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Typical pneumonia characterized by rapid onset, fever, chest pain, cough (either productive or nonproductive) Atypical pneumonia insidious

us onset, chronic in nature, mortality, but of secondary infection and mortality associated with that I. Streptococcus pneumoniae A. Gram (+) coccus, diplococci B. 25-60% of all pneumonia cases C. Causes Typical pneumonia is very fast-growing organism rapid onset D. Virulence factors 1. Capsule polysaccharide, type III most associated with pneumonia a. Can be detected by the Quellung reaction b. Quellung reaction organism is mixed with homologous antisera and then India ink and observed with light microscope for capsule swelling 2. Pneumolysin a. Similar to streptolysin O b. Toxic for pulmonary endothelial cells c. Can spread from alveoli to blood (sinusitis, otitis media, meningitis, bacteremia) i. mortality is seen with meningitis and bacteremia 3. Secretory IgA protease aids in the ability of the organism to survive E. Optochin sensitive optochin is detergent like antibiotic; remember Strep Group A (Streptococcus pyogenes) is bacitracin sensitive F. Possible autoinoculation if laying in hospital bed, you could inoculate yourself by breathing in organisms 1. Aspiration to lower lobes (lobar pneumonia) 2. 5-10 % mortality in hospitalized patients because such a rapid onset and overwhelming infection occurs G. Sensitive to penicillin G H. Anticapsular vaccine available for high risk groups (23 polysaccharides) I. Lung tissue can heal completely when infection resolves (different than Klebsiella pneumoniae infection) II. Klebsiella pneumoniae A. B. C. D. Gram (-) rod from the Enterobacteriaceae Group Causes Typical pneumonia Found as normal flora in the GI tract Capsule 1. Overwhelming amounts of capsule production (colonies can drip off plate of growth!) 2. The resulting goo from the amount of encapsulated organisms can clog alveolar sacs E. Aspiration to lower lobes 1. Alcoholics and persons with compromised pulmonary function alcoholics vomit and aspirate into lungs resulting in deep lobar peumonia 2. Friedlanders disease an old name for pneumonia caused by K. pneumoniae

F. Necrotizing pneumonia extracellular enzymes and/or associated GI anaerobes


(included with the aspirated vomit) 1. GI anaerobes cause abscess formation in the lungs 2. Extracellular enzymes cause increased tissue damage G. Currant-jelly sputum copius amounts of brown/rusty (from blood) sputum produced H. Permanent damage and loss of function in infected lung tissue

III.

Mycobacterium tuberculosis (and other species) A. Gram (-), but difficult to stain Acid Fast organism! B. Slow growing intracellular (macrophages) up to 14 hrs. to divide one time
C. D. E. F. Pathology of disease is attributable mostly to host immune response Now a common disease of HIV + or other immunocompromised people Specific area with primary focus of infection may go unnoticed Reactivation is when you see 1. Cough progressing from dry to productive 2. Eventually sputum will bring up mucus, bacteria (spread!) and pieces of lung tissue A. Prolonged combination therapy required 3. Up to 9 months 4. Indigents are difficult to treat because the patient must NOT consume alcohol during treatment

IV.

Legionella pneumophila A. Gram (-) Rod, difficulty staining, atypical cell envelope B. Atypical pneumonia B. Legionnaires Disease C. Must be grown on buffered charcoal yeast extract, slow growth (2-5 days) D. Widespread occurrence, sporadic as clusters, endemic nosocomial outbreaks E. Male to female ration is 3:1 F. Smokers, alcohol, old age, underlying defects predispose. G. Environmental exposure (water sources like air conditioning) serves as continual common source of exposure H. NO person-to-person spread I. Necrotizing multifocal pneumonia 1. Patchy (moth-eaten) regions of fluid 2. Multifocal differentiates from Klebsiella pneumoniae C. Facultative intracellular parasitism multiplies in macrophages D. Erythromycin and rifampin are drugs of choice, no vaccine is available

V.

Mycoplasma pneumoniae

A. B. C. D. E. F. G. H.

Has no cell wall Has slow growth in the lab Airborne person to person spread What we typically think of as walking pneumonia Common grade school age children arthralgia, myalgias and fever Adhesins bind organism to sialoglycolipids on respiratory epithelium Classic board question does penicillin act on mycoplasma? NO because of cell wall Use tetracycline or erythromycin for treatment; no vaccin available

VI.

Staphylococcus aureus A. Gram (+) coccus B. Part of normal flora that takes advantage of immunocompromised and has possibility of autoinoculation C. Primarily causes pneumonia in cystic fibrosis patients

V.

Pseudomonas aeruginosa A. Gram (-) Rod B. Ubiquitous in nature; even found in water C. Classic opportunistic pathogen (cystic fibrosis and neutropenic patients) D. Numerous virulence factors that are invasive and toxic E. Pneumonia caused has lots of tissue destruction and is tough to treat because of resistant strains has an rate of mortality

VI.

Haemophilus influenzae A. Gram (-) rod B. Responsible for 5-15% of pneumonia cases; colonizer of bronchitic patients C. Normal flora of upper respiratory tract. (epiglottitis, otitis, meningitis, osteomyelitis). D. Polysaccharide capsule, six types a-f, type b most important (Hib vaccination of children is important) E. Airborne person to person spread F. Requires factors X (hematin) and V (NADP) (not ten and fivethe letters X and V) for growth is grown on chocolate agar with these factors

VII.

Chlamydia pneumoniae A. Obligate intracellular parasite with distinct life cycle B. Cannot be grown in bacterial culture, but must use cell culture C. ID by immunofluorescent antibody/serological techniques D. Acquired by inhalation E. Treated with tetracycline, erythromycin, fluoroquinolones F. Vaccine unlikely Chlamydia trachomatis A. Neonatal conjunctivitis if untreated or treated topically can cause infant pneumonia B. 2-3 weeks after birth C. Staccato cough D. Afebrile throughout course of illness, but still shows other symptoms of pneumonia

VIII.

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