Microbiology One Liners - Lower Respiratory Infections
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87 terms
Terms | Definitions |
|---|---|
 In an infant w/ ?immunization, 2 wks of paroxysmal coughs, inspiratory "whoop" + post-tussive emesis. TOW? | Bordetella pertussis |
| Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor, resulting in? | Lymphocytic leukocytosis in CBC |
| Three major virulence factors of "whooping cough" pathogen? | ADP-ribosylating toxin; tracheal cytotoxin; hemolysin |
| Cause of fever + drooling, stridor, dyspnea in a child w/ ?immunization (pt appears septic) | Haemophilus influenzae b |
| Major virulence factor of Haemophilus influenzae associated with pneumonia and meningitis | Capsular polysaccharide (antiphagocytic and anti-C3b) |
| Since, absent spleen places host at increased risk for invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is ? | Hib immunization |
| Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli. | Haemophilus influenzae (non capsular types) |
| Tx of AECB, caused by an organism that needs NAD + hematin for growth; β-lactamase (+), is: | Ceftriaxone (severe) > Amoxicillin-Clavulanate (mild) |
| Most common cause of lower-respiratory infections in neonates (babies < 4 wk)? | Streptococcus agalactiae (aka: group B streptococcus) |
| Complicated illness in a newborn of a GBS-colonized mother is? | Sepsis or meningitis |
| A mother colonized (recto-vaginally) w/GBS is at risk for preterm baby or premature membrane rupture. She should receive: | Ampicillin |
| An elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ? | Annual Influenza vaccine |
| Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection, and is composed of what 3 viruses? | A:H1N1 + A:H3N2 + B |
| Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via | Respiratory Droplets |
| Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism? | Mutation |
| Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism? | Reassortment of 8 genomic segments |
| DOC of pts with influenza <48 hours is | Oseltamivir |
| Bacterial superinfection, causing pneumonia, after influenza occurs in elderly (in LTCF) due to what? | S. pneumoniae > S. aureus |
| A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get | Linezolid |
| Cause of febrile illness + bronchiolitis in an infant; BAL viral culture (+). | Respiratory syncytial virus (RSV) |
| RSV causes seasonal, nosocomial pneumonia outbreaks in the pediatric units via | Contact spread |
| Pathophysiology of asthmatic Sx + Sn in bronchioles in high-risk infants due to RSV involves | Type III Hypersensitivity |
| Inhaled anti-viral drug used in the sickest infants with bronchiolitis is | Ribavirin |
| Insidious onset of fever, dry cough, malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates. TOW? | Mycoplasma pneumoniae |
| Dx of "walking pneumonia" in older children and young adults, while waiting for serology, is supported by | Cold Agglutinin (IgM Ab against RBCs) titer ≥1:32 |
| β-lactam abx is ineffective for Tx of mycoplasma pneumonia because...? | Wall-less bacteria |
| A male child with mycoplasma pneumonia now has systemic rash, covering 10% of his body. TOW? | Erythema Multiforme (SJS) |
| Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+) | Chlamydophila pneumoniae |
| The most common cause of community-acquired pneumonia (CAP) is | Streptococcus pneumoniae |
| Cause of rapid onset of high fever, cough, & sputum, dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift, is | Streptococcus pneumoniae |
| Gram-positive diplococci from sputum from a patient with lobar pneumonia yield α-hemolytic colonies and are confirmed by | Capsular swelling (Quelling Rxn) |
| α-hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by | Optochin sensitivity (S. pneumoniae is Optochin sensitive) |
| Population w/ ↑incidence of pneumococcal pneumonia is | AIDS |
| ↑ incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI (↑PAF receptors), fall/winter season? | Streptococcus pneumoniae |
| Streptococcus pneumoniae is transmitted P2P by | Respiratory droplets |
| Nasopharyngeal mucosal colonization is facilitated by | IgA protease |
| Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via | Aspiration |
| Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is | Polysaccharide capsule |
| Pneumococcal cell wall peptidoglycans, teichoic acid elicit | Inflammation |
| ↑ Lung cell injury in pneumococcal pneumonia is caused by virulence factor? | Pneumolysin (α-hemolysin) |
| Multiple myeloma, C3 deficiency, asplenia - Hg SS, COPD, diabetes, alcoholism, smokers are risk factors for mortality due to | Pneumococcal pneumonia |
| Hematologic marker for poor prognosis of pneumococcal pneumonia is | Leukopenia |
