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Pulmonology > Bacterial Pneumonia- Cross > Flashcards

Bacterial Pneumonia- Cross Flashcards

1
Q

Most common cause of pneumonia?

A

Streptococcus Pneumoniae

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2
Q

Which bugs can cause Community-acquired pneumonia??

A

Any of them

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3
Q

Criteria for Hospital-acquired pneumonia?

A

Symptoms appear 48+ hours post-admission; bug cannot be incubating at time of admission

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4
Q

Risk factors for Hospital-acquired pneumonia (there are 5)? Which is highest risk?

A

1) Mechanical ventilation (highest risk)
2) severe underlying illness
3) immunosuppression
4) prolonged abx therapy
5) IV catheters

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5
Q

Criteria for Healthcare associated pneumonia?

A

1) Hospitalization of at least 2 days, within the prior 90 days, 2) receiving IV therapy, chemo, or wound care for last 30 days 3) Nursing home or long term care facility resident 4) attend hemodialysis clinic

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6
Q

Physical exam findings in pneumonia?

A

Crackles (rales), bronchial breath sounds, dullness to percussion, Increased tactile fremitus

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7
Q

What is an empyema?

A

Spread of infection into the pleural cavity (purulent collection)

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8
Q

2 general criteria of atypical pneumonia?

A

bug cannot be isolated on normal media;

CXR is atypical (diffuse, unilat/bilat infiltrates), presenting symptoms are atypical

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9
Q

Strep pneumoniae gram stain? shape? capsule?

A

G+, lancelet shaped, encapsulated diplococcus

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10
Q

Strep pneumoniae hemolysis?

A

Alpha (incomplete)–> green on blood agar

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11
Q

Strep pneumoniae Quelleng reaction?

A

+, cells swell due to presence of polysaccharide capsule

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12
Q

Strep pneumoniae virulence factors?

A

Polysaccharide capsule (most important), IgA protease (enhances colonization of URT), Lipoteichoic Acid

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13
Q

Strep pneumoniae risk factors (5)?

A

1) EtOH intoxication
2) abnormality of the respiratory tract (obstruction, viral infection)
3) splenectomy
4) sickle cell
5) HIV/immunocompromise

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14
Q

Optochin sensitive bug? Distinguishes it from which other bug?

A

Strep pneumo, used to distinguish from other alpha-hemolytic bugs (strep viridans)

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15
Q

Strep Pneumo catalase test? Distinguishes it from what other bug?

A

Catalase -, distinguishes from staph species (catalase +)

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16
Q

Sputum seen with Strep Pneumoniae infection?

A

Productive cough with RUSTY sputum (pathognomonic)

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17
Q

Strep Pneumonia CXR?

A

Lobar consolidation

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18
Q

Clinical manifestations of Strep Pneumo?

A

Rapid onset of fever, shaking chills, cough productive of rusty sputum (BIGGY), SOB, pleuritic pain

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19
Q

Diagnostic tests for Strep pneumoniae?

A

Gram stain and sputum culture; Rapid urinary antigen test (specific)

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20
Q

Tx guidelines for Strep pneumoniae?

A

1) PCN is drug of choice if susceptible 2) Vancomycin for severe infection until susceptibilities known 3) Floroquinolones and Azithromycin options with less severe disease

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21
Q

Who should get the pneumovax vacccine?

A

all persons >65 years of age and those 19-64 that are at increased risk

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22
Q

What is the Strep pneumoniae vaccine for children/infants?

A

Prevnar

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23
Q

Strep pneumoniae vaccine guidelines for high risk adults?

A

They get both pneumovax and prevnar sequentially

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24
Q

Staph Aureus gram stain/test characteristics?

A

G+ cocci in clusters; coagulase+ and catalase+

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25
Q

2 bugs that most commonly cause post-influenza pneumonia?

A

Strep pneumoniae and staph aureus

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26
Q

Complications of Staph aureus pneumonia?

