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Flashcards in Micro - Bacteria Deck (167):
1

catalase test

GP

staph (+)
strep (-)

2

coagulase test

GP

staph aureus (+)
staph epidermidis or saprophyticus (-)

3

novobicin test

GP

staph epidermidis (sens)
staph saprophyticus (resis)

4

hemolysis

GP

streptococci (a, ß, g)

5

alpha hemolysis

GP

Strep. pneumoniae (capsule)
Strep. viridans (no capsule)

- differentiate btwn the two using optochin + bile solubility

6

ß hemolysis

GP

Strep pyogenes (grpA)
Strep agalactiae
Staph aureus
Listeria monocytogenes

LAAP = listeria, aureus, agalactiae, pyogenes

7

gamma hemolysis

GP

enterococcus
non-enterococcus

8

optochin sensitivity

GP

Strep. pneumoniae - sensitive
Strep. viridans - resistant

9

bile solubility

GP

Strep. pneumoniae - soluble (lysed by bile)
Strep. viridans - not lysed by bile

10

bacitracin

GP

S. pyogenes (sensitive)
S. agalactiae (resistant)

11

growth in bile and 6.5% NaCl

GP

Enterococcus faecalis

12

growth in bile, not 6.5% NaCl

GP

Strep. bovis

13

B cells typically infected by this virus

EBV

14

Ganglion cells typically infected by this virus

herpes

15

oligodendrocytes typically infected by this virus

JC virus --> PML
Measles --> SSPE

16

follicular dendritic cells typically infected by this virus

HIV

17

grows at 42˚C

GN, oxidase +, comma shaped

campylobacter jejuni

18

grows in alkaline media

GN, oxidase +, comma shaped

vibrio cholera

19

produces urease

GN, oxidase +, comma shaped

helicobacter pylori

20

GN diplococci
2

neisseria meningitidis
neisseria gonorrhoeae

differentiate using maltose test

21

maltose test is used for..

neisseria MeninGitidis (fermenter - maltose + glucose)
neisseria Gonorrhoeae (non-fermenter - glucose only)

22

GN "coccoid" rods
4

haemophilus influenza (requires factor V, X)
Bordtella pertussis
Pasturella - animal bites
Brucella

23

Requires factor V, X

haemophilus influenza - GN coccoid rods
(can also be grown with staph aureus, which provides factor V)

24

lactose fermenters (rate) - Macconkey's

GN

klebsiella, e. coli, enterobacter (fast fermenter)

citrobacter, serratia (slow fermenter)

MaconKEES

25

lactose non-fermenters

how do differentiate between them?

All GN

Shigella
Salmonella
Proteus
Yersinia
Pseudomonas

Oxidase test - only pseudomonas are oxidase +

26

oxidase test - which bugs are +? -?

Oxidase (-)
Shigella
Salmonella
Proteus
Yersinia

Oxidase (+)
Pseudomonas
Campylobacter
Vibrio cholerae
Helicobacter pylori

27

oxidase +, comma shaped

campylobacter jejuni - grows at 42˚
vibrio cholera - alkaline media
helicobacter pylori - urease

28

bacterial infection associated with schistocytes

EHEC - eating undercooked meats
Shigella

29

Staph aureus virulence factor

Protein A - binds Fc-IgG - inhibits complement activation and phagocytosis; colonizes the nose

30

TSST

superantigen that binds to MHCII and TCR, resulting in polyclonal T cell activation

present in vaginal or nasal tampons

31

S. aureus food poisoning is due to

preformed ENTEROTOXIN - heat stable (not destroyed by cooking)

32

S. epidermidis is commonly associated with

What would you treat a hospitalized patient with?

how do you differentiate this from S. saprophyticus?

prosthetic devices
IV catheters

*contaminant of blood cultures

treat with vanco pending sensitivity tests because they can be resistant to multiple antibiotics


SE: Catalase (+), Coagulase (-), Novobicin (S)
SS: Catalase (+), Coagulase (-), Novobicin (R)

33

S. saprophyticus

at risk for what?


how do you differentiate this from S. epidermidis?

