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Pulmonary Week 2 > CAP AND HCAP > Flashcards

CAP AND HCAP Flashcards

1
Q

What are some risk factors for pneumonia?

A
  • chronic disease
  • immunologic deficiency
  • leukopenia/ immunosuppression
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2
Q

Impaired local defense mechanisms is a big reason why pneumonia can occur. What are some situations in which local defenses might become impaired?

A
  • alcohol suppressing cough reflex
  • cystic fibrosis
  • pulmonary edema
  • alcohol and tobacco inhibiting alveolar macrophages
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3
Q

What is the most common cause of pneumonia worldwide?

A

Strep pneumo (most of the time the causative organism is not ID’d though)

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4
Q

What (basically) happens in pneumonia?

A

bacteria invade lung parenchyma causing alveoli to be filled with inflammatory exudate, causing consolidation of the pulmonary tissue

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5
Q

What patients have the greatest risk of HAP?

A

ventilated patients

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6
Q

What is healthcare associated pneumonia?

A

Hospitalization of at least 2 days within the prior 90 days, or

has been receiving IV therapy, chemo or wound care in past 30 days, or

resident of nursing home or attends hemodialysis clinic or hospital

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7
Q

What are the physical findings of pneumonia?

A
  • crackles
  • bronchial breath sounds
  • dullness to percussion
  • tactile fremitus
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8
Q

What are crackles (rales)?

A

scratchy sounds caused by accumulation of fluid/white cells/bacteria in alveolar spaces

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9
Q

Why are bronchial sounds heard?

A

dense consolidation of lung parenchyma results in transmission of large airway noises to the periphery

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10
Q

What are some complications of pneumonia?

A
  • tissue destruction and necrosis leading to abscess
  • spread into pleural cavity causing an empyema (pus in a cavity)
  • dissemination
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11
Q

What organisms cause typical pneumonia?

A
  • Strep pneumo
  • Staph aureus
  • Pseudomonas aeruginosa
  • Klebsiella
  • Haemophilus influenzae
  • Moraxells catarrhalis
  • Acentobacter baumanii
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12
Q

What organisms cause atypical pneumonia?

A
  • mycoplasma pneumoniae
  • chlamydophila pneumoniae
  • Legionella pneumophila
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13
Q

Difference between typical and atypical pneumonia

A

CXR and symptoms are different and causative organism cannot be isolated on normal media

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14
Q

Describe Strep pneumo

A
  • Gram positive, lancet shaped, encapsulated diplococcus
  • alpha hemolysis
  • catalase neg
  • Optochin sensitive
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15
Q

Strep pneumo undergoes the Quellung reaction. What is this?

A

With type specific anti-serum the capsule swells

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16
Q

What virulence factors does Strep pneumo use?

A
  • Polysaccharide capsule
  • IgA protease
  • Lipoteichoic acid
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17
Q

What does lipoteichoic acid do?

A

activates complemtn/induces cytokine production

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18
Q

What are the risk factors for S. pneumo?

A
  • Alcohol/drug
  • Pulmonary congestion/CHF
  • Splenectomy
  • SCD (auto-splenectomy)- S. pneumo has a capsule
  • HIV (most common infection in HIV)
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19
Q

How does Strep pneumoniae present?

A

SUDDENT onset of fever, shaking chills, RUSTY sputum, SOB, pleuritic pain

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20
Q

How is Strep pneumo diagnosed?

A

gram stain and culture sputum (blood cultures will be positive in 15-25% of people), or

rapid urinary antigen test

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21
Q

What will CXR show in Strep pneumo?

A

lobar consolidation

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22
Q

Treatment of Strep pneumo?

A
  • Penicillin if susceptible
  • Vanco empirically if severe

-Ceftriaxone, Fluoro, Amoxicillin, Azithro are options

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23
Q

What are the vaccine options for S. pneumo?

A

Polyvalent (23-type) polysaccharide vaccine (PPSV23 or Pneumovax) provides 5 yr protection

Prevnar (PCV13)

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24
Q

Pneumovax is recommended for what patients?

A

all persons 65+ you and those 19-64 at increased risk

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25
Q

Prevnar is recommended for what patients?

A

children and infants and HIV patients

26
Q

What else can Strep pneumo cause?

