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43 Cards in this Set

  • Front
  • Back
Risk factors for severe pneumococcal disease?
1. Asplenia

2. Abnormal immunoglobulin
•myeloma - an accumulation of malfunctioning or "cancerous" plasma cells
•lymphoma - group of cancers that affect the lymphocytes
•HIV
10 major pathogens for CA pneumonia?
1. Strep pneumoniae
2. H. influenzae
3. Staph aureus (elderly, post influenza)
4. Mycoplasma pneu. “walking”
5. Mixed anaerobes-aspiration/abscess
6. Moraxella catarrhalis - elderly, COPD (chronic bronchitis)
7. Gram – (PEK-alcoholics)
8. Legionella (goofy/confused)
9. Chlamydia
10. viruses (kids)
What organism?

Destroys respiratory epithelium
May disrupt normal ciliary activity
May inhibit neutrophil and macrophage function
Viruses
If the airway is sterile below the larynx then why does Acute pneumonia develop?
• Defect in host defenses
• Challenge by especially virulent organisms
• Overwhelming inoculums
What G(-) bugs cause CA pneumonia?
Gram-negative
– Klebsiella pneumoniae
– Escherichia coli
– Proteus mirabilis
What disrupts mucocillary fxn and macrophage activity leading to interference of the normal host defenses against pneumonia?
Cigarette smoke
What organisms are associated with Nosocomial or health (hospital) care aquired pneumonia (HCAP)?
Gram(-) aerobes
Staph aureus
Anaerobes common

Candida common-does not cause disease
Infection?

Patient history is of very indolent course (slow progression of symptoms**)-like 2 months
Tuberculosis-usually reactivation
What bug is associated with causing CA pneumonia in the following :

– Older age group
– Underlying COPD, especially chronic Bronchitis
Moraxella catarrhalis

note: mentioned in lecture and in lecture slides
Diagnostic sputum must contain?
<10 epi cells and >25 PMNs per low power field
Possible orgs if absent on gram stain ?

*Do the gram stain-don’t be a lazy doctor and go straight for the x-ray
Mycoplasma

TB

Viruses

Legionella

PCP (pneumocystis)
Type of pneumonia?

– Mixed anaerobes
– May lead to lung abscess or empyema
– Foul smell
– Risk factors (loss of consciousness)
Aspiration Pnuemonia
Pathogen?

General risk factors:
↑ age 50+
Smoking
Malnutrition
COPD
CHF
Streptococcus pneumoniae
Symptoms of pneumonia?
Chest pain (often pleuritic)

Cough, often sputum

Shortness of breath

Difficulty and pain on breathing

note:
pleuritic chest pain:
-sudden, intense chest pain that is usually located over the area of inflammation
-pain is usually described as shooting or stabbing
-holding one's breath or exerting pressure against the chest causes pain relief
Bug?

-Kids over 5,teens, young adults (Dorms/barricks)

-Sore throat->FREQUENT INTIAL FINDING

-Bullous myringitis (blebs on tympanic membrane)

-Pleuritic pain, splinting, respiratory distress UNCOMMON

-X-ray worse than physical findings
Mycoplasma pneumoniae

Walking pneumonia
How does ALTERED CONSCIOUSNESS effect normal host defenses against pneumonia?
epiglottic closure, bugs go down respiratory tract
Classic clinical symptoms of community acquired (bad term) pneumonia?
Chronic underlying diseases common

Fever

Pleuritic chest pain
-> sudden, intense chest pain that is usually located over the area of inflammation
-> pain is usually described as shooting or stabbing
-> holding one's breath or exerting pressure against the chest causes pain relief

Productive cough (>80%)
->when some type of secretions come up during coughing
What organism causing pneumonia that is acid fast?
TB
What organism associated with CA pneumonia cause the following sx?

