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113 Cards in this Set

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  • Back
Most common cause of acute bronchitis
Viral
Bacterial causes of acute bronchitis
S. pneumoniae
H.influenzae
C.pneumoniae
M.pneumoniae
B.pertussis
Bacterial agents of chronic bronchitis
S.pneumoniae
H.influenzae
M. catarrhalis
_ can exacerbate symptoms of chronic bronchitis
Viruses
Necrotizing pneumonia with cavitation and destruction of lung parenchyma
Lung abscess
Involves invasion of lung interstitium

Typical of viral pneumonia
Interstitial pneumonia
More diffuse patchy consolidation - what type of pneumonia
Bronchopneumonia
Involvement of distinct region of lung - type of pneumonia
Lobar
This type of pneumonia produced by pyogenic bacteria living in nasopharynx

Which bacteria most commonly caused it?
Typical

S.pneumoniae
Type of pneumonia that is caused by organisms inhaled from environment not apparent on gram stain

Which organism most common?
Atypical

Mycoplasma pneumoniae
Patient presents with dyspnea, pleuritic chest pain, purulent cough, fever and shaking chills, he produces RUSTY SPUTUM - what type of pneumonia
Typical pneumonia
Patient presents with pneumonia, has less abrupt onset, cough is unproductive, no pleuritic pain, had flu like symptoms for past 2 weeks - what type of pneumonia
Atypical pneumonia
Which organisms usually cause aspiration pneumonia
ANAEROBIC
Which type of pneumonia is characterized by foul smell
Aspiration (anaerobic) pneumonia
#1 cause of community acquired pneumonia

#2?

#3 ?
STREP PNEUMONIA

Mycoplasma pneumonia

Chlamydia pneumonia
Which organisms are common causes of pneumonia following influenza
S pneumonia

S aureus

H influenza
Nosocomial infections occur _ after hospitalization
72 hours
People who are at high risk (ICU, ventillation) usually caused pneumonia by _
Pseudomonas aeruginosa

Multidrug resistant gram negative rods
What type of pneumonia is caused by Strep Pneumonia
Typical pneumonia

Lobar pneumonia
Which patients are at higher risk for Strep Pneumonia caused pneumonia
SICKLE CELL PATIENTS

Asplenic

Alcoholics

Poverty

Debilitated health
Main virulence factor of Strep Pneumonia
CAPSULE
_ vaccine recommended for elderly against Strep Pneumonia, against 23 most common serotypes
Polysaccharide vaccine
_ vaccine recommended for ages 2 months to 23 months, against 7 serotypes, reduces incidence of invasive pneumococcal disease, pneumonia and otitis media

24-59 months targeted to children at risk
Conjugate vaccine
Patient presents with symptoms of rapid onset, she had single episode of rigor, she complains of chills, fever, dyspnea and cough productive of rusty sputum - chest x ray shows lobar pneumonia - which organism responsible
Streptococcus pneumonia
Describe stages of pneumonia
1st stage - lung alveoli fill with fluid

2nd stage - early consolidation, PMN's

3d stage- late consolidation

4th stage- resolution
Alpha hemolytic

Optochin sensitive

Bile soluble

Quellung reaction
Strep Pneumonia
What is the treatment of Strep Pneumonia
DOC was penicillin but now 1/3 resistant

Multiple drug resistance developing

Need multi drug therapy
Other than pneumonia, S pneumonia causes _
Acute sinusitis

Otitis media

Bacteremia

Often follows viral infections
Gram negative rod

Oxidase negative

Lactose fermenter

Causes pneumonia
Klebsiella Pneumonia
65 year old male, alcoholic with positive history for pulmonary deficits has pneumonia, x ray shows cavitary necrotic destruction. He produces current jelly sputum

Whats the organism
Klebsiella Pneumonia
Nonfermenter

Gram negative rod

Oxidase positive
Pseudomonas Aeruginosa
Who is at risk for getting pseudomonas pneumonia
CYSTIC FIBROSIS

Chronic lung disease

Neutropenia
Microabscess formation and tissue necrosis

Diffuse bilateral bronchopneumonia

Organism?
Pseudomonas family
Hospitalized patient is found to have bilateral bronchopneumonia often with radioluscencies
Pseudomonas Aeruginosa
This organism causes nosocomial infection, normal patients spread it to cystic fibrosis patients, has long pili to bind to mucous of CF patients, CF patients become ill - very serious infection

Organism?
Burkholderia cepacia
Third most frequently isolated non-fermenter gram negative rod

Found in contaminated disinfectant solution, respiratory therapy equipment and ice machines

Organism?