UTI - second most common cause; increased risk of struvite stones (Ammonium MgPO4)

novobicin resistant

SE: Catalase (+), Coagulase (-), Novobicin (S)
SS: Catalase (+), Coagulase (-), Novobicin (R)

34

S. pneumo

causes

how to differentiate

Meningitis
Otitis media
pneumonia
Sinusitis
sepsis in sickle cell patients and splenectomy
rusty/reddish brown

a hemolysis (green)
SP: capsule, optochin (S), bile (S)
SV: ø capsule, optochin (R), bile (R)

35

shape of s. pneumo?

virulence factor?

lancet shaped GP diplococci, encapsulated

IgA protease

36

s. viridans

how do differenitate it from S. pneumo?

alpha hemolytic, optochin R

can cause
- dental caries (mutans)
- normal inhabitant of the mouth (mitis)
- subacute bacterial endocarditis on damaged valves (sanguinis)

a hemolysis (green)
SP: capsule, optochin (S), bile (S)
SV: ø capsule, optochin (R), bile (R)

37

how does strep. sanguinis cause subacute bacterial endocarditis

binds to fibrin-platelet aggregates on damaged heart valves

38

GAS is also known as

S. pyogenes

39

diseases that S. pyogenes cause

pharyngitis, cellulitis, erysipelas, rheumatic fever, PIGN

40

things that S. pyogenes produce?

Streptolysin O: degrades cell membranes; lyses RBC

Exotoxin A: superantigen - causes release of IFNg, IL2 --> shock

M protein - prevent phagocytosis *virulence factor*

41

S. pyogenes sensitivity?

what must you differentiate it from?

ß hemolysis (clear)
GAS (Spyogenes): Bacitracin (S); ASO titers
GBS (S. agalactiae): Bacitracin (R), Hippurate test (+), CAMP test

42

GBS is also known as

S. agalactiae

43

things that S. agalactiae cause?

what happens if you find out that a mother is colonized with GBS within a month of her due date?

neonatal sepsis, meningitis, pneumonia

must give INTRApartum penicillin or ampicillin

44

GDS is also known as

what does it cause?

what do you have to differentiate it from?

S. Enterococci - cocci chains

subacute endocarditis after GI/GU procedures, can cause UTIs, biliary tract; penG resistant

gamma hemolysis
S. Enterococcus (GDS: E. faecalis, E. faceium): bile and NaCl (+)
S. bovis : bile (+) only

45

S. Bovis cuases

endocarditis after colonic malignancy

46

clostridum - different types and what do you normally find them on?

CBotulinum: honey, bottles/canned food

CPerfringens: soil or raw meat, reheated meat dishes

CDiff: antibiotic use (clindamycin or ampicillin"

47

shape of clostridium?

GP Rod

48

clostridium tetanus produces

Tetanospasmin - protease that cleaves SNARES --> prevents release of GABA and glycine from Rhenshaw cells in spinal cord --> spasticity/sustained muscle contraction

49

Clostridium botulinum produces

Botulinum toxin - heat-labile protease that cleaves SNARES --> prevents release of ACh at NMJ --> floppy/descending flaccid paralysis

50

Clostridium perfringens produces

Alpha Toxin - lecithinase that degrades tissues and cell phospholipid membranes --> myonecrosis/gas gangrene + diarrhea

51

C diff produces

Toxin A (enterotoxin) binds to brush border of gut

Toxin B (cytotoxin) causes cytoskeletal disruption via actin polymerization --> pseudomembrane --> diarrea

52

white fibrinous pseudomembrane should make you think of this bug

Corneybacterium diphtheriae

53

Corneybacterium diphtheriae shape?

what does it produce?

Rod w/ blue+red granules (corn is rod-shaped)

Diphtheria Toxin - AB toxins exotoxin encoded by ß prophage, inactivates EF-2 via ribosylation; predilection for cardiac + neural cells

54

3 tests that you can use for Corneybacterium diphtheriae

Tellurite agar - dark black, slightly iridescent colonies

Loffler medium - cytoplasmic GRANULES that can be stained w/ aniline dye (methylene blue)

Elek Test for toxin

55

elongated Rod box-car chains should make you think of..

