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Microbio Gram Pos > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Pneumonitis

Causes

A

Inflammation of parenchyma (alveoli)
Caused by viruses, bacteria, radiation therapy, sepsis, adverse drug rxns, hypersensitivity rxns, smoking, and chemicals.

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2
Q

Pneumonia

A

Inflammation w/ fluid buildup in alveoli that may cause decreased gas exchange

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3
Q

Pathogenesis of pneumonia

A

Colonization of upper respiratory tract w/ injury to mucociliary escalator (such as smoking or virus).
May aspirate oral flora / vomit.
Sometimes organisms are directly inhaled (TB). Hematologic seeding by septic emboli from endocarditis may occur as well, mainly in lower lobes due to higher perfusion.

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4
Q

Clinical signs of pneumonia

A

Fever, chills, dyspnea, cough (dry or productive), pleuritic chest pain, anorexeia, headache, systemic sxs (weight loss / night sweats suggest TB or fungal cause). Hemoptysis is rare (more common w/ bronchitis).

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5
Q 
Physical exam (4 things)
What is needed for diagnosis?
A

Need CXR for diagnosis
•Ronchi / wet rales (alveoli “popping” open)
•Egophony and fremitus (vibratory tremors that can be felt through the chest by palpation) both suggest consolidation
•Dullness to percussion suggests a pleural effusion
•Auscultation may be unremarkable if area of consolidation is not close to chest wall.

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6
Q

Radiography ( 3 types of findings)

A
  • Lobar – typically bacterial.
  • Interstitial pneumonia / pneumonitis – viral, Pneumocystitis jiroveci, or atypical bacteria. Diffuse.
  • Nodules / cavities – mycobacterial / fungal cause
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7
Q

Labs (5 things)

A
  • Sputum or BAL gram stain – must not contain lots of spit due to oral microbiota. Compare ratio of neutrophils to squamous epithelial cells
  • Blood cultures
  • Urinary antigen testing for Strep pneumoniae or Legionella pneumophila
  • Pleural fluid analysis / culture
    * Empyema = bacterial infection w/in pleural space. Must be drained immediately to prevent scar tissue from building up overnight, restricting the lungs.
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8
Q 
Community Acquired Pneumonia (CAP)
Organisms
When is it most common?
Tx
What vaccines are available and for who?
A
  • Caused by S pneumoniae, H influenzae, Legionella pneumophila, M pneumoniae, Chlamydophila pneumoniae, or viruses.
  • More common in winter
  • Tx – doxycycline, macrolide, or FQ.
  • Vaccines are available for Strep pneumoniae and Haemophilus influenza. Useful in children, adults, and elderly.
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9
Q

Hospital Acquired Pneumonia (HAP)
Onset
Tx

A

Occurs 48+ hrs after intubation

Tx - FQ or beta lactam + macrolide.

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10
Q

Healthcare Associated Pneuonia (HCAP)

A

Prior hospitalization w/in last 90 days, live in nursing home, or IV antibiotics w/in last 30 days

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11
Q

What type of pneumonia affects the small airways?

A

Bronchiolitis obliterans organizing pneumonia / cryptogenic organizing pneumonia

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12
Q

Eosinophilic pneumonia caused by?

A

Parasites or autoimmune disorders

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13
Q

Necrotizing pneumonia caused by?

A

Oral anaerobes or chemical burn (gastric aspiration).

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14
Q

What is the difference b/w typical / atypical pneumonia?
What organisms cause typical?
What organisms cause atypical?

A

Typical pneumonia shows organisms w/ gram stain.
Atypical pneumonia shows neutrophils w/ gram stain but no organisms.
2 main typical strains are Strep pneumoniae and Haemophilus influenze.
3 main atypical strains are Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila

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15
Q

General characteristics of Chlamydia / Chlamydophila
Type of bacteria
What are inclusions?
Cell wall characteristics

A 
Obligatory intracellular Gram Neg
Forms inclusions (phagosomes full of EBs and RBs)
Rigid, but lack peptidoglycan
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16
Q 
Elementary Body vs Reticulate Body
Size
Infectious?
Replicating?
Released?
A

EB small / dense. RB large / loose.
EB infectious, RB not.
EB non-replicating, RB does binary fission.
EB is released when cell ruptures. RB only found inside cells.

17
Q

5 steps of Chlamydia life cycle

A
  • Small EB is passively engulfed by host cell and prevents fusion of lysozomes w/ phagosomes.
  • EB reorganizes itself into RB, which is metabolically active and starts to divide.
  • RB uses host’s ATP. Energy parasite. Replicates.
  • When many RB’s are present, they condense into large infectious EB’s.
  • Inclusion bursts after 2-3 days and cell dies.
18
Q

Chlamydia trachomatis causes which 5 disorders?

