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Flashcards in Diseases, Clinical Presentation, Time Course, Signs, Symptoms Deck (113)
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1

Streptococcus pneumonia (pneumococcus)
Disease

**CA pneumonia**
meningitis, sinusitis,
otitis media, sepsis
sometimes endocaridtis

(most common cause of
meningitis unless
outbreak of Neisseria
meningitidis, most
common cause of OM
and sinusitis, most common
cause of CA pneumonia)

2

Streptococcus pneumonia (pneumococcus)
Time Course

...

3

Streptococcus pneumonia (pneumococcus)
Signs

Pneumonia: diminished respiratory
excursion on affected side (due to
pleuritic pain); crackles, inc. fremitus
rust-colored sputum, shaking chills
pleural effusion in 40% pts

Meningitis: inflammation& swelling of
meninges& brain tissue;
babies may be irritable, high-pitched
cry, stiff or floppy, bulge over fontanelle;
drowsy, confused, delirious; seizures,
loss of consciousness

4

Streptococcus pneumonia (pneumococcus)
Symptoms

Pneumonia: cough, fatigue, fever,
chills, sweats, SOB. (esp in young
pts); appear ill, grayish, anxious;

Meningitis: headache, stiff neck,
sensitivity to bright lights (all due
to increased pressure on brain);

5

Corynebacterium diphtheria
Disease

Diptheria

Pseudomembrane lesion

Toxin in blood-->damage to
organs, esp. heart

6

Corynebacterium diphtheria
Time Course

...

7

Corynebacterium diphtheria
Signs

Neck Swelling in severe disease

8

Corynebacterium diphtheria
Symptoms

Respiratory Diptheria: sore throat,
low-grade fever, adherent psudo-
membrane of tonsils, pharynx, or throat
Pseudomembrane: sore throat,
lymphadenitis
Cutaneous diptheria: infected skin lesions
which lack a characteristic appearance

9

Acinetobacter baumannii
Disease

pneumonia: esp if in ICU on
ventilator
blood infection: catheter in
vein; spreads from primary
infection
meningitis: after surgery on
brain/spine; shunts/drains
UTI:
respiratory infections
Skin/wound infection

10

Bordetella pertussis
Disease

Pertussis (Whooping Cough)
(respiratory illness)

11

Francisella tularensis
Disease

Tularemia
("Rabbit Fever")
6 Forms:
typhoidal,
pneumonic,
oculoglandular
oropharyngeal,
ulcerogladular,
glandular

12

Yersina pestis
Disease

Plague
(Bubonic plague= most
common natural form of
plague)

Secondary plague pneumonia
(follows bubonic plague; rare)
contagious!!!
Primary plague pneumonia
(bioterrorist attack form)

13

Brucella spp.
Disease

Brucellosis
(undulant fever)

14

Coxiella burnetii
Disease

Q fever

15

Chlamydia
Disease

Atypical (Walking) Pneumonia
Chlamydia pneumoniae
mild, 7-21 day incubation
accounts for 6-10% CA-pneum

Psittacosis (parrot fever)
(caused by Chlamydia psittaci)

Ocular, Respiratory, and
Genital tract infections
(Chlamydia trachomatis)
Trachoma (conjunctiva infection)
Genital (even cervical squamous
cell carcinoma)
Neonatal pneumonia (etc.)
Neonatal inclusion conjunctivitis
Lymphogranuloma venereum (LGV)
Serious Pneumonia

16

Legionella pneumophilia
Disease

Atypical Pneumonia
(Walking Pneumonia)

(Legionaires' disease)

Pontiac fever
(milder illness caused by L.
pneumophilia also)

17

Mycoplasma
(M. pneumoniae)
Disease

Primary Atypical Pneumonia
(Walking Pneumonia)
M. pneumoniae
5-10% of all CA pneumonias
15-50% of pneumonias observed
in school children/young adults

Nonspecific (nongonococcal)
urethritis (Ureaplasma urealyticum)

Postpartum fever
Pelvic Inflammatory Disease
(both caused by M. hominis)

18

Mycobacterium bovis
Disease

TB in cows and rarely humans

19

Mycobacterium avium
Disease

TB-like disease prevalent in AIDS
pts

20

Mycobacterium leprae
Disease

leprosy

21

Mycobacterium tuberculosis
Disease

TB

recognize difference b/w infection
and disease.
Only 3-4% of infected individuals will
develop active disease upon initial
infection. 5-10% w/in one year (more
likely if HIV+)