• High fever (> 40o C)
• Multi-lobar involvement
• Rapid progression
• GI and neurologic abnormalities
• Elevated liver enzymes, creatinine
Chlamydia
What stain is used to ID pnenumocytis?
Giensa,GMS, toluidine blue
Should blood cultures be done on pt with pneumonia? And if so, why?
Yes

– Positive 20-30%
– Proves etiology
– Provides susceptibility of organism
What organism is associated with foul smelling sputum?
Mixed anaerobes
How do viruses interfere with normal host defenses against pneumonia?
-destroy resp epithelium
-may disrupt normal ciliary activity
-may inhibit neutrophil and macrophage fxn
What organism is associated with rusty sputum?
Pneumococcus also known as Strep pneumoniae
What organism is associated with Dark red, mucoid “currant jelly” sputum?
Klebsiella
What organisms are ID by Serologic tests?
Mycoplasma

Legionella (also urine Ag)

Chlamydia

serologic test:
-test to detect serum antibodies or antibody-like substances that appear specifically in association with certain diseases
Factors that interfere with normal host defenses and HOW?

Note: imp to not just list but to understand mechanism
1. Altered consciousness
-epiglottic closure, bugs go down respiratory tract.

2. Cigarette smoke
-disrupts mucocilary function and macrophage activity

3. Viruses
-inhibit host defense

4. Alcohol
-impairs cough/reflexes

5. Iatrogenic manipulation may bypass host defenses

6. Drugs (ex: cortosteriods)
-variety may inhibit host defenses
Methods for diagnosis for pneumonia?
1. sputum
2. transtracheal aspirate-rare
3. bronchoscopy
4. lung biopsy
5. exam of pleural fluid
6. blood culture-do it*
7. serologic tests
8. radiology (chest x-ray)

*proves etiology of infecton and provides susceptibility of organism
6th most common cause of death in US?
Pneumonia
Lab findings in CA pneumonia?
Elevated WBC (stress)

Neutropenia poor prognostic sign

Sputum–rust colored (classic but uncommon)

** Gram Stain may be diagnostic**
How does ALCOHOL interfere with normal host defenses against pneumonia?
- impairs cough/reflexes
- inc risk of aspiration
- associated with G(-) colonizations
- associated with dec PMN mobilization, fxn
Prevention of pneumonia?
Pneumovax-very effective

Influenza vaccine
Host Defense mechanisms for pneumonia?
Anatomic barriers
Mechanical barriers
Humoral immunity -> IgA in nose
Cellular immunity -> phagocytosis
Disease?

Advanced age
Severity of underlying disease
Intubation
Use of respiratory equip.
Nasogastric tubes
Altered mental status
Surgery
Prior antibiotics *major**
H2 blockers
Nosocomial pneumonia

or

Health (hospital) Care Aquired Pneumonia (HCAP)
Best id for atypical pneumonia?
No bugs on Gram stain

Why?
bc the 2 organisms that are associated with atypical pneumonia, Chlamydia pneumoniae and Mycoplasma pneumoniae have no cell wall so they stain poorly with Gram stain.
How does age play a role in increase risk of pneumonia?
- Diminished mucociliary clearance
– Abnormal elastic recoil
– Alteration of humoral and cell mediated immunity
Virus pathogens causing pneumonia?
Most common in kids-some adults

Sets stage for bacterial superinfection

RSV
Parainfluenza type 3
Adenovirus
Influenza

CMV in immunocomp.

Varicella-zoster
Type of Pneumonia?

Loss of consciousness
Mixed anaerobes
Periodontal disease
May lead to lung abscess
*don’t use Metronidazole
Aspiration pneumonia
Begins as mild respiratory tract, followed by dyspnea and cough without sputum?
Atypical pneumonia
What is often a misleading diagnosis?
A sputum culture
General Physical exam findings for pneumonia?
Fever

Cough with sputum

HSV labialis (cold sore) (pneumococcal pneumonia)

Bullous myringitis (mycoplasma) -> blebs on tympanic membrane

Poor dentition
What population?

Diminished mucociliary clearance, abnormal elastic recoil

Alteration in humoral and cell-mediated immune function
Older adults (age related defects)
What virus is associated with pneumonia in immunocompromised pt?
CMV