Treatment?
Stenotrophomonas maltophilia

Treatment - TMP SXT
Slender pleomorphic gram negative rod

Stain poorly with grams stain, use silver stain

Fastidiuous grow on buffered charcoal yeast agar, require cysteine in media
Legionella pneumonia
This organism can tolerate high temperatures, requires hyper chlorination to eradicate, can be a facultative intracellular parasite for Acanthomoeba, Naegleria, acquired from environment
Legionella pneumonia
Where is Legionella most commonly found
WATER DISTRIBUTION SYSTEMS
Who is at most risk for Legionella
Elderly alcoholics, smokers

IMMUNOCOMPROMISED

Dialysis patients

Chronic underlying disease
How do you acquire Legionella
Inhale infectious particles

Binds complement on surface of monocytes and macrophages

ENDOCYTOSED

Prevents phagolysosomal fusion
How do you diagnose Legionella
Silver stain
Can cause CAP or nosocomial pneumonia

Causes atypical pneumonia

Onset less explosive than pneumococcal pneumonia

Sputum production less than pneumococal

Organism?
Legionella
65 year old male presents with fever, headache, cough was nonproductive initially, now patient has CNS and GI abnormalities - he has change in mental status, also nausea, vomitting and abdominal pain, he also has BRADYCARDIA - what disease
Legionnaires disease
Patient has multi lobar pneumonia with micro abscesses in lungs, he also has multi organ disease and more monocytes than PMN's - what disease
Legionnaries
How do you make diagnosis for Legionnaries
Gram stain - moderate number of PMN's

Buffered charcoarl yeast extract for isolation

Antigen detection in urine

Direct fluorescent antibody
2nd most common cause of Legionella pneumonia, weakly acid fast, mostly nosocomial, MAY PRESENT AS ACUTE PE, common in transplant recipients, hematologic malignancies and steroid use
Legionella micdadei
Most common cause of walking pneumonia, can also cause pharyngitis, non purulent otitis media and tracheobronchitis
Mycoplasma pneumonia
This is the smallest free living bacteria, it LACKS CELL WALL, it requires sterols for growth

Name bacteria and virulence factor
Mycoplasma pneumonia

P1 adhesin - binds cilia on epithelial cells, cilistatic, results in PERSISTENT COUGH
How is mycoplasma pneumonia transmitted
Inhalation of droplets - spreads within groups/families
25 year old female presents with ear pain, bullous myringitis and persistent nonproductive "hacking" cough

Which organism? Treatment?
Mycoplasma pneumonia

Erythromycin, tetracycline, fluoroquinolones
Patient presents with pneumonia - culture of bronchial washings shows strict aerobe, however it is not seen on gram stain but can see many PMN's, organism was isolated on special media with sterols, serology positive for cold agglutinins
Mycoplasma pneumonia
Obligate intracellular bacterium, cannot generate own ATP, lacks oxidative enzymes - cant see on gram stain, many PMN's
Chlamydia pneumonia
This organism causes pneumonia in elderly, debilitated patients, but also found in helathy individuals, transmission through droplets, associated with atherosclerosis, Alzheimers and asthma
Chlamydia Pneumonia
Patient presents with mild pneumonia, he has hoarseness and fever, respiratory symptoms followed few days later, he also has severe pharyngitis
Chlamydia pneumonia
Treatment of chlamydia pneumonia
Macrolides

Tetracycline

Levofloxacin
Organism responsible for parrot fever
Chlamydophila psittaci
This organism is shed in aerosoles, feces and feathers of birds, has abrupt onset, humans inhale aerosols, systemic infection develops, mucous plugs may form (can cut down on airway but not fatal)
Chlamydia psittaci
Treatment of psittacosis
Tetracycline and macrolides

Treat the birds with tetracycline too
This organism can cause fatal septicemia - droplets are inhaled from infected individual, carried from lungs by macrophages to lymphatic system, within 24 hours causes pulmonary necrosis, septicemia

Disease
Pulmonary anthrax
Patient presents with dyspnea, cyanosis, severe pyrexia, he is disoriented, within hours he develops circulatory failure, shock, goes into coma and dies

Disease?
Anthrax
Virulence factors of anthrax
Capsule

Edema toxin

Lethal toxin

2 plasmid requirement
Military person presents with edema and widened mediastinum on x ray, gram positive rod with spores is isolated
Bacillus anthracis
Causative agent of pneumonic plague
Yersinia pestis
How is Yersinia pestis transmitted
Aerosols
Patient is 45 year old farmer, develops septicemia and pulmonary hemorrhagic necrosis

Disease, organism
Tularemia - francisella tularensis
Obligate intracellular parasite, causes Q fever, member of riccketsia family, endemic to Nova Scotia, rare or underreported in US
Coxiella burnetti
This bug is a member of riccketsia family but doesnt cause rash
Coxiella burnettie
How do you get Q fever
Cattle, sheep and goats are primary reservoir

