pneumonia Flashcards Preview

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Flashcards in pneumonia Deck (160):
1

bacillus anthracis

G+ rod, boxcar, aerobic spore former, *polypeptid capsule*
wool sorters, animal hides

2

actinomyces israelii

G+ rod, thin, branching filaments with clubbed ends, facul. anaerobe, EC bac
chronic/necrotizing pneumo
poor oral hygiene, etOH/malnourish.

3

corynebacterium diphtheria

G+, Clubbed-shaped rod, EC

4

staphylococcus aureus

G+ cocci in clusters, B-hemolytic, facult. anaerobe *coagulase*&catalase positive, EC, sens. to noboviocin, gold-yellow, EC (can be facult. IC) opportunist
*** #2 HCAP/HAP *** also CAP
chronic/necrotizing pneumo
IV drub abuse, hematogenous dissemination, antecedent viral inf (flu), inhib. of escalator/gag/swallow reflex

5

streptococcus pneumoniae

G+ cocci in chains, aerotolerant anaerobes, encapsulated lancet shaped diplococci, a hemolytic, EC, coag. neg
*** #1 CAP *** also HCAP/HAP
antecedent viral infection (flu), elderly, SCD, asplenics

6

streptococcus pyrogenes

G+ cocci in chains, aerotolerant anaerobes, Group A strep (GAS), B hemolytic, EC
lack of M-protein specific opsonizing abs, antecedent viral infection (flu)

7

croup (laryngotracheobronchitis):
more commonly viral or bac?

viral:
*PIV*
RSV, influenza, adenovirus, rhinovirus

8

agents of viral-like croup

Mycoplasma spp.
Chlamydia spp.

9

secondary bacterial tracheitis orgs (primary croup)

S. aureus
S. pneumo
H. flu
M. catarahalis

10

bronchitis in neonates: bac or viral?

BACTERIAL
Strep. agalactiea
Streptococcus agalactiae.
Escherichia coli
Klebsiella pneumoniae
Ureaplasma urealyticum and U. parvum
Chlamydia trachomatis

11

bronchitis in infants/young kids: bac or viral?

VIRAL
RSV
hMPV
influenza
parinfluenzavirus
adenovirus

12

bronchitis in infants/young kids may less commonly be caused by..

BAC:
B. pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae

13

acute bronchitis in adults: bac or viral?

VIRAL
influenza, any RT agent (RSV, parainfluenza)
bac less common: M. pneumo, C. pneumo, B. pertussis

14

AE-CB pathogens

*H. flu (NTHi)*
Moraxella catarrhalis
Strep pneumo
viral agents: influenza, others

15

pertussis (tracheobronchitis)

Bordetella pertussis (EC)
others:
other Bordetella spp., adenovirus, hPIV, RSV, hMPV, M. pneumo, C. pneumo

16

influenza agent

influenza virus !

17

consolidation pneumonia orgs

Streptococcus pneumoniae.
Staphylococcus aureus.
Haemophilus influenzae (Hib) and (NTHi)
Pseudomonas aeruginosa.
Klebsiella pneumoniae.
Other G- bac, e.g., E.coli.
Legionellosis: Legionella pneumophila and other spp.
Burkholderia cepacia, pseudomallei, mallei

18

atypical pneumonia: walking pneumo

Mycoplasma pneumoniae

19

atypical pneumo: Psittacosis

chlamydia psittaci

20

atypical pneumo: Legionellosis

Legionella pneumophila and other spp.

21

atypical pneumo: Q fever

Coxiella burnetti

22

atypical pneumo: PCP

pneumosystis jiroveci (aka pneumoxystis carinii)

23

atypical pneumo: cryptococcosis

cryptococcus neoformans

24

atypical pneumo: viral agents

RSV* (kids), PIV*, hMPV, adenovirus*, influenza* (A,B: adol/adult), hantavirus, rhinovirus, coronavirus, measles (kids), HSV-1*, VZV* (adults), CMV*
*pneumo in immunocompromised