A
  • Meningitis
  • Otitis media
  • Sinusitis
27
Q

Describe staph aureus

A

gram + cocci in clusters

  • coagulase and catalase +
  • commensal
28
Q

T or F. Antibiotic resistance to staph aureus is common

A

T. Susceptibilities must be known before treating

29
Q

What are the complications of Staph aureus?

A
  • necrotizing PNA

- lung abscess

30
Q

Staph aureus typically cause a bronchopneumonia. What does this mean?

A

more diffuse findings on CXR causes by a cute inflammatory infiltrates from bronchioles into adjacent alveoli usually patchy and involving more than 1 lobe

31
Q

Describe Pseudomonas aeruginosa

A

Aerobic gram neg bacilli that is oxidase positive and does NOT ferment lactose

32
Q

Why does Pseudomonas aeruginosa appear blue-green?

A

procyanin production

33
Q

Pseudomonas aeruginosa gives a characteristic smell on BAP. What is it?

A

grape-like

34
Q

Pseudomonas aeruginosa is a very common cause of pneumonia in what patients?

A

Cystic fibrosis

35
Q

Virulence factors of Pseudomonas aeruginosa

A
  • endotoxin (fever and shock)
  • Exotoxin A
  • elastase, leucocidin, hemolysins, proteases
36
Q

What does exotoxin A do?

A

blocks protein synthesis by inactivating elongation factor EF-2 by ADP ribosylation.

37
Q

T or F. Pseudomonas aeruginosa is a highly resistant organism

A

T. Must get antibiotic susceptibilities and know the antibiogram of the institution

38
Q

Treatment of Pseudomonas aeruginosa

A
  • Cefepime
  • Meropenem or Imipenem
  • Cipro

Ceftriaxone will NOT treat pseudomonas

39
Q

What other diseases does Pseudomonas aeruginosa cause?

A
  • wound infections in burn victims
  • sepsis in hospitalized patients
  • external otitis in diabetics
  • UTI
  • Hot tub folliculitis
40
Q

Describe Klebsiella pneumoniae

A

encapsulated, commensal gram - bacillus that DOES ferment lactose and is indole NEGATIVE

41
Q

T or F. Klebsiella pneumoniae can grow at 10C

A

F.

42
Q

Klebsiella pneumoniae is an important cause of pneumonia in which patients?

A

alcoholics and malnourished

43
Q

What is Klebsiella pneumoniae characterized on sputum culture

A

red ‘currant jelly’ sputum (produced very mucoid colonies by its capsule)

44
Q

What are the compliations of Klebsiella pneumoniae?

A

abscess and necrotizing pneumonia

45
Q

T or F. Klebsiella pneumoniae resistance is common

A

T.

46
Q

Describe Haemophilus influenzae

A

gram- neg non-motile, pleomorphic rods

47
Q

Is Haemophilus influenzae aerobic or anaerobic?

A

facultative anaerobic

48
Q

Culture of Haemophilus influenzae on chocolate agar requires what for growth?

A

factors V (NAD+) and X (hematin)

49
Q

Some serotypes of Haemophilus influenzae are encapsulated and others are not. What serotype is the most invasive?

A

capsular type B (vaccines incorporate the capsular polysaccharide b)

50
Q

What other diseases can Haemophilus influenzae cause?

A
  • otitis media
  • epiglottitis
  • meningitis
  • exacerbations of COPD
51
Q

How is Haemophilus influenzae treated?

A

Amoxicillin for mild infection and ceftriaxone for more severe

52
Q

Describe Moraxella catarrhalis

A

gram negative coccobacillary rods that commonly causes pneumonia in the ELDERLY

53
Q

Moraxella catarrhalis is the 2nd most common bacterial cause of what?

A

acute exacerbations of COPD

54
Q

Moraxella catarrhalis also causes what diseases?

A
  • otitis media (common cause)

- sinusitis

55
Q

Describe Acinetobacter baumanii

A

opportunistic (so not really a CAP cause) gram-neg coccabacillary rods found in water and soil

56
Q

When is Acinetobacter baumanii pneumonia common?

A

Hospital settings, especially associated with respiratory equipment

57
Q

What diseases does Acinetobacter baumanii cause?

A

-VAP/HAP, sepsis, line infections, UTIs

58
Q

T or F. Resistance is high in Acinetobacter baumanii

A

T.

59
Q

What are two common secondary bacterial infections following a H. flu infection?

A

Strep pneumo and staph aureus

60
Q

What kinds of bacteria produce endotoxins?

A

gram negatives

Pulmonary Week 2 (25 decks)

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