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BBS- 2nd bimonthly > Bacterial Etiologic Agents Of CAP > Flashcards

Bacterial Etiologic Agents Of CAP Flashcards

1
Q

2 are the most common causes of CAP

A
  • Streptococcus pneumoniae

- Haemophilus influenzae

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2
Q

Requires enriched media → blood containing

A

HAEMOPHILUS INFLUENZAE

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3
Q
  • Found on the mucous membranes of the upper respiratory tract of humans
  • Become opportunistic once the immune system of the host is compromised
A

HAEMOPHILUS INFLUENZAE

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4
Q

At 6-8 hours in rich medium, H. Influenzae becomes _______

A

small, coccobacillary forms

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5
Q

Later, H. influenzae becomes ________

A

longer rods, very pleomorphic

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6
Q

virulence factor of H. Influenzae

A

Capsule

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7
Q

o flat, grayish brown colonies

o Require the X (acts as Hemin) and V (NAD: Nicotinamide-Adenine-Dinucleotide) factors in blood

A

IsoVitaleX-enriched Chocolate Agar

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8
Q

Exposed in ______ for the brown color to appear

A

80 degree celsius

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9
Q

Does IsoVitaleX-enriched Chocolate Agar causes hemolysis.

A

No

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10
Q

Require both X & V factors to grow.

A

Haemophilus influenzae

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11
Q

requires V factor only for growth.

A

Haemophilus parainfluenza

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12
Q

requires only factor X without need of factor V.

A

Haemophilus ducreyi

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13
Q

In culture of H. Influenzae, it is a flat, grayish brown colonies after 24 hours incubation

A

Chocolate agar

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14
Q

In culture of H. Influenzae, it does not grow on sheep blood agar except around colonies of Staphylococci

A

satellite phenomenon

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15
Q

What are the antigenic structure of H. Influenzae?

A
  1. Capsular polysaccharides (a-f)

2. Outer membrane proteins

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16
Q

Causes meningitis in children (prior to the introduction of vaccine (HIB vaccine)

A

H. influenzae Type B (HIB)

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17
Q

it is the main cause of meningitis in young children between the age 5 months to 5 years

A

H. influenzae Type B (HIB)

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18
Q

Sx of H. Influenzae where most common cause in infants

A

Septic arthritis

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19
Q

Causes bronchitis or pneumonia in adults

A

H. influenzae Type B (HIB)

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20
Q
  • Chronic
  • Associated with cardiopulmonary disease
  • Follows upper respiratory tract infections
A

PNEUMONIA

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21
Q

Treatment for Pneumonia

A
  • Ampicillin + Sulbactam (Beta-lactamase inhibitor)
  • 3rd generation cephalosporins
    – Cefotaxime - Given IV – for meningitis
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22
Q

How to prevent patient with Pnuemonia?

A
  • Hib conjugate vaccine (H. influenzae type B)
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23
Q

At what doses should be the vaccine given for px having Pneumonia?

A

3 doses (2,4,6 months) or - 2 doses (2 and 4 months);

Booster dose (between 12 & 15 months)

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24
Q

Mollicutes (cell wall-free bacteria)

A

MYCOPLASMA SP.

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25
Q

▪ closely related to M. pneumoniae

▪ has been associated with urethral and other urogenital infections

A

M. genitalium

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26
Q

▪ sometimes causes postpartum fever

▪ has been found with other bacteria in uterine tube infections

A

M. hominis

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27
Q

It is the cause of non-gonococcal urethritis in men and is associated with lung disease in premature infants of low birth weight

A

Ureaplasma urealyticum

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28
Q
  • Smallest organisms that can be free in nature
  • Highly pleomorphic (don’t have cell wall which makes them change shape)
  • Bounded by a three-layered cytoplasmic membrane that contains sterol
A

Mycoplasma sp.

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29
Q

inhibits the cell wall bacteria and Mycoplasma is cell-wall-less

A

Penicillin

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30
Q

Inhibitories of Mycoplasma sp.

A

tetracycline or erythromycin (macrolides)

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31
Q

Grown on cell-free media that contain lipoprotein and sterol

A

Mycoplasma sp.

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32
Q

Form minute colonies → round, with granular surface and a dark center typically buried in the agar
o “Fried egg appearance”
o Requires lipoprotein and sterol

A

Mycoplasma sp.

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33
Q

Mycoplasma requires ____ ______ ____ and ____ in the culture medium

A

serum, glucose, or urea and yeast extract

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34
Q

Most important in Mycoplasma sp.