25

chronic OR necrotizing pneumonia: TB

mycobacterium tuberculosis and bovis

26

chronic OR necrotizing pneumo: blastomycosis

blastomyces dermatitidis

27

chronic OR necrotizing pneumo: coccidioidomycosis

coccidioides immitis (and posadasii for necrotizing)

28

chronic OR necrotizing pneumo: histoplasmosis

histoplasma capsulatum

29

chronic OR necrotizing pneumo: nocardiosis

nocardia asteroides

30

chronic pneumo: others

abscesses +/- anaerobic bacteria
actinomyces israelii
brucella abortus, suis, melitensis

31

necrotizing pneumo

Staphylococcus aureus.
Pseudomonas aeruginosa.
Klebsiella pneumoniae.
Other Gram-negative bacteria, e.g., Escherichia coli.
Abscesses + anaerobic bacteria.
Actinomyces israelii

32

necrotizing pneumo: aspegillosis

aspergillus fumigatus, niger, flavus

33

necrotizing pneumo: mucormycosis

absida spp.
mucor spp.
rhizormucor spp.
rhizopus spp.

34

other infectious diseases which may manifest pneumo

Cryptococcosis – Cryptococcus neoformans
Disseminated Mycobacterium avium and intracellular disease.
Pulmonary Anthrax: Bacillus anthracis.
Plague (pulmonary form): Yersinia pestis.
Tularemia: Francisella tularemia.
Complications of some viral diseases such as chicken pox, measles, CMV.
Vermis pneumonitis due to helminthes.
Pulmonary hydatid cysts, Cystic Echinococcosis – Echinococcus spp.
Malaria (Plasmodium vivax and ovale).
Chlamydia psittaci
Coxiella burnetii
Hantavirus
New World Arenavirus
Cryptococcus gattii.

35

pneumo complications

pneumo-->bacteremia-->distributive shock

36

pneumo complications: Guillain-Bare's syndrome

mucosal infection by:
influenza virus, chlamydia spp.

37

CAP severity

6th leading COD in US
1/4 die w/in a year, (1/3 of >65)

38

most common way to get CAP?
agents

ASPIRATION
strep pneumo
klebsiella pneumo
oral anaerobes

39

CAP: aerosoled agents

M. tb, viruses, mycoplasma pneumo, chlamydia pneumo, fungi & legionella spp. from the environment

40

TYPICAL (lobar/consolidation) pneumo

extracellular bacteria or fungal
colonization of alveolar sac lining-PMN infil-->"white-out"
peripheral leukocytosis (el. WBC w/ band forms/left shift)

41

atypical (intersitial/patchy) pneumo

mycoplasma, chlamydia, viral, ureaplasma, legionella, pneumocystis
repl. in interstitium/lung parench.-->inflamm.-->"lacy"
mono/macro infil., leuko count normal or only bit elev.

42

chronic pneumo

anaerobes, M. tb, fungi, nocardiae, actinomycosis
(2-3 wks to mos)
pulmonary nodule ("coin-like") OR abscess (PMNS) OR consolidation (lesions)
mono/macro infilt

43

what pneumonia has the highest severity?

VAP!

44

VAP agents

S. aureus
S. pneumoniae.
H. influenzae.
P. aeruginosa.
Acinetobacter spp.
enteric bacteria

45

HCAP factors

-hospital >48 hrs in last 3 mod
-nursing home, etc. in last 3 mod
-outpt infusion tx or home wound care
-hospital-based clinic or chronic hemodialysis center last 30 days
-fam mem w. MDR pathogen

46

CAP orgs

*Streptococcus pneumoniae*
*Mycoplasma, Chlamydia, Viruses*
Staphylococcus aureus
Klebsiella pneumoniae
Haemophilus influenzae
Legionella pneumophila
other G- rods, unID'd orgs

47

HCAP/HAP orgs

*Klebsiella pneumoniae*
*Staphylococcus aureus*
Pseudomonas aeruginosa
Acinetobacter sp
Legionella pneumophila
Streptococcus pneumoniae
other G- rods, unID'd orgs

48

aspergillus sp.

fungi (EUK), opportunistic, phagocytic mycose
T cell compromise, neutropenia, Fe overload
cause of necrotizing pneumo: Aspergillosis: A. fumigatus, niger, flavus

49

anaerobes (prim. oral NF)

poor oral hygiene, etOH/malnourish.