Inhale from aerosols of feces or genital secretion of infected domestic animals

May reactivate years later - especially during pregnancy
34 year old female presents with systemic illness after visit to a farm 20 days ago. She has rigors, fever, headache, myalgia and nonproductive cough, she also has maculopapular rash, she is also diagnosed with hepatitis, x ray shows patchy infiltrate

Diagnosis
Q fever
What can occur in chronic Q fever
ENDOCARDITIS (especially if previous valvular disease, transplant recipients and immunosuppressed)

Children - bone and joint involvement
Cell wall of mycobacteria is 60% _
Lipid (mycolic acid)
Who is at risk for TB
Minorities

HIV

Homeless

Recent immigrants

IVDU
47 year old male presents with fatigue, weight loss, fever, night sweats and productive cough. He complains of blood stinged sputum and pleuritic chest pain

Diagnosis
TB
How is TB spread
Droplet spread
Which cells pick up TB
Macrophages
How long for immune response to take place after infection with TB
3 weeks
What is the evidence for TB infections
Positive PPD

Ghon complex on x ray
Organized collection of epitheloid cells surrounded by lymphocytes and capillaries
Granuloma
What is TB test
Purified protein derivative
If patient is at no known risk what should be reaction to PPD
< or equal to 15 mm
If patient is at intermediate risk what should be reaction to PPD
< or equal to 10 mm
If patient is at high risk what should be reaction to PPD
5 mm
What can give you false positive TB test
Infected with atypical mycobacteria

BCG vaccination
HIV patients - what should be reaction to PPD
Less than 5 mm
Close contact of person with active TB - what should be PPD
Less than 5 mm
Patient has chest x ray suggestive of previous inactive TB - what should be PPD
Less than 5 mm
HIV negative IV drug user - what should be PPD
Less than 10
Immigrant from Asia - what should be PPD
Less than 10
Resident of nursing home/correction facility - what should be PPD
Less than 10
Locally identified high prevalence group - what should be PPD
Less than 10
Immunosuppressive disease (not HIV) - what should be PPD
Less than 10
If person on TB drug is non compliant - what do you need to do?
DOT - direct observation therapy
What do you need to have before removing patient with TB from isolation room
3 negative AFB sputum smears prior to removal
Which bacteria are part of MAC complex
M. avium

M. paratuberculosis

M intracellulare

M leprae
TB that causes osteomyelitis is called_
Potts disease
Positive HIV patient has productive cough, fever, weight loss, GI symptoms, night sweats but no pneumonia. He has disseminated infection with fever and wasting. PE shows enlargement of liver, spleen, intrabdominal and mediastinal lymph nodes. He has history of chronic diarrhea and abdominal pain

Diagnosis?
MAC complex infection
What is MAC treatment
Clarithromycin

Ethambutol

Rifabutin
This organism is second to MAC, has highest incidence in midwest and southwest, common in miners, welders and sandblasters, looks like TB
Mycobacterium kansasii
Gram positive rod with true branching, STRICT AEROBE, weakly acid fast, opportunistic pathogen
Nocardia
Who is at risk for nocardia
Lymphoma

Leukemia

Solid tumors

Organ tumors

Organ transplants

AIDS

Children with CGD
Patient presents with confluent necrotizing bronchopneumonia, CAVITIES ARE PRODUCED. He complains of cough, dyspnea and fever

Organism?
Nocardia
Current or recent pneumonia with cavities on x ray - what should you think first
Nocardia
Organism was grown on charcoal buffered yeast extract, gram stain shows gram positive rod with branching

Organism?
Nocardia
Looks like star on blood agar
N asteroides
How do you treat Nocardia infections
Sulfonamides
This organism is aerobic actinomycete, it is similar to Nocardia and is an opportunistic pathogen

ASSOCIATED WITH SEVERELY IMMUNOCOMPROMISED PEOPLE ESPECIALLY IF EXPOSED TO HORSES
Rhodococcus
Alcohol and smoking inhibit this protective mechanism of upper respiratory tract
Mucociliary elevator
2 most common URT infections in adults
Sinus infections

Chronic sinusitis
2 most common URT infections in kids
Pharyngitis

Acute otitis media
ONLY pharyngiits that requires treatment
Strep pyogenes
This type of pharyngitis occurs in winter, early spring, in children, has abrupt onset, fever, sore throat with exudate and petechiae on palate
Streptococcal
This type of pharyngitis occurs all year long, at all ages, patient has cold like symptoms, absence of fever, mild sore throat
Viral