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PHARM 232 Final > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

What are typical vs atypical bacteria causes of pneumonia

A

Typical
- S. pneumo, H. influ, Staph. Aureus, GAS, M. cat, aerobic gram-negative bacteria (Acinobacteria)

Atypical (not severe, can still walk)
- legionella (gram-neg)
- Mycoplasma pneumo
- Chlamydia pneumo

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2
Q

What are characteristics of S. pneumo
Gram?
Shape?
Hemolytic?
Capsule?

A
  • Gram-positive
  • Cocci in pairs/short chains
  • Alpha-hemolytic
  • Polysaccharide capsules (virulent serotypes only)
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3
Q

Which bacteria is one of the most important causes of pneumo?

A

Staph aureus especially MRSA

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4
Q

H. influ characteristics?
Gram?
Shape?
Capsule that causes pneumo?
Requires?

A
  • Gram-negative
  • coccobacilli
  • non-typeable h. influ causes penumonia
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5
Q

Klebsiella pneumonia characteristics
Family?
Gram?
Found where?
Who it affects?
Symptoms?
Lactose fermenter?
Capsule?

A

Family? Enterobacteriacae
Gram? Negative
Found where? Normal flora, mouth, skin
Who it affects? diabetes, alcoholism (people with debillating diseases)

Symptoms?
- alveoli destruction –> thick/bloody sputum

Lactose fermenter?
- Yes

Capsule: yes

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6
Q

Pseudomonas aeruginosa
Gram?
Who does it affect?
Shape?
Virulence factors?

A
  • Gram-negative
  • Opportunistic pathogen
  • Shape: Rod-shpaed (bacillus)
  • Virulence factors (BAPE PO)
    Biofilm formation from exopolysaccharide
    Pili
    Endotoxin
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7
Q

Legionella Pneumophilia
Gram?
Aerobic/anaerobic?
Environment
Fastidious?
Disease?

A

Gram? Negative
Aerobic/anaerobic? Anaerobic
Environment? Needs w/ iron L-cysteine
Fastidious
- Pontiac fever

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8
Q

Mycoplasma pneumoniae
Shape, cell type?
Symptom?
Virulence?
Biggest organism? T/F

A

Shape, cell type?
- no cell wall
- pleomorphic cells (can change shape)

Symptom?
- “walking pneumo”

Virulence?
- specific adhesion protein

Biggest organism? F
- smallest organism that can be free living in nature and self-replicating

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9
Q

Chlamydophila pneumoniae
Cell wall characteristics? (4)
Shape it forms?
STD?
Disease it caused?
Symptoms?
How does it reproduce?

A

Cell wall characteristics?
- high lipid content
- rigid, no peptidoglycan (but contains the genes to make it)
- plays role in cell division
- Has lipopolysaccharide LPS

Shape?
- form elementary bodies –> infectious, resistant

STD? NO
Diseases it caused?
- bronchitis, pneumonia, sinusitis

Symptoms? Malaise, cough

How does it reproduce?
- must infect another cell (obligate intracellular pathogen)

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10
Q

What are major risk for opportunistic pneumonia (3)

A
  • AIDS
  • long-term corticosteroid
  • Anything that suppresses the immune system
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11
Q

Mycobacterium tuberculosis characteristics
Aerobic/anaerobic?
Spore/non-spore forming
Cell wall characteristic?
Affects who?
Symptoms?

A

Aerobic/anaerobic?
- Aerobic

Spore/non-spore forming
- Non-spre forming

Cell wall characteristic?
- ACID FAST: cell wall that has a lot of lipid called mycolic acids

Affects who?
- immunocompromised NOT healthy people

Symptoms?
- Coughing, chest pain, weakness, weight loss

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12
Q

What is the staining technique for M. tuberculosis and acid-fast bacteroa? What are the steps?

A

Ziehl-Neelsen technique
1. Apply primary stain of carbolfuschin for 30 seconds
2. Heat fix cells to the slide using flame
3. Decolorize with acid alcohol for 15-20 seconds
4. Apply counterstain of methylene blue for 30 seconds then rinse excess stain

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13
Q

which pathogens are NOT likely in children in community acquired pneumonia? and NOT atypicals?