50

blastomyces dermatitidis

fungi (EUK)
chronic/necrotizing pneumo
exposure to contam. soil in Ohio-Miss. River Valleys (wtf?)

51

brucella spp.

chronic pneumo
exposure to inf. animals, animal tissues, blood, bodily fluids (poultry world, farmer, vet, pet store (cat, cattle, sheep, goats))

52

coccidioides immitis

fungi (EUK)
chronic/necrotizing pneumo; produce sporangia, systemic mycoses
exposure to contaminated soil SW US

53

chlamydia pneumoniae

Gram-negative Cell Wall Architecture -- obligate intracellular bacteria/pathogen- pleomorphic -- without peptidoglycan, unique growth cycle: elem. and reticulate bodies
*** #2 for CAP! ***
viral-like croup, bronchitis in neonates (less so infants/y. kids)
atypical (walking) pneumonia, closed pops,
increased exposure due to crowding

54

chlamydia psittaci

G- cell wall arch., ob IC bac
exposure to birds, poultry worker/farmer/vet/pet store worker

55

cryptococcus neoformans

fungi (EUK), systemic mycoses
atypical (walking) pneumo
lymphoma, AIDS

56

coxiella burnetti

atypical pneumo: Q fever
ob. IC bac
exposure to contam. soil/infectious dust, exposure to inf. animals, animal tissues, blood, bodily fluids (poultry world, farmer, vet, pet store (cat, cattle, sheep, goats))

57

francisella tularensis

rabbit exposure
Tularemia

58

hantavirus

viral agent of atypical pneumo
exposure to contam. soil/infect. dust, exp. to infected rodents, tissues, blood, bodily fluids, droppings

59

Hib

G- rod, EC
secondary bacterial tracheitis, second. bac pneumo in flu pt
#1 AE-CB (and COPD), consolidation pneumo, VAP, CAP
antecedent/current viral LRT infection (esp. influenza)

60

histoplasma capsulatum

fungi (EUK), systemic mycoses
chronic/necrotizing pneumo
exposure to contam. soil in North-Central US
exp. to bats, bird droppings

61

klebsiella pneumoniae

G- rod, EC, oxidase neg, facult. anaerobe, among * most imp. hosp. pathogens, NF, opportunistic, currant jelly sputum
*** #1 HCAP/HAP ***
necrotizing, consolidation pneumo, CRKP
etOH, elderly, SCD, asplenics

62

legionella pneumophila

G- rod, facult. IC
HAP/HCAP and CAP
consolidation, atypical pneumo (Legionellosis), MDR
exp. to aerosolized water

63

mycoplasma pneumoniae

Cell Wall-less pleomorphic bacteria (Not Gram-positive or negative, bacteria which lack peptidoglycan, have a cytoskeleton) (mollicute), EC(EIA/ELISA)
prod. ADP-ribosylating, vacuolating cytotoxin, manif. w/ rash
viral-like croup, bronchitis in infant/y. kids, acute bronchitis, mycoplasma encephalitis
atypical (walking) pneumo
inc. exp. due to crowding, *IMMUNODEFICIENCY*

64

mycobacterium tuberculosis

acid fast bacilli, strict aerobe, facult. IC
chronic/necrotizing pneumo (TB) MDR
foreign-born minority in US, HC worker, low income pop/malnourished, T cell compromise, AIDs

65

mucormycoses

fungi (Absida spp., Mucor spp., Rhizormucor spp., Rhizopus spp)- opportunistic, phagocytic
necrotizing pneumo
neutropenia, DM, Fe overload

66

nocardia asteroides

acid fast bacilli, strict aerobe, EC
chronic/necrotizing pneumo
exp. to soil and cancer

67

pneumocystis jiroveci

fungi, EC, prod. sporangias
atypical (PCP), T cell opportunist
T cell compromise, AIDS

