10-26-d.txt

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10-26-d.txt
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10-26-d
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  1. Community acquired lobar pneumonia
    • Lobar – consolidative:
    • Streptococcus pneumoniae
    • Haemophilus, Moraxella (Branhamella)
    • Legionella
    • Staphylococcus aureus
    • Atypical – diffuse, interstitial, bronchial, pathy:
    • Mycoplasma
    • Chlamydia/Chlamydophila
    • Viruses
    • Legion
  2. Microbiology – Legionellaceae
    • Legionella pneumophila: 15 serogroups based on LPS; 1, 6, 4, 3? Most common
    • 40 other legionella species (17 human pathogens)
    • Very thing Gram –‘ve bacillus
    • Fastidious growth requirements
    • Extracellular products – many enzymes cause tissue destruction in course of pathogenesis
  3. Legionella – Epidemiology
    • This one comes from environment
    • Water: esp. thermally polluted – plumbing; mud, rivers, streams
    • Intracellular in free-living amebae – hitches a ride until it gets to humans
    • Biofilms – in nature of in plumbing
    • Persistent and adapted
    • Sourse of Infection: Environment, NOT person to person
    • Mode of Transmission: aerosols, potable H2O – microaspiration
  4. Legionella – Pathogenesis
    • Mechanism: distal airways, alveoli – pulmonary alveolar macrophages – swallow it, but organisms replicate within the macrophage
    • Path: Bronchiolitis/alveolitis; exudative, inflammatory, some destruction
    • Immunity: Cell-mediated; role of antibody
  5. Legionella – Clinical
    • Lobar or atypical
    • Often in immune-compromised patients: transplants, COPD, smokers
    • Sometimes in “Normal” patients
    • 2-10% of CAP; some nosocomial
    • “Pontiac Fever”: mild fever, chills, malaise, headache; no respiratory complaints, often in clusters – common source
  6. Think Legionella where
    • Pneumonia with Gram stain showing WBC but no organisms
    • Patient not responding to conventional antibiotics, especially if cultures do not reveal a pathogen
  7. Legionella – Diagnosis
    • Direct fluorescent antibody – BUT it’s serogroup dependent
    • Culture on buffered Charcoal Yeast Extract – supplemented and made selective: best for Dx
    • Urinary Antigen: BUT serogroup 1 only in U.S., may remain +’ve for months
    • Serology: not useful for acute state – it’s unreliable
  8. Legionella – Rx and Control
    • Antibiotics: penicillin doesn’t work!
    • Fluoroquinolones, Macrolides
    • Water delivery systems: Superheating Hyperchlorination, Ag/Cu ions, ClO2, Aquatic device maintenance
    • Aquatic device maintenance
  9. Mycoplasma - pathogenesis
    • Mycoplasma pneumoniae: Prototypical for atypical pneumonia
    • Mucosal attachment
    • “nondestructive”
    • Cilostasis:
    • Sloughing:
    • Oxidative injury:
    • Immunity: lasting? Repeat infections definitely occur
  10. Mycoplasma – clinical presentation
    • Pharyngitis:
    • Tracheobronchitis:
    • Otitis Media: Bullous
    • Pneumonia: generally mild
  11. Bullous otitis media
    Micoplasma – the main cause, choose it on boards
  12. Mycoplasma: Diagnosis
    • Serology: IgM
    • Cold Agglutinins: not specific, nos sensitive
    • Culture: not warranted
  13. Mycoplasma Rx:
    • Antibiotics: cell wall agents nor active
    • Macrolides:
    • Tetracyclines (do not use in young children)
  14. Chlamydia Organisms
    • Chlamydia trachomatis
    • Clamydophila pneumoniae
    • Clamydophila psittaci
    • Obligate intracellular parasites
    • Extracellular – elementary body
    • Replicative – reticulate body
  15. Chlamydia Antigens and immunity:
    • group-specific LPS
    • genetic heterogeneity
    • serological variability
  16. Clamydia Treatment:
    • Macrolides
    • Tetracyclines
    • Fluoroquinolones
    • Cell wall agents not effective!
  17. Clamydia Dx
    • Culture in cells – but expensive
    • Histology – fluids, scrapings, tissue
    • Nucleic acid amplification (NAAT) – more widely used
    • Serology – not helpful for acute infection
  18. Clamydia trachomatis
    • Epidemiology – contact transmission; reinfection common
    • Serotypes A, B, C – Trachoma
    • Attachment, cell-cell transfer
    • Local infections – persistence and cycling
  19. Clamydia Tracomatis – Clinical
    • Keratoconjuctivitis (trachoma)
    • LGV
    • Urethritis, cervicitis, PID, epidydymitis
    • Pneumonitis in newborns
  20. Clamydia pneumoniae
    • Epidemiology similar to Mycoplasma
    • Spread by large droplets/contact
    • Disease spectrum: generally mild, slow onset; cough prominent, may persist, airway hyperreactivity
    • May have associated sinusitis
    • Immunity short-lived, recurrences common
    • Link with atherogenesis
    • Dx: serology
  21. Clamydia psittaci
    • Psittacosis, ornithosis, parrot fever
    • Zoonosis: any bird, bird tissue, droppins, feathers, bird may/may not be ill, excrete more particles when stressed
    • Epidemiology: bird contact; often illegally obtained exotics
  22. Clamydia psittaci Pathogenesis, clinical, Dx
    • Pathogenesis: inhalation RES liver, spleen, hematogenous seeding of lungs
    • Clinical manifestations: systemic disease, long incubation period (7-14 days); variable illness, but may be severe
    • Serology may be helpful in acute disease:

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