what type of microbe is bordetella
gram negative coccobacilli
3 phases whooping cough
catarrhal
paroxysmal
convalescent
Dx whooping cough
nasal swabs for culture or PCR
Tx whooping cough
zpak
supportive
Klebsiella pneumonia is what type micrbe
gram - non-motile capsulate rods, faculative anaerobes
Currant jelly sputum is pathoneumonic for what
klebsiella ppneumonia
what type of microbe is moraxella catarrhalis
gram - that grow on blood or chocolate agar
diplococci
catalase and oxidase +
Neisseria meningitidis is what type microbe
gram - aerobic kidney shaped diplococci
oxidase +
ferments maltose and glucose
grows on thayer-martin media and chocolate agar!!
Dx and tx neisseria
gram stain from CSF, or PCR
CSF culture blood culture, skin culture
penicillin or 3rd generation cephalosporin
if left unTx neisseria m. patients have what mortality
70-90%
What microbe produces pyocyanin
pseudomonas
type of microbe that pseudomonas is
aerobic gram - rod
blue/green pigment
nosocomial pathogen
what type of infections does pseudo cause
HAP, CAP
otitis externa!! most common cause of this.
puncture wounds
endopthalmitis
endocarditis
UTI
skin infections, burns, ecthyma gangrenosum
Tx pseudomonas
extended spectrum penicillin and aminoglycoside combination
Chlamydophila psittaci is what type microbe
gram - obligate intracell bacteria
macrophages are principle host
Tx Chlamydophila psittaci
tetracyclines, macrolides, FQs
What is a very common infection in most adults and cause atypical pneumonia in children <5
chlamydophila penumonia
CXR and labs for chlamydophila pneumonia
pneumonitis on CXR
labs actually have normal WBC
Dx of chlamydophila pneumonia
serology
coxiella burnetii is what type microbe
gram - infects host monocytes
what does coxiella burnetii cuse
Q fever
sometimes endocarditis
major outbreaks of coxiella has been associated with what
sheep and goats
clinical manifestation Q fever
60% seroconvert wihtout disease
38% self limited disease
prolonged fever, pneumonia, hepatitis, rash
meningitis, encephalitis, peripheral neuropathy
pericarditis, myocarditis
what is risk of coxiella during pregnancy
chronic uterine infection leading to multiple spontaneous abortions
Dx coxiella burnetii
based on serology
Tx coxiella burnetii
doxy for 2 wks
doxy+hydroxychloroquine for 18-36 mo for endocarditis
how does hydroxychloroquine work?
increases pH in phagosomes
francisella tularensis is what type microbe
zoonotic
small aerobic pleomorphic gram - bacillus
rabbits squirrels and muskrats
clinical manifestation tularemia
ulcerglandular glandular oculoglandula typhoidal oropharyngeal pneumonic- most serious
Sx ulceroglandulat tularemia
fever
ulcer formation
sore throact
patchy infiltrates on CXR
glandular tularemia
fever, constitutional and lymphadenopathy
oralpharyngeal tularemia
oral mcous membranes of mouth
inadequately cooked game meat
pharyngeal ulcers
pneumonic tularemia
most serious
inhalation exposure
fever, dry cough, substernal chest discomfort, eribronchial infiltrates and bronchopneumonia
hilar adenopathy
Dx tularemia
serologic
typhoidal tularemia
fever only
Tx tularemia
genta or streptomycin
cipro
doxy
type microbe bacillus anthracis
spore forming gram + non motile rod that is aerobic or faculatively anaerobic
catalase +, hemolysis -
sheep agar!