Usually host will control infection
so that it will not progress to disease
or it won't progress through all stages

22

Nocardia Asteroides Complex
Disease

Nocardiosis
(opportunisitic infection)
usually presents as pulmonary

Can present as local abscess if
traumatically induced

If dissemination from lungs-->
bacteremia, empyema, brain abscess
pericarditis, synovitis, soft tissue
infection

Peritonitis and corneal ulcers

23

Actinomyces israelii Complex
Disease

Actinomycosis
(Chronic bacterial disease)

infections of oral and cervicofacial
regions=most common

thoracic, abdominopelvic, CNS regions
can be involoved

Pulmonary actinomycosis
Facial actinomycosis
Jaw actionmycosis ("Lumpy jaw")
GI infections

24

Bordetella pertussis
Clinical Presentation

Rarely more than debilitating annoyance
for adolescents and adults (may never
experience classic cough), but if
untreated, persistent coughing lasts for
7 weeks

Divided into 3 stages: Catarrhal,
Paroxysmal, Convalescent

May have atypical presentation in
infants and children who've been
vaccinated

25

Francisella tularensis
Clinical Presentation

Mimics many other diseases

26

Yersina pestis
Clinical Presentation

If exposure via flea:
bubonic…25% progress to septicemia…
leads to secondary pneumonic plague
with septicemia (100% fatal if left
untreated)

If exposure via bioterrorism:
Primary pneumonic plague first…
then septicemia

27

Brucella spp.
Clinical Presentation

Symptoms often confused w/ TB, but
rarely involves the lungs

Slow moving, chronic infection; but
initial infection can be acute

may go on for several yrs before treated

Long term sequelae sometimes:
hepatitis, endocarditis

28

Coxiella burnetii
Clinical Presentation

One-third to one-half asymptomatic

Acute febrile illness, atypical pneumonia
(lasts 2-4 wks);
Sometimes liver and heart involvement;
Long-term chronic infections=rare,
but may lead to endocarditis or
granulomatis hepatitis

29

Chlamydia
Clinical Presentation

hallmark of chlamydial infection:
most cases have mild to no apparent
clinical disease, while some have
severe

Pneumonia also assoc w/
sinusitis, pharyngitis, bronchitis,
exacerbated asthma, coronary heart
disease?

(interaction of serum lipoprotein w/
circulating C. pneumoniae immune
complexes-->atherosclerosis)

cause of 35-50% nongonococcal urethritis
in men; common cause of cervicitis, PID, &
sterility in women
**All three serotypes can-->systemic (hemotagenous spread)

30

Legionella pneumophilia
Clinical Presentation

usually single, isolated cases--NOT cluster of
cases

Pontiac Fever usually milder disease and
passes in 2-5 days

31

Mycoplasma
(M. pneumoniae)
Clinical Presentation

mild respiratory infections w/ sore throat and
pharyngitis in the 1-5yr old group w/ primary
atypical pneumonia


Upper and lower respiratory illness in all age
groups

32

Actinomyces israelii Complex
Clinical Presentation

Localized swelling w/ suppuration, abscess
formation, tissue fibrosis, draining sinuses

33

Histoplasma capsulatum
Clinical Presentation

95% of infections are asymptomatic or lead
to cough and fever

minority of infections-->chronic and relapsing
pneumonia that resembles TB

Fatality rate w/ untreated systemic disease=
80% (25% if treated)

(flu like symptoms at first)

34

Acinetobacter baumannii
Time Course

...

35

Bordetella pertussis
Time Course

...

36

Francisella tularensis
Time Course

...

37

Yersina pestis
Time Course

...

38

Brucella spp.
Time Course

...

39

Coxiella burnetii
Time Course

...

40

Chlamydia
Time Course

incubation period of C. pneumoniae
is 3-4 wks
gradual onset (may be biphasic)
symptoms of bronchits or pneumonia
may follow URI symptoms (i.e. rhinitis,
laryngitis, pharyngitis, sinusitis) in
1-4 wks

41

Legionella pneumophilia
Time Course

symptoms usually begin 2-14 days
after exposure

Pontiac fever: symptoms last for 2-5
days

42

Mycoplasma
(M. pneumoniae)
Time Course

Gradual, insidious onset of several
days to weeks

incubation period about 3 wks
(in contrast to viral pneumonias, which
average few days)

43

Mycobacterium tuberculosis
Time Course

Slow generation time (15-20 hrs)

Stage 2 begins 7-21 days after intial
infection

44

Nocardia Asteroides Complex
Time Course

...

