can be infected by this bacteria

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Legionnaires and Pontiac Fever

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Can cause pneumonia, community acquired, and nosocomial. Often asymptomatic

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Legionella Pneumophila

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Pt with mild-flu like URT (2-3 d), fever, chills, myalgia, malasise, headache, mild cough, soar throat, dizziness, photophobia, neck stiffness, high attack rate so every1 susceptible

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Pontiac Fever - Legionella Pneumophila

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Severe disease caused by this bacteria, high mortality, bronchitis, bronchiolitis, pneumonia. Also multilobe involvement, headache, high fever, abdominal cramps, vomiting, diarrhea, non-productive cough ----> Can have systemic spread (lung abscesses, bacteremia, hypotension, DIC, shock)

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Legionnaire's Dz - Legionella Pneumophila

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Generally not observed in Gram stain sputum or respiratory secretions. Resp secretions are thin & watery. Presents as progressive severe atypical pneumo

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Legionella Pneumo

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Can be ID'd be immunofluorescense (most specific), direct fluorescent Ab, indirect fluorescent Ab (highly sense, can be difficult), also via gene probe tests or Na Amplif tests

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Legionella Pneumo

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Treat Legionella Pneumo with?

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Macrolides & Fluoroquinolones

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Legionella Pneumo immunity?

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Cell-mediated mechanisms

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How can you prevent Legionella Pneumo?

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Monitor H2O systems (hyperchlor, cycles of super headting, treatment w/ Cu or Ag, maintain hot water)

Front 51

Obligate intracellular bacteria, lack metabolic & biosynthetic pathways, relys on host for intermediates

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Chlamydia Pneumo

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No known animal reservoir, presumed P2P, airborne route

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Chlamidya Pneumo

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Respiratory infections are usually asymptomatic/mild illness (pharyngitis, sinusitis, OM)

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Chlamidya Pneumo

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Can cause atypical pneumo in pts (20%)

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Chlamidya Pneumo

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Treat Chlamydia Pneumo w/ Tetracycline or Erythromycin

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Chlamydia Pneumo

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Obligate intracellular bacteria, lacks metabolic and synthetic pathways, zoonosis

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Chlamydia Psittaci

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Cause resp tract infections in birds, exposure to dead/living infected birds (direct/indirect contact), P2P very rare

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Chlmydia Psittaci

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Can cause psittacocsis or Ornithosis, infection usually in resp tract (incubation avg of 10 days)

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Chlamydia Psittaci

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Has sudden onset (malaise, fever, anorexia, sore throat, photophobia, severe headache) --> more severe have non-productive cough, rales, consolidation --> Can have mortality rate up to 20% if untreated

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Chlamydia Psittaci

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How to treat Chlamydia Psittaci

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Tetracycline or Erythromycin

Front 61

Obligate intracellular organism (similiar to other rickettsial agens but no arthopod vector or associated rash); zoonosis

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Coxiella Burnetti

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Infects ticks, livestock, animals, present in urine, feces, animal products. Infection from livestock & products (but not ticks)

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Coxiella Burnetti

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Heat, dessicant resistant --> aiborne (no P2P)

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Coxiella Burnetti

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Occupational hazard to exposed farm workers, febrile resp disease, abrupt onset, chills, fever, headache, no rash --> May progress to hepatitis or endocarditis

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Q Fever (Coxiella Burnetti)