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4 - Y5 a Path lectures 2021/22 > Microbiology 7s: RTIs > Flashcards

Microbiology 7s: RTIs Flashcards

1
Q

What is pneumonia? Sx?

A
  • inflammation of alveoli
  • Sx:
    • fever
    • cough
    • SOB
    • pleuritic chest pain
    • abnormal CXR
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2
Q

Classification of pneumonia?

A
  • Community acquired
    • typical
    • atypical
  • Hospital-acquired = >48hrs since admission / artificial ventilation
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3
Q

What are the main organisms associated with pneumonia?

A

CAP:

  • ** Streptococcus pneumoniae
  • ** Haemophilus influenzae
  • Moraxella catarrhalis

HAP:

  • ** Staphylococcus aureus
  • Klebsiella pneumoniae

** = more common

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4
Q

Most common organisms causing CA pneumonia in 0-1 month

A
  • Escherichia coli,
  • Group B Streptococcus,
  • Listeria monocytogenes
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5
Q

Most common organisms causing CA pneumonia in 1-6 months

A
  • Chlamydia trachomatis,
  • Staphylococcus aureus,
  • RSV
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6
Q

Most common organisms causing CA pneumonia in 6months-5yrs

A
  • Mycoplasma pneumoniae,
  • Influenza
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7
Q

Most common organisms causing CA pneumonia in 16-30yrs

A
  • Mycoplasma pneumoniae,
  • Streptococcus pneumoniae
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8
Q

What are the causes of typical CAP?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
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9
Q

Main causes of atypical CAP?

A
  • Legionella pneumophilia
  • Mycoplasma pneumoniae
  • Coxiella burnetii (Q fever)
  • Chlamydia psittaci (Psittacosis)
  • Mycobacterium tuberculosis

All gram -tive, except TB

non-TB: none have cell wall →

Cell-wall active antibiotics (e.g. penicillins) do NOT work → so need agents that work on protein synthesis:

  • Macrolides (clarithromycin/erythromycin)
  • Tetracyclines (doxycycline)
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10
Q

Ix for ?pneumonia?

A
  • Bloods: FBC, U&Es, CRP → blood culture
  • Sputum MC&S
  • ABG
  • CXR
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11
Q

What is the CURB 65 score?

A
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12
Q

Most DDx for pneumonia in pre-existing lung disease?

A

Haemophilus influenzae

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13
Q

CXR: ground glass shadowing. DDx?

A
  • bats wing = PCP
  • general = COVID
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14
Q

CT shows ground glass opacities. DDx?

A

Haemophilus influenzae

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15
Q

neonate with pnuemonia + sepsis. DDX?

A

Group B Streptococcus

Listeria monocytogenes

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16
Q

Pneumonia + hypoNa, abnormal LFTs. DDx?

A

Legionella pneumophilia

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17
Q

Urinary antigens +tive. DDx?

A

Legionella pneumophilia

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18
Q

Pneumonia + transverse myelitis + Otitis media + Bullous myringitis.

DDx?

A

Mycoplasma pneumoniae

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19
Q

pneumonia + hepatitis. DDx?

A

Coxiella burnetii (Q fever) - farm animals

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20
Q

Pneumonia + haemolytic anaemia, splenomegaly, rash. DDx?

A

Chlamydia psittaci

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21
Q

CXR: upper lobe/apical consolidation. DDx?

A

Mycobacterium tuberculosis

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22
Q
  • Red rods acid-fast bacilli
  • Culture: Lowenstein-Jenson medium → Auramine stain (screening) + Ziehl-Neelsen stain (diagnosis)
  • EBUS → histology – i.e. caseating granuloma

DDx?

A

Mycobacterium tuberculosis

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23
Q

CXR halo sign. DDx?

A

aspergillus (fungal)

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24
Q

Cough + SOBOE. DDx?

A

PCP

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25
Q

pneumonia + silver stain. DDx?

A

PCP

26
Q

Tx of Streptococcus pneumoniae

A

PO Amoxicillin/IV benzylpenicillin

If penicillin allergy:

PO Clarithromycin/IV cefuroxime, cefotaxime, ceftriaxone

27
Q

Tx Haemophilus influenzae

A

Non-beta-lactamase-producing: PO/IV Amoxicillin

Beta-lactamase-producing:

PO/IV Co-amoxiclav

If penicillin allergy: IV cefuroxime, cefotaxime, ceftriaxone

28
Q

Tx Moraxella catarrhalis

A

PO Amoxicillin/IV benzylpenicillin

If penicillin allergy:

PO Clarithromycin/IV cefuroxime, cefotaxime, ceftriaxone

29
Q

Tx Group B Streptococcus

A

Benzylpenicillin /ampicillin + gentamycin (10 days)

If penicillin allergy: Vancomycin / clarithromycin

30
Q

Tx. Legionella pneumophilia

A

Ciproflaxin/Clarithromycin

31
Q

Tx Mycoplasma pneumoniae

A

azithromycin

32
Q

Tx

Coxiella burnetii (Q fever)

A

PO Doxycycline/IV Clarithromycin

33
Q

Tx Chlamydia psittaci

A

PO Doxycycline/IV Clarithromycin

34
Q

Tx Mycobacterium tuberculosis

A

RIPE

  • Rifampicin 6m
  • Isoniazid 6m
  • Pyrazinamide 2m
  • Ethambutol 2m
35
Q

tx Staphylococcus aureus

A

Non-MRSA: IV Flucloxacillin

MRSA: IV Vancomycin

36
Q

tx Pseudomonas auroginosa

A

IV Ceftazidime/Ciprofloxacin + IV gentamycin

37
Q

Tx Klebsiella pneumoniae

A

IV Ceftazidime/Ciprofloxacin

38
Q

Tx aspergillosis

A

Amphotericin B

39
Q

Tx influenza?