45

Actinomyces israelii Complex
Time Course

...

46

Fungal Infections in General
Time Course

...

47

Histoplasma capsulatum
Time Course

...

48

Blastomyces dermatitidis
Time Course

...

49

Coccidioides immitis
Time Course

...

50

Aspergillosis
Time Course

...

51

Mucormycosis
(Zygomycetes fungi:
Absidia, Rhizopus, Mucor Species)
Time Course

...

52

Acinetobacter baumannii
Signs

Fever
Red, swollen, warm, painful skin areas
orange, bumpy skin w/ blisters
Cough

53

Brucella spp.
Signs

Typical lesion on biopsy (bone/liver) is
granuloma

54

Chlamydia
Signs

pharyngeal erythema w/out exudate
rhonchi and rales (even in mild disease)

55

Legionella pneumophilia
Signs

high fever, chills, cough

56

Nocardia Asteroides Complex
Signs

Cutaneous Nocardiosis:
ulcers or nodules
chronic infection-->draining tracts

57

Actinomyces israelii Complex
Signs

sulfur granules

58

Acinetobacter baumannii
Symptoms

Chest pain
Dyspnea
burning feeling while urinating
sleepiness
headaches
stiff neck

59

Bordetella pertussis
Symptoms

Early symptoms (last for 1-2 wks):
Runny nose, low-grade fever, mild cough,
apnea (in infants)
Catarrhal: similar to "common cold"
mild cough gradually increases (see above)
Paroxysmal: cough persists and incr…
paroxysmal attacks…classic cough
(long series w/ gagging&cyanosis, whooping)
2-6 wks; complications most likely this stage
Convalescent: cough subsides over wks and
months; episodic cough may reappear w/
subsequent URIs

60

Francisella tularensis
Symptoms

fever, chills, joint and muscle pain,
headache, weakness, pneumonia-->
chest pain, bloody sputum, dyspnea
Ulcerglandular tularemia (most common):
skin ulcer@site of infection, swollen&pain-
ful lymph glands; fever; chills; headache;
exhaustion
Glandular tularemia: same as ulceroglandular
except no skin ulcers
Oculoglandular tularemia: eye pain, eye redness,
eye swelling and discharge; ulcer on inside eyelid
Oropharyngeal tularemia: (digestive tract); fever
sore throat; vomiting; diarrhea
Pneumonic tularemia: pneumonia signs&symptoms

61

Yersina pestis
Symptoms

Bubonic: (60% fatality if untreated);
initial infection from flea bite (1-8 day incubation)
swollen painful axial/inguinal, femoral lymphnode
fever, chills, headache, nausea, vomiting, prostration
ulcerous/macular lesion possibly @site of flea bite
(not as prominent as in tularemia/anthrax)
Septicemic: (w/ or w/out buboes); rapid progression,
severe toxemia & general organ failure; vomiting,
diarrhea; petechiae to extreme DIC
Pneumonic: (100% fatal if not treated); Secondary
pneumonic will include septicemia; dissemination
from primary infection; productive sputum more
bloody and watery than purulent; necrotic

62

Brucella spp.
Symptoms

Flu symptoms w/ high fever
Relapsing fever (nocturnal w/ night sweats)
weakness, generalized symptoms (back ache, etc.)
weight loss, fatigue

Can be localized… infects bones (esp. lower vertebrae)
liver, heart, GI, and genitourinary tracts (orchitis)

If inhaled aerosols….dry cough, pleuritic pain (CXR
might be negaitve); expected course if bioterrorism

63

Legionella pneumophilia
Symptoms

similar to many other forms of pneumonia
high fever, chills, cough
muscle aches and headaches sometimes


Pontiac fever: fever, headaches, muscle aches
WITHOUT Pneumonia!