Bacillus anthracis - Aerobe, spore forming

56

Bacillus anthracis causes

painless black eschar w/ edematous borders, mediastinal widening

spores can be present on wool

57

Bacillus anthracis virulence factor

polypeptide capsule (D-glutamate) - antiphagocytic

Edema Factor - mimics adenylate cyclase to incr. cAMP"

58

reheated rice, pasta should make you think of...

bacillus cereus - GP Rod, spore forming

59

bacillus cereus produces

Cereulide - preformed toxin --> watery dairrhea

60

Listeria Monocytogenes - features

GP rod with tumbling motility - rocket tails (actin) that propel them into cells (intracellular)

catalase +, LPS (UNIQUE!!!), ß hemolysis

61

Listeria Monocytogenes - where is it normally found on?

unpasteurized milk, soft cheeses, deli meats

transplacental or vaginal transmission --> meningitis in neonates and elderly

62

Mycobacterium - features

GP Rod; mycolic acid w/ high lipid content
obligate aerobe (use O2 to generate ATP) - lung apices

63

reactivation of Mycobacterium is usually due to...

Immunocompromised state or TNFa inhibitors (infliximab or adalimumab)

64

two virulence factors of mycobacterium?

Cord-factor- inhibits macrophage maturation; induces release of TNFa

Sulfatides (surface glycolipids) - inhibit phagolysosomal fusion

65

Mycobacterium tubuerculosis symptoms

fever, night sweats, weight loss, hemoptysis

66

MAC - when does it normally occur? how do you deal with it?

AIDS, CD4 <50; prophylaxis w/ Azithromycin; usually unable to form the caseating granulomas

67

mycobacterium leprosy - predilection for...

skin/superficial nerves (likes cool temperatures --> causes glove and stocking loss of sensation)

normally found on....armadillos

68

2 forms of mycobacterium leprosy and when do they normally occur?

lepromatous (low CMI, Th2 response) - more serious forms

tuberculoid (high CMI, Th1 response)

69

PAS(+) foamy macrophages in intestinal lamina propria should make you think of...

Tropheryma whipplei

70

symptoms that Tropheryma whipplei cause

cardiac sx, arthralgias, neurologic sx, esp. in older men

71

long-branching Filaments that resemble fungi

2 - how to differentiate between them?

Actinomyces - anaerobe, NOT acid fast
Nocardia - aerobe, acid fast

72

actinomyces - features

causes..
treatment?

Oral flora

long-branching Filaments that resemble fungi
obligate ANaerobes, ø catalase or superoxide dismutase (susceptible to oxidative damage)
FOUL smelling
Yellow sulfur granules"

oral/facial abscesses; trmt: pencillin

73

Nocardia

features

how is it detected?

long-branching Filaments that resemble fungi

obligate aerobe (use O2 to generate ATP
Urease (+)

Ziehl-Neelsen (carbolfuchsin/aniline dye) in Acid fast Stain

74

Neisseria

GN diplococci

75

#1 cause of all UTIs

E. coli.....

76

E. coli

feature
all produce this

GN rod

encapsulated (K capsule)
Catalase (+)

77

How can E. coli can be detected?

MacConkee's agar - pink, fast (lactose fermenter)

EMB plates - purple colonies w/ green metallic sheen

78

EIEC method of pathogenesis

invasive -> necrosis + inflammation -> dysentery

79

ETEC method of pathogenesis

trmt?

heat-labile toxin (LT) - increases cAMP

heat stable toxin (ST) - increases cGMP -> watery diarrhea; NO inflammation (travelers)

trmt: loperamide, fluoroquinolones, azithromycin, rifampin "Travelers Love to travel FAR"

80

EPEC method of pathogenesis

EPEC: pili allows for adheres + flattens vili --> prevents absorption (children)

81

EHEC 0157:H7 method of pathogenesis

Shiga-like toxin (SLT) - incactivates 60S rRNA (prevents binding of tRNA -> enhances cytokine release -> dysentery + HUS (anemia, thrombocytopenia, ARF, schistocytes due to microthrombi)

usually due to undercooked meats, raw unpasteurized milk

82

how to differentiate EHEC 0157:H7 from other e. coli?

ø sorbitol fermentation, ø glucorinidase production (compared to the other E. coli).

