HT040 Microbiology Final Systems Review -- URI
Terms
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Sinusitis causes
- in normal
- in immunocompromised/diabetics/cf -
normal: S. pneumo, G- coccobacilli (Moraxella, H.Influenzae)
ic/dm/cf: pseudomonas -
otitis media
causes
pe
tx -
causes: s.pneumo, moraxella, h.flu
pe: bulging, erythematous tympanic membrane
tx: decongestants and *amoxilliciln* (bactrim/augmentin/cephalosporin if failure -
otitis externa
causes
pe
tx -
"swimmer's ear"
causes: pseudomonas
pe: "tragal ear" -- hurts when pulled down
tx: polymyxin - neomycin -
pharyngitis
causes
dx
rx
complications -
causes: strep throat -- s.pyogenes (group A strep)
other causes: viral, fungal, mycoplasma, tb, etc.)
dx: throat cultures
rx: penicillin (amoxicillin if allergy)
compliations: toxic (scarlet fever, tss), pyogenic -
deep tissue infections
sx
types
common bugs implicated -
types: peritonsillar abscesses, retropharyngeal infections, prevertebral space, parapharyngeal space, ludwig's angina
sx: "hot potato voice," headpain, fever, dysphagia, drooling, sore throat
common bugs: staph, strep, mouth flora -
acute epiglottitis
causes
sx
dx -
causes: h.flu (b/c of vaccine, this dz is mostly eradicated)
sx: dysphagia, fever, sore throat
dx: cherry red epiglottis, "thumb" sign on lat neck film xray
note: DO NOT CULTURE (could cause layrngospasm) -- protect airway first (tube/tracheostomy) -
croup
causes
rx -
causes: viral--*parainfluenza*, rsv, adenovirus
rx: cool mist, epinephrine, protect airway - how do you get pna
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inhalation of droplets
aspiration of mouth flora
hemotogneous spread (e.g. endocarditis) - cxr findings types
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consolidated
necrotizing
interstitial
granulomatous - consolidated cxr pna -- bugs
- **s.pneumo**, h.flu
- necrotizing cxr pna -- bugs
- abscesses formed by anaerobic bac, s.aureus, g- coccobacilli
- granulomatous cxr pna -- bugs
- TB, fungi (histo, aspergillus)
- types of pnas
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community acquired
atypicals
nosocomial
immunocompromised (e.g. pcp) - pna: s.pneumo
-
productive cough, pleuritic pain
rust colored sputum
CXR: consolidation + patchy infiltrate
ID: g+ cocci, + quelling rxn, encapsulated, IgA protease
tx with penicillin, flouroquinolones if drug-resistant, or cephalosporin - pna: s.pyogenes
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productive
tx. with penicillin - pna: s.aureus
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productive cough
hospital acquired
pink salmon-colored sputum
CXR: patchy bronchial infiltration; seen in infants/immunocompromised/elderly
ID: G+ cocci, Coagulase +
Tx: methicillin, vancomycin for mrsa - pna: h.influenze
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productive cough, pleuritic pain, may be preceded by URI
CSR: patchy bronchial infiltration or lobar consolidation
ID: G- coccobacillus, req's X and V, pili, IgA protease, encapsulated
tx w/ HIB Vax; ampicillin, cephalosporins if resistant - pna: klebsiella
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**alcoholics** (aspiration)
reddish "currant jelly" sputum
CXR: multiple lobes, abscesses
tx: cephalospirines +/- aminoglycosides - pna: pseudomonas aeruginosa
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cystic fibrosis patients
hospital acquired
productive cough
ID: g- bacillus, blue-green colonies, fruity odor, gun-metal sheen - pna: mycoplasma pneumonia
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atypical (nonproductive cough) "walking pneumonia" -- looks fine, cxr horrible
community acquired
cervical lymphadenopathy?
CXR: patchy infiltrates, appears worse than sx
ID: cholesterol membranes, cold agglutinins
Tx: Erythromycin / Azithromycin - pna: legionella
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community/hospital acquired
atypical (productive?? cough), diarrhea, confusion, ataxia
csr: patchy infiltrate +/- lobar consolidation
ID: PMNs on gram stain, no bacteria
epi: elderly male, alcoholic, exposed to water
tx: erythromycin - pna: tb
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fever, cough, blood tinged sputum, weight loss, night sweats, anorexia
CXR: +/- ghon complex, cavitary lesion
ID: ppd
tx: inh, rifampin, more.. - pna: viral
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most common in kids
causes:
RSV
parainfluenza
influenza
adenovirus
cmv (noonates, IC)
CXR: patchy infiltrates
TX: amantadine for influA, gancyclovir for CMV - pna: chlamydia
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c. trachomatis: neontal PNA, retinits
c. psittaci: "parrot fever"
c. pnemo: pna in young adults
TX: tetracycline, erythromycine - pna: histoplasmosis
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starlings (bat shit)
fungal - typical pnas
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acute onset of fever, productive cough
s.pneumo
h.flu
klebsiella
moraxella
s.aureus - atypical pnas
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slow onset, nonproductive cough, minimal increase in wbc
mycoplasma
pneumo
tb
chlamydia
legionella
coxiella
viral - community-acquired pnas
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s.pneumo
h.flu
legionella
viral
younger pts:
mycoplasma
chlamydia - hospital-acquired pnas
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s.pneumo
h.flu
legionella
e.coli
klebsiella
enterobacter
proteus
serratia
pseudomonas
s.aureus - alcohol abuse pnas
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klebsiella
s.pneumo
h.flu - COPD pnas
- s.pneumo, h.flu, moraxella
- post influenza pnas
- s.aureus, h.flu, s.pneumo
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special exposure:
birds
cattle, hides
animals, white powders... -
birds: chlamydia psattaci
cattle: coxiella burnetti
animals, white powders: bacillus anthracis