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SM_181a: Bacterial Infections Flashcards

1
Q

Streptococcus pneumoniae is a [Gram stain, shape}

A

Streptococcus pneumoniae is a Gram-positive lancet-shaped diplococci (pneumococci)

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2
Q

What are the determinants of pathogenicity of Streptococcus pneumoniae?

A

Streptococcus pneumoniae

  • Capsule: protects bacteria from phagocystosis, antibodies against them are protective in humans, 80 distinct serotypes
  • Pneumolysin: degrades hemoglobin to greenish pigment, may form pores, activates complement
  • Peptidoglycan fragments and teichoic acid: activate complement, leading to intense inflammation and tissue damage
  • IgA protease
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3
Q

Describe the clinical disease caused by Streptococcus pneumoniae

A

Streptococcus pneumoniae

  • Only infects humans
  • Spread person-to-person by small droplets
  • Colonizes oropharynx and nasopharnx of some healthy adults and kids
  • Most common bacterial cause of community-acquired pneumonia
  • Pnuemonia leading to bacteria in the very young and old
  • Pneumonia leading to meningitis
  • Pneumonia in healthy individuals and those with predisposing conditions
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4
Q

Describe the presentation of Streptococcus pneumoniae

A

Streptococcus pneumoniae

  • Fever
  • Cough productive of rusty-colored sputum
  • Pleuritic chest pain
  • Diminished respiratory excursion (splinting): not taking much effort to avoid pain
  • Abrupt onset of symptoms
  • Chest radiographs show lobar infiltrates
  • May cause empyema
  • Frequent cause of otitis media, acute bronchitis, sinusitis
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5
Q

Describe diagnostic testing for Streptococcus pneumoniae

A

Streptococcus pneumoniae

  • Sputum sample: numerous Gram-positive cocci in pairs and chains, many neutrophils, no epithelial cells
  • Culture on blood agar: alpha-hemolytic
  • Catalase-negative
  • Optochin-susceptible
  • Pneumococcal urinary antigen test for urine
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6
Q

Describe the treatment for Streptococcus pneumoniae

A

Streptococcus pneumoniae

  • Penicillin, although now there is significant resistance which is often associated with resistance to other antibiotics as well
  • Vancomycin, cephalosporins, doxycyline, TMP-SMX, macrolides, clindamycin
  • Moxifloxacin effective but cipro is not
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7
Q

Describe prevention of Streptococcus pneumoniae

A

Streptococcus pneumoniae

  • Pneumococcal polysaccharide vaccine (Pneumovax 23)
  • Pneumoccocal polysaccharide-protein conjugate vaccine (Prevnar-13): capsular polysaccharide from 13 serotypes conjugated to protein
  • Vaccination recommended for young children 2-23 months, adults 65 years or older, all others at risk for pneumococcal infections (diabetes mellitus, chronic lung disease, HIV, etc)
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8
Q

Streptococcus pneumomiae is ______-hemolytic

A

Streptococcus pneumomiae is alpha-hemolytic

(partial/green hemolysis)

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9
Q

______ of Streptococcos pneumoniae degrades hemoglobin to a ______ pigment

A

Pneumolysin of Streptococcos pneumoniae degrades hemoglobin to a greenish pigment

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10
Q

Sputum sample shows Gram-positive cocci in pairs and chains along with many neutrophils. The organism is ________

A

Sputum sample shows Gram-positive cocci in pairs and chains along with many neutrophils. The organism is Streptococcus pneumoniae

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11
Q

Most common cause of community-acquired pneumoniae is ______

A

Most common cause of community-acquired pneumoniae is Streptococcus pneumoniae

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12
Q

Pneumonia from Streptococcus pneumoniae can cause _____ in very young and old people

A

Pneumonia from Streptococcus pneumoniae can cause bacteremia in very young and old people

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13
Q

Haemophilus influenzae is a [size, Gram-stain, shape]

A

Haemophilus influenzae is small Gram-negative coccobacilli

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14
Q

What are the determinants of pathogenicity of Haemophilus influenzae?

A

Haemophilus influenzae - polysaccharide capsule

  • Six types (a-f), antiphagocytic
  • Type b caused most serious disease but becoming less common with routine use of vaccination
  • Type specific antibodies are protective
  • Encapsulated H. influenza primarily infects children because most adults have protective antibodies
  • Unencapsulated strains often isolated from adults and children
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15
Q

Describe the clinical disease caused by Haemophilus influenzae

A

Haemophilus influenzae

  • May colonize the upper respiratory tract of healthy individuals
  • Spread by airborne droplets or by direct contact with secretions
  • Frequent cause of otitis media, sinusitis, community-acquired pneumonia, bronchitis, conjunctivitis, meningitis in children under age of 6, septic arthritis in children, may cause life-threatening epiglottitis
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16
Q

_______ may cause life-threatening epiglottitis

A

Haemophilus influenzae may cause life-threatening epiglottitis

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17
Q

_______ is the radiographic sign you would see in a patient with epiglottitis from Haemophilus influenzae

A

Thumb sign is the radiographic sign you would see in a patient with epiglottitis from Haemophilus influenzae