64

Mycoplasma
(M. pneumoniae)
Symptoms

Fever
Malaise
Persistent, slowly worsening dry cough
(absence of cough makes Dx unlikely)
headache
chills, not rigors
scratchy sore throat
sore chest and tracheal tenderness (due to cough)
pleuritic chest pain (rare)

65

Nocardia Asteroides Complex
Symptoms

Pulmonary nocardiosis:
blood in sputum
fever
night sweats
weight loss
chest pain accompanying ventilation

Cerebral nocardiosis:
headache
confusion
general lethargy
dissipating neuro function
seizures

66

Actinomyces israelii Complex
Symptoms

Chest pain when taking deep breath
Cough w/ sputum
Fever
Lethargy
night sweats
shortness of breath
weight loss

67

Histoplasma capsulatum
Symptoms

fever
night sweats
weight loss

In immunodeficient individuals/infants:
disseminated disease…renal failure, CNS effects (i.e.
meningitis, encephalitis)
In AIDS:
abdominal masses/ ulcers

68

Coccidioides immitis
Symptoms

fever
arthralgia
fatigue
rash
(fatigue can last for wks/months)

69

Aspergillosis
Symptoms

life-threatening hemoptysis

70

Influenza viruses
Symptoms

Chills
fever (can be very high in infants-->convulsions, nausea
vomiting, abdominal pain)
headache
weakness/fatigue
muscle pains
general discomfort, body aches
runny or stuffy nose
sore throat
dry cough

fever may be absent in elderly/immunocompromised
pts (as well as other systemic symptoms)

Symptoms of complications:
viral pneumonia: preceding flu syndrome-->worsening
cough, tachypnea, increasing dyspnea, sometimes
bloody sputum
Secondary bacteria pneumonia: typical episode of flu
w/ recovery-->recurrence of fever, increased respiratory
symptoms, productive cough, purulent sputum, dyspnea

71

Rhinoviruses
Symptoms

dryness/irriation of nose
sore throat
rhinorrhea
nasal congestion
sneezing
headache
facial & ear pressure
loss of smell and taste
Sometimes cough, sometimes hoarseness for up to wk

Fever and malaise and other systemic symptoms are
usually ABSENT
(consider other diagnosis if present)

72

Adenovirus
Symptoms

Respiratory: Cough, fever, runny nose, watery eyes,
sore throat

Ocular:
"sand" in eye, fever, runny nose, sore throat

GI:
Diarrhea, fever, nausea, vomiting, blood in urine
(cystitis)

73

Coronaviruses
Symptoms

Cold Symptoms (runny nose, sore throat, cough, head-
ache, fever, chills, etc.)
Enteric infection: (occasionally, mostly in infants< 1yo)
nausea, vomiting, diarrhea
Neurological syndromes (rare)
SARS:
Fever is first symptom
flu-like symptoms
Dry cough, SOB, hypoxia
Respiratory failure in 20% of pts
GI symptoms
Lymphopenia

74

Respiratory Syncytial Virus (RSV)
Symptoms

In adults: rhinorrhea, cough, headache, fatigue, fever

Initial URT symptoms:
similar to common cold w/ progression rapidly in 1-2 days

LRT disease
Low-grade fever
Cough
tachypnea
polyphonic wheezing
rales
cyanosis
retractions
sepsis-like presentation/ apneic episodes in very young

May have associated OM (viral OR bacterial)
Also should assess infant's hydration status

75

Human Metapneumovirus (hMPV)
Symptoms

Broad spectrum, from mild-->severe

Similar to RSV, but may include:
high fever
myalgia
rhinorrhea
dyspnea
tachypnea
wheezing

May exacerbate asthma or COPD
OM
pneumonitis
flu-like illness
CA pneumonia

76

Human Parainfluenza viruses 1-4 (hPIVs)
Symptoms

fever
nasal congestion
pharyngeal erythema
nonproductive or minimally productive cough
(or cough that may develop into croup…high-pitch, seal-
like barking cough w/ stridor)
hoarseness

If hPIV3 involved, symptoms worsen, bronchiolitis and/
or pneumonia may develop

77

Hantavirus Pulmonary Syndrome (HPS)
Symptoms

1st Stage:
Fever and chills
headaches
muscle aches
vomiting, diarrhea, abdominal pain
sometimes cough, usually dizziness
tachycardia
tachypnea
Usually ABSENT:
signs of viral URI (i.e. rhinorrhea and pharygitis)

2nd Stage:
A cough w/ secretions
SOB
Fluid accumulating in lungs
Low blood pressure
Reduced heart efficiency
Symptoms may worsen suddenly as lungs fill w/ fluid

"feels like tight band around my chest and pillow
over my face"

