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32 Cards in this Set
- Front
- Back
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A 70 yo man has rapid onset of high fever and chills. His sputum is a rust color. He is a smoker and a diabetic. What condition does he have?
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pneumonia caused by S. pneumoniae
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What is seen on PE in someone with S. pneumoniae infection?
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fever, tachycardia, tachypnea, respiratory distress, dullness to percussion on localized area of thorax, FREMITUS, bronchial breath sounds and crackles over area of dullness
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What is seen in the blood work of someone with S. pneumoniae?
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leukocytosis with elevated bands, low pO2 and O2 sat
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What is another name for S. pneumoniae?
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pneumococcal pneumoniae
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What are the characteristics of S. pneumoniae?
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gram + lancet shaped diplococci, have a capsular polysaccharide
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What are the criteria for sputum gram smear?
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less than 10 epithelial cells per low power field, greater than 25 PMN, and presence of single predominant organism
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When grown on blood agar how does S. pneumoniae present?
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alpha hemolytic
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Is S. pneumoniae catalase + or - and optochin resistant or sensitive? strep viridans is alpha hemolytic. Is it optochin sensitive or resistant?
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1) catalase - and optochin sensitive
2) resistant |
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Are the capsular proteins of different S pneumoniae serotypes sensitive to the same antibody?
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no
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When is S. pneumoniae infection most likely?
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during the winter in crowded places
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What is the most common cause of community acquired pneumonia afflicting all ages?
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S. pneumoniae
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What is the sequence of pathogenesis of S. pneumoniae?
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1) upper airway colonizaiton
2) aspiration to lower airways 3) failure of normal host defenses 4) proliferation 5) inflammation |
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What must S. pneumoniae have in order to adhere to epithelial cells?
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an IgA protease to degrade the IgA released in the respiratory tract
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What does S. pneumoniae bind on epithelial cells?
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it has adhesins to PAF receptors and glycolipids on epithelial cells
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What toxin does S. pneumoniae release that forms pores in all cells in the respiratory tract?
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hemolysin (pneumlysin)
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What is the earliest stage of lobar pneumonia caused by S. pneumoniae?
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congestion with serous exudation, vascular engorgement and bacterial proliferation
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What is red hepatization?
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Seen in S. pneumoniae. it is the liverlike appearance of the consolidated lung, airway spaces are filled with PMNs, vascular congestion, extravasation of RBCs causing reddish discoloration
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What is grey hepatization?
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seen in S. pneumoniae it follows red hepatization and is marked by fibrin accumulation, WBCs and degrading RBCs, alveolar spaces are filled with inflammatory exudates
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What occurs during the resolution phase of S. pneumoniae?
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reabsorption of the exudate
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What is the order of stages of S. pneumoniae infection?
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1) congestion
2) red hepatization 3) grey hepatization 4) resolution |
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S. pneumoniae causes an intra-alveolar exudate. How does it spread through entire lobe?
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through pores of Kohn until consilidation occurs
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What cytokines would be released to cause fever with S. pneumoniae?
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TNF and IL-1
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How is S. pneumoniae treated? If it is a community acquired infection what might it be treated with? If a high resistant S. pneumoniae is present what drug should be used?
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1) penicillin
2) 3rd gen ceph like cefotaxime or ceftriaxone with either a macrolide or newer quinolone (levofloxacin or gatifloxacin) 3) vancomycin |
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When is the S. pneumoniae vaccine given? What is the vaccine made of?
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1) people over 60 or people at high risk (AIDS, asplenia, sickle cell disease, alcoholism)
2) it is a capsular vaccine covering 23 types of S. pneumoniae |
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What syndrome caused by S. pneumoniae is very common in young children?
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acute otits media... recurrent episodes can lead to hearing loss
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Can pneumonia caused by S. pneumoniae spread into the pleural space?
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yes it can cause emypema
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S. pneumoniae can cause bacteremia. What is the systemic inflammatory response associated with?
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cardiac failure and death
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Endocarditis can result from bacteremia caused by S. pneumoniae. Where does the infection go in the heart?
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aortic valve
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What is the most common cause of meningitis in adults?
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S. pneumoniae. note it is the 2nd most common in children
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What can result from infection of children with S. pneumoniae?
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neurologic sequale and/or learning disabilities
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What is the major virulence factor of S. pneumonaei and what does it do?
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polysaccarhide capsule that prevent phagocytosis.
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How is S. pneumoniae offered protection by the host?
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It causes production of PAF which induces clotting and gives the bacteria a place to hide
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