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18
Q

Haemophilus influenzae _____ grow on sheep blood agar

A

Haemophilus influenzae does not grow on sheep blood agar

(needs hemin and NAD which sheep blood agar does not have)

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19
Q

Haemophilus influenzae requires ______ and ______ for growth

A

Haemophilus influenzae requires hemin (X factor) and NAD (V factor) for growth

(can grow on chocolate agar)

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20
Q

Haemophilus influenzae can grow on ______ agar

A

Haemophilus influenzae can grow on chocolate agar

contains hemin (X factor) and NAD (V factor)

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21
Q

Describe treatment of Haemophilus influenzae

A

Haemophilus influenzae

  • Ampicillin, amoxicillin, or penicillin G not effective against beta-lactamase producing strains (25%)
  • Cephalosporins, TMP-SMX, macrolides, amoxicillin/clavulonic acid, and quinolones
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22
Q

Prevention of Haemophilus influenzae involves _______

A

Prevention of Haemophilus influenzae involves Type B capsular conjugate vaccine (Hib)

  • Given to all infants starting at 2 months of age
  • Dramatically reduced incidence of Haemophilus influenzae meningitis in infants and children
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23
Q

Describe Mycoplasma pneumoniae

A

Mycoplasma pneumoniae

  • Extracellular pathogen
  • Lacks cell walls
  • Pleimorphic in shape
  • Smallest organisms that can be free-living in nature and self-replicating on laboratory medium
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24
Q

Mycoplasma pneumoniae is an ______ pathogen and lacks ______

A

Mycoplasma pneumoniae is an extracellular pathogen and lacks cell walls

(pleimorphic in shape)