A

oseltamivir

40
Q

Tx COVID

A

dexamethasone

41
Q

Tx PCP?

A

co-trimoxazole

42
Q

Summarise Streptococcus pneumoniae

A
  • 50% of CAP
  • RFs: young & old more at risk of invasive
  • Gram +tive cocci
  • Ix:
    • MC&S:
      • 5% CO2,
      • blood agar
    • CXR:
      • Lobar/apical consolidations
      • Double heart border (‘Sail’ sign)

PO Amoxicillin/IV benzylpenicillin

If penicillin allergy:

PO Clarithromycin/IV cefuroxime, cefotaxime, ceftriaxone

43
Q

Summarise Haemophilus influenzae

A
  • 40% of CAP
  • RFs: more common in pre-existing lung disease e.g., COPD
  • Gram -tive coccobacilli
  • Ix:
    • MC&S: chocolate agar
    • CXR:
      • Cavitating lesions
    • ~CT:
      • ground glass opacities

Non-beta-lactamase-producing:

PO/IV Amoxicillin

Beta-lactamase-producing:

PO/IV Co-amoxiclav

If penicillin allergy:

IV cefuroxime, cefotaxime, ceftriaxone

44
Q

Summarise Moraxella catarrhalis

A
  • Small cause of CAP
  • RFs: Older age, immunocompromised
  • Gram -tive diplococcus
  • Ix:
    • MC&S:
      • blood agar → honey puck sign
    • CXR:
      • Lobar consolidations rare

Mx: Same as strep pneumoniae

45
Q

Summarise Group B Streptococcus

A
  • Small cause of CAP
  • RFs: Neonates, (<1month), older age, DM immunocompromised, lines, catheter
  • Gram +tive, beta-haemolytic, cocci
  • Sx:
    • Normal pneumonia Sx
    • ~ meningitis
    • ~ sepsis
    • ~ septic arthritis
  • Ix:
    • MC&S:
      • blood agar
    • CXR;
      • lobar consolidation
      • neonates: diffuse infiltrates

Benzylpenicillin /ampicillin + gentamycin (10 days)

If penicillin allergy: Vancomycin / clarithromycin

46
Q

Summarise Legionella pneumophilia

A
47
Q

Summarise Mycoplasma pneumoniae

A
48
Q

Summarise Q fever

A
49
Q

Summarise Chlamydia psittaci

A
50
Q

Summarise Mycobacterium tuberculosis

A
51
Q

Summarise E coli

A
  • 30% of HAP
  • RFs: younger age (0-1 months)
  • Gram -tive bacilli
  • CXR: Lower lobe consolidation
  • Tx:
52
Q

Summarise Staphylococcus aureus

A
  • More common in 1-6months
  • Gram +tive
  • CXR: Cavitating lesions

Non-MRSA: IV Flucloxacillin

MRSA: IV Vancomycin

53
Q

tx for Pseudomonas auroginosa

A

IV Ceftazidime/Ciprofloxacin + IV gentamycin

54
Q

Summarise Klebsiella pneumonia

A
  • More common alcoholics/DM
  • Gram -tive
  • CXR: Cavitating lesions

IV Ceftazidime/Ciprofloxacin

55
Q

Summarise aspergillus

A
  • Fungal
  • RFs: immmunocompromised
  • special Sx:
    • haemopytsis
    • ‘asthma’
  • CXR: halo sign
  • Tx: amphotericin B
56
Q

Summarise influenza

A
  • viral
  • RFs: extremes of ages, unvaccinated
  • special Sx: myalgia
  • Tx: oseltamivir
57
Q

Summarise COVID

A
  • viral
  • RFs: unvaccinated
  • Special Sx: anosmia
  • CXR: ground glass shadowing
  • Tx: dexamethasone
58
Q

Summarise PCP

A

CXR: ground glass shadowing

59
Q

Main difference between bronchitis & pneumonia

A

Bronchitis:

  • Mainly smokers
  • CXR normal
60
Q

Main causes of bronchitis?

A
  • Viruses
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
61
Q

tx of bronchitis?

A

§ Bronchodilation

§ Physiotherapy

§ Antibiotics

62
Q

74yo woman

SOB, fever (38.5C), right-sided pleuritic chest pain, reduced percussion note & decreased air entry right base

PMHx IHD, CABG, AF; DHx warfarin Otherwise well

Admitted → commended on cefuroxime and doxycycline → continued to spike fevers

CXR → homogenous shadowing with meniscus level of right side

NEXT STEP? DIAGNOSIS?

A
  • CT
  • empyema

These are difficult to treat because they have a wall around them and the pus itself is very acidotic which

→ inactivates the antibiotics →hence why she continued to spike fevers even on ABx

4 - Y5 a Path lectures 2021/22 (37 decks)

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