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Pulm by Minnie: AH Update > SM 181a - Bacterial Infections > Flashcards

SM 181a - Bacterial Infections Flashcards

1
Q

List the different clinical manifestations of
typical vs. atypical pneumonias.

A
  • Typical
    • Abrupt onset
    • Productive cough
    • No upper respiratory symptoms
    • Frequently severe
  • Atypical
    • Gradual onset
    • Nonproductive cough
    • Upper respiratory symptoms
    • Extrapulmonary symptoms
    • Occurs in younger people
    • Usually mild
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2
Q

What are the most common bacterial causes of community-acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophila
  • mixed anaerobic bacteria (aspiration pneumonia)
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3
Q

Pneumonia caused by S. pneumoniae can progress to…

A

Bacteremia

Meningitis

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4
Q

Which area of the lung is most likely to be affected by aspiration pneumonia?

A

The lung fields that aspiration gets to (dependent lung fields)

Right more likely than left

Posterior lung fields if the patient aspirated while lying on their back

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5
Q

Bordetella pertussis

Gram stain:

Size:

Shape:

Anaerobic/aerobic:

A

Gram stain: Gram negative

Size: Tiny

Shape: Coccobacilli

Anaerobic/aerobic: Strict aerobe

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6
Q

What are the most common causes of acute bronchitis/tracheitis?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasm pneumoniae
  • Chlamydia pneumoniae
  • Bordetella pertussis
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7
Q

What toxin ADP-ribosylates EF-2?

A

Diphthera toxin

This causes cells to die and form the oropharyngeal pseudomembrane associated with diphtheria

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8
Q

How does aspiration pneumonia develop?

A

People with poor gag reflexes aspirate bacteria into their lungs

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9
Q

Who is most likely to get aspiration pneumonia?

A

People with a depressed gag reflex

  • Elderly patients
  • People who get siezures
  • Anyone who blacks out from drinking
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10
Q

What is the treatment for S. aureus?

A
  • MSSA - Nafcillin/oxacillin
  • MRSA - Vancomycin or Linezolid
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11
Q

Pseudomonas aeruginsa

Gram stain:

Shape:

Aerobic/anaerobic:

A

Gram stain: Gram-negative

Shape: Bacilli

Aerobic/anaerobic: Aerobic (oxidase positive)

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12
Q

Which bacteria are most likely to cause pharyngitis?

A
  • Streptococcus pyogenes
  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
  • Corynebacterium diphtheriae
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13
Q

How is H. influenzae transmitted?

A

Direct contact with secretions or respiratory droplets

Colonizes in the upper respiratory tract of healthy individuals

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14
Q

Which bacterial causes of pneumonia will not be detectable in gram-stained sputum specimens?

A
  • Legionella pneumophila*
  • Mycoplasma pneumoniae*
  • Chlamydia spp.*
  • Mycbacterium tuberculosis*
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15
Q

A patient with pneumonia and a really high fever (>40C/104F) and GI symptoms is most likely infected with….

A

Legionella pneumophilia

  • Atypical pneumonia
  • Water, air conditioning systems, cooling towers
  • GI symptoms
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16
Q

Nosocomial pneumonia is pneumonia that occurs ________ hours after______________

A

Nosocomial pneumonia is pneumonia that occurs >48** hours after **hospitalization (includes VAP and HAP)

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17
Q

What organism is most likely caused this patient’s pneumonia?

a. H. influenzae or S. pneumoniae
b. M. pneumoniae or C. pneumoniae

A

b. M. pneumoniae or C. pneumoniae

No lobar infiltrate

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18
Q

How is S. pneumoniae diagnosed?

A
  • Sputum sample
    • Numerous gram-positive cocci in pairs and chains
    • Many neutrophils
  • Culture
    • Alpha-hemolytic
      (incomplete hemolysis aka green on blood agar)
  • Catalase-negative
  • Optochin-susceptible
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19
Q

What cells in the body does Mycoplasma pneumoniae bind?

A

Respiratory epithelium, using protein adhesin P1

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20
Q

How can H. infleunzae be prevented?

A

Type B capsular conjugative vaccine (Hib)

Give to all infants @ 2mo

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21
Q

Describe the clinical presentation of diphtheria

A
  • Sore throat
  • Fever
  • Difficulty swallowing
  • Cough
  • Harseness
  • Rhinorrhea
  • Oropharyngeal pseudomembrane
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22
Q

Pneumonia accompanied by pharyngitis is most often caused by

A

C. pneumoniae

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23
Q

What is the treatment for Legionella pneumophila?

A

Macrolide or fluoroquinolone

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24
Q

Which bacteria are associated with ventilator-associated pneumonia?

A
  • Staphylococcus aureus
  • Enterobacteriaceae
    • (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Serratia spp.)
  • Legionella pneumophila
  • Pseudomonas aeruginosa
  • Acinetobacter baumannii
  • mixed anaerobic bacteria (aspiration pneumonia)
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25
Q

Where in the body does s. pneumoniae colonize?

A

Oropharynx and nasopharynx

26
Q

How is S. pneumoniae treated?

A

Penicillin

If resistant, use vancomycin

27
Q

What clinical disease is asociated with Bordetella pertussis?

A

Whooping cough

28
Q

What is the most life-threatening complication of H. influenzae?

A

Epiglottitis

29
Q

Which bacteria is the most common cause of community-acquired pneumonia?

A

Strep. pneumoniae

30
Q

Encapsulated H. influenzae primarily affects ____________.

Why?

A

Encapsulated H. influenzae primarily affects children.