68

pseudomonas aeruginosa

G- rod, EC, may be encapsulated, motile, grows BOTH aerob. and anaerobically, non-fermenter, oxidase +
*ubiquitous habitat (environment) and NF (moist sites)
HCAP/HAP, CR/MDR
consolidation, necrotizing pneumo (rapid, fulminant)
blue-green sputum, fruity odor
neutropenia, CF, Ca, burn pts, COPD, equipment (biofilms)
*rarely causes pneumo, but HIGHEST MORTALITY RATE*

69

ureaplasma urealyticum

Cell Wall-less pleomorphic bacteria (Not Gram-positive or negative, bacteria which lack peptidoglycan) EC
bronchitis in neonates, atypical(walking) pneumo
vaginal infection in gravid female/passage through infected vaginal canal

70

RT viral etiology

inc. exp. due to crowding

71

acute bacterial (typical lobar) pneumonia onset

sudden onset and rapid
progress with fever, chills, productive, mucopurulent cough and chest pains (Pleuritic chest pain is chest pain that worsens with breathing, causing a sharp pain in the chest during deep inhalation but may also be triggered by coughing), lobar presentation, tachycardia, tachypnea, leukocytosis

72

atypical pneumo

subacute onset, milder than lobar. Interstitial pulmonary involvement on Chest x-ray, minimal or absence of the following: high fever, pleuritic chest pain, rigors, mucopurulent cough, leukocytosis. (e.g., walking pneumonia –Mycoplasma)

73

chronic pneumo

subacute onset of weeks to months – a cause of fever of unknown origin, manifestations vary with etiology.

74

sputum

> 25 neutrophils,

75

urinary Ag tests for

Legionella pneumophila
Streptococcus pneumonia

76

antiviral tx

neuraminidase inhibitors (oseltamivir, zanamivir)-->influenza virus
ribavirin-->RSV

77

influenza pt abx?

NO! will predispose to pneumonia, give neuraminidase inhibs instead

78

aspiration pneumo: ppx abx?

NO! will inc. risk of occurrence

79

vaccines: dec. incidence of pneumo

Hib, pertussis, invasive pneumococcal (strep pneumo)

80

pure polysaccharide vaccines

(pure B-cell Ag) type II, T-independent Ag
S-pneumo: pneumovax/pnu-immune (23-valent)

81

T-dependent Ag vaccines: prevent LRT disease bronchitis and/or pneumonia

diphtheria, Hib, pertussis, flu, S. pneumo (Prenevar, 13-valent), measles, M.tb (not in US)

82

S. pneumo is a sig. cause of

pneumonia.
meningitis.
conjunctivitis, otitis media, sinusitis, mastoiditis.
bacteremia.
pericarditis.
peritonitis

83

virulence factors of strep pneumo

capsular polysaccharide: anti-phago, 23 serotypes: 90%
pneumolysin: cytotoxin

84

strep pneumo risk factors

viral infec.
loss of mucocil. elevator/cough/gag reflex-->aspiration
innate/acq immune system defect
smoking, etOH
SCD, acute chest syndrome
elderly w. unreg. DM, chronic heart/lung disease

85

strep pneumo clin manifest

patchy infiltrates > consolidation
productive cough ("rusty" sputum)
single bout of rigors (chills) several hrs before other symps.

86

strep pneumo comps

usually NO abscesses, NO nec. pneumo/perm. lung damage
Bacteremia *in 1/3, doubles mort. rate!*
Meningitis.
Septic shock, DIC.
Hemolytic Uremic Syndrome (HUS).
Rhabdomyolysis.

87

invasive pneumococcal disease (IPD)

in kids w/ chronic diseases: cancer, chronic renal disease, splenectomy, transplant; otherwise: frail kids w/ repeat hosp. contact

88

strep pneumo dx

G+ a-hemolytic diplococci colonies; + (to dif. from NF)
1. optochin susceptibility 2. bile/deoxycholate solubility
3. + Quellung test

89

strep pneumo tx

Penicillin
resistance: PNSP, DRSP, MDRSP, Vancomycin tolerance

90

strep pneumo: vaccine?

