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Pulmonary Bugs & Drugs for Exam 2

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darodri6's version from 2016-09-18 00:31

Lower Respiratory Infections

Infection typeCommon causes(s)Treatment
Outpatients with CAPStrep. pneumo, M. pneumo., H. influenzae, C. pneumo.Uncomplicated = Azithromycin (can also include Ceftriaxone/Azithro combo or a resp Fluroquinolone

"CAF for CAP (atypical)"
NON-ICU patients with CAPS. pneumo, M, pneumo, C. pneumo, H. influenzae, Legionalla spp.Uncomplicated = Azithromycin (can also include Ceftriaxone/Azithro combo or a resp Fluroquinolone

"CAF for CAP (atypical)"
ICU patients with CAPS. pneumo, S. aureaus, Legionella spp, Gram - bacilli, H. influenzaeUncomplicated = Azithromycin (can also include Ceftriaxone/Azithro combo or a resp Fluroquinolone

"CAF for CAP (atypical)"
Atypical CAPM. pneumo, C. pneumo, C. psittaci, Legionella pneumo., Francisella tularensis & Coxiella burnetti
"My Lungs Contain Viral Factory"
Uncomplicated = Azithromycin (can also include Ceftriaxone/Azithro combo or a resp Fluroquinolone

"CAF for CAP (atypical)"
Healthcare-Associated Pneumoniae (HCAP) & Hospital-Associated Pneumonia (HAP)MRSA most common & Pseudomonas, among other resistant, advantageous organismsPseudomonas =2 drugs
-1st = antipsedomonal Ceph (Cefepime or Ceftazidime) OR anti-pseudomonal Carbapenems (Imipenem or Mepenem) OR Zosyn (piperacillin-tazobactum)

-2nd drug = Fluroquinolone (Cipro- or Levo- floxicin) OR Aminoglycoside (Amikacin, Gentamicin, or Tobramycin)

MRSA = ADD either Linezolid or Vancomycin
Ventilator-Associated Pneumonia (VAP)Diverse amount of pathogens that can cause it.Carbapenem or Zosyn + Fluroquinolone or Aminoglycoside
Aspiration pneumoniaAnaerobes, G+ cocci, S. milleri, Klebsiella pneumo, NocardiaZosyn (piperacillin +Tazobactrum)

Alternatively: Clindamycin or Ceftriaxone+Metronidazole
Pneumonia in Cystic FibrosisS. aureus & H. influenzae (early on)
or Pseudomonas aeruginosa (later one)
if due to MSSA = Oxacillin or Nafcillin
if due to MRSA = Vancomycin
if due to Pseudomonas = 2 drugs with pseudomonas coverage
Pneumonia in HIV patientPneumpcystis cariniiTMP-SMX (Bactrim)
BronchiectasisH. influenza, P. aeruginosaNormalization of secretions and/or anti-inflammatory therapy (glucocorticoids)
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Microbio of the Respiratory System

Infection TypeCommon cause(s)Clinical presentationOther ::
Otitis mediaStrep pneumo (< 3 months old),
H. influenzae (added if > 3 months old),
Moraxella catarrhalis
Fever, Ear pain (toddler "ear tugging"), HAs, bulging tympanic membrane w/poor mobility, irritability (may be only sign in toddlers)
SinusitisAcute (< 4 weeks) = viral or bacterial
-viruses: Rhinovirus, Influenza A virus, Parainfluenza, RSV, Adenoviruses
-bacteria: Strep pneumo, H. influenzae, Moraxella catarrhalis (80% in kids)

Chronic (>12 weeks) = wide range allergic/non-allergic causation or fungal
-fungal = Aspergillus, Mucormycoses, Rhizopus
Fever, purulent discharge, Sinus tenderness & pain (possible maxillary toothache), Fetid breath, HAs, Tender face to percussionduring acute stage, must be able to differentiate between bacterial vs viral

hallmark of bacterial origin = Persistence (> 10 days), Severity, Worsening of resp symptoms (crap-feel better-crap...)

Chronic form usually seen in compromised pt (DM or immunocompromised)
RhinitisVIRAL!
Rhinoviruses, Adenoviruses, Coronaviruses, Parainfluenza viruses, Influenza viruses (C), RSV and Coxsachie A virus
variable fever, inflammatory edema of the nasal mucosa, increased mucous secretion (initially clear/watery --> thick, purulent over next 5-10 days)manifestation of "common cold"
Pharyngitis70-90% VIRAL = Thinovirus & Adenovirus

Bacterial (10-30%) = Group A Strep (mainly), Non-GAS, Neisseria gonorrhoeae (oral sex)
erythema & swelling of throat, exudates of inflammatory cells in throat, petechial hemorrhages on mucosal membranes, tender swelling of anterior cervical nodesyoung children < 3 years = viral - Rhinovirus, Adenovirus and RSV

Older children (5-15 years) = mainly Strep pyogenes (GAS).......S. pyogenes MUST be diagnosed to prevent sequelae!!!!
Laryngitis/CroupMainly Respiratory VIRUSES = Parainfluenza, Influenza, Adenovirus (sometimes RSV, Rhinovirus, Coronavirus)variable fever, inspiratory stridor, hoarseness, harsh barking cough, inflammation limited to subglottic laryngeal structures (vocal cords)
Trachiobronchitis/Bronchitis (for a Normal/Non-COPD pt)Mainly Respiratory VIRUSES = Parainfluenza, Influenza, Adenovirus (sometimes RSV, Rhinovirus, Coronavirus)....Infants = RSV mainly

in Adults, as vaccine immunity wanes, bacteria may also be a cause = Bordetella pertussis
Cough, variable fever, sputum production (clear initially --> purulent later on), auscultation reveals coarse bubbling rhonchi (inflammation & increase fluid production in larger airways)
Trachiobronchitis/Bronchitis (for a COPD pt)Mainly BACTERIAL =
H. influenza, S. aureus, Bordetella pertussis, Moraxella catarrhalis
Cough, variable fever, sputum production (clear initially --> purulent later on), auscultation reveals coarse bubbling rhonchi (inflammation & increase fluid production in larger airways)mostly due to opportunisitc bacterial infections due to mucociliary clearance not functioning
Pneumonia (typical-CAP)Strep pneumo (most common in adults)SUDDEN ONSET of shaking chiils, fever, dyspnea, productive cough (sputum with or w/o blood), Pleuritic chest pain

Pt presents with tachypnea, tachycardia, rales on lung exam, x-rays show chest consolidation
Pneumonia (atypical-CAP)Mainly BACTERIAL:
Mycoplasma pneumonia, Chlamydia, Legionella,

Mycoplasma & Chlamydia = most common in young adults

In infants/kids = VIRAL:
RSV, Influenza

If condition does NOT improve with antibiotic treatment, consider Mycobacterium tuberculosis!!!
GRADUAL ONSET of non-productive cough, Dyspnea

on PE, pt presents with fever, tachypnea, tachycardia, and X-rays show patchy or interstitial infiltrates w/o consolidation

Also may show extra-pulmonary signs = HAs, sore throat, diarrhea
Pneumonia (nosocomial)MRSA, Klebsiella pneumo
Pneumonia related to alcoholismStrep pneumo, Klebsiella, pneumo, Anaerobes
Pneumonia related to IV drug use and/or post-viral infectionStaph aureus
Pneumonia related to chronic steroid useNocardia spp.
Pneumonia in association w/neutropeniaAspergillus spp.
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