Clinical Aspects of Pneumonia

Question 1

What is the #1 cause of death in the United States from infectious disease?

Answer 1

Pneumonia

Question 2

What is pneumonia?

Answer 2

Infection of the lower respiratory tract

Question 3

What is the difference between “typical” and “atypical” pneumonia?

Answer 3

“Typical” – Sudden onset of fever, cough, productive purulent sputum, pleuritic chest pain

“Atypical” – Gradual onset, dry cough, prominence of extrapulmonary symptoms: headache, myalgia, fatigue, sore throat, nausea, vomiting

Question 4

What is the difference between Group I and Group II outpatients?

Answer 4

Group I
Has neither cardiopulmonary disease nor modifying factors

Group II
Has cardiopulmonary disease and/or other modifying factors

Question 5

what are group I patients?

Answer 5

Has neither cardiopulmonary disease nor modifying factors

Question 6

what are group II patients?

Answer 6

Has cardiopulmonary disease and/or other modifying factors

Question 7

What are the “Top 4 Contenders” for Group I and II outpatients?

Answer 7

Group I
o	Streptococcus pneumonia
▪	Causes up to 50% of community-acquired pneumonia
▪	If bacteremic, mortality is 30%
o	Mycoplasma pneumonia
o	Chlamydia pneumonia
o	Hemophilus pneuonia

Group II
o	Streptococcus pneumonia
o	Mycoplasma pneumonia
o	Chlamydia pneumonia
o	Mixed infection

Question 8

what are the top four contenders for group I?

Answer 8

o	Streptococcus pneumonia
▪	Causes up to 50% of community-acquired pneumonia
▪	If bacteremic, mortality is 30%
o	Mycoplasma pneumonia
o	Chlamydia pneumonia
o	Hemophilus pneuonia

Question 9

what are the top four contenders for group II?

Answer 9

o Streptococcus pneumonia
o Mycoplasma pneumonia
o Chlamydia pneumonia
o Mixed infection

Question 10

what factors increase the risk of pneumonic infection?

Answer 10

Penicillin-resistant pneumococci
Enteric gram negatives
Pseudomonas aeroginosa

Question 11

how is Penicillin-resistant pneumococci developed?

Answer 11

• Age >65
• B-lactam therapy within the past 3 months
• Alcoholism
• Immune suppressive illness (including tx with corticosteroids)
• Multiple medical comorbidities: DM (diabetes mellitus), CRI (chronic renal insufficiency), CHF (congestive heart failure), CAD (coronary artery disease), malignancy, chronic liver disease
• Exposure to a child in a day care center

Question 12

how is Enteric gram negative developed?

Answer 12

• Residence in a nursing home
• Underlying cardiopulmonary disease
• Multiple medical comorbidities
• Recent antibiotic therapy

Question 13

how is Pseudomonas aeroginosa developed?

Answer 13

• Structural lung disease (bronchiectasis)
• Corticosteroid therapy (>10mg prednisone/day)
• Broad spectrum antibiotic therapy for > 7 days in past month
• Malnutrition

Question 14

Drug-resistant strep pneumonia continues to increase worldwide. What are the two most common mechanisms by which resistance to macrolides occur?

Answer 14

Methylation of a ribosomal target encoded by the erm gene

Efflux of the macrolides by cell membrane protein transporter, encoded by mef gene