PPSV Pneumovax, Pnu-immune: 23-valent polysacc. vaccine
Prevenar 13: conj. to diphtheria CRM-197 protein (all kids, prev. IPD)

91

Pneumovax (23) cons

pure B-cell, TII, T-ind. Ag, no mem cells, short term, only IgM produced, not recomm. for

92

necrotizing pneumonia orgs
(perm. lung damage)

most commonly: anaerobes
S. aureus
P. aeruginosa
K. pneumoniae
M. tb
(not always necrotizing)

93

necrotizing pneumo dx

HAP/HCAP
no initial s/s diffs btw typical pneumo, **pt history**
*dx: abscess or cavitation w. CXR/CT scan*
tx. aggressively!

94

staph epidermidis

catalase-positive, *coagulase-negative (CoNS)
sensitive to novobiocin, gamma hemolytic, white

95

staph saprophyticus

catalase-positive, *CoNS
novobiocin resistant, gamma hemolytic, white/yellow

96

staphyloslide test

determines if bac has fibrinogen receptor and protein A; will agglutinate if staph *aureus*

97

staph aureus virulence factors

coagulase: antiphago, promotes abscess formation
degrad. enzymes: nuclease
exotoxins: PVL (CAP MRSA): can lyse leukos-->necrosis
alpha-hemolysin: cytolytic (pneumo, skin/ST inf)
cell wall + teichoic acid polymer: shock prod.
quorum sensing: exotoxins prod-->spreading

98

staph aureus: severity

Most common cause of skin and soft tissue infections and invasive infections acquired in hospitals in the US

99

staph aureus: bacteremia/hematog. dissem to

pneumonia
endocarditis (A patient with two positive S. aureus blood
cultures has a 50% risk of Acute Infectious Endocarditis
[AIE] with a 100% mortality if not treated!!)
soft tissue abscesses
bone (osteolitis)
joint infections
(can occlude BVs-->necrosis-->painful black eschar (pyoderma, ecthyma gangrenous, P. aeruginosa)

100

staph aureus primary infection

skin
pneumo (prim or sec)
bacteremia (prim or sec)

101

staph aureus clin manifest

-acute pneumonia +/- permanent lung damage, cavitation can occur with PVL production
-chronic lung infections (abscess) with permanent lung damage
-secondary bacteremia

102

dx staph aureus

Cx, phage type to ID strains

103

MSSA

abx-sens (RARE)
PCN-resistant (B-lactamase prod), sens to methicillin
*actually oxacillin and nafcillin used, not methicillin*

104

MRSA

not via B-lactamase (may still be produced)
mutation of mec gene: mecA-->prod. resistant PBP2a
*oxacillin, nafcillin used in abx susc. testing*
**marker for resistance to other drugs (MDR)
mecR does NOT confer MDR to S. aureus

105

MRSA hospital acquired infection (HAI)

HA-HOI or HA-COI
**tx w. VANCOMYCIN** (>50% are true MDR)

106

community acq. infection: CAI-MRSA

resistant to B-lactam abx (PCN, oxacillin, cephalosporins)
sometimes others, typ. MDS **can tx w. other abx, no need for vancomycin**
exception: now CAI-MRSA (true MDR cases) are on the uprise; skin/ST inf. (less necrotizing) *these strains are more virulent*

107

VISA (vanco intermediate resistant S. aureus) resist. mech

mutations in PBP genes
thickened PTG cell wall-->seq. vancomycin from PBPs
(NOT due to alt in pentapeptide side chain (like VRE)

108

VRSA resist mech

alt in pentapeptide side chain (VREnterococci) via HGT
*Linezolid* for tx

109

Burkholderia cepacia

G- rod, pseudomonad
consolidation pneumo, necrotizing pneumo
opportunistic pathogen: CF pts, HAI in immunecomp pts
*complex* (bcc)-->cepacia syndrome (bacteremia)

110

Burkholderia cenocepacia

subcat. of B. cepacia, opportunistic MDR bac, damp/wet places, causes pneumo in CF pt-->cepacia syndrome

