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Pneumonia Bacterial Pathogens Flashcards

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1
Q

Strep pneumo risk factors

A

alcohol/drug intoxication causing cerebral impairment depressing the cough reflex and increasing aspiration; abnormality of the reps fact including injury, infection, and obstruction; abnormal circulatory dynamics; splenectomy, sickle cell, HIV

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2
Q

How is sickle cell a risk factor for strep pneumo

A

auto-splenectomy. Encapsulated pathogens like strep pneumo are typically cleared by the spleen

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3
Q

Strep pneumo virulence factors

A

capsule, lipoteichoic acid (activates complement, induces cytokine production), IgA protease enhancing ability to colonize mucosa

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4
Q

How is strep pneumo diagnosed

A

Urinary antigen, Gram stain and culture; it is optochin sensitive and shows Quellung reaction

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5
Q

What does strep pneumo look like on gram stain

A

Lancet-shaped, gram positive diplococcus

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6
Q

Treatment options for Strep pneumo

A

Ceftriaxone, Amoxicillin, Levofloxacin, Azithromycin

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7
Q

Strep pneumo vaccines

A

Pneumovax (23 type) provides 5yrs of protection used for people 65+ and those at heightened risk

Prevnar (13 types) recommended for children and infants

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8
Q

Herd Immunity

A

if most of the population receive a vaccine then those who do not are protected because they are surrounded by people who will not get the disease

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9
Q

What populations usually get mycoplasma pneumonia

A

military recruits, prison inmates, and school aged children

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10
Q

Mycoplasma pneumonia’s pathogenesis

A

Adhesin binds to ciliated epithelial cells and causes reduced ciliary clearance

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11
Q

Diagnostic methods for myoplasma infection

A

Cold agglutinins (IgM), serology, grown on Eaton agar, PCR on respiratory secretions

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12
Q

Best treatment for Mycoplasma

A

Levofloxacin, Azithromycin, or Doxycycline

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13
Q

Why does penicillin not work to treat mycoplasma

A

Mycoplasma has no cell wall

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14
Q

Chlamydia pneumonia

A

similar presentation to mycoplasma (walking pneumonia) except more common in older people (40ish); has no good diagnostic test; treat with Doxycycline

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15
Q

Psuedomonas typical habitat

A

common in hospital; lives in wet environments and can be problematic for patients on ventilators; also in soil and plants

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16
Q

Pseudomonas microbiologic features

A

non-fermentative, motile, oxidase-positive, elaboration of green pigment; smells fruity

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17
Q

H. influenza microbiologic features

A

small, pleomorphic; facultatively anaerobic, nonmotile

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18
Q

Klebsiella pneumonia microbiologic features

A

lactose fermenting, indole-negative; incapable of growth at 10C

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19
Q

A. baumanii microbiologic features

A

gram-negative coccobacilli, non-motile, strictly aerobic, catalase positive, oxidase-negative

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20
Q

Microplasma pneumonia virulence factor

A

Adhesin

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21
Q

Ps. aeruginosa virulence factor

A

endotoxin and exotoxin A (enzyme blocks protein synthesis by inactivating EF-2 by ADP ribosylation), elastase, leucocidin, lemolysins, alginate, exoenzyme S

