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Pulm > Micro - Atypical pneumonia (Chlamydia, Legionella, Mycoplasma) > Flashcards

Micro - Atypical pneumonia (Chlamydia, Legionella, Mycoplasma) Flashcards

1
Q

3 bugs that cause atypical pneumonia

A

Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae

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2
Q

Which bug causing atypical pneumonia has a biphasic lifecycle? Describe it.

A

Chlamydia

  1. EB is inert and enters cells, inhibiting the phagolysosome
  2. Transforms into metabolically active, obligate intracellular parasite RB
  3. RB replicates, forming mature EB daughter cells
  4. EB released from cell to infect others
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3
Q

What is unique about chlamydia?

A

Resembles gram - organisms but cell wall lacks peptidoglycan and muramic acid

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4
Q

How do we know peptidoglycan is involved in formation of chlamydia cell wall although not present in finished structure?

A
  1. Chlamydia is sensitive to ampicillin, which inhibits transpeptidase that crosslinks peptidoglycan during cell wall synthesis
  2. Chlamydia infection stimulates Nod1 and Nod2 activated pathways (Nod1 and Nod2 are PRRs that detect peptiodglycan)
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5
Q

Legionella is (G+, G-), (aerobic, anaerobic), (shape)

A

G- aerobic (remember it lives in H2O) bacilli

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6
Q

Why is Legionnaire’s becoming more recognized?

A

It is now looked for anytime a pt has a pneumonia

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7
Q

When is Legionnaire’s more common?

A

Summer and early fall

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8
Q

What is unique about Mycoplasma?

A

Smallest free living organisms and lack a cell wall

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9
Q

What does mycoplasma require from host?

A

Cholesterol

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10
Q

Which two bugs causing atypical pneumonia are IC pathogens and which is an EC pathogen?

A

IC - Chlamydia, Legionella

EC - Mycoplasma

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11
Q

Two virulence factors of mycoplasma

A
  1. Polarized adhesin molecule which allows it to stick to respiratory epithelium without entering cell
  2. Diacyl-lipoprotein stimulates inflammation via macrophage TLR2 and TLR6
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12
Q

What is unique about mycoplasma’s diacyl-lipoprotein?

A

Most bacteria have triacyl-lipoprotein

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13
Q

What causes symptoms of mycoplasma infection?

A

Host immune response (although it also clears infection; host immune response also causes sx of sepsis!)

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14
Q

Virulence factor of chlamydia

A

Type three secretions - in host cytosol, inhibit different pathways

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15
Q

Where does legionella replicate?

A

Inside alveolar macrophages

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16
Q

Virulence factor of legionella

A
  1. Able to avoid phagolysosome in phagocytic cells
  2. Injects host cells with bacterial proteins that transform its vesicular mechanisms into a specialized vacuole that resembles bacterial ER, facilitating legionella replication
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17
Q

Hallmark of chlamydial infection

A

Some have no to mild disease while some have severe disease

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18
Q

What is psittacosis?

A

RTI caused by Chlamydia psittaci acquired via dried bird feces

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19
Q

Incubation period of C. pneumoniae

A

7-21 days

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20
Q

What % of CAP is caused by C. pneumoniae?

A

6-10%

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21
Q

C. pneumoniae is associated with what other disease?

A

Coronary artery disease

C. pneumoniae binds serum lipoproteins –> immune complexes –> inflammation –> atherosclerosis

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22
Q

Ocular, respiratory tract, and genital infections caused by C. trachomatis is due to infection of:

A

Squamocolumnar cells of mucous membranes

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23
Q

What is trachoma?

A

Chronic conjunctivitis caused by C. trachomatis immunotypes A-C

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24
Q

C. trachomatis is the most common cause of:

A

Preventable blindness worldwise

STI’s in developed countries

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25
Q

C. trachomatis immunotypes D-K cause ___ infections and are associated with what disease?

A

Genital tract infx

Squamous cell carcinoma of cervix

26
Q

2 neonatal diseases caused by Chlamydia and how to prevent them

A

Neonatal pneumonia and neonatal inclusion conjunctivitis; erythromycin

27
Q

3 diseases that can be caused by chlamydia and mycoplasma

A
  1. Atypical pneumonia
  2. Nongonococcal urethritis
  3. Pelvic inflammatory disease
28
Q

Big problem with chlamydia infections?

