Pneumonia Lecture Lobar Strep pneumonia Klebsiella Bronchopeumonia Strep pneumo H Influenza Staph Aureus Atypical Legionella Mycoplasma

coplasma Chlamydia Pneumococcal Pneuomnia MC bacterial pneumonia Epi: o Dz in elderly; after URI CF o Fever, chills, purulent sputum o Leukocytosis Dx: o Sputum gram stain and culture Rx: o Penicillin/ 3rd gen cephalosporin Staphylococcal Pneumonia Epi: o Nocosomial pneumonia; inhalation and hematogenous routes CF o Parenchymal necrosis o Ill appearing, purulent sputum o Leukocytosis Dx: o Sputum gram stain and culture, blood culture Rx: o Vanco Klebsiella Pneumonia Epi: o Alcoholics, diabetics CF: o Currant jelly sputum o Leukocytosis

Dx: o Sputum gram stain and culture, blood culture Rx: o Cephalosporin/quinolones

Streptococcal (pyogenes) pneumonia CF: o Chills, fever, cough, chest pain o Pleural effusions o Empyema Dx: o Sputum gram stain and culture, blood culture, ASO titer Rx: o Penicillin/clindamycin Hemophilus Pneumonia Epi: o COPD pts CF: o Difficult to distinguish from chronic bronchitis o SOB, fever, cough, sputum, mild leukocytosis Dx: o Sputum gram stain, culture, Rx: o Ampicillin/Cephalosporin Mycoplasma Pneumonia (atypical) 2nd MC cx of CAP Aerobic and anaerobic CF: o HA, malaise, low grade fever, non-productive cough, ear pain o Rash, hemolysis, CNS dz Dx: o Culture not done, PCR of secretions, antigen detection (EIA), o Cold agglutinin test Rx: o Tetracyclins, macrolides, quinolones Chlamydia Pneumonia Biphasic life cycle Epi: o Elderly and 18-30 CF o Pharyngitis, hoarseness, sinusitis Dx:

o Serology, DFA, PCR, culture not usually done Rx: o TCN or macrolides

Legionella Epi: o o o o

Smokers w/ COPD Transplant pts Steroid meds CMI deficient; in water Mip, DOT, and ICM virulence factors Serogroups 1,4, 6 MC CF: o Cough, GI, fever, bradycardia, hyponatremia, hematuria, proteinuria, leukocytosis Dx: o Culture, urinary antigen serology Rx: o Quinolones or macrolides

Aspiration Pneumonia Dx o Sputum gram stain, transtracheael, aspirate, clinical Rx: o Aerobic and anaerobic coverage

Fungal Lecture Endemic Fungi Dimorphic Fungi o Histoplasma capsulatum o Coccidioides immitis o Blastomyces dermatitidis o Paracoccidioides brasiliensis Yeast o Cryptococcus neoformans Histoplasma capsulatum Soil based assoc w/ river valleys o Ohio, Mississippi river valleys Bird and bat poop Transmission: via micronidia CF: o Pneumonia o Flu like sx o Erythema multiforme, erythema nodosum o Caseating and noncaseating granulomas-- Calcify Dx: o Culture o Antigen detection in urine o Serology Pathology o Silver stains, PAS, H&E, Wright-Giemsa Tx: o Spontaneous recovery o Itraconazole if sx, hypoxemic o AmpB if severely ill

Coccidioides immitis (immitis and posadasii) Location: o Soil Pathology: o Arthroconidia o Spherule Pathogenesis: o Arthroconidia inhaled, at terminal bronchioles change into spherules local inflammation o Acute infection (neutrophils, eosinophils, granulomatous inflammation)

Epi: o AA, Latinos, Filipinos Clinical presentations o aSx to pneumonia o Erythema multiforme, and erythema nodosum, migratory arthralgias o Hilar adenopathy, nodules, cavitating lesions Dx: o Growth from culture o Serology o Skin test: precitpitin, complement fixation, immunodiffusion, ELISA o PCR: sensitive and specific Tx: o Amphotereicin o Fluconaole o Dissemination: lifelong suppression

Blastomyces dermatitidis Location: soil Pathology: o Conidia (infectious form)- become aerosolized Convert to yeast form at 37C Broad Based Bud Epidemiology: o Ohio, Mississippi o Exposure to outdoors Pathogenesis; o Entry through lung, or hematogenous o Mimic squamous cell carcinoma CP: o Most asymptomatic o Skin, bone, GU infection o Non specific Cough, myalgia, arthralgia, chills fever Pulm infection (acute/ chronic) CXR o Lobar or segmental Dx o Cytology, wet mount o Culture o PAS, GMS stains o Serology not sensitivity and not specific o Urine antigen Tx: o Azoles mild-moderate infection o AmpB f/b itraconazole (severe infection)

Paracoccidioides brasiliensis Mexico argentina Pathology o Multiple daughter cells CF o Chronic progressive pulmonary and extrapulmonary infection in adults Dx: o Direct examination of specimens o Histology o Culture o Serology Tx: o Sulfadiazine o TMP/sulfa o Am sulfa o Itraconazole Immunocompromised Hosts Lecture Pneumocystis Pathogenesis o Trophic form attaches to type 1 pneumocytes o Honeycomb, foamy alveoli o Major surface glycoprotein inhibit surfactant production Epi: o AIDS patients w/ low T cell <50 Death defying dz in AIDs patients Dx: o Sputum cytology o PCR (expensive), plasma S-adenosylmethionine, Beta-D-glucan o Silver stain Tx: o TMP/SMP o Steroids Cryptococcus Encapsulated; monomorphic Associated w/ pigeons Patho: o Narrow-based bud Dx:

o Latex particle agglutination o Urease positive yeast o Stains (india ink, H&E, GMS) o Serology: cryptococcal Ag Pathophysiology: o Capsule: o Phenol oxidase CP: o aSx to cough/chest pain/SOB o Immunocompetent: nodules that calcify o AIDS: Dissemination to CNS, bone, skin, prostate, eye Tx: o CNS: AmpB, flucytosine then o Fluconazole Aspergillus Dz: o Allergic bronchopulmonary aspergillosis o Fungus ball o Invasive aspergillosis CF: o Pneumonia Dx: o Biopsy, culture o Galactomannan o CT (nodules, halo sign) Tx: o AmpB, -onazole CMV Dz: o CMV pneumonitis: lung transplant pts, dz in first 3 mo if no prophylaxis CXR o Patchy or diffuse ground-glass opacity Dx: o Viral replication/antigens o Histopathology Tx: o Ganciclovir, valganciclovir o Foscarnet