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CPR > Bacterial Pneumonias > Flashcards

Bacterial Pneumonias Flashcards

1
Q

CAP- 3 main causes

A

S. Pneumo, H. Influenzae, M. Catarrhalis

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2
Q

15% CAP caused by what 3 bacteria

A

Legionella, Mycobacteria Pneumoniae, Chlamydophila Pneumoniae

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3
Q

Less common cause of CAP (2 bacteria)

A

Klebsiella pneumoniae, Staph. aureus

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4
Q

Most common causes of HCAP

A

More likely multidrug resistant gram neg

Pseudomonas, E coli, Klebsiella or MRSA

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5
Q

Most common causes of HAP

A

Pseudomonas, E Coli, Klebsiella, Serratia marcescens

Less commonly: Legionella, viruses

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6
Q

Most common causes of VAP

A

Bacteria that colonize the skin (Staph Aureus, GAS, H. Influenza)
Enteric gram negative (E coli, Klebsiella)
Environmental (Pseudomonas)

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7
Q

Typical Pneumonia

A

Acute, shaking chills, productive cough, consolidation on CXR, no extra pulmonary symptoms

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8
Q

Atypical Pneumonia

A

Slow onset, non productive cough, extra pulmonary symtopms

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9
Q

Pathogens of Typical Pnemonia

A

S. Pneumo, H. Influenzae, M. Catarrhalis

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10
Q

Pathogens of Atypical Pneumonia

A

Legionella, Mycobacteria Pneumoniae, Chlamydophila Pneumoniae

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11
Q

Most common pathogen for Cystic Fibrosis

A

Pseudomonas and Berkholdaria

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12
Q

Most common pathogen for alcoholics

A

Klebsiella

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13
Q

Most common pathogen for COPD

A

Klebsiella

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14
Q

Most common pathogen for AIDS

A

Pneumocystis

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15
Q

Most common pathogen for Corticosteroid Therapy

A

Nocardia

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16
Q

Pathogens for AIDS, diabetes, transplant patients

A

Opportunistic Fungi

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17
Q

Empiric Therapy for CAP-outpatient

A

No previous antibiotics: Macrolide or Doxycyclin
Recent Antibiotic Treatment:
Respiratory Fluoroquinolone (Levofloxacin) or advances macrolide plus high dose amoxicillin +/- clavulanate

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18
Q

Empiric Therapy for CAP- In patient

A
  • Advanced Macrolide (Azithromycin, Clarithromycin) plus Beta Lactam
  • Respiratory Fluoroquinolone
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19
Q

What bacteria has lipotechoic and teichoic acid in their cell wall and what does it do?

A

Strep Pneumo

Induces Inflammation

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20
Q

Strep P. has hyaluronidase as a virulence factor. What does it do?

A

Breaks down CT

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21
Q

What will the gram stain of Strep P. look like?

A

Few epithelial cells, many neutrophils, purple diplococci

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22
Q

DOC for susceptible Strep P.

A

Penicillin group (penicllin, ampicillin, amoxicillin)

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23
Q

DOC for high level drug resistant Strep P.

A

Respiratory fluoroquinolone

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24
Q

Classify H. influenza

A

gram neg, pleomorphic rod

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25
Q

Classify M. catarrhalis

A

Gram neg, diplococci

non hemolytic on blood agar

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26
Q

DOC for H. influenza with beta lactamase

A

Amoxicillin-clavulanate, 2nd or 3rd gen cephalosporins, macrolides, resp. fluoro.

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27
Q

Classify Staph Aureus

A

Gram pos cocci, beta hemolytic, catalase and coag postive

28
Q

What kind of antibiotic is oxacillin? If S. Aureus is resistant what does that mean?

A 
Penicillinase resistant (antistaphylcoccal penicillin)
Tells you it's MRSA
29
Q

What is responsible for pathology of necrotizing pneumonia?

A

Panton-Valentine Leukocidin

30
Q

What organism grows on BYCE agar?

A

Legionella

31
Q

Where does Legionella like to live?

A

Inside amoebaes in water

Facilitative Intracellular Pathogen

32
Q

What other systems does Legionella affect?

A

GI, liver, kidney, CNS

33
Q

What two tests are best for Legionella?

A

BYCE agar and Urine antigen test (DFA requires a lot of organisms to be present)

34
Q

DOC for legionella

A

Azithromycin or Levofloxacin

35
Q

Classify Mycoplasma P.