111

Burkholderia pseudomallei

CAI in tropical regions

112

Burkholderia mallei

stable, Glanders dis. in livestock, pot. human germ warfare agent

113

P. aeruginosa pigment production

pyocyanin and 1-hydroxyphenazine: blue-green, iron siderophore, antiphago
pyoverden (fluorescein): yellow (wood's lamp), iron siderophore

114

P. aeruginosa virulence factors

-pigments
-exotoxins: Exotoxin A- heat labile, ADP-ribosyltransferase, like DT: inact of EF-2 (kills host cells), local and systemic disease
-degrad. enz: proteases, elastases/alk proteases
-mucoid exopolysacch/slime layer: in bronchial tree of CF pts-->biofilm formation, antiphago
-quorum sensing: exotoxins prod, biofilm initiated-chr inf

115

P. aeruginosa drug resistance/tx

-lim. perm of OM, abx efflux pump
CR/MDR PA: cephalosporins, cipro (FQ), imipenem, piperacillin
*susc only to AMINOGLYCOSIDES (tobramycin) in combo tx*
*pts must be in resp. isolation*

116

Kleb pneumo virulence factor

polysacch capsule: antiphage, mucoid colony form, K1 and K2 serotypes most virulent

117

Kleb pneumo 2nd to E. coli in nosocomial G- bac

pneumonia (esp. HAI)
UTI (DM pts)
bacteremia-->meningitis (neonates)
*pyogenic liver abscess w/ comps of septic/pyog mening/endophthalmitis*
(50% immunecomp)

118

kleb pneumo resist/tx

panresistant: KPC-1 (prod. carbapenemase): resistant to ALL!
CRKP: susc. only to cefepim, imipenem
*pt must be placed in resp. isolation*

119

moraxella catarrhalis

G- diplococci (kidney bean) (flatten abbutting sides
resists destain, nonencap, ox +
*no exotoxin prod, but produce B-lactamases*
3rd for: OM, acute sinusitis, bac cause of AE-CB/COPD
*imp. agent of LRTI (tracheitis-->pneumonia) esp hosp. setting and immunosuppr.

120

acinetobacter baumanii

G- coccobacilli (rod), non-motile, MacConkey agar, MDR (1/3) tx: CARBAPENEMS (shows some resist.)
VAP

121

acinetobacter baumanii inf

pneumonia
endocarditis
meningitis
peritonitis
osteomyelitis
endopthalmitis
urinary tract infections
skin and wound infections

122

Bordatella pertussis

G- rod
LRT disease, bronchitis (kids/adults), pertussis pneumo
pertussis w/ second. bac pneumo

123

atypical pneumo orgs

Mycoplasma pneumoniae
Ureaplasma urealyticum, U. parvum
Chlamydia pneumoniae, C. trachomatis

124

hallmarks of atypical pneumo

subacute-slow progression over days (milder than lobar)
flu-like disease (no exudate/cerv lymph/coryza)
SOB OE, no rigors, sed rate/CRP often inc., "lacy" CXR
lymphocytosis if viral etiology, prolong. convalescence

125

atypical pneumo tx

NOT tx w/ PCNs or cephs

126

viral causes of atypical pneumo

RSV, parainfluenzavirus, adenovirus, human metapneumovirus, influenza virus

127

bacterial pneumonia caused by G+ agents

strep pneumo and staph aureus

128

necrotizing pneumonia caused by G+ agents

staph aureus

129

necrotizing pneumonia caused by G- agents

pseudomonas aeruginosa
burkholderia cepacia, etc.
klebsiella pneumonia, k. oxytoca

130

pneumonia caused by G- agents

moraxella catarrhalis
acinetobacter baumanii
Hib, NTHi, B. pertussis
Legionella pneumophila

131

agents that cause atypical pneumonia

mycoplasma pneumoniae, chlamydia spp., ureaplasma spp.
viral agents

132

why mycoplasma pneumo, u. urealyticum, u. parvum, m. haemofelis, m. spp. are not observed on Gs

they are mollicutes: proc. grp of smallest free-living cell orgs., smallest genome