83

shigella - features

GN rod

84

shigella method of pathogenesis

invades intestinal mucosa (M cells of Peyer's patches) -> PMN infiltration -> dysentery

Shiga Toxin - inactivates 60S rRNA (prevents binding of tRNA) + enhances cytokine release -> HUS

very low ID50

85

antibiotics may prolong fecal excretion of this bug

Salmonella - Rod, with flagella

86

Salmonella typhi - pathogenesis

encapsulated - invades intestinal mucosa -> MONOCYTIC infiltration

Vi antigen prevents opsonization and phagocytosis, produces H2S

can disseminate hematogenously

87

salmonella typhi - clinical features

ROSE spots on abdomen, fever, HA, diarrhea

carrier state in GALL BLADDER; causes typhoid fever

usually due to poultry, meats, eggs

88

pseudo-appendicitis

cause?
typically affects?
where can it be found?

Yersinia - GN Rod, intracellular

mini-epidemics in children --> pus + blood in diarrhea

PET feces, contaminated milk, pork

89

Proteus - features

GN Rod - swarming motility on agar

Urease (+), produces H2S - can cause struvite stones/ammonium MgSo4

90

Klebsiella - features

who does it usually affect?

what does it cause?

treatment?

GN Rod
Urease (+)
lactose fermenter (MacConkee's - pink, fast)
Encapsulated, MUCOID colonies"

aspiration --> lobar pneumonia (abscess forming) in alcoholics and diabetics
Red-current jelly sputum

trmt: 3rd gen cephalosporin

3rd leading cause of UTI's - can cause struvite stones/ammonium MgSo4"

91

Bacteroides

GN Rod, part of GI flora

Obligate Anaerobes, ø catalase or superoxide dismutase (susceptible to oxidative damage),
FOUL smelling (short chain FA)

Produce CO2, H2

92

Serratia

GN Rod
Red pigment
Catalase (+)

MacConkee's agar - pink, slow

93

spiral shape, w/ multiple flagella at one pole

H. pylori - "catalase (+), oxidase (+), Urease (+)
creates alkaline environment"

94

how is H. pylori detected? treated?

Silver Stain
urease breath test (+)
fecal antigen

triple Rx: PPI, clarithromycin, amoxicllin/metronidazole

95

can cause Guillain-Barre, reactive arthritis

campylobacter

96

campylobacter - features

comma shaped
oxidase (+)
42˚C

97

campylobacter - clinical features (how is it transmitted?

bloody diarrhea, esp in children
FECAL-ORAL transmission (poultry, meat, unpasteurized milk)
can cause Guillain-Barre, reactive arthritis

98

vibrio - features

GN, comma shaped, oxidase (+)

99

vibrio - types and clinical features

Parahemolyticus: voluminous watery diarrhea

vulnificus: septicemia -> blisters and muscle necrosis on lower extremity

cholera: profuse rice water diarrhea

100

vibrio cholera - pathogenesis

Cholera toxin - permanently activates Gs -> incr adenylate cyclase -> incr. cAMP -> H2O loss"

101

how do you grow vibrio cholera?

alkaline media

102

sputum w/ grape like odor

pseudomonas

103

Pseudomonas - general features

GN rod
Obligate Aerobe
Catalase (+), Oxidase (+)
Exotoxin A - inactivates EF-2 via ribosylation
Blue-green pigment (pyocyanin)

104

Pseudomonas pathogenesis

Exotoxin A - inactivates EF-2 via ribosylation
(same as c. diptheria)

105

how is pseudomonas generally acquired - list at least 4

burns/wounds
DM
CF
water sources (hot tubs, ventilators)
indwelling catheters

106

What does pseudomonas generally cause?

Pneumonia
Sepsis
External otitis
UTI
Diabetics/Drugs
Osteomyelitis
Echthyma gangrenosum cutaneous necrotic disease - usually associated with bacteremia in immunocompromised host

107

Pseudomonas - treatment

Gentamycin + piperacillin or cefepime

108

Neisseria - features

what is it grown on?

GN diplococci

Pili for attachment
IgA protease (to colonize mucosa)

Thayer-Martin (contains VPN) for isolation

109

Neisseria M - features

GN diplococci

encapsulated (polysaccharide capsule)

NM: maltose (+), glucose (+)

110

Neisseria M - route of transmission, clinical picture and treatment

respiratory/oral secretions

petechial rash on trunk, palm, soles
meningitis
Waterhouse-Friderichsen Syndrome

post-exposure prophylaxis: Rifampin, ciprofloxacin, ceftriaxone for contact prophylaxis

trmt: ceftriaxone or penicillin G

111

Neisseria G - features

GN diplococci
facultative intracellular, in PMNs

112

Neisseria G - route of transmission, clinical picture and treatment

STD

gonorrhea, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh-Curtis Syndrome;

neonates: erythromycin ointment

adults: ceftriaxone (MUST ADD azithro/doxycycline for possible chalmydia coinfection)

113

c5-c9 deficiency

think Neisseria

114

Haemophilus features

GN coccoid rods

encapsulated (type B = worst; made w/ polyribosyl-ribitol phosphate)

IgA protease (to colonize mucosa)

115

Haemophilus - how is it transmitted? what does it cause? how is it treated/prevented?

