pneumonia Flashcards
(160 cards)
1
Q
bacillus anthracis
A
G+ rod, boxcar, aerobic spore former, polypeptid capsule
wool sorters, animal hides
2
Q
actinomyces israelii
A
G+ rod, thin, branching filaments with clubbed ends, facul. anaerobe, EC bac
chronic/necrotizing pneumo
poor oral hygiene, etOH/malnourish.
3
Q
corynebacterium diphtheria
A
G+, Clubbed-shaped rod, EC
4
Q
staphylococcus aureus
A
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
Q
streptococcus pneumoniae
A
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
Q
streptococcus pyrogenes
A
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
Q
croup (laryngotracheobronchitis):
more commonly viral or bac?
A
viral:
PIV
RSV, influenza, adenovirus, rhinovirus
8
Q
agents of viral-like croup
A
Mycoplasma spp.
Chlamydia spp.
9
Q
secondary bacterial tracheitis orgs (primary croup)
A
S. aureus
S. pneumo
H. flu
M. catarahalis
10
Q
bronchitis in neonates: bac or viral?
A
BACTERIAL Strep. agalactiea Streptococcus agalactiae. Escherichia coli Klebsiella pneumoniae Ureaplasma urealyticum and U. parvum Chlamydia trachomatis
11
Q
bronchitis in infants/young kids: bac or viral?
A
VIRAL RSV hMPV influenza parinfluenzavirus adenovirus
12
Q
bronchitis in infants/young kids may less commonly be caused by..
A
BAC:
B. pertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae
13
Q
acute bronchitis in adults: bac or viral?
A
VIRAL
influenza, any RT agent (RSV, parainfluenza)
bac less common: M. pneumo, C. pneumo, B. pertussis
14
Q
AE-CB pathogens
A
H. flu (NTHi)
Moraxella catarrhalis
Strep pneumo
viral agents: influenza, others
15
Q
pertussis (tracheobronchitis)
A
Bordetella pertussis (EC)
others:
other Bordetella spp., adenovirus, hPIV, RSV, hMPV, M. pneumo, C. pneumo
16
Q
influenza agent
A
influenza virus !
17
Q
consolidation pneumonia orgs
A
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
Q
atypical pneumonia: walking pneumo
A
Mycoplasma pneumoniae
19
Q
atypical pneumo: Psittacosis
A
chlamydia psittaci
20
Q
atypical pneumo: Legionellosis
A
Legionella pneumophila and other spp.
21
Q
atypical pneumo: Q fever
A
Coxiella burnetti
22
Q
atypical pneumo: PCP
A
pneumosystis jiroveci (aka pneumoxystis carinii)
23
Q
atypical pneumo: cryptococcosis
A
cryptococcus neoformans
24
Q
atypical pneumo: viral agents
A
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