We develop type-specific antibodies against the capsule antigens, so most adults have protective immunity

31
Q

S. Pneumoniae can infect __________

A

S. Pneumoniae can infect humans only

32
Q

_______ is the smallest organism that can be free-living in nature and self-replicating on laboratory medium.

A

Mycoplasma pneumoniae is the smallest organism that can be free-living in nature and self-replicating on laboratory medium.

33
Q

Why don’t people get the same s. pneumoniae infection twice?

A

Anibodies against the capsule are protective

34
Q

Which enterobacteriaceae are common culprits in hospital-acquired pneumonia?

A

SEEK

  • Serratia spp.
  • E. coli
  • Enterobacter spp.
  • Klebsiella pneumoniae
35
Q

How can streptococcal pneumoniae be prevented?

A
  • Polysaccharide vaccine (Pneumovax 23)
  • Capsular polysaccharide conjugated to protein (Prevnar-13): works better in children

Indicated for peole at risk (young, old, immunocompromised, chronic lung disease)

36
Q

A Mycoplasma pneumoniae pneumonia may cause unusual manifestations such as….

A
  • Hemolytic anemia
  • Neurologic abnormalities (encephalitis)
  • Skin rashes
37
Q

How is pneumonia caused by Mycoplasma pneumoniae differ from pneumonia caused by S. pneumoniae and H. influenzae?

A

M. pneumoniae pneumonia…

  • More gradual in onset
  • Cough is non-productive
  • Chest x-ray is non lobal
  • More mild
38
Q

What media should you use to grow H. influenzae?

A

Chocolate agar

  • Requires hemin and NAD
  • If it grows on sheep blood agar, it is not H. influenzae
39
Q

What is the treatment for H. influenzae infection?

A
  • Cephalosporins, trimethoprim-sulfamethoxazole, macrolides, amoxicillin/clavulanic acid, quinolones
  • Penicillins not effective against beta-lactamase producing strains
40
Q

Community-acquired pneumonia with hemolytic anemia, many neutrophils, and less severe symptoms is most likely caused by which bacteria?

A

M. pneumoniae

41
Q

Clamydia pneumoniae

Gram stain:

Intracellular or extracellular:

A

Gram stain: gram negative but does not take up gram stain

Intracellular or extracellular: Obligate intracellular

42
Q

Describe the clinical presentation of s. pneumoniae infection

A
  • Fever
  • Productive cough - rusty colored sputum
  • Pleuritic chest pain
  • Diminshed respiratory excursion
  • Abrupt onset
43
Q

Corynebacterium diphtheria

Gram stain:

Shape:

A

Gram stain: Gram positive

Shape: Bacilli (club shape)

44
Q

Which bactera cause pneumonia with lobar infiltrates on chest x-ray?

A
  • S. pneumoniae*
  • H. influenzae*
45
Q

Which of the following is a cause of life-threatening epiglottitis?

A. Streptococcus pneumoniae

B. Haemophilus influenzae

C. Mycoplasma pneumoniae

D. Legionella pneumophila

A

B. Haemophilus influenzae

46
Q

Streptococcus pneumoniae

Gram stain:

Shape:

Hemolysis:

A

Gram stain: Gram +

Shape: “lancet-shpaed” diplococci

Hemolysis: alpha-hemolytic

47
Q

What will you see on H. influenzae CXR?

A

Lobar infiltrate

48
Q

What are the determinants of pathogenicity of H. influenzae?

A
  • Polysaccharide capsule
    • 6 types
    • Antiphagocytic
    • We can develop protective immunity against the capsule
      • => There is a vaccine that works!
49
Q

What will you see in a chest x-ray of somebody infected with S. pneumoniae?

A

Lobar infiltrates

50
Q

What are the determinants of pathogenicity of s. pneumoniae?

A
  • Capsule
  • Pneumolysin
    • Degrades hemoglobin
    • Activates complement
    • May form pores in human cells
51
Q

All of the following are said to cause an atypical pneumonia EXCEPT:

A. Streptococcus pneumoniae

B. Chlamydia pneumoniae

C. Mycoplasma pneumoniae

D. Legionella pneumophila

A

A. Streptococcus pneumoniae;

52
Q

Which organism causes cold hemagglutinins?

  1. H. influenzae
  2. S. pneumoniae
  3. M. pneumoniae
A

c. M. pneumoniae

53
Q

Which bacteria most likely caused this?

A

Corynebacterium diptheria

54
Q

How does s. pneumoniae spread?

A

Human to human via droplets

55
Q

Hospital acquired (HAP) pneumonia is pneumonia that occurs ________ hours after hospitalization

A

Hospital acquired (HAP) pneumonia is pneumonia that occurs >48 hours after hospitalization

56
Q

Ventilator-associated pneumonia (VAP) is pneumonia that occurs ______ hours after mechanical ventilation

A

Ventilator-associated pneumonia (VAP) is pneumonia that occurs >48 hours after mechanical ventilation

57
Q

Unencapsulated strains of H. influenzae can infect _______.

Why?

A

Unencapsulated strains of H. influenzae can infect adults and children.

We cannot develop protective immunity if there is no capsule - no capsule = no antigens to make antibodies against

58
Q

Which bacteria has protein adhesin P1? What does it do?

A

Mycoplasma pneumoniae

Allows the bacteria to bind tightly to respiratory epithelium

59
Q

Who gets streptococcal pneumonia?

A

Anyone - healthy or immunocompromised

Especially people who recently had the flu

60
Q

Enterobacteriaceae

Gram stain:

Shape:

Anaerobic/aerobic:

A

Gram stain: gram -

Shape: rod

Anaerobic/aerobic: facultative anaerobes

61
Q

Haemophilus influenzae

Gram stain:

Shape:

A

Gram stain: gram negative

Shape: small, gram-negative coccobacilli

Pulm by Minnie: AH Update (34 decks)

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