78

Histoplasma capsulatum
Disease

Histoplasmosis

79

Blastomyces dermatitidis
Disease

Blastomycosis

80

Coccidioides immitis
Disease

Coccidioidomycosis
(Valley Fever)

81

Aspergillosis
Disease

Aspergillosis

Seen as allergic sinusitis and allergic
bronchopulmonary aspergillosis
(ABPA)
… in asthma and CF pts

Seen as invasive pulmonary infection
in immunocompromised pts
(Invasive aspergillosis can spread
beyond lung-->CNS)

82

Mucormycosis
(Zygomycetes fungi:
Absidia, Rhizopus, Mucor Species)
Disease

Mucormycosis
zygomycosis

fungal pneumonia
invasive rhinocerbral

83

Pneumocystic jerovici (carinii)
Disease

Pneumocystic pneumonia (PcP)

84

Influenza viruses
Disease

Influenza

85

Rhinoviruses
Disease

Common Cold

86

Adenovirus
Disease

Respiratory infection
Eye infection
GI tract infection

Acute febrile disease, pharyngitis, or
pharyngoconjunctival fever
Bronchitis/bronchiolitis
Croup
Pneumonia
Acute Respiratory Disease (sero. 4& 7)
Conjunctivitis
Epidemic keratoconjunctivitis
Acute hemorrhagic cystitis
Acute gastro enteritis (sero. 40& 41)
Obesity? (serotypes 36& 37)

87

Coronaviruses
Disease

Respiratory infections
enteric infections

Common cold (15-395 common cold
cases in winter and early spring)

Croup in young children

Exacerbations of asthma and chronic
bronchitis

Pneumonia occasionally (infants,
elderly, immunocompromised)

SARS
(can lead to systemic disease-->
GI tract, liver, kidney, brain, etc.)

88

Respiratory Syncytial Virus (RSV)
Disease

Leading viral cause of serious lower
respiratory tract infections in infants
world wide
Most common cause of bronchiolitis
and pneumonia in infants < 1yo

Recurrent infections w/ increasing
age are usually limited to URT
(usually more severe than common
cold)

Does NOT cause systemic infection

89

Human Metapneumovirus (hMPV)
Disease

Second most commonly identified
cause of pediatric lower respiratory
illness (behind RSV)

Acute respiratory disease (ARDs)
(in older children & adults)

broad spectrum of respiratory illness
(from mild symptoms-->severe cough,
bronchiolitis, pneumonia)


Does NOT cause systemic infection

90

Human Parainfluenza viruses 1-4 (hPIVs)
Disease

Croup (hPIV 1, 2, and 3)…(larynx and
upper trachea are involved)
bronchiolitis (hPIV 3)
pneumonia (hPIV3)
(hPIV3 second only to RSV as cause of
pneumonia and bronchiolitis in infants
and young children!!)
hPIV4 causes less severe disease, so
detected less often
Other upper and lower RTIs

30-40% of all acute respiratory tract
infections in infants and children

Does NOT cause systemic infection

91

Hantavirus Pulmonary Syndrome (HPS)
Disease

Hantavirus Pulmonary Syndrome
(severe, sometimes fatal respiratory)

92

Blastomyces dermatitidis
Clinical Presentation

50% of infections are symptomatic

least significant= flu-like illness

Some cases = acute pneumonia w/ purulent,
brown, or bloody sputum

chronic lung infections mimics TB or lung
cancer b/c formation of mass-like lesions

Infection can disseminate despite lung
resolution-->warty skin lesions, bone, GU tract
prostate
5% AIDS pts will contract meningitis

93

Coccidioides immitis
Clinical Presentation

Disease in 40% of infections

Almost all pts fully recover, but w/ lingering
fatigue

5% develop progressive pneumonia
1% disseminated infection-->meninges, skin,
bone

94

Aspergillosis
Clinical Presentation

Pts w/ underlying pulmonary conditions
(chronic bronchitis, asthma, TB, etc.) may form
"fungal ball" (aspergilloma) at sites of
pre-existing lesions

Disseminated disease is almost universally
fatal

95

Mucormycosis
(Zygomycetes fungi:
Absidia, Rhizopus, Mucor Species)
Clinical Presentation

pneumonia:


invasive rhinocerbral:
headache-->coma-->death (b/c sinus infection
erodes straight to brain)

96

Pneumocystic jerovici (carinii)
Clinical Presentation

diffuse, interstitial pneumonia w/ little
fever-->dyspnea and cyanosis as lung
infiltrates appear on x-ray-->reduced O2
saturation-->death by asphyxia