A

M. catt
staph auerus

Atypicals?
legionella

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14
Q

which pathogens are NOT likely in adults in community acquired pneumonia? and NOT atypicals?

A

staph auerus

Atypical?
legionella

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15
Q

When does hosptial-acquired pneumo develop HAP?

A

48+ hrs after hosptial admission

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16
Q

When does ventilator-acquired pneumo develop VAP?

A

after 48-72 hrs after intubation

17
Q

When does healthcare-associated pneumo develop HCAP? (3)

A

Must have all the following
- hospitalized for 2+ days within the last 90 days
- Resided in nursing or LTC
- In last 30 days, received IV antibiotic, chemotherapy or wound care>

18
Q

which bacterias are the leading cause of HAP VAP & HCAP (3)

A
  • gram-negative aerobic bacilli (acinobacteria)
  • Staph aureus esp. MRSA
  • Multidrug resistant pathogens
19
Q

What are challenges for lab diagnosis of CAP

A

Hard to narrow the pathogen of CAP to 1 microbe

20
Q

Is CAP causative agents required for outpatients? What are indications for extensive diagnosting tests? (2)

A

No

Indication
- if the result of the diagnostic test is likely to change individual antibiotic management
- to detect reportable infections or ones that may lead to outbreak

21
Q

Who is blood culture tests indicated for? (3)

A
  1. Patients with host factors that make it DIFFICULT TO CLEAR BACTEREMIA
  2. Patients who require hospitaliztion due to moderate or severe bacterial CAP
  3. Children who fail to show improvement
22
Q

What are advantages of blood culture (3)? What are limitations?

A

Adv
- Specific daignosis
- Increased potential to affect antibiotic management
- Provide data on causative agent

Limitations
- cant detect mycoplamsa pneumo and viral causes
- False negatives
- If had prior antibiotic therapy = less positive results
- False positives: due to contamination of blood culture

23
Q

What presence of sputum suggests heavy contamination from saliva in the sputum sample?

A

Presence of many squamous epithelial cells/low-power field (10+ cells, 100x field)

24
Q

What suggests a purulent exudate in a sputum sample?

A

A large number of polymorphonuclear leukocytes (25+)

25
Q

What are advantages of sputum sample (3)? Limitations?

A

Adv?
- Gram stain results help in preliminary diagnosis
- Gram stain results validate subsequent culture results
- Antibiotic sensitivity testing can be performed if culture results are available

Limitations
- Prior antibiotic treatment
- Gram stain affected by many factors
- False positive due to contamination with saliva and ORAL flora
- Children usually can’t produce good sputum

26
Q

Who are endotracheal aspirate for?

A
  • For adult patients intubated with severe CAP
  • gram-stain and culture, viral testing
27
Q

Advantages (2) and disadvantages (1) of endotracheal aspirate gram stain & culture?

A

Advantages
- does not require patient cooperation
- clearly a lower resp. tract specimen

Limitation
- False positive: catheter may be contaminated with other microorganisms from the tube or trachea

28
Q

Advantages (3) and disadvantages (2) of s. pneumo urinary antigen tests

A

Adv
- Rapid (15 min), simple
- can detect pneumococci AFTER ABX
- Very SPECIFIC (negatives are negatives)

Limitations
- No susceptibility data
- False positives due to nasopharyngeal colonization or extrapulmonary infection

29
Q

Legionalla pneumophilia serogroup antigen tests
Explain a positive test?
Advantage?
Disadvantage?

Children?

A

Positive test on day 1 and stays positive for weeks

Adv
- VERY SPECIFIC

Disadv
- Detects only 1 group

RARE IN CHILDREN

30
Q

What tests are for immunocomprimised patients, patients with CAP with failed therapy, and children with severe CAP if initial test is not positive (2)

A
  • Transthoracic lung aspiration
  • Bronchoalveolar lavage (BAL)
31
Q

If mycobacteria is suspected what test do you do?

A

Acid-fast stain

32
Q

What test do you if fungal infection is suspected?

A

10% potassium hydroxide

33
Q

What bacteria is PCR test kind of useful for?

A

Legionella pneumophilia

PHARM 232 Final (5 decks)

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