Pulmonary Infections Part 1 Flashcards by Nolan Padilla

What are the most common bacterial pathogens that cause community-acquired pneumonia?

Streptococcus pneumoniae
Haemophilus influenzae

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What are 3 atypical bacteria that can cause community-acquired pneumonia?

Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumonphila

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What are 5 common viral agents that can cause community-acquired pneumonia?

RSV
Adenovirus
Influenza virus
Metapneumovirus
Parainfluenza virus

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What are two common fungal agents that can cause community-acquired pneumonia?

Histoplasmosis
Coccidioidomycosis

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What are the 4 major symptoms of community-acquired pneumonia?

Fever
Chills
Cough
Sputum production

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What pathogen(s) do multilobar infiltrate on chest X-ray suggest in community-acquired pneumonia?

S. pneumoniae
Legionella pneumonphila

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What etiology do interstitial markings on chest X-rays suggest in community-acquired pneumonia?

Viral
Mycoplasmal

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What etiology do cavities on chest X-rays suggest in community-acquired pneumonia?

S. aureus
Fungal
Mycobacterial

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What antibiotics should be used for community-acquired pneumonia in healthy patients less than 65 years old?

Amoxicillin
Doxycycline

*Macrolides as an alternative

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What antibiotics should be used for community-acquired pneumonia in patients with comorbidities?

Amoxicillin-clavulanate PLUS:
Macrolide or Doxycycline

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What are the 2 best ways to prevent community-acquired pneumonia?

Smoking cessation
Vaccines

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What vaccines can be used to protect against community-acquired pneumonia?

Pneumococcal conjugate vaccine (PCV13)
Pneumococcal polysaccharide vaccine (PPSV23)
H. influenzae type b vaccine (Hib)
Varicella vaccine
Influenza vaccine

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How many hours does it need to be to qualify pneumonia as healthcare-associated or ventilator-associated pneumonia?

48 hours

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Name 3 ways nosocomial infections differ from community-acquired infections.

Less common infectious causes
Higher incidence of drug resistance
Pool underlying health of patients

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Name 4 common hospital-acquired pneumonia organisms.

S. pneumonia (often drug resistant)
Staph. aureus (MSS and MRSA)
Klebsiella pneumonia
E-coli

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What 3 symptoms and 1 exam finding can ventilator-associated pneumonia have?

Fever
High WBC count
Purulent sputum
Chest x-ray with new or progressive opacity

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What two tests can you use in hospital-acquired pneumonia to help determine the severity of the illness and the need for ventilation?

Arterial blood gas
Pulse oximetry

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True or false: you should always order a sputum stain and culture to diagnose pneumonia

False, not always helpful because it is neither sensitive nor specific

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What antibiotic should you use on hospital-acquired pneumonia with a patient who is at LOW risk for multiple drug-resistant pathogens?

Piperacillin-taz
Cefepime
Levofloxacin

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How many antibiotics should you use on hospital-acquired pneumonia with a patient who is at HIGH risk for multiple drug-resistant pathogens?

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You see gram-positive encapsulated “lancet-shaped” diplococci under the microscope. What is the pathogen?

S. pneumoniae

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How is S. pneumonia spread?

Airborne droplets

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What is the most common cause of community-acquired pneumonia?

Streptococcal pneumonia

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What are 6 risk factors for S. pneumonia?

Flu
Alcohol abuse
Smoking
Splenectomy
Immunocompromised
COPD/Asthma

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What pathogen are you suspicious of when you see "rust" colored sputum?

S. pneumonia

What test is best for helping see S. pneumonia really close up?

Quellung test (India ink stains the capsule, can also use methylene blue stain)

What antibiotics should you use to treat S. pneumonia?

Beta-lactam Macrolide Respiratory fluoroquinolone

What is the best prevention for S. Pneumonia

Vaccine

True or false: Klebsiella is a mild common disease.

False, it is a rare and severe disease

Is Klebsiella pneumonia more of a community or hospital-acquired infection?

Hospital-acquired

What are 2 major risk factors for Klebsiella pneumonia?

Prior antibiotic use Use of invasive plastic devices

What pathogen are you suspicious of when you see "red currant jelly" colored sputum?

Klebsiella pneumonia

How do you diagnose Klebsiella pneumonia?

Culture and gram stain of sputum or aspirated body fluid + chest x-ray

You see gram-positive cocci under the microscope. What is the most likely pathogen?

Staph. A causing pneumonia

True or false, Staph. pneumonia is a rapidly progressing disease.

True

What is the key symptom progression of Staph. pneumonia?

