CC Nov 2015 Atypical pneumonia

echoecho's version from 2015-12-13 16:49


Question Answer
Originally used to describe viral pneumonia (compared to the "typical" bacterial pneumonia), atypical pneumonia is currently used to indicated lower respiratory tract infections due to what 3 zoonotically transmitted organisms and what 3 non-zoonotically transmitted bacteria?1) Chlamydia psittaci, Francisella tularensis, Coxiella burnetii 2) Chlamydia pneumoniae, Mycoplasma pneumonia, Legionella pneumophila
The 3 non-zoonotically bacteria are responsible for 20-30% of all cases of what disease in the US?community-acquired pneumonia (CAP)
Although these organisms may cause HCAP (healthcare associated penumonia), they are more likely to cause CAP particularly in the ______ (hospital vs ambulatory) setting?ambulatory
*** What manifestations are commonly seen in atypical pneumonia, but clinically these manifestations may NOT be helpful in distinguishing them from typical pneumonia?extrapulmonary
Older definitions of atypical pneumoniases suggested a disease with milder symptoms and ____ sputum, however, the ____ range of entities in the current classification of atypical pneumnonia include diseases with POTENTIAL for severe disease and significant complications?1) scant 2) broad
Although the CXR may support the diagnosis of atypical pneumonia, does it reliably differentiate between bacterial and atypical etiologies?no
Atypical pneumonia is caused by what 2 organisms?1) streptococcus pneumoniae 2) haemophilus influenza
Describe what typical pneumonia organisms have that atypical pneumonia organisms do not have and explain how antibiotics work on typical pneumonia organisms?1) prominent cell walls 2) antimicrobial therapy (beta-lactams) targets cell wall synthesis
Why are beta-lactams LESS effective against atypical pneumonia organisms? What medications works better for atypical pneumnia organisms?1) because atypical pathogens do NOT have a cell wall but are intracellular (Legionella) or paracellular (Mycoplasma) 2)antibiotics that interfere with intracellular protein synthesis enzymes such as macrolides, TCN, fluoroquinolones tend to be more effective
Question Answer
What type of bacteria is it?intracellular aerobe
Famous breakout in 1976?at the American Legion in Philadelphia
Latest breakout in the US in 2015?in New York City
What milder-flu like disease can be caused by this organism?Pontiac fever
List the extrapulmonary manifestations of Legionella infection?1) CNS (HA, lethargy, confusion) 2) heart (bradycardia) 3) GI (diarrhea, abdominal pain, mild transaminasemiai) 4) kidney (acute kidney injury) 5) elevated creatinine kinase
CXR findings?rapidly progressive and asymmetric
What lab test aids in the dx of Legionella but only detects one serogroup?urine antigen test
Question Answer
What type of bacteria is it?obligate intracellular organism that lacks a cell wall
Is difficult to clinically distinguish from what other bacteria?Mycoplasma pneumoniae
What symptom is more commonly seen in patients infected with Chlamydia pneumoniae?upper respiratory tract symptoms (laryngitis)
Unlike Legionella, infection with Chlamydia pneumoniae rarely results in _____ symptoms?gastrointestinal
Question Answer
What type of bacteria is it?nonstainable organisms that lacks a cell wall
What common upper respiratory conditions are associated with this organism?1) otitis 2) bullous myringitis 3) mild nonexudative pharyngitis
Common pathogen in what population?pediatric
What titers are high?cold agglutinins
CXR findings?patchy infiltrates that "look worse" than the patient does clinically
What GI complaints can occur?abdominal pain and diarrhea
What antibiotic class treat these organisms? List antibiotics?1) macrolides 2) Azithromycin (Zithromax), Doxycycline (Doryx)
Comment on empiric therapy?is still appropriate despite lack of demonstrated significant benefit
In adult hospitalized patients or those with co-morbidities, what antibiotic classification may be considered alone or in combination with a macrolide?fluoroquinolones
Question Answer
This is the causative agent of what disease?psittacosis
This is transmitted by exposure to what?1) birds especially pet birds (parrots, parakeets, macaws, cockatiels) 2) poultry (ducks and turkeys)
About 50 cases are reported per year, but the number of cases has decreased since ____?1988
Extrapulmonary manifestations may cause what 2 diseases?1) endocarditis 2) hepatitis
Antimicrobial therapy?doxycycline (Doryx)
Question Answer
Causes what disease?tularemia
Occurs in what animals?rodents (rabbits, mice, hares)
How is it spread?to humans via infected tick and deer fly bites
While the most common form of tularemia is ______ , list examples, other forms include typhoidal, oculoglandular, oropharyngeal and pneumonic?1) cutaneous 2) skin ulcer accompanied by LAD
Sites of disease depend on the ____ or entry?portal
Treatment?Streptomycin (however, standardized sensitivity testing for Gentamycin, TCN, doxycycline, Cipro, Levofloxacin and Chloramphenicol all proved adequately bacteriocidal)
Question Answer
Causes what disease?Q fever
Gram?negative pleomorphic coccobacillus
Found in what animals?cattle, sheep, goats
High numbers of organisms are present in what 2 parts of infected animals?1) placenta 2) amniotic fluid
*** Q fever is very common in what 2 occupations?1) veterinarians 2) livestock farmers (up to 25% of individuals)
Recent studies have isolated the organisms in ____ water?pond
In addition to pulmonary manifestations in patients, what other s/s are present? What 2 diseases can patients develop?1) fever 2) myocarditis or hepatitis
Treatment?1) TCN 2) quinolones 3) macrolides
Question Answer
*** SUMMARY = What 3 organisms are felt to be responsible for 20-30% of all cases of CAP (community-acquired pneumonia) in the US?1) Chlamydia pneumoniae 2) Mycoplasma pneumonia 3) Legionella pneumophila
*** SUMMARY = Mycoplasma, Legionella and Chlamydia organisms are generally treated with what class of antibiotics? List 2 of these antibiotics?1) macrolides 2) azithromycin (Zithromax), doxycycline (Doryx)
*** SUMMARY = Is empiric therapy appropriate?yes, however, there is lack of demonstrated significant benefit
*** SUMMARY = If the CXR may support the dx of an atypical infection, does it reliably differentiate between bacterial and atypical etiologies?no