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SFM4 > Respiratory Microbio and Antibiotics > Flashcards

Respiratory Microbio and Antibiotics Flashcards

1
Q

indications for hospitalization with pneumonia

A
  • hypoxemia r/q O2
  • hemodynamic instability
  • AMS
  • IV abx
  • comorbidities
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2
Q

strep pneumonia (pneumococcus) usual consolidation pattern

A

lobar (entire lobe of lung)

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3
Q

staphylococcus usual consolidation pattern

A

bronchopneumonia

multiple small foci centered around bronchioles in >1 lobe

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4
Q

klebsiella usual consolidation pattern

A

bronchopneumonia

multiple small foci centered around bronchioles in >1 lobe

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5
Q

typical presentation for bacterial CAP

A
  • rapid onset
  • severe
  • significant infiltrates on CXR
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6
Q

most common cause of CAP

A

streptococcus pneumoniae

aka pneumococcal pneumonia

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7
Q

strep pneumoniae microscopic appearance

A

paired diplococci
lancet shaped
gram positive
alpha-hemolytic

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8
Q

common non-pneumococcal causes of “typical” CAP

A

gram –

  • klebsiella pneumoniae (most common gram – pneumonia)
  • H. influenzae
  • Moraxella catarrhalis
  • legionella pneumophilia (severe atypical-typical overlap)

gram +
- s. aureus incl. MRSA

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9
Q

common causes of “atypical” CAP

A

no gram stain
- mycoplasma pneumoniae (not tb)

gram –

  • chlamydophilia pneumoniae
  • chlamydophilia psittaci (parrot)
  • Coxiella burnetii

viral

  • influenza A & B
  • parainfluenza (children)
  • metapneumovirus
  • adenovirus
  • COVID
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10
Q

distinguishing features of strep pneumoniae

A
  • lobar consolidation
  • rust-colored sputum d/t slow bleeding into alveoli
  • quick dissemination in asplenic patients (trauma, sickle cell, other splenectomy)

(usually)

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11
Q

legionella microscopic appearance

A
  • gram negative bacillus
  • sputum gram stain generally shows many neutrophils and few to no bacteria
  • positive urinary antigen
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12
Q

distinguishing features of legionella

A
  • lobar pneumonia
  • severe illness
  • high fever
  • diarrhea
  • vomiting
  • bacterium lives in water; hx may indicate exposure to contaminated water

lab findings:

  • hyponatremia
  • hypophosphatemia
  • hematuria
  • proteinuria

risk fx:

  • ^ age
  • s.p. transplant
  • comorbid disease
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13
Q

klebisella microscopic appearance

A

gram negative bacillus

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14
Q

distinguishing features of klebsiella

A
  • abrupt onset
  • “currant jelly” sputum (sometimes)
  • lobar, bronchopneumonia, and/or lung abscess

risk fx:

  • alcohol use disorder
  • malnourishment
  • debilitation
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15
Q

mycoplasma pneumoniae microscopic appearance

A

not visible on gram stain as it lacks cell wall

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16
Q

distinguishing features of mycoplasma pneumoniae

A
  • younger age (school-age thru college)
  • atypical
  • – nonproductive cough
  • – “walking pneumonia”
  • – less remarkable physical exam findings
  • – lack of lobar consolidation on CXR
  • non-pulmonary features uncommon, but identifying when seen
  • – erythema nodosum or multiform
  • – meningitis, encephalitis, transverse myelitis, cranial nerve palsies, or cerebellar ataxia
  • – cold agglutinins with hemolysis
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17
Q

distinguishing features of chlamydophilia pneumoniae

A

similar to mycoplasma pneumoniae but with older age

  • atypical
  • – nonproductive cough
  • – “walking pneumonia”
  • – less remarkable physical exam findings
  • – lack of lobar consolidation on CXR
  • non-pulmonary features uncommon, but identifying when seen
  • – erythema nodosum or multiform
  • – meningitis, encephalitis, transverse myelitis, cranial nerve palsies, or cerebellar ataxia
  • – cold agglutinins with hemolysis
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18
Q

distinguishing features of chlamydophilia psittaci

A

get it from a parrot

atypical “walking pneumonia”

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19
Q

influenza A and B microscopic appearance

A

viral

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20
Q

distinguishing features of influenza A and B

A
  • viral
  • upper airway
  • – cough
  • – rhinorrhea
  • – sore throat
  • abrupt onset d/t IFN
  • fever
  • myalgia
  • lower airway infection possible on its own but usually due to rebound bacterial pneumonia (usually pneumococcus and s. aureus)
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21
Q

tx influenza A and B

A

zanamivir or oseltamivir

ideally w/in 48 h

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22
Q

outpatient tx of uncomplicated CAP

A

amoxicillin ± clavulanate
only covers gram +
strep, staph

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23
Q

outpatient tx of CAP w/ comorbidities

A

amoxicillin/clavulanate + azithromycin

    • gram +
    • and moraxella, h. flu

or cefpodoxime + azithromycin

    • broad gram + and gram – coverage
    • no pseudomonas

or respiratory fluoroquinolones (–floxacin)

    • broad gram + and gram –
    • levofloxacin covers pseudomonas
    • moxi does not cover pseudomonas
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24
Q

azithromycin coverage

A 
gram +
some gram –
- "atypicals"
-- chlamydophilia
-- mycoplasma pneumoniae
-- legionella
25
Q

cefpodoxime coverage

A

broad gram + and gram –
3rd gen cef
“typicals”

NO:

  • pseudomonas
  • bacteroides
  • enterococcus
26
Q

ceftriaxone coverage

A

broad gram + and gram –
3rd gen cef
“typicals”

NO:

  • pseudomonas
  • bacteroides
  • enterococcus
27
Q

levofloxacin coverage

A

broad gram + and gram –
typicals and atypicals
pseudomonas

28
Q

moxifloxacin coverage

A

broad gram + and gram –
typicals and atypicals

NO pseudomonas

29
Q

inpatient tx of CAP

A
  • ceftriaxone + azithromycin (preferred)
  • or other 3rd gen cef + macrolide
  • or respiratory fluorquinolones (levo or moxi)

goal is broad coverage of typicals and atypicals

30
Q

duration of abx with CAP

A

usually 5 days

31
Q

HAP vs CAP

A

HAP = hospital-acquired
at least 48 h in hospital
much more likely to be multi-drug resistant

32
Q

abx pseudomonas

A

*needed for empiric HAP coverage

FIRST LINE

4th gen cef:

  • cefepime
  • ceftazidime

carbapenem:

  • imipenem
  • meropenem

piperacillin/tazobactam

ADD-ON (severe)

some fluoroquinolones:

  • ciprofloxacin
  • levofloxacin

aminoglycoside:

  • amikacin
  • gentamicin
  • tobramycin
33
Q

MRSA abx inpatient

A

linezolid

vancomycin

34
Q

duration of abx with HAP

A

usually 7 days

35
Q

VAP vs HAP

A

VAP = ventilator acquired
subset of HAP
very common cause of HAP
HAP can often be avoided by using non-invasive (non-intubation) ventilation where possible

36
Q

reducing HAP risk

A
  • non-invasive ventilation where possible
  • keep bet at 30-45 degrees
  • oral hygiene
37
Q

chronic vs acute pneumonia, common pathogens

A

gradual onset, longer duration

bacterial:
- TB
fungal:
- coccidioidomycosis
- histoplasmosis
- blastomycosis

38
Q

CXR primary TB

A

Ghon complex:
tb foci in mid-lung
+ enlargement of hilar lymph nodes
= foci near hilum

39
Q

CXR secondary TB

A

secondary TB = reactivation of latent TB

  • fibro-caseating lesions
  • – fibrosis + caseating granulomas
  • apex of lung d/t high V/Q ratio
40
Q

potential outcomes of primary TB

A
  • complete immune clearance
  • pulmonary containment (–> latency)
  • extra-pulmonary containment (–> latency)
  • in i.c. pts
    • progressive primary TB
    • miliary (systemic) TB
41
Q

dx latent TB

A

+PPD or IGRA (IFNg release assay)
— only works in immunocompetent pts

AND
CXR not suggestive of active infection

42
Q

dx active TB

A

sx:

  • cough w/ hemoptysis
  • fever
  • night sweats
  • weight loss
  • exposure hx

risk factors

  • endemic country
  • jails
  • homeless shelters

dx and labs:

  • CXR or chest CT
  • PCR
  • AFB (acid-fast bacilli) stain
  • sputum cultures
  • uncommon: biopsy + special AFB stain w/ caseating granulomas
43
Q

tx latent TB

A

classic (and cheap):
- isoniazid x 9 mo

newer ($$):

  • rifampin x 4 mo
  • isoniazid + rifampin or rifapentine x 3 mo
44
Q

tx active TB

A

RIPE x ≥6 mo

  • rifampin
  • isoniazid
  • pyrazinamide
  • ethambutol
45
Q

fluconazole

A

anti-fungal

long term tx for cocci

46
Q

histoplasmosis epidemiology

A

Mississippi and Ohio river

bird and bat droppings, or soil containing bird and bat droppings

47
Q

sx histoplasmosis

A

often asymptomatic

possible:

  • nodular infiltrates
  • erythema nodosum
  • pancytopenia d/t bone marrow involvement
  • splenomegaly
48
Q

dx histoplasmosis

A
  • granulomatous pneumonia
  • calcified lesions in lungs, mediastinum, spleen, liver
  • urine and serum antigen tests
49
Q

tx histoplasmosis

A

mild
- spontaneous

moderate
- itraconzole po

severe
- amphoterrible iv

50
Q

itraconzole

A

anti-fungal

po tx for moderate histoplasmosis or blastomyces

51
Q

blastomyces epidemiology

A

midwest and east coast

52
Q

sx blastomyces

A
  • abrupt
  • productive cough
  • fever
  • upper lung CXR
  • acute –> chronic
  • skin lesions
53
Q

dx blastomyces

A
  • fungal culture
  • broad based budding on tissue biopsy
  • epithelial hyperplasia (may be mistaken for lung cancer)
  • neutrophil recruitment
54
Q

tx blastomyces

A

mild
- spontaneous

moderate
- itraconzole po

severe
- amphoterrible iv

55
Q

cocci epidemiology

A

southwestern and far western US
San Joaquin valley
inhaled spores from soil disruption
earthquake, major construction

56
Q

sx cocci

A
  • varied
  • fevers (of unknown origin as it is often an initial presenting sx)
  • cough
  • pleuritic chest pain
  • erythema nodosum on shins
  • abx resistant pneumonia
  • lung, skin, bone, meningeal involvement if disseminated
57
Q

dx cocci

A
  • spherule w/ endospores on tissue stain (big circles filled with little circles)
  • granulomas
  • pneumonia on CXR
58
Q

tx cocci

A

long course of fluconazole

SFM4 (10 decks)

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