Respiratory Infections - Pneumonia

Question 1

Organisms associated with ventilator associated pneumonia

Answer 1

S.aureus
Klebisella and other coliforms
Pseudomonas spp
Acinetibacter 
Legionella

Question 2

Organisms associated with hospital acquired pneumonia

Answer 2

S. Pneumoniae
H. Influenzae 
S. Aureus 
Klebsiella and other coliforms
Pseudomonas spp.
Legionella

Question 3

Organisms associated with aspiration pneumonia I.e. Post stroke/difficulty swallowing

Answer 3

Streptococci
Coliforms
Anaerobes
From oro-pharynx and vomitus

Question 4

What is used to rate the severity of pneumonia?

Answer 4

Curb-65 score?

Question 5

What does CURB65 stand for and represent?

Answer 5

Confusion (new onset)
Urea > 7 mmol/L
Resp rate >= 30/min
BP Systolic 65 years

Question 6

What is the empiric abx treatment of mild/moderate CAP?

Answer 6

PO amoxicillin +- erythromycin/Clarithromycin
OR po levofloxacin (quinolone)
Clarith or doxy if pen allergic
ADD Macrolide if atypical pathogen suspected

Question 7

What is the empiric treatment for a severe CAP?

Answer 7

Co-amoxiclav and IV Clarithromycin
Pen allergic = cefuroxime and Clarithromycin
Severe pen allergic = vancomycin IV PLUS levofloxacin

Question 8

Symptoms of pneumonia caused by s. Pneumoniae

Answer 8

Sustained fever 39-41
Single shaking episode at onset
Productive cough in 75% 
Pleuritic chest pain 
Rusty, blood streaked, mucopurulent sputum

Question 9

Micro diagnosis of S. Pneumoniae

Answer 9

Alpha haemolysis on blood agar
Sensitive to optochin
Draftsman colonies
GPdiplococci on gram

Question 10

Symptoms of pneumonia caused by H. Influenzae

Answer 10

Fever variable 
Rigors unusual
Productive cough 
Wheezy in children 
Purulent sputum 
Lobar consolidation may occur

Question 11

Microbiological diagnosis of h.influenzae

Answer 11

Short gram negative cocco bacilli on gram

Grows with x and v factors

Question 12

Symptoms of pneumonia with mycoplasma pneumoniae

Answer 12

Gradual and subtle onset
Fever usual 38-40
Rigors in 25% 
Persistent hacking non productive cough
Scant mucoid sputum

Question 13

Diagnosis of mycoplasma pneumoniae

Answer 13

PCR or serology

No cell wall so doesn’t gram stain

Question 14

Symptoms of pneumonia caused by S. aureus

Answer 14

Fever intermittent, swinging or sustained 39-40.5
Rigors common
Pleuritic pain common
Often non productive cough (when haematogenous)
Purulent sputum, blood streaked, occasionally gross haemoptysis
Lung abscess/empyema common
Cavitating lesions on chest X-ray

Question 15

Symptoms of pneumonia caused by klebsiella pneumoniae

Answer 15

Uncommon but severe
Swinging 39-40.5
Multiple rigors
Productive cough, severe pleuritic pain
Thick, bloody, mucopurulent sputum
Upper lobes often affected, abscess formation common

Question 16

Symptoms and manifestation of pneumonia caused by e.coli; proteus spp. , and Enterobacter spp.

Answer 16

Prominent cou
Thick, purulent sputum,
Lower lobes commonly involved

Question 17

When is klebsiella pneumoniae pneumonia seen?

Answer 17

Seen in setting of alcohol abuse and diabetics c

Question 18

When is pneumonia caused by gram negative coliforms seen?

Answer 18

Associated with pre-existing chronic debilitating illness or ventilator associated pneumonia on intensive care unit

Question 19

Symptoms and manifestation of pneumonia caused by pseudomonas aeruginosa

Answer 19

Prominent cough
Copious yellow or green sputum
Diffuse broncho-pneumonia in patients with underlying pulmonary or cardiac disease.

Question 20

When is p. Aeruginosa seen in pneumonia?

Answer 20

Associated with hospitals as environmental organism that colonises moist surfaces

Question 21

Symptoms associated with pneumonia caused by legionella pneumophila

Answer 21

Fever 37.5-40
Rigors uncommon
Cough prominent
Scant sputum

Question 22

Who is at risk of acquiring legionella pneumophila pneumonia?

Answer 22

Elderly, male smokers, patients with underlying pulmonary or cardiac disease.
Communities near cooling towers, use of swimming or spa facilities.

Question 23

Diagnostic characteristics of legionella pneumophila

Answer 23

Slow growing 3-5 days on BCYE agar
Ground glass surface under microscope, white colonies on agar
Fluorescent yellow green pigment under UV
PCR, Urine antigen detection and immunofluorescence

Question 24

Symptoms and manifestations of pneumonia caused by chlamydia psittaci

Answer 24

Variable Fever 38-40.5 
Rigors occur in one third
Dry, hacking cough 
Pleurisy rare
Small amount of blood streaked sputum 
Hepatosplenomegaly common
Can cause culture negative endocarditis - rare
Neurological presentations - confusion, meningitis and encephalitis 
Rashes common

Question 25

Which abx for psittacosis?

Answer 25

Tetracyclines

Question 26

Symptoms of pneumonia caused by Coxiella burnetti

Answer 26

Fever up to 40.5
Rigors common
Cough and pleurisy are late manifestations
Systemic illness with headaches and myalgias
Scant sputum
May cause endocarditis

Question 27

How is q- Fever diagnosed?

Answer 27

Clinical history - lambing, sheep. Cattle, goats

Serology

Question 28

Organisms associated with community acquired pneumonia

Answer 28

S. Pneumoniae; 
H. Influenzae,
S. Aureus, 
Klebsiella,
Legionella, 

Atypicals - M. Pneumoniae, C. Burnetti, Chlamydia spp.