clnical manifestation bacillus anthracis
mediastinal adenopathy
mediastinal widening**
pleural effusion
rapidly fatal if not Tx with multiple antibiotics and pleural drainage
Dx bacillus anthracis
blood cultures
tx bacillus anthracis
multi drug regimen
pleural drainage
what type of microbe is yersinia pestis
gram - coccobacillus, microaerophilic, nonmotile, and non spore forming
prairie dogs
clinical manifestations yersinia pestis (bubonic plague)
bubonic( nodules), septicemia, penumonic
septicemia from yersinia present how
nausea, vomiting, diarrhea
DIC
hypotension, renal failure and obtundation
ARDS
pneumonic plague of yersinia presents how
highly fatal, die in 24 hrs
respiratory distress, hemoptysis
Tx plague
strepto- pneumonic
tetracyclin- bubonic
chlorphenicol- speticemia
What type microbe is leptospirosis
spirochete with terminal hook
use dark filed microscopy
where in hosts does leptospirosis live
renal tubules
early clinical phase leptospirosis
fever, myalgias, HA nasuea vomiting ab pain, diarrhea cough muscle tenderness conjunctival redness
late clinical phase leptospirosos
thrombocytopenia
jaundice
weils disease
GI bleed
Dx and tx lepto
Dx: agglutination test
Tx: doxy or penicillin
H influenza is what type microbe
encapsulated gram - pleomorphic rod
aerobic or faculative
grows on chocolate agar
Factor X (hemin) and Factor V (NAD)
common cause of meningitis in young children
H influenza type b
clincal manifestations H influenza
meningitis
epiglottitis- children <5. high fever drooling, dysphagia, resp distress with stridor
rapid course
Dx test for H influenza epiglottitis
lateral neck film
thumb sign
pneumonia signs from H influenza
fever cough, lobar consolidation
Tx H influenza
3rd generation cephalosporins- meningitis
what is prophylactic Tx for unvaccinated person in contact with infected person with H influenze type b
rifampin
corynebacterium diptheria is what type microbe
gram + bacillus, club shaped
non spore forming
aerobic
signs resp diphteriae
sore throat, malaise thick tonsillar exudate, very sticky exudate changes into grayish membrane "bull neck" from cervical adenopathy stridor myocarditis, recurrent laryngeal nerve damage
Tx diphteriae
erythromycin
antitoxin
type microbe legionella pneumophila
wekaly gram - pleomorphic rod that is facultative intracellular
requires charcoal yeast extract!!
legionella is commonly found where
water type reservoirs like air conditioner units
risk factors legionella
smokers with high alcohol intake, immunosuppression
signs legionaires disease
mental confusion
myalgias, severe HA!!! and diarrhea!!!!
fevers, malaise, cough, chilld, dyspnea, myalgias!!!! HA chest pain and diarrhea
low pulse for how high fever is
what is pontiac fever?
caused by?
fever, sore throat myalgia, HA and extreme fatigue
short duration lasting on average 3 days
caused by legionella
Dx legionella
Ag urine test
DFA (direct fluorescent antibody)
Tx legniella
FQ, or zpak or erythromycin + rifampin for immunocompromised
type of microbe mycoplasma pneumonia
smalles
no cell wall
sterol containing membrane
need cholesterol in media
highest incidence of infection caused by mycoplasma pneumonia
5-20 yrs
military or dorms (like meningitis)
resp infection from mycoplasma
2-3 week incubation fever malaise, HA cough walking pneumonia cough is non-productive some progress to tracheobronchitis bullous myringitis
Dx and Tx mycoplasma atypical pneumonia
clinical Dx, positive cold agglutinins!!! (65%)
Tx: macrolides: erythromycin, zpak and clarithromycin
tetraclyines
what type microbe is strep pneumonia
gram + diplococci, lancet shapet
faculative anaerobe, grows on blood agar
alpha hemolytic, optochin sensitive
lysed by bile
risk factors for strep pneumonia
influenzae infection, COPD, CHF, alcoholism, asplenia
clinical manifestations pneumonia from strep
shaking chills, high fever, rigors, lobar consolidation, bloody tinged sputum (rusty)!!!
most common cause otitis media and sinusitis in children
strep pneumonia
Tx strep pneumonia
beta lactams, macrolids or FQ
Tx meningitis from strep pneumonia
3rd generation cephalosporings, vanco if penicillin R
What type of microbe is staph aureus
gram + clustered cocci catalse, coagulae + beta hemolytic small yellow colonies on blood agar ferments mannitol
what are the 3 toxin mediated diseases from staph aureus
staph food poisoning
staph TSS
staph scalded skin syndrome
clinical manifestations staph
impetigo, folliculitis, furuncle, abscess bacteremia, endocarditis pericarditis osteomyelitis septic arthritis pneumonia
salmon colored sputum
staph aureus
signs of endocarditis
roth spots, oslers nodes, janeway lesions and petichiae
TSS from staph
secondary to TSST-1 super Ag
involvement of 3+ organ systems, desquamation of palms and soles
what toxins are involved in scalded skin syndrome
exotoxin A and B
Tx for Staph aureus
nafcillin/oxacillin
MRSA- vanco
pneumocystis jirovecii microbe
fungus
obligate extracell parasite
silver stain
opportunistic infection HIV patients CD4 count <200
pneumonia presentation from pneumocystic jirovecii
fever, nonproductive cough, SOB
CXR pathcy infiltrate with ground glass appearance, lower lobes and periphery
silver staining
Tx pneumocystis jiroveci
sulfamethaxole/trimethoprim or dapsone
Histoplasma capsulatum is what type microbe
dimorphic fungus in central US
faculative intracell parasite
soil, caves and abandoned buildings
Mississippi and Ohio River Valleys
acute pulmonary histoplasma
asymptomatic
sometimes fevers, chills, anterioe chest pain myalgias
chronic histoplasma infection
progressive often fatal
especially elderly and COPD patients
CXR histoplasma
pathcy lobar or multilobar infiltrate
chronic with upper lobe infiltrates and multiple cavities, fibrosis of lower lobes
mimics TB
Tx histoplasma capsulatum
antifungals
though if not severe, don’t always require Tx
type of microbe blastomyces dermatitidis
thermally dimorphic fungus
broa based! budding yeast!!