97

Influenza viruses
Clinical Presentation

Type C usually asymptomatic, sometimes very
mild respiratory, not epidemics

usually self-limited and not serious, but can
be deadly, esp. due to lower respiratory
complications

Complications:
Pneumonia (most common and most serious)
…primary viral pneumonia: abruptly develops
and deteriorates w/in 1-4 days
…Secondary bacterial pneumonia (super-
infection): common; virus damages bronchial
epithelium and disrupts mucociliary clearance
of bacteria; susceptible pts 5 days after onset
(especially pneumococcus, but S. aureus &
haemophilus also seen)…Combined bacterial-
viral infection (during recovery) vs. Post-flu
bacterial pneumonia (after recovery)
Sinus & ear infections
Reye's syndrome--noninflammatory cerebral
edema & fatty infiltration of liver-->severe
hepatic dysfunction; usually in children
If flu during pregnancy:
loss of fetus, congenital heart defects, limb
malformations (esp during 2nd &3rd trimesters

98

Rhinoviruses
Clinical Presentation

Restricted to upper respiratory tract (but may
also cause otitis media and sinusitis)

(Many pts w/ actue otitis media have rhinovirus
present in nasopharyngeal secretions/middle
ear fluid)

May exacerbate asthma, CF, chronic bronchitis
and serious lower respiratory tract illness in
infants, elderly persons, immunocompromised

99

Adenovirus
Clinical Presentation

Up to 55% infections may be asymptomatic

100

Human Metapneumovirus (hMPV)
Clinical Presentation

Bronchiolitis = most common presentation of
hMPV (w/ or w/out pneumonia)

101

Hantavirus Pulmonary Syndrome (HPS)
Clinical Presentation

flu-like symptoms that can progress to life-
threatening pneumonia

Starts w/ prodrome of fever, muscle aches…
rapid onset of interstitial pulmonary edema-->
respiratory failure-->cardiogenic shock-->death

2 distinct stages:
….flu-like symptoms difficult to distinguish from
influenza, pneumonia, etc.
…After 3-7 days, more serious signs and symptoms

102

Pneumocystic jerovici (carinii)
Time Course

...

103

Influenza viruses
Time Course

Virus shedding begins 1 day before
onset of illness
viral titer peaks w/in 48 hours post
infection
Little virus shedding occurs after 6-8
days

Fever and general systemic complaints
usually disappear 3-5 days
Respiratory complaints last for wks

Short, 2-day incubation period, rapid
onset and dissemination of infection

104

Rhinoviruses
Time Course

12-72 hr incubation period
illness usually begins w/ nose dryness/
sore throat-->then watery rhinorrhea,
nasal congesition, sneezing…intensify
over next 2-3 days

Symptoms generally last 7-11 days

105

Adenovirus
Time Course

...

106

Coronaviruses
Time Course

Incubation for SARS is 2-10 days
…early sympoms last 2-7 days
…dry cough, SOB, hypoxia begin after
3-7 days

107

Respiratory Syncytial Virus (RSV)
Time Course

1-3 days after infection…cough & low
fever develop (w/ possible wheezing)
(mild courses don't progress beyond this)

Coughing and wheezing progress;
infants become dyspneic & tachypnea

hypoxemia; may require hospitalization
for several wks

108

Human Metapneumovirus (hMPV)
Time Course

...

109

Human Parainfluenza viruses 1-4 (hPIVs)
Time Course

...

110

Hantavirus Pulmonary Syndrome (HPS)
Time Course

Symptoms may develop b/w 1-5 wks
after exposure to urine, droppings, etc.

111

Rhinoviruses
Signs

No erythema, exudate, ulceration
despite sore throat

112

Coxiella burnetii
Symptoms

Acute febrile illness, atypical pneumonia (lasts 2-4 wks)
Sometimes liver and heart involvement
Long-term chronic infections=rare, but may lead to
endocarditis or granulomatis hepatitis

113

Chlamydia
Symptoms

usually asymptomatic

sometimes symptoms of bronchitis or pneumonia may
follow URI symptoms

sputum scant, cough prominent
persistent cough
malaise
Hx of hoarseness
headache (common nonclassical finding)
fever in first few days esp., usually not reported
sinus percussion tenderness (more common than in
other pneumonias)