Short prodrome of fever followed by: Respiratory symptoms followed by: Respiratory distress could also have: GI symptoms

True or false: sputum specimens are helpful and diagnostic for Staph. pneumonia.

False, they are not helpful due to common upper respiratory tract colonization

True or false: empiric therapy for treating Staph. pneumonia may not be enough when using penicillins or cephalosporins.

True, this is because of community-associated MRSA

Is Staph. pneumonia is more often found in community-acquired or hospital-acquired pneumonia?

Community

What are 3 meds that can be used to treat Staph. pneumonia?

Clindamycin T-sulfa Rifampin

Where can you usually find Legionella pneumophilia bacteria?

Soil Freshwater

What are some extra symptoms of Legionnaires pneumonia besides the common flu-like symptoms?

Nausea/vomiting Diarrhea Abdominal pain

What are some extra symptoms of Legionnaires pneumonia besides the common flu-like symptoms?

Nausea/vomiting Diarrhea Abdominal pain

What are two antibiotics you can use to treat Legionnaires pneumonia?

Azithromycin (macrolide) Levofloxacin (fluoroquinolone)

You see patchy, asymmetric, progressive infiltrates on a chest x-ray, what is the most likely diagnosis?

Legionnaires pneumonia

You see a short rod under the microscope that does not show up on Gram stains. What is the most likely diagnosis?

Mycoplasma pneumonia

Are young adults, children, adults, or the elderly more commonly affected by Mycoplasma pneumonia?

Young adults Children

Mycoplasma pneumonia characteristically shows up in the following locations:

Military barracks University dorms

What is the diagnostic method of choice for Mycoplasma pneumonia

NAAT: nucleic acid amplification test

True of false: there is no vaccine available for Mycoplasma pneumonia?

True

What are three antibiotics that can be used for outpatient management of Mycoplasma pneumonia?

Macrolide Doxycycline Respiratory fluoroquinolone

What are the 3 most common types of fungal pneumonia?

Pneumocystis jirovecii Aspergillus species (especially A. fumigatus) Cryptococcus neoformans

What patient population is it common to find Pneumocystis pneumonia (PJP)?

HIV patients (immunocompromised) Those receiving systemic corticosteroids

What CD4 + T lymphocyte count on a patient with HIV would contribute to a major risk factor for Pneumocytosis pneumonia (PJP)?

Less than 200 micro liters FYI: less than 50 microliters = risk factor for death

You see bilateral, diffuse, perihilar infiltrates with a patient who is hypoxic, what is the most likely diagnosis?

Pneumocystosis pneumonia (PJP)

What CD4 + T lymphocyte count on a patient with HIV would contribute to a major risk factor for Pneumocytosis pneumonia (PJP)?

Less than 200 microliters FYI: less than 50 microliters = risk factor for death

What is the appropriate antibiotic used to treat Pneumocystosis pneumonia (PJP) and how long do you give it for?

T-sulfa for 14 to 21 days Can also give corticosteroids

What treatment should you use for HIV patients previously infected with PJP or those with CD4+ with T lymphocyte count of less than 200?

DAILY t-sulfa

What vaccine can reduce bacterial meningitis in children?

Hib vaccine

What is the preferred treatment for Haemophilus pneumonia?

Beta-lactam agents such as Amoxicillin or 2nd or 3rd gen cephalosporins

Which community-acquired pneumonia is also referred to as "walking pneumonia?"

Chlamydia pneumonia

What two types of pneumonia are almost clinically indistinguishable from each other?

Mycoplasma pneumonia and Chlamydia pneumonia

This type of pneumonia is common for people in closed populations such as nursing homes, prisons, military groups, and university dorms

Mycoplasma pneumonia and Chlamydia pneumonia

What antibiotics are the first-line treatments for outpatients with Chlamydia pneumonia?

Azithromycin (superstar) Doxycycline

What antibiotics are the first-line treatments for inpatients with Chlamydia pneumonia?

Respiratory fluoroquinolone Beta-lactam + macrolide

You see gram-negative bacilli under a microscope, you are also suspicious that this was a hospital-acquired infection ESPECIALLY from a ventilator burn patient. What is the most likely disease?

Pseudomonas aeruginosa

Community-acquired infections are less common for Pseudomonas pneumonia, but can be found in patients with what 2 diseases?

HIV patients Cystic fibrosis patients

What is the best way to diagnose Pseudomonas pneumonia?

Sputum culture

What two types of antibiotics are preferred for Pseudomonas pneumonia?

Anti-pseudomonal beta-lactams (piperacillin-taz, ceftizanidime) Anti-pseudomonal quinolones (ciprofloxacin and levofloxacin)