Aerosol transmission
Epiglottitis (cherry red) -> stridor, odynophagia, drooling; lateral CXR: ""thumbs up"" sign
Meningitis - treat w/ ceftriaxone
Otitis Media
Pneumonia

trmt: Amoxicillin w/ clavulanate

Post-exposure prophylxis: rifampin

Prevention: conjugated vaccine "

116

how do you grow haemophilus?

"Chocolate Agar w. Factors V, X
- or -
grown w/ S. aureus (provides V)"

117

legionella - features

GN Rod, facultative intracellular

antigen present in urine

118

legionella - clinical picture
how is it treated?

aerosol transmission from environment: AC, hot water tanks, sprayers at restaurants, grocery stores

causes HYPONATREMIA (SIADH mediated)

Legionnaire's dz: pneumonia,high fever, GI, CNS sx (typical: smoker w/ 104˚ T, diarrhea, confusion, and sputum w/ very few or ø bacteria but LOTS of PMNs)

Pontiac fever: mild flu

trmt: macrolide, quinolone

119

how is legionella detected?

Silver Stain
Charcoal yeast w. Cysteine + Iron

120

B. pertussis - features

coccoid rods, encapsulated

121

B. pertussis - pathogenesis

Pertussis toxin - disables Gi --> overactivation of adenylate cyclase --> incr. cAMP

-> Whooping cough: "coughing spells" or paroxysms of coughing

122

how do you grow B. pertussis

Bordet-Genou (potato)

123

Pasteurella - features

GN coccoid rods
animal bites

124

Bartonella Henslae - features
clinical picture
treatment

GN Rod

"cat-scratch dz" - tender regional adenomapthy, stellate granulomas w/ central necrosis

ø trmt necessary, but if immunosuppressed, give ciprofloxacin + dox + macrolides

125

rash (vasculitis) starts at wrists and ankles and then spreads to trunk, palms, and soles.

R rickettsii - Rocky-MTN spotted fever; triad: HA, fever, rash (vasculitis)

126

rash starts centrally and spreads out, sparing palms and soles

R typhi - endemic (fleas)

127

monocytes w/ morulae (berry like inclusions)

R ehrlichiosis

128

granulocytes w/ morulae (berry like inclusions)

R anaplasmosis

129

Rickettsiae - features and general treatment? How do you detect them?

GN pleomorphic Obligate intracellular (need CoA + NAD+ because they can't make ATP)

Giemsa stain

trmt: dox

130

cattle placenta

Coxiella
ovoid GN
spores released from tick feces + cattle placenta --> spores inhaled -> pneumonia; ø rash, ø vector

131

Chlamydiae

forms?
subtypes?
features?

Elementary body "Enfectious" - Enters cells via Endocytosis

Reticulate body - Replicates via fission and reorganizes into elementary bodies

trachomatis, Pneumoniae, psittaci

Obligate intracellular - can't make their own ATP

ø muramic acid in cell wall - why is this impt?? DON'T KNOW

132

reactive arthritis (Reiter), follicular conjunctivitis (dots on inner eye lids), nongonoccal urethritis, and PID

features of this bug

Chlamydiae trachomatis - DK serotype

133

Chlamydiae trachomatis serotypes

ABC: African, blindness, Chronic infection

DK
women: urethritis/PID/ectopic pregnancy
neonates: staccato cough + conjunctivitis, acquired via vaginal delivery

L1, L2, L3 - lymphogranuloma venereum - painless ulcers on genitals + painful ulcerated inguinal LN "buboes"

134

chlamydiae trachomatis - how to detect it?

Giemsa
Fluorescent antibody stain

135

chlamydiae Pneumoniae

atypical pneumonia; aerosol transmission

136

chlamydiae psittaci

atypical pneumonia; avian (parrots) reservoir

137

treatment for chlamydiae

azithromycin or doxycline

138

Borrelia - features

GN spiral shaped

139

Borrelia - clinical features

how to diagnose it?