A

No cell wall, cell membrane contains only sterols
They do not gram stain, not susceptible to b-lactam antibiotics and vancomycin
most common older children and young adults

36
Q

CXR of Mycoplasma

A

Diffuse unilateral and bilateral infiltrates involving lower lung, rarely shows consolidation

37
Q

Manifestations of M. pneumoniae

A

Slow onset beginning with URT symptoms (lasts for fairly long time and don’t go to doctor right away)

38
Q

Pathogenesis of M. pneumoniae

A

P1 adhesion protein mediates attachment to cilia on epithelial cells, cilia stop moving and die

39
Q

Diagnosis of M. pneumoniae

A

Hard, negative sputum grain stain and difficult to culture
Many pts develop cold agglutinins (Coumbs +)
Serology is the best

40
Q

Treatment of M. Pneominae

A

No resistance to macrolides or resp. fluoroquinolones so empiric therapy is enough

41
Q

Classify Chlamydophila

A

Obligate intracellular pathogens

  • elementary bodies (metabolically inactive, infectious form)
  • reticulate (metabolically active, non infectious form)
42
Q

Clinical Manifestations of C. pneumoniae

A

inhalation of elementary bodies, incubation =3-4weeks, persistent non productive cough and malaise, no fever

43
Q

Diagnosis of C. pneumoniae

A

Diagnosis is difficult, hard to culture, identified by immunoassay or immunofluorescence
Serology is not that great: antibodies are slow to develop
PCR not widely available

44
Q

Treatment of C. Pneumoniae

A

Doxycycline is DOC except for children and women

Macrolide is alternative choice

45
Q

Empiric Therapy for HAP

A

Antipseudomonal cephalosporin (3rd or 4th) OR carbapenem OR extended spectrum penicillin + beta lactamase inhibitor
PLUS fluoroquinolone or aminoglycoside
If MRSA is suspected: add vancomycin or linezolid

46
Q

Classify Pseudomonas Aeruginosa

A

aerobic, catalase postive, Gram neg rod
cause infections in risk patients
ubiquitous organism
found in soil and water

47
Q

Virulence Factors for Pseudomonas

A

Pili for attachment, Pyocyanin impairs cilia, capsule, exotoxins A and S

48
Q

Diagnosis of Pseudomonas

A

biopsied lung tissue is the best sample, most common is bronchoscopic or BAL, grows on blood agar or MacConkey agar

49
Q

Treatment of Pseudomonas

A

Susceptibility testing essential

Antipseudomonal penicillins with an aminoglycoside (e.g. ticarcillin,-clavulanate)

50
Q

Classify Klebsiella

A

Gram neg rods, catalse positive, oxidase negative

colonizes mucosal surfaces

51
Q

Klebsiella Pneumoniae

A

inflammation, necrosis, cavitation and hemorrhage in the lung
produces thick bloody mucoid sputum

52
Q

Diagnosis of Klebsiella

A

growth on MacConkey Agar and blood agar- slimey appearance

53
Q

Treatment of Klebsiella

A

Non- extended spectrum b-lactamase strains - 3rd gen chephalosporins with or without aminoglycosides
EBSL strains and carbapenem resistant strains base on susceptibility data

54
Q

Classify Tuberculosis

A

Acid fast, aerobic rods
cell wall contains mycolic acid
does not gram stain

55
Q

Pathogenesis of Mycobacetrium Tuberculosis

A

infection by inhalation

Bacteria gain access to lungs, replicate within alveolar macrophages - replication is slow

56
Q

Latent Mycobacterium Tuberculosis

A

immune competent will produce this infection, bacteria contained by granuloma formation
90% of initial infections are latent
over time, granulomas may be calcified
bacteria inside granulomas can not replicate

57
Q

Active TB

A

Can result upon initial infection =primary (Miliary) OR following reactivation of latent= secondary (immune suppression allows break down of granulomas= pulmonary TB)

58
Q

Manifestations of Reactivated TB

A

fever, night sweats, weight loss, anorexia, malaise, weakness

  • cough productive with blood tinged sputum
  • apical most often affected
  • may see cavitary lesions
59
Q

Miliary TB

A

Seen w/ TB patients co infected with HIV

Infected macrophages can take organism hematogenously throughout the body

60
Q

Diagnosis of TB

A

TB skin test and gamma IFN-release assay (more consistent)
Acid fast stain of sputum
Culture is gold standard and must be done to assess antibitoic sensitivity - can take 2-6 wks
CXR- cavitations

61
Q

What is the measurement of induration for positive TB test for normal person w/o risk factors

A

15 mm

62
Q

Measurement for positive TB test for recent travel from high prevalence country

A

10 mm

63
Q

Measurement for positive TB test for immunosuppressed patients (HIV, cancer, etc)

A

5 mm

64
Q

Treatment of Active TB

A 
Intensive phase (2 months): Isoniazid, Rifampin, Ethambutol, Pyrazinamide 
Continuation phase (4-7 months): isoniazid plus rifamycin
65
Q

What are multi-drug resistant TB resistant to?

A

INH and Rif

66
Q

What drugs are extensively drug resistant TB resistant to?

A

INH, Rif, any fluoroquinolone, at least one of three injectable second line drugs

67
Q

Treatment of Latent TB

A

Isoniazid (6-9 months)

CPR (2 decks)

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