inhalation
acute pulmonary blastomyces
asymptomatic or CAP like
fever, malaise, nonproductive cough
CXR lobar and nodular infiltrates
chronic pulmonary blastomyces
cavitary lesions and fibrosis
Tx blastomyces
all patients Tx
itraconazole in mild
amphotericin B in severe
Coccidiodes immitis is what type microbe
dimorphic fungi
southwest deserts
spherules that undergo septation into endospores
clinical manifestations coccidiodes
asymptomatic usually
if more severe:
Sx 5-21 days post exposure
fever, weight loss, dry cough, pleuritic chest pain, arthralgias, erythema nodosum
CXR show pulm infiltrates with hilar adenopathy
cavitary pulmonary nodules
What patients are at risk for disseminated infection cocciocdes
HIV, AIDS
3rd trimester pregnangy
skin, joints and bones
Tx coccidiodes
amphotericin B and itraconazole
Strongyloides stercoli is endemic where
warm climates worldwide
trasmission stronglyoides
skin penetration of larvae rupture in alveoli then ascend and swallowed in GI tract and lay eggs which hatch in small intestine, larvae passed in feces
pulmonary manifestations stronglyoides
can be severe in immunocompromised
resembles ARDS with acure onset dyspnea, hemoptysis accompanied by fever
Tx stronglyoides
ivermectin
aspergillosis microbe
spore like conidia that is aerosolized
isolated in basements, crawl spaces, ventilation ducts, potted plants
invasive aspergillosis
immunocompromised
fever, pulm infiltrates
nodules
wedge shaped densities resembling infarcts
sinusitis
CNS abscesses, MI, GI, renal, osteomyelitis
Dx invasive aspergillosis
BAL, needle aspiration, thoracoscopic biopsy or open lung biopsy
Tx invasive aspergillois
antifungals like voriconazole or liposomal amphotericin B
reversal immunosuppression
surgical resection infected lesions
chronic pulmonary aspergillosis
aspergilloma
ball in cavity
debris form in cavity
Tx chronic pulmonary aspergilloma
limited benefit
sometimes antifungals
Allergic bronchopulmonary aspergillosis
chronic asthma or CF patients
airway obstruction, eos!!, + sputum cultures, mucus plugs iwth hyphae, brown flecks in sputum
elevated IgE
upper lobe contraction, central bronchiectasis
Tx allergic bronchopulmonary aspergillosis
corticosteroids and itraconazole
cryptococcosis neoformans occurs in what patients?
what type of microbe is it?
immunosuppressed- HIV CD4<50
meningitis is comon presentation
capsulated yeast
Pulmonary involvement cryptococcus?
risk factors?
Tx?
fever, cough ,dyspnea
risk factors: COPD, corticosteroid use and solid organ transplant
Tx: antifungals
Dx cryptococcus
yeast in CSF, blood, sputum, skin lesions or other body fluids
India Ink stain!!!! visualization of budding yeast with large capsuel
latex agglutination for crytpococcal polysaccharide Ag!!!
Tx CNS cryptococcosis
amphtericin B and flucytosine for 6 wks
AIDS: both for 2 weeks then fluconazole for 8 weeks and suppressive therapy after
HACEK organisms that are common causes endocarditis
Haemophilus spp Actinobacillus Cardiobacterium hominis Eikenella corrodens Kingella spp