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43 Cards in this Set

  • Front
  • Back
Strep pneumoniae
Gram positive diplococci
Big capsule
Lots of serotypes
Leading cause of lobar bacterial p.
Hist: gram + diplococci
CF: acute onset of fever, chills, chest pain, rusty sputum, lobar consolidation
Pathogenesis: Proliferation in alveoli and influx of PMNs w. minimal structural damage (NO NECROSIS)
mycoplasma pneumoniae
atypical
No cell wall
•Intracellular
•Long doubling time
Epi: children and young adults, often in epidemics
CF:more insidious onset, brief clinical course,Often cough
Character: infl. confined to interstitium, no alveolar exudate, intra-alveolar hyaline disease
Pathogenesis: Attaches to bronchial epithelium secondary infl. and edema
Legionella pneumophila
atypical
Lives in water
Gram negative
Epi: contaminated AC
Multilobe involvement
Purulent sputum without visible organisms, hyponatremia, failure to respond to beta-lactams suggests
intracellular pathogen
Chlamydophila
atypical
Obligate intracellular bacteria
CAP
Histoplasma capsulatum
fungus
Epi: spelunking, avian droppings
path: just like TB
histo: TINY yeast, granulomas
empiric rx for putpatient CAP
2nd or 3rd generation cephalosporin OR b-lactam/b-lactamase inhibitor AND macrolide OR fluoroquinolone
empiric rx for inpatient CAP
b-lactam inh + macrolide OR fluoroquinolone
vancomycin for resistant staph
Aspergillus
 Epi: Organ-transplantation, iatrogenic
histo: septate hyphae (45)
Path: invade blood vessels
PCP
 Epi: AIDs
 Pathogenesis: Proliferation within alveoli with edema
 CXR: Batwing infiltrate
o Fungus
o SS
 Develops insidiously, with gradual SOB, fever, dry cough over weeks (can be faster)
 Most common cause of ARDs in HIV pts
 Usually in pts with CD4<200
o CXR: diffuse bilateral infiltrates
o DX:
 Show in sputum (culture or PCR)
o TX: bactrim
Haemopholus Influenza
CAP
• Small, pleomorphic gram – rod
• Most virulent is type B
 Epi: healthcare setting
COPD --> risk
o Psittacosis
 Epi: chilling w sick birds
Moraxella catarrhalis
CAP
 The bug: Gram-negative diplocci
elderly and people w chronic lung disease most susceptible
Staph aureus
o HCAP
 Pathogenesis: Proliferation within alveoli with destruction
assoc w IV drug abuse
• CMV
o SS
 Similar to PCP, SOB, non productive cough
o DX:
 Visualize: owl eyes,
• Intracellular inclusion bodies
o TX:
 Ganciclovir
klebsiella p
CXR: fills like a ball
associated with extensive necrosis (s. aureus as well)
thick capsule
Cryptococcus Neoformans
 Epi: worldwide
 Loc: often associated with meningitis
 CD4<100 usually
 TX: amphotericin B
 Hist: India Ink, Foamy cells
Histoplasmosis
 Epi: Ohio and Mississippi river valleys, Central and South America, Carribean
 Very low CD4 count usually
 SS
• Subacute pneumonia
 CXR:
• military infiltrates on CXR
• diffuse
 DX: see in speicim
 TX: amphotericin B or itraconazole for less severe infections
o Aspergillosis
 CD4<30
 Rare but DEADLY
 Often post bone marrow TX (neutropenia)
 CXR: upper lobar disease with cavitations and hemoptysis
 DX: see organism in normally sterile sites
• 45 branching hyphae
 TX: amphotericin B
Path: infarction and necrosis secondary to vascular involvement
Blastomycosis
Midwest, southeast
Both CXR diffuse, TX: ampho B
Histo: big yeast, granulomas
CC: similar to TB but inital infection can --> symptoms
• Kaposi Sarcoma
o Most common malignancy in HIV pts
o Caused by HHV8 (sex transmission probably)
o Usually mucutaneous lesions too
o SS:
 Asymptomatic often
 Cough, SOB, hemoptysis, fever
o CXR:
 Bronchial thickening, kerley b lines, nodules, adenopathy
PORT clinical prediction rules
to det if ok to send home
<50
doesnt have:
1) neoplastic diseas
2) liver
3) CHF
4) Cerebrovascular disease
5) renal disease
Pseudomonas a
path: severe necrotzing infl with vasculitis
assoc w CF
Lung abscess by which bac?
staph aureus, klebsiella (other gram - rods, aspiration p.
aspiration p most commonly which lobe
RLL
atypical p are?
chlamydia pneumoniae, myocplasma p, viruses
enter interstitium
cell-mediated: lymphocytes
legionella (clinically, not pathologically)
Pathogenesis of TB
TB enter macrophages, drains to LN, Th1 --> Il-12 --> prod of IFN-gamma --> macrophages stimulated --> granulomas
coccidiomycosis
just like TB
hitso: thick walled spherules with endospores
candida
budding yeast with pseudohyphae
• Rhinovirus
o Early fall spring
o Highly contagious
• Adeno
o In military
o DNA virus
o Ped often w conjunctivitis and fevers
• Parainfluenza
o Croup in young
o Acute
• Coronavirus
o SARS
• Influenza
o Often leads to secondary bacterial pneumoniae
o Has a vaccine
Virus tx
oseltamivir - influenza A and B
amantadine - hit ONLY A
Penicillins
For Strep p
AE: Rash, cytopenia
b-lactams - excellent anaerobe coverage
Macrolides
intracellular (atypicals)
gram +
limited gram -
SE: GI, liver Torsades de pointes
Mech: Inhibit RNA dependent protein synthesis at step of chain elongation
Strep capsule important in pts with...
liver disease, no spleen
2nd or 3rd generation Cephalosporin
B-lactam
gram +s
gram -s, Pseudomonas
in-patient bc IV
no atypicals therefore used w macrolide
Fluoroquinolones
gram + strep, staph
Gram - other CAPs, Pseudomonas
atypicals
SE:
TERATOGENIC NOT FOR KIDS
joint cartilage, tendinitis
Photosensitivity
m: inhibits DNA synthesis
Bactrim
PCP
Group A Strep can -->
Rheumatic fever
Carbapenems
B-lactam
broad gram +, - (CAP)
pseudomonas
Vancomycin
MRSA TX
POST INFLUENZA SYNDROME!
SE:CN VIII
Red man synd
neutropenia
MECH: Cell membrane