25
Describe the pathogenesis of Mycoplasma pneumoniae
Mycoplasma pneumoniae tightly adheres to respiratory epithelium via protein adhesin P1
26
Mycoplasma pneumoniae tightly adheres to _______ via \_\_\_\_\_\_\_
Mycoplasma pneumoniae tightly adheres to respiratory epithelium via protein adhesin P1
27
Describe the clinical disease caused by Mycoplasma pneumoniae
Mycoplasma pneumoniae * Person to person spread by airborne small droplets * May cause pharyngitis, rhinorrhea, acute bronchitis, or community-acquired pneumoniae * Causes atypical pneumoniae: gradual onset, cough without sputum, common in young people aged 5-20, usually mild disease (walking pneumoniae), non-lobar on chest radiographs
28
Mycoplasma pneumoniae causes ______ pneumonia
Mycoplasma pneumoniae causes atypical pneumoniae * Gradual onset * Cough without sputum * Common in young people ages 5-20 years * Usually mild disease (walking pneumonia) * Non-lobar infiltrates on chest radiographs
29
Describe the clinical presentation of someone with Mycoplasma pneumoniae
Mycoplasma pneumoniae * Fever * Headache * Malaise * Sore throat * Non-productive cough * Occasionally pneumonia accompanied by neurologic abnormalities (encephalitis), skin rashes, hemolytic anemia
30
Pneumonia accompanied by hemolytic anemia is caused by \_\_\_\_\_\_
Pneumonia accompanied by hemolytic anemia is caused by Mycoplasma pneumoniae
31
Classic CXR pattern of someone with ______ is diffuse reticulonodular or interstitital infiltrates
Classic CXR pattern of somone with Mycoplasma pneumoniae pneumonia is diffuse reticulonodular or interestitial infiltrates (but any pattern can be seen)
32
Describe diagnostic testing for Mycoplasma pneumoniae
Mycoplasma pneumoniae * Cultured from pharynx or sputum - requires sterols for growth * Rise in specific antibody titers in the blood * Cold hemagglutinins may be seen in 50% of patients: antibodies directed against mature RBCs that cause reversible agglutination at 4ºC
33
\_\_\_\_\_\_\_ may be seen in the diagnostic testing of many Mycoplasma pneumoniae patients
Cold hemagglutinins may be seen in the diagnostic testing of many Mycoplasma pneumoniae patients (antibodies directed against mature RBCs that cause reversible agglutinations at 4ºC)
34
Describe the treatment of Mycoplasma pneumoniae
Mycoplasma pneumoniae * Macrolides, tetracycline/doxycycline, quinolones * Penicillins not active (no cell wall)
35
\_\_\_\_\_ are not active against Mycoplasma pneumoniae because they do not have a \_\_\_\_\_\_
Penicillins are not active against Mycoplasma pneumoniae because they do not have a cell wall
36
Describe prevention of Mycoplasma pneumoniae
Mycoplasma pneumoniae * None (no vaccine)
37
Chlamydia pneumoniae is [location]
Chlamydia pneumoniae is obligate intracellular (closely related species are Chlamydia trachomatis which causes STDs and Chlamydia psittaci which causes pneumonia contracted from birds)
38
Describe the clinical disease caused by Chlamydia pneumoniae
Chlamydia pneumoniae * Community-acquired pneumonia: atypical pneumonia * Relatively common (5-20%) cause of pneumonia in young adults * Pneumonia often accompanied by pharyngitis * Chest radiographs resemble those of patients with Mycoplasma pneumonia
39
Describe diagnosis of Chlamydia pneumoniae
Chlamydia pneumoniae * Acute and convalescent antibody titers
40
Describe treatment of Chlamydia pneumoniae
Chlamydia pneumoniae * Macrolides and tetracycline/doxycycline
41
Describe prevention of Chlamydia pneumoniae
Chlamydia pneumoniae * None (no vaccine available)
42
Staphylococcus aureus are [Gram-stain, shape, appearance]
Staphylococcus aureus are Gram-positive cocci that may have a gold appearance * Cause of community-acquired pneumonia and nosocomial pneumonia * MRSA * Treat with nafcillin/oxacillin (vancomycin or linezolid if MRSA)
43
Legionella pneumophila resembles [Gram-stain] but does not take up Gram-stain
Legionella pneumophila resembles Gram-negatives but does not take up gram stain
44
Legionella pneumophila causes \_\_\_\_\_\_\_\_
Legionella pneumophila causes Legionnaire's disease * May be community-acquired or hospital-acquired * Considered an atypical pneumonia * May be quite severe, with high fevers (greater than 40ºC) * Associated with water, air conditioning systems, and cooling towers * Treatment: macrolide or fluoroquinolone
45
Describe aspiration pneumonia
Aspiration pneumonia * Seen in patients with depressed gag reflex: elderly patients, seizures, alcoholic blackouts * Clinical presentation: cough, fever, malaise, foul-smelling sputum * CXR: consolidation on dependent lung fields * Causative organisms are pharyngeal flora: Prevotella, Fusobacterium, anaerobic cocci * May evolve into lung abscesses or empyema
46
Patient has pneumonia with pleuritic chest pain. The causative organism is \_\_\_\_\_\_\_\_
Patient has pneumonia with pleuritic chest pain. The causative organism is Streptococcus pneumoniae
47
Gram-negative rod that is oxidase positive is \_\_\_\_\_\_\_\_
Gram-negative rod that is oxidase positive is Pseudomonas aeruginosa
48
Which organisms can cause ventilator-associated pneumonia?
Ventilator-associated pneumonia * Staphylococcus aureus * Enterobacteriaeceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Serratia spp.) * Legionella pneumophila * Pseudomonas aeruginosa * Acinetobacter baumannii * Mixed anaerobic bacteria * Aspiration pneumonia
49
Describe the Enterobacteriaeceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Serratia spp.)
Enterobacteriaeceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Serratia spp.) * Gram-negative rods * Oxidase negative * Many inhabit the human GI tract * May colonize the oropharynx in hospitalized patients -\> HAP or VAP * Hospital-acquired organisms tend to be resistant to multiple antibiotics
50
Describe Pseudomonas aeruginosa
Pseudomonas aeruginosa * Gram-negative, aerobic bacilli * Common cause of HAP and VAP * Resistant to many antibiotics: must check susceptibilities for definitive treatment regimen
51
Describe Acinetobacter baumannii
Acinetobacter baumannii * Gram-negative, aerobic bacillus or coccobacillus * Causes HAP or VAP * Resistant to many antibiotics * 50% of isolates may be resistant to carbapenems
52
Which organisms caise acute bronchitis/tracheitis?
Acute bronchitis/tracheitis * Streptococcus pneumoniae * Haemophilus influenza * Mycoplasma pneumoniae * Chlamydia pneumoniae * Bordetella pertussis
53
Describe Bordetella pertussis
Bordetella pertussis * Tiny gram-negative coccobacilli, strict aerobe * Cause of whooping cough * Secretes pertussis toxin * Historically a disease of children but recently outbreaks among adults have been repoted
54
Describe Corynebacterium diphtheria
Corynebacterium diphtheria * Gram-positive bacilli, club-shape * Diphtheria toxin (DT): ADP-ribosylating EF-2 * Causes diphtheria: patients (historically children) present with sore throat and fever, difficulty swallowing, cough, hoarseness, rhinorrhea - oropharyngeal pseudomembrane may lead to airway obstruction
55
Oropharyngeal ______ is characteristic of CCorynebacterium diphtheria infection
Oropharyngeal pseudomembrane is characteristic of Corynebacterium diphtheria infection (may lead to airway obstruction)
56
Gram-positive cocci causing alpha-hemolysis: \_\_\_\_\_\_\_\_
Gram-positive cocci causing alpha-hemolysis: Streptococcus pneumoniae
57
Atypical pneumonia, hemolytic anemia, neutrophils and no growth on sputum: \_\_\_\_\_\_\_
Atypical pneumonia, hemolytic anemia, neutrophils and no growth on sputum: Mycoplasma pneumoniae
58
Air conditioner repair man, high fever, CXR shows bilateral patchy infiltrates, no growth on culture: \_\_\_\_\_\_\_
Air conditioner repair man, high fever, CXR shows bilateral patchy infiltrates, no growth on culture: Legionella pneumophila
59
Homeless, blood-tinged sputum, weight loss, right upper lobe rhonchi: \_\_\_\_\_\_\_\_\_
Homeless, blood-tinged sputum, weight loss, right upper lobe rhonchi: Mycobacterium tuberculosis

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