A

Necrotizing pneumonia and lung abscess

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27
Q

CXR findings of Staph aureus pneumonia?

A

Typically a bronchopneumonia (more diffuse findings on CXR)

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28
Q

Tx guidelines for Staph aureus?

A

Must get susceptibilities; resistance is common

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29
Q

Pseudomonas aeruginosa gram stain/test characteristics?

A

Aerobic gram(-) bacilli, does not ferment lactose; oxidase (+); Blue-green pigment (Pyocyanin production); Grape-like odor

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30
Q

Patients that Pseudomonas aeruginosa is common in?

A

Very common in HAP; most common cause of pneumonia in cystic fibrosis patients

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31
Q

Pseudomonas aeruginosa virulence factors?

A

Endotoxin (elicits shock), Exotoxin A (blocks protein synthesis by inhibiting EF-2 elongation factor). Other hemolysins/proteases

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32
Q

Tx guidelines for Pseudomonas aeruginosa?

A

Must know antibiogram (highly resistant);

1) Cefepime (4th generation cephalosporin)
2) Meropenem or Imipenenem (carbapenem)
3) Ciprofloxacin (flouroquinolone)
4) Piperacillin/Tazobactam (extended spectrum PCN)
5) Gentamicin (Aminoglycoside)

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33
Q

Klebsiella pneumoniae gram stain/test characteristics?

A

Gram(-) bacillus; ferments lactose; indole negative

34
Q

Klebsiella virulence factor?

A

Capsule

35
Q

Patients you see Klebsiella in the most?

A

Alcoholics, malnourished, and those on ventilators/hospitalized

36
Q

Sputum seen with Klebsiella?

A

Red “currant jelly” sputum (pathognomonic)

37
Q

Complications seen in Klebsiella pneumoniae?

A

Necrotizing pneumonia and lung abscess

38
Q

Tx guidelines for Klebsiella pneumoniae?

A

Check susceptibility, resistance is high

39
Q

Haemophilus influenzae gram stain/test characteristics?

A

small gram(-) coccobacilliary rod; pleomorphic; facultative anaerobe; nonmotile

40
Q

How do you culture Haemophilus influenzae?

A

chocholate agar with factors V (NAD+) and X (hematin)

41
Q

Haemophilus influenzae virulence factor?

A

Capsule

42
Q

Tx guidelines for Haemophilus influenzae?

A

Amoxicillin for mild infection, Ceftriaxone (3rd generation) for serious infection

43
Q

2 bugs that most commonly cause bacterial COPD exacerbation? Which causes it the most?

A

Haemophilus influenzae (most common) and Moraxella catarrhalis

44
Q

Acinetobacter baumanii gram stain?

A

Gram(-) coccabacillary rods

45
Q

Which bug is almost only seen causing HAP?

A

Acinetobactor baumanii

46
Q

Tx guidelines for Acinetobacter baumanii?

A

Need susceptibility, highly resistant to many abx

47
Q

Bug you suspect if the CXR looks much worse than the patient?

A

Mycoplasma pneumoniae

48
Q

What does Mycoplasma pneumoniae most commonly cause?

A

atypical “walking pneumonia” (most common cause of atypical pneumonia)

49
Q

Mycoplasma pneumoniae gram stain?

A

Can’t gram stain, has no cell wall

50
Q

Pathogenesis of Mycoplasma pneumoniae?

A

Adhesins bind to ciliated epithelial cells and reduce mucocilliary clearance

51
Q

Types of people that most commonly get Mycoplasma pneumoniae?

A

school-aged children and prison inmates/military personnel

52
Q

Clinical manifestation of Mycoplasma pneumoniae?

A

Insidious onset of dry cough, sore throat, myalgias, low-grade fever

53
Q

Diagnosis of Mycoplasma pneumoniae?

A

1) PCR on sputum 2) Cold agglutination 3) Will grown on Eaton agar 4) Serology (not great)

54
Q

Tx guidelines for Mycoplasma pneumoniae?

