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43 Cards in this Set
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- Back
Strep pneumoniae
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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) |
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mycoplasma pneumoniae
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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 |
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Legionella pneumophila
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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 |
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Chlamydophila
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atypical
Obligate intracellular bacteria CAP |
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Histoplasma capsulatum
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fungus
Epi: spelunking, avian droppings path: just like TB histo: TINY yeast, granulomas |
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empiric rx for putpatient CAP
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2nd or 3rd generation cephalosporin OR b-lactam/b-lactamase inhibitor AND macrolide OR fluoroquinolone
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empiric rx for inpatient CAP
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b-lactam inh + macrolide OR fluoroquinolone
vancomycin for resistant staph |
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Aspergillus
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Epi: Organ-transplantation, iatrogenic
histo: septate hyphae (45) Path: invade blood vessels |
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PCP
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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 |
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Haemopholus Influenza
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CAP
• Small, pleomorphic gram – rod • Most virulent is type B Epi: healthcare setting COPD --> risk |
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o Psittacosis
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Epi: chilling w sick birds
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Moraxella catarrhalis
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CAP
The bug: Gram-negative diplocci elderly and people w chronic lung disease most susceptible |
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Staph aureus
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o HCAP
Pathogenesis: Proliferation within alveoli with destruction assoc w IV drug abuse |
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• CMV
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o SS
Similar to PCP, SOB, non productive cough o DX: Visualize: owl eyes, • Intracellular inclusion bodies o TX: Ganciclovir |
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klebsiella p
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CXR: fills like a ball
associated with extensive necrosis (s. aureus as well) thick capsule |
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Cryptococcus Neoformans
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Epi: worldwide
Loc: often associated with meningitis CD4<100 usually TX: amphotericin B Hist: India Ink, Foamy cells |
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Histoplasmosis
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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 |
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o Aspergillosis
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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 |
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Blastomycosis
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Midwest, southeast
Both CXR diffuse, TX: ampho B Histo: big yeast, granulomas CC: similar to TB but inital infection can --> symptoms |
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• Kaposi Sarcoma
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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 |
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PORT clinical prediction rules
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to det if ok to send home
<50 doesnt have: 1) neoplastic diseas 2) liver 3) CHF 4) Cerebrovascular disease 5) renal disease |
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Pseudomonas a
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path: severe necrotzing infl with vasculitis
assoc w CF |
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Lung abscess by which bac?
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staph aureus, klebsiella (other gram - rods, aspiration p.
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aspiration p most commonly which lobe
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RLL
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atypical p are?
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chlamydia pneumoniae, myocplasma p, viruses
enter interstitium cell-mediated: lymphocytes legionella (clinically, not pathologically) |
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Pathogenesis of TB
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TB enter macrophages, drains to LN, Th1 --> Il-12 --> prod of IFN-gamma --> macrophages stimulated --> granulomas
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coccidiomycosis
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just like TB
hitso: thick walled spherules with endospores |
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candida
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budding yeast with pseudohyphae
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• Rhinovirus
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o Early fall spring
o Highly contagious |
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• Adeno
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o In military
o DNA virus o Ped often w conjunctivitis and fevers |
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• Parainfluenza
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o Croup in young
o Acute |
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• Coronavirus
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o SARS
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• Influenza
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o Often leads to secondary bacterial pneumoniae
o Has a vaccine |
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Virus tx
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oseltamivir - influenza A and B
amantadine - hit ONLY A |
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Penicillins
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For Strep p
AE: Rash, cytopenia b-lactams - excellent anaerobe coverage |
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Macrolides
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intracellular (atypicals)
gram + limited gram - SE: GI, liver Torsades de pointes Mech: Inhibit RNA dependent protein synthesis at step of chain elongation |
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Strep capsule important in pts with...
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liver disease, no spleen
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2nd or 3rd generation Cephalosporin
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B-lactam
gram +s gram -s, Pseudomonas in-patient bc IV no atypicals therefore used w macrolide |
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Fluoroquinolones
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gram + strep, staph
Gram - other CAPs, Pseudomonas atypicals SE: TERATOGENIC NOT FOR KIDS joint cartilage, tendinitis Photosensitivity m: inhibits DNA synthesis |
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Bactrim
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PCP
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Group A Strep can -->
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Rheumatic fever
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Carbapenems
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B-lactam
broad gram +, - (CAP) pseudomonas |
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Vancomycin
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MRSA TX
POST INFLUENZA SYNDROME! SE:CN VIII Red man synd neutropenia MECH: Cell membrane |