| Emipiric DOC of CAP in pts at risk or w/ comorbidity is | Azithromycin (or Levofloxacin) + Ceftriaxone |
| Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive | Moxifloxacin or Vancomycin |
| Mechanism of penicillin resistance in Streptococcus pneumoniae is | PBP alteration by mutation |
| Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or ↓C3 should be vaccinated with | Pneumococcal polysaccharide vaccine (PPSV: 23-valent) |
| Hx: a patient w/ serious CAD now on a ventilator, acquires bronchopneumonia >72 hrs after hospitalization. TOW? | Pseudomonas aeruginosa (VAP) |
| Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness | Staphylococcus aureus (assume MRSA) |
| Patients that are aspiration prone have hx of | Dysphagia, decreased consciousness |
| Hx of a patient w/ seizure illness has fever, cough evolving over 2-4 wks; CXR infiltrate (+). TOW? | Aspiration pneumonia |
| Community-acquired respiratory pathogens that cause aspiration pneumonia | Streptococcus pneumoniae > Anaerobes |
| Hospital-acquired respiratory pathogens that cause aspiration pneumonia | Gram-negative bacilli > S. aureus +/- anaerobes |
| Clinical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is | Acid-related pneumonia |
| Bacterial etiology and Tx of aspiration pneumonia are determined by | Gram stain (polymicrobic) and culture of sputum |
| Empiric DOC of necrotizing pneumonia in a patient with seizure illness | Clindamycin + Levofloxacin |
| Targeted Abx for anaerobic aspiration pneumonia is | Clindamycin |
| Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. TOW? | Streptococcus pneumoniae |
| Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear. TOW? | Klebsiella pneumoniae |
| Cause of pulmonary embolism in a pt with IVDU | Staphylococcus aureus |
| Common cause of pneumonia in pts with CF | Pseudomonas aeruginosa |
| Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+). TOW? | Pseudomonas aeruginosa |
| Common cause of external otitis due to hot tub use is | Pseudomonas aeruginosa |
| A patient with diabetes has osteomyelitis after penetrating foot injury. TOW? | Pseudomonas aeruginosa |
| The most widely used anti-pseudomonal penicillin | Piperacillin > Imipenem |
| The most widely used anti-pseudomonal aminoglycoside | Tobramicin > Gentamicin |
| This pt >50 years, smoking hx, CMI↓ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. TOW? | Legionella penumophila |
| Penicillin is ineffective against Legionnaire's dz because | Intracellular organism |
| Individuals with defective CMI response have poor prognosis of Legionnaire's dz because | Intracellular organism |
| Asymptomatic patient with PPD (+) | Latent tuberculosis infection (LTBI) |
| Cough > 2 wks, fever, night sweats, weight loss, hemoptysis, SOB; CXR: upper lobe infiltrate. TOW? | Active Mycobacterium tuberculosis infection |
| stOral drug regimen of choice for treatment of active TB (aka: 1 line drugs) is | INH + RIF + PZA + EMB (oral) + Vit B6 (RIPE) |
| Pyridoxine is added to 4-drug therapy for TB to prevent | Neuropathy (due to INH) |
| Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because | Multiply drug-resistant (MDR) TB |
| Pt w/ MDR-TB fails to respond to INH + RIF + FQ + an injectable drug (amikacin, capreomycin, or kanamycin) because | Extremely-drug resistant (XDR) TB |
| Cause of TB-like Dz that does not respond to primary regimen, in a pt. w/ AIDS | TB Tx Mycobacterium avium - intracellulare (aka: MAC) |
| Cause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)? | Aspergillus fumigatus |
| Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4µm wide, septate, acute- angle branching. TOW? | Aspergillus fumigatus |
| Cause of TB-like LRI in a pt with outdoor activity (Giemsa stain of bronchoscopy specimen: (+) for 2-5 µm yeasts) is | Histoplasma capsulatum |
| Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on | Ergosterol in fungal cell membrane |
| TB-like Dz w/ ulcerative skin lesions. Lung bpsy histopathology (+) for large yeast w/ broad-based bud. DOC? | Intraconazole |
| Hx of acute onset of cough, fever, infiltrate in a black male with CMI↓; histopathology of lung (+) for a large sac of endospores. DOC? | Fluconazole (indefinite) |
| Pt w/ aspiration pneumonia with cervico-facial lesion should respond to | Penicillin G |
| Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield | Actinomyces israelii |
| Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. TOW? | Nocardiosis |
| Organism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is | Nocardia asteroids |
| Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): BL interstitial infiltrates, hypoxemia; ↑LDH, CD4 count <200/mm^3 in a MSM. TOW? | Pneumocystis pneumonia |
| DOC of pneumocystis pneumonia (PCP) | TMP-SMX |
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