A

MYCOPLASMA PNEUMONIAE

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35
Q

Prominent cause of community-acquired pneumonia esp. in persons ________

A

5-20 years of age

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36
Q

MOT of Mycoplasma Pneumoniae

A

person to person by means of infected respiratory secretion

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37
Q

Initiated by attachment of the tip _______ of the organism to the receptor on the surface of respiratory epithelial cells

A

P1 Adhesin

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38
Q

Adherence factor of Mycoplasma Pneumoniae

A

P1 Pili

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39
Q

Reside extracellularly in the respiratory & urogenital tracts

A

Mycoplasma pneumoniae

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40
Q

Toxic metabolic products of Mycoplasma pneumonia

A

peroxide & superoxide

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41
Q

Immunopathogenesis of Mycoplasma pneumoniae

A

activate macrophages, stimulate cytokine production

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42
Q

IP of Mycoplasma Penumoniae

A

1-3 weeks (time of exposure to the time of onset of symptoms)

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43
Q

Its symptoms are: Malaise, fever, sore throat and cough (initially nonproductive, later with blood streaked-sputum and chest pain)

A

Mycoplasma pneumoniae

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44
Q

Other organisms that can cause atypical pneumonia

A

Mycoplasma, Chlamydia, Legionella

45
Q

Resolution of pulmonary infiltrates in Mycoplasma pneumoniae

A

1-4 weeks

46
Q
  • Interstitial with peribronchial pneumonitis

- Necrotizing bronchiolitis

A

Pathogenesis of Mycoplasma pneumoniae

47
Q

Complication of Mycoplasma pneumoniae

A
  • Uncommon - Hemolytic anemia
48
Q

How to diagnose Px with Mycoplasma pneumoniae

A

Largely based on clinical diagnosis

49
Q

In Lab test of px w/ M. Pneumoniae, what is the result?

A

Slightly elevated WBC count

50
Q

What can be found in the Sputum Gram stain of Px with M. pneumoniae?

A

PMNs and monocytes, no bacterial pathogens

51
Q

What is the signifincance of using Sputum Gram stain?

A

To rule out other bacterial causes (S. pneumoniae)

52
Q

Used for for group O human erythrocytes (50% of untreated patients) in M. Pneumoniae

A

Cold hemagglutinin:

53
Q

Used to detect detect IgM and IgG antibodies in M. Pneumoniae

A

Enzyme Immunoassay (EIA)

54
Q

Treatment of M. Pneumoniae

A

Tetracycline, Macrolides, Fluoroquinolone

o Produce improvement but do not eradicate M. pneumoniae

55
Q

Obligate intracellular parasites with a tropism for the columnar epithelial cells

A

CHLAMYDIA (CHLAMYDOPHILA ) PNEUMONIAE

56
Q

o Lack the mechanism for energy production so they cannot synthesize ATP, they need the mechanism from the host cell

A

CHLAMYDIA (CHLAMYDOPHILA ) PNEUMONIAE

57
Q

Produce round, dense, intracytoplasmic inclusions that lack glycogen

A

CHLAMYDIA (CHLAMYDOPHILA ) PNEUMONIAE

58
Q

Resistant to sulphonamides

A

CHLAMYDIA (CHLAMYDOPHILA ) PNEUMONIAE

59
Q

Small, dense, pear-shaped body

The infectious form

Attaches and enters into target cells

Contains equal amounts of DNA and RNA

Stains purple with Giemsa

A

Elementary body

60
Q

Larger, osmotically fragile

Metabolically active form

Form that divides by binary fission

Contains about 4 times RNA than DNA

Stains blue with Giemsa

A

Reticulate Body

61
Q

immunodominant component of the antigen of the Chlamydia pneumoniae

A

2-ket0-3-deoxyoctanoic acid

62
Q

Needs a cell for growth because they are obligate parasites

A

HL or Hep-2 cells (McCoy cells)

63
Q

Clinically similar to M. pneumoniae but prodromal symptoms last longer up to 2 weeks

A

Atypical pneumonia

64
Q

Usually affected by the atypical pneumonia of Chlamydia

A

Teenagers and young adults

65
Q

What is found in the chest radiograph in Px with Chlamydia?

A

subsegmental infiltrate

▪ Less prominent than the infiltrate in M. pneumonia

66
Q
  • Pharyngitis
  • Sinusitis
  • Otitis media
A

Chlamydia

67
Q

inhibits metabolism of eukaryotic cells

A

HL of Hep-2 cells with cycloheximide

68
Q

Culture for chlamydia needs to be incubated at ______

A

35˚C for 3 days

69
Q

Most sensitive method for the diagnosis of C. pneumoniae infection

A

Microimmunofluorescence test

70
Q

Treatment for C. pneumoniae infection

A
  • Tetracycline - Macrolides - Fluoroquinolone
71
Q
  • Fastidious (complex growth requirements)
  • aerobic (require oxygen for growth, killed by the absence of oxygen)
  • Gram (-) pleomorphic bacteria, but stain poorly by Gram’s method
A

LEGIONELLA PNEUMOPHILA

72
Q

should be used as the counterstain by Legionella Pneumophila

A

Basic fuchsin (0.1%)

73
Q

Colonies are: colorless to iridescent pink or blue and are translucent and speckled

A

Legionella P.

74
Q

Its culture is BCYE media (buffered charcoal yeast extract) with alpha-ketoglutarate and iron

A

Legionella P.

75
Q

Culture of Legionella P.

A

pH 6.9, T = 35°C, and 90% humidity

76
Q
  • Catalase (+), Oxidase (+)
  • Hydrolyzes Hippurate
  • Produces gelatinase and beta-lactamase
A

Legionella P.

