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Term 4: Infectious Diseases > Strep Pneumoniae > Flashcards

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Which organism causes the majority of the cases of bacterial pneumonia, leading to hospitalization?

-Strep Pneumoniae


Is strep pneumoniae gram positive or negative?

Gram + (Blurple)


What is alpha hemolysis?

-when grown on agar that contains RBC's, a molecule called alpha-hemolysin breaks hemoglobin down to a greenish pigment


What is the outermost layer of pneumococcus?

-a polysaccharide capsule -contains peptidoglycan


What does PMN stand for?

-polymorphonuclear Leukocytes


Why is pneumococcus not readily ingested by PMNs?

-The capsule is not recognized by receptors on PMN -in the absence of antibodies to specific capsular polysaccharide, they won't be eaten by PMN -IgG to cell wall can't be "seen" by PMN


Why are antibodies for the cell wall of pneumococcus not immune response inducing?

-The capsular polysaccharides are too long, and shield the Fc region of abs from PMNs **Ig and complement diffuse through capsule, but capsule prevents PMN receptors from interacting with Fc of IgG.


What are the constituents of pneumococcus from the outside going in?

-Polysaccharide capsule -Teichoic acid attached to lipid (lipoteichoic acid) -Choline-Binding Proteins -Peptidoglycan: Principal constiduent of cell wall -Pneumolysin -Autolysin


What factors cause decreased neutrophil function (chemotaxis, ingestion, killing)?

-Diabetes Mellitus -Glucocorticosteroids -Renal insuficiency -Cirrhosis -Alcohol Ingestion -Genetic defects in PMN function


What factors can lead to defective IgG production?

-Congenital -Acquired: myeloma, lymphoma, common variable immunodeficiency -HIV infection


How are splenectomies related to pneumococcal pneumonia?

-doesn't predispose to infection ***but does predispose to overwhelming sepsis and shock in pneumococcal pneumonia


What is pneumolysin?

-a major virulence factor produced by pneumococci -activates complement (inflammation) -Damages ciliated cells and PMN -reproduces changes of pneumonia in animals


What is the difference between epidemiology & pathogenesis?

Epidemiology = where the organism likes to hang out Pathogenesis = how disease comes about


How is pneumococcal pathogenesis related to viral illness?

-viral infection characterizes the major form of pneumococcal disease -virus messes up our normal anatomy (cilia), and pneumococcus gets stuck where its not supposed to be


Describe the microbiology of pneumococcus.

-pairs or chains of elongated cocci -gram positive -colonies on blood agar surrounded by greenish zone (alpha-hemolysis) -colonies collapse in center (autolysin) -optochin susceptibility (ring of death around white thing) -dissolve in bile salts (definitive identification)


Which TLR does Teichoic acid of pneumococcus interact with ?

TLR 2 >>4


What is important about Choline-binding proteins on pneumococcus?

-they contribute to virulence -highly conserved between pneumococci strains


What are bacterial cell wall peptidoglycans made of?

-alternating glucosamine and muramic acid in long chains


Which TLR recognizes cell wall peptidoglycans?

TLR 2 >> 4


What is the epidemiology of pneumococcus?

-Confined to humans -lives in nasopharynx of healthy children/adults -contact or aerosol spread (facilitated by viral resp infection)


What must first happen for bacteria to cause disease?

-adhere to epithelial cells -bacterial surface constituents interact with surface molecules on mammalian cells, causing adherence


What molecule on pneumococcus is responsible for adherence?

-Lipoteichoic acid


What is colonization?

-when bacteria are present in sufficient number that we can find them by culture, AND, they cause no symptoms or signs of infection **some organisms never colonize, mere presence indicates infection (TB)


What is the pathogenesis of pneumococcus?

-carried by secretions to space from which clearance is poor (damage/obstruction) -aspiration & inhalation = pneumonia **organisms get where they do not belong, clearance is damaged, induce inflammation & disease results.


What is the difference between inhalation and aspiration of an organism?

-inhalation = breathing in aerosolized organisms -aspiration = mouth contents bypass glottis


What factors decrease action of cilia and cough in the respiratory tract?

-Smoking -inflammation -viral infection -Alcohol, codeine, morphine (suppress cough) -pollution


How does pneumonia result from pneumococcus infection?

-cocci reach alveoli, activating inflammatory response -WBCs attracted & capillary permeability increased -this means WPCs, plasma constituents, and RBC's collect in alveoli = pneumonia infiltrate


What factors predispose people to infection by pneumococcus?

-Multifactorial: extremes of life, prior hospitalization, malnutrition, alcoholism -Decreased pulmonary clearance -diminished neutrophil function -defective IgG production -absence of spleen


What are the common clinical manifestations of pneumonia?

(often preceded by viral infection) -Cough (90%) -Fever (90+%) -sputum production (variable) -chest pain (50-75%) -general appearance = look sick -can percuss and listen for rales, but xray is best


What are the lab findings for pneumonia?

-High WBC, possible left shift **reduction in EBC = overwhelming infection -opacity in chest xray -decreased O2 sat