Hersh CIS Pneumo Flashcards
no cell wall
causes microcytic anemia
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mycoplasma pneumonia
Hyponatremia
- Legionella
Positive urinary antigens
– S. pneumo and Legionella
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mycoplasma pneumonia
similar in presentation to Mycoplasma but with a hoarse voice!!!
Chlamydia pneumoniae – similar in presentation to Mycoplasma, hoarse voice!!!
Fevers, chills, cough (may be dry), dyspnea (typically with exertion)
CAP atypical pneumonia (legionelle, chlymedia, mycoplasma pneumonia)
Follows URI like sx
CAP atypical penumonia
Follows URI like sx: rhinitis, laryngitis, pharyngitis, sinusitis
EMPIRIC ABX FOR CAP: ambulatory
macrolide (azithromycin, clarithromycin, erythromycin)
- EMPIRIC ABX FOR CAP in pt w/ncreased risk for drug resistance due to
- having Abx in the past 90 days
- immunosuppression
- exposure to kids
FLUOROQUINOLONE OR MACROLIDE + beta-lactam
EMPIRIC ABX FOR CAP: hospitalized patients
Hospitalized Patients – FLUROQUINOLONE
EMPIRIC ABX FOR CAP: ICU pts
- ICU
- Combo of
- FLUROLOQUINOLONE
-
antipneumococcal beta lactam
- 3rd gen cephalosporin or ampicillin sulbactam
- Add piperacillin-tazobactam, cefipime, or a “penem” for Pseudomonal coverabe
- Combo of
EMPIRIC ABX FOR CAP: ICU pts needing pseudomonal coverage
- ICU:
- FLUROLOQUINOLONE + antipneumococcal beta lactam (3rd gen cephalosporin or ampicillin sulbactam)
- Add piperacillin-tazobactam, cefipime, or a “penem” for Pseudomonal coverabe
How do you know what to do with a pt presenting with symptoms of pneumonia?
CURB65
- Confusion = 1 pt
- Blood Urea nitrogen > 20 mg/l = 1 pt
- Respiration >/= 30 breaths/min
- Blood pressure = 1 pt
- systolic < 90 mmHg
- diastolic = 60 mmHg
- Age >/= 65 = 1 pt
Score
0-1 = low risk, outpatient
2 = moderate severity: short impatient hospitalization or closely supervised outpatient tx
3-5 = severe pneumonia: hospitalization required, consider ICU admission
gram negative bacillus (pleomorphic), aerobic, flagellate: what will i grow on?
legionelle
Legionella pneumophilia – gram negative bacillus (pleomorphic), aerobic, flagellate, water lover, urinary antigen
buffered charcoal yeast extract agar
gram negative bacillus, encapsulated, pyocyanin and pyoverdine, smells like grapes, water lover, colonizer in CF and bronchiectasis.
Pseudomonas aeruginosa
gram negative diplococci, encapsulated (typeable) or no capsule (non-typeable), Chocolate agar (factors V and X), smokers, immunocompromised.
Haemophilus influenzae
gram negative diplococci, encapsulated (typeable) or no capsule (non-typeable), Chocolate agar (factors V and X), smokers, immunocompromised.
gram negative DIPLOCOCCUS
fastidious, aerobic. Big time for smokers, COPD, asthmatics, malignancies. Generally exacerbates predisposing conditions and then forms a PNA
Moraxella catarrhalis
– gram negative coccobacillus, fastidious, aerobic. Big time for smokers, COPD, asthmatics, malignancies. Generally exacerbates predisposing conditions and then forms a PNA
positive Thompson test, difficulty walking, pain behind ankle
levofloxacin
MacConkey agar
What the dickens is MacConkey agar??
- Selects for G(-) bacteria, especially enteric bacteria!
Has bile salts and crystal violet in the media: these select for Gram negative bacteria only.
Also, has LACTOSE which selects for fermenters
ENCAPSULATED, gram negative, ferments lactose, grows in mucoid colonies. Bulging fissure, currant jelly sputum, immunocompromised and EtOH.
Klebsiella pneumoniae
– ENCAPSULATED, gram negative, ferments lactose, grows in mucoid colonies. Bulging fissure, currant jelly sputum, immunocompromised and EtOH.
IS gram negative, but not a lactose fermenter. Additionally, SEVERE pt presentation: fever, headache, weakness, chest pain, dyspnea, pulmonary hemorrhages (bloody sputum)
Yersinia pestis – IS gram negative, but not a lactose fermenter. Additionally, SEVERE pt presentation: fever, headache, weakness, chest pain, dyspnea, pulmonary hemorrhages (bloody sputum)
Fast Fermenters
Fast Fermenters: “Lactose? OH-KEE!!!!”
KEE: Klebsiella, E. coli, Enterobacter
Slow Fermenters:
CS
Citrobacter, Serratia
atypical, no cell wall, extracellular, bullous myringitis, cold agglutinins, scattered pulmonary infiltrates (if anything), younger pts, generally self-limiting, dry cough
Mycoplasma pneumoniae – atypical, no cell wall, obligate intracellular, bullous myringitis, cold agglutinins, scattered pulmonary infiltrates (if anything), younger pts, generally self-limiting, dry cough
gram positive diplococci, encapsulated, alpha hemolytic, optochin sensitive, urinary antigen, lobar PNA, MOST COMMON CAUSE OF CAP (and meningitis). Sick patients: fevers, chills, cough, rust colored sputum, dyspnea, and weakness.
Streptococcus pneumoniae – gram positive diplococci, encapsulated, alpha hemolytic, optochin sensitive, urinary antigen, lobar PNA, MOST COMMON CAUSE OF CAP (and meningitis). Sick patients: fevers, chills, cough, rust colored sputum, dyspnea, and weakness.
gram negative, non-lactose fermenter, buffered yeast charcoal medial, lover of water systems, hyponatremia, relative bradycardia, can affect multiple people at same time
Legionella pneumoniae – gram negative, non-lactose fermenter, buffered yeast charcoal medial, lover of water systems, hyponatremia, relative bradycardia, can affect multiple people at same time
gram positive, catalase and coagulase positive, known to follow viral pneumonia, necrotizing, pulmonary hemorrhages, salmon colored sputum.
Staphylococcus aureus
– gram positive, catalase and coagulase positive, known to follow viral pneumonia, necrotizing, pulmonary hemorrhages, salmon colored sputum.
encapsulated gram negative, lactose fermenter, mucoid colonies, currant jelly sputum….
Klebsiella pneumoniae – encapsulated gram negative, lactose fermenter, mucoid colonies, currant jelly sputum….you can fill in the rest!
vaccination against capsular polysaccharide antigens of 23 strains
Pneumovax – against capsular polysaccharide antigens of 23 strains
vaccination protective against 13 strains
Prevnar 13
Prevnar 13 – protective against 13 strains
who gets the pneumococcal vaccine? what are C/I? when is it administered?
Age ≥65, immunocompromised, asplenic patients, pts 2-64 for risk factors
Contraindications: serious allergic reaction to previous vaccination (anaphylaxis)
**Hold off on vaccination until your patient’s are better!!!
Gram (-) encapsulated organism that produces pyocyanin
Pseudomonas aeruginosa