77
Q

cause of outbreak of Legionnaire’s disease

o Can also cause Pontiac fever

A

Serogroup 1

78
Q

(+) cross-reactive antigenicity among different species

A

Legionella ap.

79
Q

Produces proteases, phosphatase, lipase, DNase, RNase, metalloprotease

A

Legionella P.

80
Q

Aquatic setting of Legionella that promotes bacterial growth (stagnant water)

A

Found in warm, moist environments, lakes, streams

81
Q

Infection follows inhalation of bacterial from aerosols generated from contaminated air-conditioning systems and shower heads

A

Antigenic structure of Legionella P.

82
Q
  • Readily enters & grows within human alveolar macrophages and monocytes
  • Do not require opsonization by C3b / antibody to enter macrophage
A

Pathogenesis of Legionella P.

83
Q

virulence factor of Legionella P.

A

Mip protein

84
Q

Mostly affected by Legionella P.

A

Disease is highest in men > 55 years old

85
Q

Factors associated with high risk of Legionella P.

A

o Smoking
o Chronic bronchitis
o Emphysema

o Steroid and other immunosuppressive agents
o Cancer therapy
▪ Biologic agents as target, eg. Anti-TNF
o Diabetes mellitus

86
Q

Symptoms: High fever, chills, malaise, non-productive (prominent) cough, hypoxia, diarrhea, and delirium (due to high fever)

A

Legionnaire’s Disease

87
Q

Chest X ray findings in Px with Legionella P.

A

Reveal patchy, multilobular consolidation

88
Q
  • Milder form (flu-like manifestation)

- Fever and chills, myalgia, malaise, and headache that develop over 6-12 hours, dizziness, photophobia, confusion

A

Pontiac Fever

89
Q
  • Mild cough and sore throat
  • Self-limited
  • You may not give antibiotics
A

Pontiac Fever

90
Q

Specimens used for Lab test in Legionella P.

A

o Bronchial washings
o Pleural fluid
o Lung biopsy specimens
o Blood

91
Q

May be used early in the course (specific for serogroup 1) for the Dx of Legionella P.

A

Legionella urinary antigen test

92
Q

Treatment for Legionella P.

A
  • Tetracycline, Macrolides, Quinolones

- Prolonged therapy (may be up to 3 weeks)

93
Q
  • Small gram (-) bacilli, coccobacilli, or cocci in pairs
  • Oxidase (+)
  • Non-motile, non-fermentative
  • Produce DNase
A

MORAXELLA CATARRHALIS

94
Q

Basis for rapid fluorometric tests for identification

A

butyrate esterase

95
Q
  • Members of the normal microbiota of the upper respiratory tract
  • Often produce beta-lactamase
A

MORAXELLA CATARRHALIS

96
Q

Result of chest radiograph in Px with Moraxella Catarrhalis

A

Patchy infiltrates; occasional lobar consolidation

97
Q

Treatment for Moraxella Catarrhalis

A
  • Trimethoprim-sulfamethoxazole (Cotrimoxazole) or
  • Amoxicillin-clavulanate or
  • 2nd or 3rd generation cephalosporin
    o 1st generation – Gram (+)
    o 2nd generation – Gram (+) and (-)
    o 3rd generation – Gram (-)
98
Q
  • Member of Enterobacteriaceae
  • Gram (-) rods, non-motile
  • With capsules – produce mucoid colonies
  • Lactose fermenters
A

KLEBSIELLA PNEUMONIAE

99
Q

Only lactose fermenter that produces urease

A

KLEBSIELLA PNEUMONIAE

100
Q

CHARACTERISTIC ON CULTURE on Blood Agar

A

Slimy appearance of the colonies

101
Q

CHARACTERISTIC ON CULTURE on MacConkey Agar (Mac)

A

Red/pink colonies

102
Q

Culture characterisctic of Klebsiella P. On EMB

A

Produces large, mucoid, pink to purple colonies with no metallic green sheen

103
Q

Klebsiella P. causes Pneumonia in _______

A

o Persons on alcohol abuse

o Those with diabetes mellitus

104
Q
  • Can be nosocomial (hospital-acquired)

- “Currant jelly” sputum (reddish jelly-like)

A

Klebsiella P.

105
Q

Chest radiograph result in patients with Klebsiella P.

A

Lobar consolidation (like S. pneumoniae and H. influenzae)

106
Q

Cavitation and empyema/pus (like S. aureus [#1 cause of empyema] and L. pneumophila pneumonia)

A

Complications of Klebsiella P.

107
Q
  • Severe form of CAP caused by K. pneumoniae with a predilection for upper lobes of the lungs
  • Liable to suppurate and form abscess
  • Seen in patients with chronic debilitating illnesses or alcoholism
  • Alcoholic + currant jelly + infiltrates in upper lobe
A

Friedlander’s Pneumonia

108
Q

Treatment for Px with Klebsiella P.

A
  • 3rd or 4th generation cephalosporin

- For severe infection: add Gentamicin or Tobramycin

BBS- 2nd bimonthly (3 decks)

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