A

Macrolide (azithromycin), doxycycline, or flouroquinolones (levofloxacin)

55
Q

Extrapulmonary manifestations of Mycoplasma pneumoniae?

A

CNS involvement (encephalitis), Cardiac involvement (rhythm disturbance, CHF, myocarditis)

56
Q

Chlamydia pneumoniae characteristics?

A

Obligate intracellular organism (can’t gram stain)

57
Q

2 bugs that most commonly cause atypical pneumonia? Which is most common?

A

Mycoplasma pneumoniae (most common) and Chlamydia pneumoniae

58
Q

Most common cause of atypical pneumonia in adults?

A

Chlamydia pneumoniae

59
Q

Tx for Chlamydia pneumoniae?

A

Doxycycline

60
Q

Legionella pneumophila gram stain

A

Gram(-) rod, faculatative intracellular anaerobe

61
Q

Pathogenesis of Legionella pneumophila?

A

Avoids phagolysosome fusion and replicates within alveolar macrophages–> decreased clearance

62
Q

Legionella pneumophila virulence factor?

A

Endotoxin

63
Q

Legionella pneumophila transmission?

A

Aerosol (air-conditioning ducts, outbreaks at conventions or military barracks)

64
Q

Clinical presentation of Legionella pneumophila?

A

Legionnaire’s disease: Severe pneumonia with unique symptoms (dry cough, fever, diarrhea, confusion) Pontiac fever: mild flu-like syndrome

65
Q

CXR of Legionella pneumophila?

A

Very variable (consolidation, diffuse interstitial infiltrates, pleural effusions)

66
Q

Growth of Legionella pneumophila on culture plates?

A

gram stain will only show macrophages/neutrophils; must use silver stain. Grows on charcoal yeast extract, culture with iron and cysteine

67
Q

What will labs show in someone with Legionella pneumophila?

A

Hyponatremia

68
Q

Diagnosis of Legionella pneumophila?

A

Urine antigen

69
Q

Treatment of Legionella pneumophila?

A

Macrolide (azithromycin) or Flouroquinolone (levofloxacin)

70
Q

Who most commonly gets aspirational pneumonia?

A

Alcoholics

71
Q

What are the three bacteria that have capsules and would give a + Quellung reaction?

A

Strep pneumo, Klebsiella pneumo, Haemophilus influenzae

72
Q

Which bacteria would stain Gram positive?

A

Strep pneumo Staph auereus

73
Q

Which bacteria would stain Gram negative?

A

Pseudomonas aeruginosa

Klebsiella pneumoniae

Haemophilus influenzae

Acinetobacter baumanii

Moraxella catarrhalis

74
Q

Which bacteria can’t be stained with Gram stain?

A

Mycoplasma pneumoniae (lacks cell wall) Chlamydia pneumoniae (intracellular) Legionella pneumophila (intracellular)

75
Q

Which bacteria cause necrotizing pneumonia with lung abscess?

A

Staph aureus (Gram +) Klebsiella pneumo (Gram -)

76
Q

Which bacteria can be diagnosed with urinary antigen?

A

Strep pneumo (Gram +) Legionella pneumophila (Gram -)

77
Q

Pseudomonas aeurginosa can cause 5 other diseases besides pneumonia. List them.

A

Wound infections in burn victims

Sepsis in hospitalized patients

External otitis (esp in diabetics)

UTI

Hot tub folliculitis

78
Q

Klebsiella normally found where in body?

A

intestinal flora

79
Q

Haemophilus influenzae has how many serotypes? All encapsulated or nonecapsulated?

A

6 serotypes, both encapsulated and nonencapsulated

80
Q

Most invasive capsular type of Haemophilus influenzae?

A

Capsular type B

81
Q

Besides pneumonia, what other diseases are associated with Haemophilus influenzae?

A

otitis media, epiglottitis, and meningitis. Also common bacteral cause of acute exacerbations of COPD

Pulmonology (31 decks)

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