A

STD causes urethritis, mucopurulent cervicitis, and PID.

Eye infections cause trachoma and opthalmia neonatorum (acute conjunctivitis in newborns)

19
Q 
Chlamydophila pneumonia
Diseases (5 things)
Transmission
Pneumonia sxs
Diagnosis
Tx (mild vs severe)
A

Causes CAP, bronchitis, sinusitis, AOM, and atherosclerosis.
•Transmitted person-to-person via respiratory droplets.
•Pneumonia sxs include sore throat, dry cough, low fevers.
•Diagnose w/ 4x increase in Ab titer
•Tx for mild cases of CAP includes doxycyline or a macrolide. Quinolone used for severe infections.

20
Q 
Chlamydia psittaci
Cause
Transmission
Sxs
Diagnosis
Tx
A

Caused by parrots
•Transmitted by inhaling EB from infected bird or bird feces. Rarely transmitted person-to-person.
•Sxs include fever, chills, headache, and dry cough. “Parrot fever”. Often asymptomatic.
•Diagnosed w/ 4x increase in Ab titer
•Tx w/ tetracycline, macrolide, or FQ

21
Q

Long term complications of Chlamydia infections (4 things)

A
  • Trachoma → blindness
  • PID → infertility, pain, ectopic pregnancy
  • Urethritis → reactive arthritis
  • Cervicitis → C trachomatis may cause cervical cancer
22
Q 
General properties of Mycoplasma species
Genome
Cell wall
Agar
Broth
Action against host cell
Adhesion
Tx
Vaccine?
A

Smallest known genome
Lack peptidoglyan –> squishy
Grown on PPLO agar
May form filamentous structures in broth (“myco”, like fungi)
Inhibits host cells catalase –> increased peroxide / superoxide –> host cell damage
Adhere to epithelium via P1 adhesins –> stops ciliary motion –> dry cough
Tx - doxycyclin, macrolide, or FQ
No vaccine

23
Q 
Mycoplasma pneumoniae
AKA
Transmission
Sxs
Diagnosis
A

AKA “walking pneumonia”. Type of CAP.
•Transmitted person-to-person via respiratory droplets. High attack rate in families (contagious).
•Sxs are usually mild w/ dry cough
Diagnosis is rarely confirmed. Best w/ combination of specific IgM and cold agglutinins (Abs directed against blood group I that show up before specific Abs).

24
Q

Mycoplasma hominis
Appearance
Diseases

A

Fried-egg appearance

Causes tubo-ovarian abscess, salpingitis, and PID

25
Q

Mycoplasma genitalium causes?

A

Causes urethritis and PID

26
Q 
General characteristics of Legionella species
Morphology and Gram stain
Agar
Environment
Transmission
Peak time of year
A

•Slender, motile aerobic rods. Gram Neg but take up stain poorly
•No capsule
•Do not form spores
•Grown on buffered charcoal yeast extract (BCYE) w/ increased CO2.
•Found in fresh water and moist soil. Can withstand heat / chlorination so often found in water systems, air conditioning towars, hot tubs, or shower heads. May cause nosocomial infections.
•Transmitted via inhalation of droplets, such as while taking a shower. No person-to-person transmission.
•Infections peak in summer / fall.
Severity increases in elderly.

27
Q

Most important strain of Legionella

A

Legionella pneumophila serogroup 1. Causes 80% of Legionella infections.

28
Q

Legionella’s effect against host cells

A

Ingested by macrophages by binding to complement receptor. Engulfed by phagosomes, but fusion w/ lysosomes is inhibited. Proliferation → host cell rupture / spread → lung inflammation / tissue destruction

29
Q

Sxs of legionella pneumonia

A

Headache, fever, malaise, muscle aches, dyspnea, non-productive cough, abdominal pain, diarrhea, and confusion

30
Q

Diagnosis of Legionella

A

ELISA test for urine Legionella antigen (most common method, but only detects serogroup 1).
Sputum DFA stain may also be used

31
Q

Tx or Legionella

A

Macrolides, tetracyclines, or FQ

32
Q

Pontiac Fever
Cause
Sxs
Tx

A

Influenza-like illness caused by hypersensitiviy rxn to Legionella proteins.
Sxs include fever, myalgia, arthraglia, and headache. NO respiratory sxs. High attack rate (very contagious).
No tx needed, resolves in 2-5 days.

33
Q

Prevention of Legionella infection

A

Find / treat environmental water sources w/ superheating or copper-silver ionization.

Microbio Gram Pos (11 decks)

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