Pulmonary Infections Part 1 Flashcards
What are the most common bacterial pathogens that cause community-acquired pneumonia?
Streptococcus pneumoniae
Haemophilus influenzae
What are 3 atypical bacteria that can cause community-acquired pneumonia?
Chlamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumonphila
What are 5 common viral agents that can cause community-acquired pneumonia?
RSV
Adenovirus
Influenza virus
Metapneumovirus
Parainfluenza virus
What are two common fungal agents that can cause community-acquired pneumonia?
Histoplasmosis
Coccidioidomycosis
What are the 4 major symptoms of community-acquired pneumonia?
Fever
Chills
Cough
Sputum production
What pathogen(s) do multilobar infiltrate on chest X-ray suggest in community-acquired pneumonia?
S. pneumoniae
Legionella pneumonphila
What etiology do interstitial markings on chest X-rays suggest in community-acquired pneumonia?
Viral
Mycoplasmal
What etiology do cavities on chest X-rays suggest in community-acquired pneumonia?
S. aureus
Fungal
Mycobacterial
What antibiotics should be used for community-acquired pneumonia in healthy patients less than 65 years old?
Amoxicillin
Doxycycline
*Macrolides as an alternative
What antibiotics should be used for community-acquired pneumonia in patients with comorbidities?
Amoxicillin-clavulanate PLUS:
Macrolide or Doxycycline
What are the 2 best ways to prevent community-acquired pneumonia?
Smoking cessation
Vaccines
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
How many hours does it need to be to qualify pneumonia as healthcare-associated or ventilator-associated pneumonia?
48 hours
Name 3 ways nosocomial infections differ from community-acquired infections.
Less common infectious causes
Higher incidence of drug resistance
Pool underlying health of patients
Name 4 common hospital-acquired pneumonia organisms.
S. pneumonia (often drug resistant)
Staph. aureus (MSS and MRSA)
Klebsiella pneumonia
E-coli
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
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
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
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
How many antibiotics should you use on hospital-acquired pneumonia with a patient who is at HIGH risk for multiple drug-resistant pathogens?
3
You see gram-positive encapsulated “lancet-shaped” diplococci under the microscope. What is the pathogen?
S. pneumoniae
How is S. pneumonia spread?
Airborne droplets
What is the most common cause of community-acquired pneumonia?
Streptococcal pneumonia
What are 6 risk factors for S. pneumonia?
Flu
Alcohol abuse
Smoking
Splenectomy
Immunocompromised
COPD/Asthma
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)