PAINLESS erythema chronicum migrans

BAMM Sequelae: Bells, Arthritis, Myocarditis (AV block), Meningoencephalitis

ELISA + WB only if its not clear that it is is Lyme dz

to stain it: Giemsa stain

140

Borrelia treatment

Doxycycline - 1st line (or ceftriaxone)

children/pregnant women - use amoxicillin

141

Leptospira features

GN spiral shaped

142

How is leptospira acquired? What does it cause?
who is it most common in?

contaminated water with animal urine -> leptospirosis (flu, jaundice, photophobia w/ conjunctival suffusion - red eyes)

Weil dz: severe; jaundice, azotemia from liver/kidney dysfunction; fever, hemorrhage, anemia

common in surfers and tropics

143

Treponema/Syphilis - general features + 3 stages

Treponema/Syphilis - GN Spiral

1˚ Painless chancre (1˚)
2˚ maculopapular rash on palms/soles, condylomata lata
3˚ gummas, aortitis (vasa vasorum), neurosyphilis (tabes dorsalis), Argyll Robertson Pupil "Prostitute pupil" - accomodates but does not react to light

144

How is Treponema/Syphilis diagnosed?

dark field microscopy + Fluorescent antibody staining (FTA-ABS)

145

How do you know if an infant suffers from Syphilis?

Congenital: saber shins, saddle nose, CN8 deafness, Hutchinson teeth, mulberry molars

146

treatment for syphilis?

trmt: PenG; can cause Jarisch-herxheimer rxn (flu due to killed spirochetes releasing pyrogens)

147

gray vaginal discharge w/ fishy smell; not painful

Gardnerella vaginalis - GN rod

148

Gardnerella vaginalis - features, how is it diagnosed, and treatment

GN rod that causes gray vaginal discharge w/ fishy smell; not painful

Light microscopy - Clue cells - vaginal epithelial cells covered w/ Gardnerella bacteria

trmt: metronidazole or clindamycin

149

malodorous gray green frothy discharge with inflammation

trichomoniasis

150

gray vaginal discharge w/ fishy smell; not painful

Gardnerella vaginalis - GN rod

151

thick, white, adherent discharge "cottage cheese" + inflammation

candida vulvovaginitis

152

only bacteria that does not have a cell wall

Mycoplasma Pneumoniae

153

Mycoplasma Pneumoniae - how is it grown?

sterols in membrane for stability - therefore must be grown on Eaton agar - cholesterol

154

Mycoplasma Pneumoniae - what does it cause? who is it most common in? how do you treat it?

"walking ATYPICAL pneumonia" - insidious onset, HA, nonproductive cough, patchy or diffuse interstitial pneumonia

high IgM titers can agglutinate or lyse RBCs

outbreaks in military recruits, prisons

trmt: macrolide, dox, fluoroquinolone (NOT penicillin, duh)

155

What is macconkey agar used for? what does it contain

MaConKEE'S agar - contains BILE (inhibits growth of contaminant organisms), but allows growth of lactose fermenters, which show up as pink colonies:
Klebsiella
E. Coli
Enterobacter
Serratia

156

catalase +

Pseudomonas
Listeria
Aspergillus
Candida
E coli
S. auerus
Serratia

157

Otitis Media

H. influenza
S. pneumo
Morxaella

158

Otitis Externa

Pseudomonas

159

Atypical Pneumonia

Mycoplasma
Legionella
Chlamydia

160

Bloody diarrhea

Campylobacter
E. Histolytica
EHEC
EIEC
Salmonella
Shigella
Yersinia

161

Watery diarrhea

C. Diff
C. perfringens
ETEC
Protozoa
Vibrio cholera
Vibrio vulnificus

162

Pneumonia IVDU or alcholics

S. pneumo, klebsiella, s. aureus

163

Pneumonia Aspiration

anaerobes

164

Pneumonia atypical

mycoplasma, legionella, chlamydia

165

Pneumonia CF

pseudomonas, s. aureus, s. pneumo

166

Pneumonia nosocomial

s. aureus (MRSA, MSSA), pseudomonas, enterics

167

Pneumonia post-viral infection

staph, H. influenza, S. pneumo