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51 Cards in this Set
- Front
- Back
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What is the most common cause of bacterial pneumonia?
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Streptococcous pneumoniae
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What viral agents have been known to cause pneumonia?
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- RSV
- Influenza, Parainfluenza - Adenovirus - Herpes Virus - Hantavirus - Measles Virus - SARS |
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What fungal agents have been shown to cause pneumonia?
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- Aspergillus
- Histoplasma capsulatum - Cryptococcous - Coccidioides - Pneumocystis |
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What type of pneumonia is the result of fungal agents?
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Sub-acute/chronic pneumonia; which are more common in immunocompromised patients.
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What Rickettsial (intracellular parasite) causes Q-Fever?
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Coxiella brunetti - main manifestation of Q-Fever is pneumonia.
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What Rickettsial (intracellular parasite) causes Rocky Mountain Spotted Fever?
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Rickettsia rickettsiae - RMSF, HA, temporal myalgias, pneumonia; mainly a systemic presentation.
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What bacteria-like agent is the most common cause of pneumonia in healthy children and young adults?
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Mycoplasma pneumoniae
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What parasites are known to cause pneumonia?
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- Ascaris
- Strongyloides |
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What organisms are most likely to cause chronic pneumonia?
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- Anaerobic bacteria
- Fungi - Nocardia - Mycobacterium |
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What characterizes the anaerobic bacteria that cause chronic pneumonia?
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Originate in the mouth and involved with aspiration pneumonia.
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What characterizes Nocardia?
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High order bacterium that present as chronic pneumonia, can mimic tuberculosis.
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What characterizes nontuberculosis mycobacteria?
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Non-communicable pathogen whose common manifestation in immunocompromised individuals is chronic pneumonia.
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What non-infectious diseases have been known to mimic pneumonia?
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- CHF
- Atelectasis - Pulmonary embolism - Malignancy - Vasculitis - Granulomatous Diseases - Hypersensitivity Pneumonitis - Drug Reactions |
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What does an elevated WBC count with a left-shift usually indicate?
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Bacterial Infection - left-shift is indicated by increase in PMNs >60% and bands >0-1%.
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What should be cultured when a patient present with pneumonia looking extremely ill?
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Sputum and blood cultures
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What factors increase the risk of developing pneumonia caused by Streptococcus pneumoniae?
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- Elderly (i.e. age > 65 yrs)
- CHF - Smoking - Immunocompromising Conditions |
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What other diseases are caused by Streptococcus pneumoniae?
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- Otitis
- Sinusitis - Meningitis |
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What is the treatment for pneumonia caused by Streptococcus pneumoniae?
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Ceftriaxone or Vancomycin IV if hospitalized; switch to penicillin or azithromycin if sensitive.
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What are potential complications associated with Streptococcus pneumoniae?
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- Bacteremia
- Empyema - Pneumatocele |
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What type of pneumonia should be considered in a patient with a positive cold agglutinins test?
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Mycoplasma pneumoniae - which causes an Atypical Community Acquired Pneumonia.
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What is the drug of choice for Mycoplasma pneumoniae?
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Azithromycin - beta-lactams are not useful for Mycoplasma pneumoniae because they lack a cell wall.
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What disease state often accompanies Mycoplasma pneumoniae?
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Hemolytic Anemia (High reticulocyte count).
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What does an S3 gallop suggest?
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Left Ventricular Failure
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How does Streptococcus pneumoniae appear on Gram Stain?
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Gram positive diplococci
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Macrolides (azithromycin) are the drugs of choice for which organisms that cause pneumonia?
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- Mycoplasma pneumoniae
- Legionella pneumophila |
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What organisms mentioned in lecture will not stain via Gram stain due to the absence of a cell wall?
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- Mycoplasma pneumoniae
- Legionella pneumophila - Chalmydia (All cause Atypical Community Acquired Pneumonia) |
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How does an Mycoplasma pneumoniae infection usually present?
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Very common cause of respiratory tract infections in young children, young adults and is often accompanied by hemolytic anemia.
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What organisms are the most common causes of Health Care Associated Pneumonia (i.e. already hospitalized for 72 hrs)?
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Gram Negative Bacilli (most common)
- Enterobacter - Klebsiella - Pseudomonas aeruginosa Stapylococcus aureus (less common) |
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What is the usual treatment for Gram negative rods (bacilli)?
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Gentamycin/Piperacillin; then switch when specific species/sensitivity is determined (i.e. Enterobacter is found, can switch to TMP/SMX).
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What organism is becoming the most common cause of Health Care Associated Pneumonia?
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Enterobacter cloacae
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What is the treatment for nosocomial pneumonias?
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IV antimicrobials directed at presumed eitologic agents; there is a high morbidity and mortality associated Health Care Associated Pneumonias.
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What are the physical findings can be seen in a patient with pneumonia?
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- Fever
- Tachypnea - Crackles - Bronchial breath sounds (consolidation) - Dullness to percussion - Egophony (E to A change) - Tactile fremitus |
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What pneumonia agent is associated with exposure to cattle and animal hides?
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Anthrax (Bacillus anthracis) - can be weaponized for bioterrorism.
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What pneumonia agent is associated with exposure to squirrels, chipmunks, rats, or rabbits?
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Plague (Yersinia pestis) - can be weaponized for bioterrorism.
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What pneumonia agent is associated with exposure to rabbits, foxes, and squirrels?
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Tularemia (Francisella tularensis) - can be weaponized for bioterrorism.
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What pneumonia agent is associated with exposure to goats, sheep and cattle?
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Q-Fever (Coxiella brunetti) - can be weaponized for bioterrorism.
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What pneumonia agent is associated with exposure to exotic birds (i.e. parrots)
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Psittacosis (Chlamydia psittaci) - aka parrot fever.
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What is the predominant flora of the normal oropharynx?
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Oral anaerobes:
- Peptococcus - Peptostreptococcus - Fusobacteria |
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What conditions predispose to aspiration pneumonia?
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Decrease in mental status, inability to clear airway.
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What is the treatment for Community Acquired Aspiration Pneumonia?
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Clindamycin
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What is the primary treatment for Staphylococcus aureus?
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Vancomycin; unless sensitivities are known (i.e. is it MRSA) can switch to IV Nafcillin/Oxacillin.
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What is the major complication of influenza infection in adults?
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Secondary bacterial pneumonia
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What organisms are the most common causes of secondary bacterial pneumonia?
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- Streptococcus pneumoniae
- Haemophilus influenzae - Staphylococcus aureus |
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What are the most common etiologic agents of community acquired pneumonia in smokers and patients with COPD?
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- Streptococcus pneumoniae
- Haemophilus influenzae - Legionella pneumophila |
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What bacterial etiologic agents are the most common cause of pneumonia in a patient on high dose steroids?
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- Legionella pneumophila
- Mycobacterium - Nocardia |
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What risk factors are associated with an increased risk of contracting Legionaire's Disease?
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- Smoking
- COPD - Steroid Therapy - Immunosuppressive Drugs |
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What is the treatment for Legionella pneumophila (Legionaire's Disease)?
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Azithromycin (Macrolides drugs of choice)
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What test can be done to rapidly diagnose Legionaire's Disease?
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Legionella Urinary Antigen Test
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What etiologic agent should always be considered in a patient with a community acquired pneumonia?
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Streptococcus pneumoniae
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What term is often used to describe Haemophilus influenzae?
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Pleomorphic (Gram Negative)
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What bacteria do not show up on Gram stain?
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- Legionella pneumophila
- Mycoplasma pneumoniae (Both do not posses a cell wall) |