133

mycoplasma pneumonia seasonality

late summer, fall, early winter (july-jan) when other pneumos are less common!
(ureaplasma has no seasonality)
IMMUNODEFICIENCY

134

comps of m. pneumo RT disease (esp. pneumo)

multiple organ involvement with increased mortality
immunodeficients (hypogam.glob.) may develop joint inf.
CNS-PNS infection (peds enceph)
induction/exacerb. of asthma

135

m. pneumo tx

macrolides: *erythromycin*, azithromycin$$
tetracyclines
quinolones
(some ab resist)

136

ureaplasma urealyticum produces

resp. inf. from perinatal period-->3 yo
chronic lung disease in premies

137

u. urea manifest.

bronchiolitis, resp. distress (pneumo, ARDS)
neonate, infant, y. kid have cough and wheeze
dx. w/ throat/vag swab in special broth-->Cx

138

u. urea txq

clarithromycin

139

chlamydia spp. deets

slow growing, alt. btw 2 cell forms:
elementary body (EB, EC infectious form- inert)
reticulate body (RB, IC parasitic form- active)
forms large intracytoplasmic inclusions, not visible by Gs
lytic infection
C. psittaci (parrot fever), C. trachomatis (Tric), C. pneumo (TWAR)

140

chlamydia spp. may cause

RT inf (bronchitis, pneumo), conjunctival inf (dev. countries), UG infections (#1 for STDs in US!)

141

c. trachomatis (Tric) causes

cervicitis (STDs) in women, vert. transmission to child:
conjunctivitis, pneumo, both
rare agent of pneumo in adults

142

c. pneumoniae (TWAR) causes in who

human RT disease
adult males, reinfection in elderly (also mycoplasma)
smokers
coinfect. (50%) w/
strep pneumo
sycoplasma pneumo
legionella pneumophila
influenza virus type A

143

comps of c. pneumo

heart, CNS, septic arthritis, exacerbation of asthma, induction of asthma/atherosclerotic lesions?

144

how to dx c. pneumo

microimmunofluroescent test (MIF) (EBs)
comp. fixation (CF), DFA/IFA, EIA (for c. LPS), PCR
CXR when appropriate, not vis. on Gs, Cx only spec. labs

145

c. pneumo tx

macrolides: *azithromycin*$$, erythromycin
tetracyclines, doxycyclines

146

viral pneumo

Influenza virus, RSV, adenovirus (Ad), PIV, hMPV, rhinoviruses, coronaviruses, measles, HSV-1, VZV, CMV

147

viruses signif. in

cause 90%!
*RSV* causes 50%

148

this virus is causes > 50% CAP (viral)

influenza virus A and B (esp. during influenza outbreak)

149

70% of viral nosocomial viruses

Ad, influenza, PIV, RSV

150

viral pneumo deets

-multiply in up. airway epi-->inf. lung via secretions or blood
-patchy/diffuse inflitrates, consolid., pleural eff (occasion.), hemorrhage, alveolar damage
-cytopathic or inflammatory
-cytokine production: Type 1: CMI, Type 2: allergic response

151

viral pneumo deets

fever, chills, nonprod. cough, rhinitis/rhinorrhae-->sinus cong, ha, myalgias, body aches, fatigue, throat discomfort/pharyngitis, SOB
*most resolve w.in 2 weeks

152

dx viral pneumo on clinical evidence?

NO, nearly impossible

153

roentgenographic findings w. viral pneumo in kiddos

hyperexpansion
parahilar peribronchial infiltrates
atelectasis
hilar adenopathy
*rarely seen: consolidated alveolar/diffuse interstitial infiltrates and large pleural effusions

154

influenza virus tx

zanamirvir, oseltamivir

155

RSV, PIV, Ad, hMPV tx

ribavirin

156

HSV tx

acyclovir

157

VZV tx

acyclovir and VZIG

158

CMV tx

ganciclovir or foscarnet and IVIG

159

measles tx

ribavirin and IVIG

160

ppx viruses

vaccines for influenza, VZV, measles
Ig/MoAb for RSV

Decks in Micro Class (61):