Pneumonia Flashcards
What is Pneumonia and who does it inflict
Inflammation of the lungs accompanied by fluid filled alveoli and bronchioles.
It is the most common cause of death from infection in the elderly.
How are Pneumonia bacteria getting into the lungs?
- Inhalation of aeroslas
- Aspiration of normal flora including UTI and GI microbes
- Hematogenous spread from another site of infection
What are the Types of Pneumonia
bacterial, viral, fungal
Example of Bacteria pneumonia
Pneumococcal pneumonia
Where is Pneumonia acquired
Community acquired CAP
Hospital acquired HAP*
-2nd leading type of nosocomial infection
-Highest mortality of all nosocomial infections
What are the Symptoms of Pneumonia-Define them
Hemoptysis-expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs.
- Abrupt onset
- Fever, Chills
- Congestion
- Shortness of breath
- Chest pain
- Productive cough
Bacteria That cause Pneumonia
Streptococcus pneumoniae (Most common) Klebsiella pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus
Whats the Characteristics of Streptococcus pneumoniae (pneumococcus) 10 in total
Normal flora of URT for approximately 70% of the adult population. Lobar pneumonia Gram positive Pairs or chains Alpha hemolytic Blood agar CAPSULE Adhesin IgA protease Pneumolysin: lyses ciliated epithelial cells
How is Streptococcus pneumoniae Diagnosed
Sputum sample:
-Rust colored
- Microscopy
- gram positive cocci and numerous PMNs
- Antigen agglutination
- Secreted in urine as well as sputum
Hemolysis
Optochin sensitive
Factors Affecting Occurrence of Pneumonia
fall & winter
CAP
Predisposing factors: Viral infection Influenza HIV Alcoholism Children Elderly Splenectomy
Pneumonia Vaccination
What are its name and the age catatory ?
Pneumovax (PPSV23): 23 most common capsule serotypes.
For Adults
Pneumococcal conjugate vaccine
(PCV13)
For Children 2 months -59 months
Name Atypical Pneumonia
Mycoplasma pneumoniae
Chlamydophila spp.
Legionella pneumophila
Coxiella burnetii
Describe atypical Pneumonia and its symptoms
Organisms not seen with Gram stain (except Lp)
Signs and symptoms fever headache malaise myalgia nausea diarrhea nonproductive cough (no sputum)
Whats are the symptoms and occurrence of Mycoplasma pneumoniae
Primary atypical pneumonia CAP Symptoms: fever headache malaise myalgia nausea diarrhea persistent nonproductive cough (no sputum) Excessive sweating
May last several weeks to months
Lack of seasonality
Predominant in high school and college age students
Whats are the characteristics of Mycoplasma pneumoniae
Smallest free living microbe No cell wall Capsule Adhesin: attachment to the base of the cilia Transmission: Inhalation of aerosols
How is Mycoplasma pneumoniae diagnosed and how is it treated
Usually can not see the bacteria with microscopy Large number of PMNs Grows very slowly in culture, 2-6 weeks Cold agglutinins PCR
Treatment:
Erythromycin
Doxycycline
Whats are the characteristics Chlamydophila pneumonias
Characteristics: -Gram negative -CAP -obligate intracellular bacteria -2 stages of infection 1-Elementary body 2 -Reticulate body
How is Chlamydophila pneumonias diagnosed
Diagnostics:
-Microscopy/Gram stain:
-no organisms seen
large number of PMNs
-ELISAWhat is the mode of Transmission and treatment of Chlamydophila pneumonias
Respiratory droplets
Treatment:
Doxycycline
Erythromycin
What are the symptoms of Chlamydophila pneumonias
Mild Fever
Sore throat
Malaise
Persistent cough
What are the characteristics of Pneumonia Psittacosis and name some of its treatment.
Atypical
Caused by Chlamydophila psittaci
Parrot fever
Disease of birds can be transmitted to humans
Treatment:
Doxycylcine
Erythromycin
What is the risk factor associated with Legionella pneumophila
Smokers COPD High alcohol consumption Elderly Immunosuppressed Renal transplant patients or patients on dialysis
How is Legionella pneumophila diagnosed?
Culture: fastidious
Buffered charcoal yeast extract- need Fe salts and cysteine to grow
Fluorescent antibody staining
-Antigen can be detected in urine
Which Microbes are the common causes of nosocomial pneumonia (HAP)
Pseudomonas aeruginosa S. aureus H. influenza Enterics -Enterobacter -Klebsiella -E. coli -Serratia marcescens
What are characteristic of Pseudomonas aeruginosa:
13 in total
- Gram-negative rod
- Ubiquitous
- Capable of growing on many substrates
- Temperatures 4-42C
- Aerobic
- Forms a biofilm
- Alginate capsule
- Highly antibiotic resistant
- Characteristic color
- Characteristic sweet grape like odor
- Motile
- Flagella
- Pili
- Oxidase positive
- Opportunistic infections
- Nosocomial infections
What are the risk factors Pseudomonas aeruginosa and name treatments.
- Cystic fibrosis
- S. aureus first
- Colonized with P.a. by 5 yr old
- Burkholderia cepacia
- Hospitalized on ventilation
- VAP
- P.a . & Burkholderia cepacia
Treatment:
very difficult to treat
Resistant to many antimicrobials
Cystic Fibrosis
Causes
Autosomal, recessive disease
1 every 3,500 live births
Caused by a defective Cystic Fibrosis Transmembrane Regulator
What kind of pulmonary disease does can you get with CF
Chronic microbial colonization
Spectrum of pathogens
-Pseudomonas aeruginosa
Some clinical presentation of CF
Most patients acquire chronic Pseudomonas aeruginosa infection by early teenage years.
- Mucoidy
- Biofilm
Chronic infections which can last several years.
-lead to the appearance of antibiotic resistant strains
More than 90% of the cystic fibrosis patients die from lung infection with P. aeruginosa
What is Alginate and describe it.
Alginate is very important for lung infections by P. aeruginosa
Alginate contributes to the biofilm formation
Fresh isolates of P. aeruginosa from CF patients are mucoidy
In vivo and in vitro switching in the mucoidy phenotype
What are the causes Anaerobes in LRT infection.
- Aspiration of respiratory or gastric material
- Dental work
- Loss of consciousness
Name two anaerobes that exist together in infection and what they cause
Mixture of Bacteroides and Fusobacterium causes necrotizing lung abscesses, empyema
At Copious amounts causes foul smelling sputum
What is the treatment for Anaerobes
Metronidazole
2-4 months
Potential bioterroism agents
Anthrax Plague Q fever Tularemia Brucellosis
Bacillus anthracis, character and Virulence Factors
Gram Positive Rod
Aerobic, non-motile
- Forms resistant endospores
- Spores remain viable for years in soil, dried or processed hides
- Present in air, water, soil and vegetation
HIGH MORTALITY RATE
Virulence Factors : Capsule – polyglutamic acid capsule (AA capsule)
Anthrax toxin
Bacillus anthracis symptoms
Initial: Sore throat Mild fever Myalgia – muscle aches and pain Cough
After several days: Severe coughing Nausea/vomiting Lethargy Confusion Shock Death
Chest Pain + Heavy Breathing
Tissue Destruction, bleeding, and death of host
Bacillus anthracis diagnosis
Box-car-like arrangement
Microscopy/Gram stain of sputum