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22
Q

Staph aureus virulence factor

A

enterotoxin

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23
Q

S. pneumonia virulence factor

A

capsule

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24
Q

Pseudomonas effects

A

can cause extensive vasculitis with thrombosis and hemorrhage with necrosis

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25
Antibiotics for psuedomonas
Cefepime, Zosyn, Meropenem, Ciprofloxacin
26
Legionella location
contaminated water source (hotel/hospital showers, hot tubs, AC units)
27
Legionella signs and symptoms
fever, dry cough, diarrhea, confusion, Hyponatremia in older smoking population with comorbidities
28
Legionella Diagnostic tools
CXR, silver stain, culture on charcoal yeast extract agar enriched with cysteine and iron, urinary antigen testing, direct fluorescent antibody
29
Pontiac fever
acute, febrile self limited illness; symptoms include fever, malaise, chills, fatigue, HA, no respiratory complaints; no abnormalities on CXR; usually requires no treatment
30
Legionella Virulence factors
intracellular (results in decreased clearance and can parasitize and live in alveolar macrophages); cell wall endotoxin (major virulence factor; causes host inflammatory response which causes lung damage)
31
Treatment for Legionella
Levofloxacin and Azithromycin
32
Crackles
scratchy sounds caused by accumulation of fluid/white cells/bacteria in alveolar and interstitial spaces
33
Bronchial breath sounds
dense consolidation of lung parenchyma results in transmission of large airway noises to the periphery
34
Dullness to percussion
normal, air filled tissue has been displaced by fluid or infiltrated with white cells and bacteria
35
Increased tactile fremitus
consolidation alters transmission of air and sound.
36
Lung consolidation
occurs when lung parenchyma becomes engorged with fluid or tissue usually in the presence of pneumonia
37
Organisms that cause community acquired pneumonia
staph aureus, Hemophilus influenza, klebsiella pneumonia, moraxella catarrhalis
38
What bacteria causes currant jelly sputum, often seen in chronic alcoholics and malnourished
Klebsiella pneumonia
39
What bacteria is seen in post-viral respiratory infections
Staph aureus
40
Bacteria very common cause of hospital acquired PNA
Staph aureus
41
Bacteria with 6 serotypes, encapsulated and non, gram - coccobacillary
H. influenza
42
Bacteria grows on chocolate agar, requires factors V and X for growth
H. influenza
43
Bacteria that have complications including abscess and necrotizing PNA
Staph aureus and Klebsiella pneumonia
44
Bacteria with common drug resistance
S. aureus and K. pneumonia
45
Bacteria where amoxicillin is used for mild infection and ceftriaxone is used for serious infections
H. influenza
46
Bacteria where capsule is one of the major virulence factors
H influenza and K. pneumonia
47
Bacteria that also causes otitis media, epiglottitis, and meningitis
H. influenza
48
Bacteria whose vaccine incorporates the capsular polysaccharide b; and antibodies against capsule are protective
H. influenza
49
Common bacterial cause of acute exacerbations
H influenza and M. catarrhalis
50
Hospital acquired pneumonia risk factors
severe underlying disease, immunosuppression, prolonged antibiotic therapy, invasive devices such as IV catheters, mechanical ventilation
51
Difference between hospital acquired and health care associated pneumonia
HAP acquired during hospital stay; HCAP is hospitalization of at least 2 days within 90days; received IV therapy, wound care, or chemo in 30days; resident of nursing home; has hemodialysis
52
Most common organisms to cause HCAP
Pseudomonas aeruginosa and Staphylococcus aureus
53
Alpha hemolysis
seen in strep pneumo; shows dark red outline on blood agar
54
Beta hemolysis
seen in staph pyogenes; looks bright yellow on blood agar
55
Quellung reaction
antibodies to capsule material causing swelling
56
Optochin
used to distinguish S. pneumo (sensitive) from viridans strep
57
Step pneumo invasion
can alter vascular permeability to allow access to blood stream and cause bacteremia; can also directly invade endothelial cells; can cross blood brain barrier by binding to cerebral capillaries and cause meningitis
58
Strep pneumo virulence factors
capsule (resists phagocytosis), pili (used for bacterial adhesion to epithelial cells), cell wall components (techie acids and lipotechoic acid that cause inflammatory response)
59
Mycoplasma facts
lack a cell wall, smallest free-living organism, can cause primary atypical pneumonia; pleomorphic with polar structure
60
Mycoplasma virulence
attaches to surface of respiratory epithelia, and the lipoproteins interact with alveolar macrophage Toll-like receptors activating the production of inflammatory cytokines
61
Chlamydia pneumonia pathogenesis
transmitted via respiratory droplets or secretions, gradual onset of cough leading to pneumonia, can range from asymptomatic to severe, most common in school age children
62
Chlamydia pneumonia extrapulmonary associations
associated with chronic atherosclerotic disease
63
Legionella
Typically effects elderly, immunocompromised, heavy smokes, alcoholics, and others with compromised lungs; generally spread by fomites and vehicles (water), can survive community water treatment, usually occurs in isolated incidence but associated with mass outbreaks
64
Legionella virulence factors
replicates in alveolar macrophages after inhalation; it avoids phagosome-lysosome fusion by creating a specialized vacuole that resembles the ER of the host and supports bacterial replication (wild type and Dot/Icm - type IV secretion system)
65
Staph aureus micro
colonize the nasal passages but can be found on the skin; form large yellow colonies on rich agar medium; catalase +, coagulase +, hemolytic
66
Staph epi micro
colonizes the skin; forms small white colonies on rich agar medium; catalase +, coagulase -, non-hemolytic
67
Primary infections caused by staph aureus
Pneumonia and Meningitis
68
Primary infections by staph epi
usually nosocomial infections of implants
69
Pathogenesis of staph aureus
many virulence factors including adhesins, invasins, antiphagocytic surface factors, immunologic decoys, lytic toxins, exotoxins, and abx resistance
70
H. flu virulence
Capsule polysaccharide (serotype B)
71
H flu vaccine
Hib - type b capsular polysaccharide conjugated to a carrier protein (diphtheria) - given to children 2-15 months
72
Pseudomonas micro
important nosocomial pathogen especially in patients with leukemia, cystic fibrosis, and extensive burns; has ability to survive and proliferate in water
73
Klebsiella micro
large capsule, no one antigen is associated with disease; causes lobar pneumonia; opportunistic infections
74
Enterobacter micro
opportunistic pathogens, nosocomial infections in patients on anitbiotics
75
Klebsiella staining
negatively stained with India ink revealing the cell wall
76
Strep pyogenes facts
Group A Strep (GAS) beta hemolytic - strep throat; causative agent of numerous local and systemic disease and post-disease sequelae; can cause necrotizing fasciitis, shock, sequelae including acute rheumatic fever or glomerulonephritis
77
Strep agalactiae facts
Group B strep (GBS) beta hemolytic
78
Strep pyogenes pathogenesis
M proteins (resist phagocytosis), hyaluronic acid capsule, adhesins, invasins, exotoxins, strep pyrogenic exotocins

Pulmonary Block (8 decks)

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