PBL 7 - Pneumonia Diagnosis and Treatment

Question 1

Typical presentation of Moraxella Catarrhalis:

Answer 1

Typical Pneumonia/Bronchopneumonia: sudden onset, productive cough, consolidation

Question 2

What is the second most common cause of bacterial pneumonia in patients with COPD behind HiB?

Answer 2

Moraxella Catarrhalis

Question 3

How do you diagnose Moraxella Catarrhalis?

Answer 3

• Hydrolyzes tributyrin
• Produces DNase
• Reduces nitrite to nitrate
• Does NOT ferment sugars

Question 4

How should you treat Moraxella Catarrhalis?

Answer 4

• Amoxicillin-Clavulanate
• Cephalosporins
• TMP-SMX

Question 5

What is the clinical presentation of Strep. pneumo?

Answer 5

Lobar pneumonia (CAP)

Question 6

What is the most common cause of community acquired pneumonia (CAP) and secondary pneumonia?

Answer 6

Strep. pneumo.

Question 7

How do you diagnose Strep pneumo.?

Answer 7

• Gram +
• Diplococci
• Catalase (-)
• Susceptible to optochin (OVRPS)
• Quellung Reaction (Ig binds to capsule)

Question 8

What is important to remember about treatment of Strep. pneumo.?

Answer 8

Treatment is MANDATORY.

-Use Penicillin G (G= IV, IM)

Question 9

How can you prevent Strep. pneumo.?

Answer 9

Pneumovax with capsular polysaccharides

Question 10

What is the most common cause of secondary pneumonia and pneumonia superimposed on COPD?

Answer 10

Haemophilus Influenza Type B

Question 11

How do you diagnose Haemophilus Influenza Type B?

Answer 11

• Gram (-)
• Requries Hemin (Factor X) and NAD (Factor V) on Chocolate Agar
• Immunofluorescence
• Positive Quellung test

Question 12

What should you use for treatment of Haemophilus Influenzae Type B?

Answer 12

Cephalosporin (Ceftriaxone)

Question 13

What should you use for prevention of HiB?

Answer 13

• HIB vaccine (capsular polysaccharide)

- Rifampin prophylaxis for close contact

Question 14

What does Respiratory Syncytial Virus (RSV) cause?

Answer 14

Kids pneumonia

Question 15

How do you diagnose RSV?

Answer 15

• Detection of virus in respiratory secretions

- Serology

Question 16

How should you treat RSV pneumonia?

Answer 16

• Supportive

- Ribavirin in severe cases

Question 17

What is Ribavirin?

Answer 17

Guanosine analog to stop vRNA synthesis (Nucleoside inhibitor)

Question 18

How do you prevent RSV pneumonia?

Answer 18

Synagis (F antigen vaccine)

Question 19

What type of pneumonia does Streptococcus agalactiae cause?

Answer 19

(GROUP B STREP)

-Neonatal penumonia -within days after birth

Question 20

How do you diagnose Streptococcus agalactiae?

Answer 20

• Gram (+)
• Beta-hemolytic
• Bacitracin resistant

Question 21

How do you treat Streptococcus agalactiae?

Answer 21

Penicillin G

Question 22

What is Mycoplasma Pneumoniae also known as?

Answer 22

Atypical Pneumonia/Walking Pneumonia

Question 23

What symptoms are associated with Mycoplasma Pneumoniae?

Answer 23

Gradual onset, non-productive cough, interstitial pneumonia

Question 24

How do you diagnose Mycoplasma Pneumoniae?

Answer 24

• Presence of cold hemagglutinin
• No cell wall = NO gram stain
• Fried egg appearance
• Serology

Question 25

What are the best drugs used to treat Mycoplasma Pneumoniae?

Answer 25

- Erythromycin | - Tetracycline

Question 26

What are the signs of Chlamydia Pneumoniae?

Answer 26

-Atypical Pneumonia: gradual onset, non-productive cough, interstitial CXR

Question 27

How do you diagnose Chlamydia Pneumoniae?

Answer 27

- Giemsa stain to visualize intracytoplasmic inclusions | - Serology

Question 28

How should you treat Chlamydia Pneumoniae?

Answer 28

Doxycycline

Question 29

What is the second most common cause of secondary pneumonia?

Answer 29

Staph. aureus

Question 30

What does Staph aureus show?

Answer 30

Pneumonia with cavitations

Question 31

How do you diagnose Staph. aureus?

Answer 31

Gram (+) Catalase (+) Coagulase (+)

Question 32

What should you use to treat Staph. aureus?

Answer 32

- Penicillinase-resistant penicillins | - Vancomycin

Question 33

In what populations do you usually see Legionella pneumophila?

Answer 33

CAP in elderly smokers ("Legion smokers")

Question 34

What type of pneumonia and symptoms does Legionella pneumophila cause?

Answer 34

- Gradual onset - Non-productive cough - Interstitial CXR

Question 35

What do you use to Diagnose Legionella pneumophila?

Answer 35

- Gram stain sucks; use silver stain - Culture on Charcoal yeast extract with iron and cysteine - Urinary antigen detected by radioimmunoassay

Question 36

What should you use to treat Legionella Pneumophila?

Answer 36

Erythromycin

Question 37

What is Pneumocystis Jirovecii known for?

Answer 37

Fungal opportunistic infection in AIDS. | -Pneumonia

Question 38

How do you diagnose Pneumocystis Jirovecii?

Answer 38

- Silver stain of sputum - Bronchoalveolar lavage or lung Bx - Cysts forming dark oval bodies

Question 39

How should you treat Pneumocystis Jirovecii?

Answer 39

- TMP-SMX | - Pentamidine

Question 40

What is Nocardia Asteroides associated with?

Answer 40

Pneumonia (chronic steroid use/immunocompromised)

Question 41

How do you make a diagnosis of Nocardia Asteroides?

Answer 41

- Gram (+) - Aerobic - Beaded filaments - Weakly acid fast

Question 42

What drug should you use to treat Nocardia Asteroides?

Answer 42

TMP-SMX