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

Microbiology 7s: RTIs Flashcards

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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
pneumonia + silver stain. DDx?
PCP
26
Tx of **Streptococcus pneumoniae**
PO Amoxicillin/IV benzylpenicillin _If penicillin allergy:_ PO Clarithromycin/IV cefuroxime, cefotaxime, ceftriaxone
27
Tx **Haemophilus influenzae**
_Non-beta-lactamase-producing_: PO/IV Amoxicillin _Beta-lactamase-producing:_ PO/IV Co-amoxiclav _If penicillin allergy_: IV cefuroxime, cefotaxime, ceftriaxone
28
Tx **Moraxella catarrhalis**
PO Amoxicillin/IV benzylpenicillin _If penicillin allergy:_ PO Clarithromycin/IV cefuroxime, cefotaxime, ceftriaxone
29
Tx **Group B Streptococcus**
Benzylpenicillin /ampicillin + gentamycin (10 days) _If penicillin allergy:_ Vancomycin / clarithromycin
30
Tx. **Legionella pneumophilia**
Ciproflaxin/Clarithromycin
31
Tx **Mycoplasma pneumoniae**
azithromycin
32
Tx ## Footnote **Coxiella burnetii (Q fever)**
PO Doxycycline/IV Clarithromycin
33
Tx **Chlamydia psittaci**
PO Doxycycline/IV Clarithromycin
34
Tx **Mycobacterium tuberculosis**
RIPE * Rifampicin 6m * Isoniazid 6m * Pyrazinamide 2m * Ethambutol 2m
35
tx **Staphylococcus aureus**
_Non-MRSA_: IV Flucloxacillin _MRSA_: IV Vancomycin
36
tx **Pseudomonas auroginosa**
IV Ceftazidime/Ciprofloxacin + IV gentamycin
37
Tx **Klebsiella pneumoniae**
IV Ceftazidime/Ciprofloxacin
38
Tx aspergillosis
Amphotericin B
39
Tx influenza?
oseltamivir
40
Tx COVID
dexamethasone
41
Tx PCP?
co-trimoxazole
42
Summarise **Streptococcus pneumoniae**
* 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
Summarise **Haemophilus influenzae**
* 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
Summarise **Moraxella catarrhalis**
* 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
Summarise **Group B Streptococcus**
* 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
Summarise **Legionella pneumophilia**
47
Summarise M**ycoplasma pneumoniae**
48
Summarise Q fever
49
Summarise **Chlamydia psittaci**
50
Summarise **Mycobacterium tuberculosis**
51
Summarise E coli
* 30% of HAP * RFs: younger age (0-1 months) * Gram -tive bacilli * CXR: Lower lobe consolidation * Tx:
52
Summarise **Staphylococcus aureus**
* More common in 1-6months * **Gram +tive** * **CXR:** Cavitating lesions _Non-MRSA_: IV Flucloxacillin _MRSA_: IV Vancomycin
53
tx for **Pseudomonas auroginosa**
IV Ceftazidime/Ciprofloxacin + IV gentamycin
54
Summarise Klebsiella pneumonia
* More common **alcoholics/DM** * **Gram -tive** * CXR: Cavitating lesions **IV Ceftazidime/Ciprofloxacin**
55
Summarise aspergillus
* Fungal * RFs: immmunocompromised * special Sx: * haemopytsis * ‘asthma' * CXR: halo sign * Tx: amphotericin B
56
Summarise influenza
* viral * RFs: extremes of ages, unvaccinated * special Sx: myalgia * Tx: oseltamivir
57
Summarise COVID
* viral * RFs: unvaccinated * Special Sx: anosmia * CXR: ground glass shadowing * Tx: dexamethasone
58
Summarise PCP
CXR: ground glass shadowing
59
Main difference between bronchitis & pneumonia
Bronchitis: * Mainly smokers * CXR normal
60
Main causes of bronchitis?
* Viruses * *Streptococcus pneumoniae* * *Haemophilus influenzae* * *Moraxella catarrhalis*
61
tx of bronchitis?
§ Bronchodilation § Physiotherapy § Antibiotics
62
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?**
* **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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