A

Up to 50% are asymptomatic so they continue to be spread

29
Q

Disease caused by C. trachomatis immunotypes L1-L3?

A

Lymphogranuloma venerum - infection of endothelial and lymphatic cells

30
Q

2 diseases caused by Legionella

A
  1. Atypical pneumonia

2. Pontiac disease

31
Q

Who is at increased risk of Legionella infection?

A

Elderly, heavy smokers, alcoholics, chronic lung disease pts, immunocompromised, males

32
Q

Incubation period for Legionnaire’s?

A

2-10 days

33
Q

What is Pontiac fever?

A

Milder form of Legionnaire’s that presents within 2 days, does NOT result in pneumonia, has flu-like sx, and clears within 5 days

34
Q

3 diseases caused by Mycoplasma/Ureaplasma?

A
  1. Atypical pneumonia (M. pneumoniae)
  2. Nongonococcal urethritis (Ureaplasma urealyticum)
  3. Postpartum fever and PID (M. hominis)
35
Q

When is Mycoplasma pneumonia more common?

A

Summer and early fall

36
Q

Mycoplasma pneumoniae is most common cause of:

A

Pneumonia in pt 5-20 yo

37
Q

Two symptoms that point to Chlamydial pneumonia?

A

Hoarseness

Sinus tenderness

38
Q

Two symptoms that point to atypical pneumonia?

A

HA

Pharyngeal erythema without exudate

39
Q

Why don’t most patients with Chlamydial infection have fever?

A

More common in first few days of infection so generally absent by time of clinical presentation

40
Q

Key symptom of mycoplasma infection?

A

Dry cough that is persistent and progressive

41
Q

Chlamydial vs. Legionnaire’s symptoms

A

Chlamydia generally has no fever but has hoarseness; Legionnaire’s has high fever

42
Q

Mode of transmission and reservoir for various Chlamydia spp?

A

C. pneumoniae - Inhalation, humans
C. psittaci - Direct contact or inhalation, birds
C. trachomatis - Sex or birth, humans

43
Q

Where is Legionella found?

A

Heated water (hot tubs, air conditioning units, hot water tanks)

44
Q

How is Legionella transmitted? Reservoir?

A

Inhalation of contaminated mist/vapor; water is reservoir - NOT spread human to human, so typically Legionella infection occurs in a single, isolated case

45
Q

Places where Legionella infection is more likely?

A

Hospital, cruise ship, hotel

46
Q

What causes 50% of all pneumonias in summer?

A

M. pneumoniae

47
Q

Mycoplasma pneumonia vs. viral pneumonia

A

Mycoplasma incubation is 3 weeks, while viral is 3 days

48
Q

M. pneumonia most common in what setting and more severe in what group?

A

Closed setting

Males

49
Q

For which cause of atypical pneumonia are lab tests not very useful?

A

M. pneumoniae

50
Q

Diagnostic criteria for Chlamydia

A
  1. IgM titer 1:16
  2. 4 fold increase in IgG
  3. PCR assay for C. pneumoniae DNA
51
Q

Key diagnostic tool for Legionella

A

Urine antigen test - detects Legionella in urine samples

52
Q

+ urine antigen test + pneumonia =

A

Legionnaire’s

53
Q

Another way to diagnose Legionnaire’s

A

Isolate Legionella from lung biopsy, sputum sample, lavage

54
Q

Which cause of atypical pneumonia has high incidence of mixed infection?

A

Chlamydia (up to 60%)

55
Q

DOC chlamydia

A

Doxy

56
Q

CI doxy

A

Under 9 yo

Pregnancy

57
Q

How long to treat chlamydial infection?

A

10-14 days after fever resolves

58
Q

Important feature of treating Legionella

A

Delaying tx increases mortality!!!!!!! (like sepsis)

59
Q

3 weeks of progressive dry cough =

A

Mycoplasma pneumonia

60
Q

When to give prophylactic tx for Mycoplasma

A

Pt with underlying condition (SCD, Ab deficiency) in household with recent Mycoplasma exposure

Pulm (33 decks)

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