Pneumonia

Question 1

Chlamydia psittaci: Two states

Answer 1

 Extracellular: infectious, elementary body

 Intracellular: replicative

Question 2

Chlamydia psittaci: Risk/exposure

Answer 2

 Pets, poultry, pigeons  Native birds o Lawn mowing

Question 3

Chlamydia psittaci: Physical exam “clue”

Answer 3

> temperature/pulse dissociation > Headache

Question 4

Drug-induced pneumonitis/pneumonia

Answer 4

 Antibiotics: o INH o PAS o Sulfasalazine o Daptomycin  CV: o Amiodarone o Flecainide  Chemotherapy: o Bleomycin

Question 5

Nitrofurantoin pneumonitis presentation . . .

Answer 5

May present like atypical pneumonia or interstitial fibrosis • Acute • Subacute (after 1 month) • Chronic

Question 6

Legionella diagnostics

Answer 6

> Culture > Urinary Ag

Question 7

Löffler’s syndrome

Answer 7

“PNA” + migratory pulmonary infiltrates + Peripheral eosinophilia

• Migration of parasites

Question 8

Acute eosinophilic pneumonia Drugs association . . .

Answer 8

o Daptomycin

o Nitrofurantoin

o Minocycline

o Ampicillin

o Sulfonamides

 NSAIDs

 Phenytoin

Question 9

Mycoplasma pneumoniae

Extra-pulmonary manifestations

Answer 9

 Stevens-Johnson syndrome (SJS), E. multiforme

 Hemolytic anemia

 Hepatitis

 CNS: encephalitis, meningitis

Question 10

Possible Microbial Causes of Community-Acquired Pneumonia

Lung cavity infiltrates

Answer 10

Community-associated MRSA

Oral anaerobes,

Endemic fungal pathogens,

Mycobacterium tuberculosis,

Atypical mycobacteria

Question 11

Possible Microbial Causes of Community-Acquired Pneumonia

Exposure to bat or bird droppings

Answer 11

Histoplasma capsulatum

Question 12

Possible Microbial Causes of Community-Acquired Pneumonia

Exposure to birds

Answer 12

Chlamydophila psittaci (if poultry: avian influenza)

Question 13

Possible Microbial Causes of Community-Acquired Pneumonia

Exposure to rabbits

Answer 13

Francisella tularensis

Question 14

Possible Microbial Causes of Community-Acquired Pneumonia

Exposure to farm animals or parturient cats

Answer 14

Coxiella burnetii

Question 15

Possible Microbial Causes of Community-Acquired Pneumonia

Hotel or cruise ship stay in previous 2 weeks

Answer 15

Legionella species

Question 16

Possible Microbial Causes of Community-Acquired Pneumonia

Travel or residence in southwestern United States

Answer 16

Coccidioides species,

Hantavirus

Question 17

Possible Microbial Causes of Community-Acquired Pneumonia

Bronchiectasis or cystic fibrosis

Answer 17

Burkholderia cepacia,

P. aeruginosa,

S. aureus

Question 18

Possible Microbial Causes of Community-Acquired Pneumonia

Bioterrorism

Answer 18

Bacillus anthracis,

Yersinia pestis,

Francisella tularensis

Question 19

Suppurative lymphadenitis + septic shock due to a Gram-negative bacillus . . .

Treatment . . .

Answer 19

Tularemia or plague.

TOC for tularemia or plague: streptomycin or gentamicin (or FQs)

Question 20

Melioidosis, facts . . .

Answer 20

• Burkholderia pseudomallei, a facultative intracellular gram negative
• Southeast Asia and Northern Australia; soil/dust or water.
• described after near drowning, or after tsunamis.
• may be misidentified as B. cepacia, P. stutzeri, or other Pseudomonas species.
• Common Clx manif : skin lesions, pneumonia, and abscesses.
• acute, sub-acute or chronic course.
• Tx: Ceftazidime or imipenem.