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Respiratory - Pneumonia (3 main types of pneumonia
lobar
interstitial
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Respiratory - Pneumonia
Rare causes of Pneumonia
- opportunistic pathogens in HIV / AIDS
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*CAP = Community Aquired Pneumonia
- most common cause is strep. pneumo
--> Alpha hemolysis = partial
--> OVRPS - Optochin and bile salt sensitive
- What's common is common
--> almost all community aquired pneumonias are assumed to be stret pneumo until proven otherwise
--> even for HIV patients
Virulence of Strep Pneumo
- diplo + Polysacharide
--> dipplococci
- polysaccharide capsule = main virulence factor
--> stops phagocytosis
-
Investigations and Management of CAP
- CURB 65 score out of 5
- note that each score has a different bacteria with it
- 0-1 = discharge
- 2-3 = monitor close as outpatint
- 4-5 = admit
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myeloperoxidase (Neutrophils) = green sputum
- sign of bacterial infection
Notes:
- note the green colour of pus and sputum is actually bleach released from neutrophils trying to kill bacteria
- think white cells = neutrophils come from bone marrow - making hydrochlorus acid from Chloride and hydrogen peroxide
- myeloperoxidase makes green sputum
--> Myelo = bone
--> peroxidase = breaks down hydrogen peroxide
--> makes hydrochlorus acid = bleach
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*Common Causes of Pneumonia
- in elderly, 3 most common causes are
--> Strep. pneumo, Influenza virus, H. influenzae
*Atypical Pneumonia
- Mycoplasma, Legoinella, Chlamydia = C pneumonia
*Legionnaire's Disease / Pneumonia
- Legoinella
- key is watery diarrhea and GI involvement
- air conditioning and contaminated water
--> think of the legion...
--> COCKY, Smoking VET
- Cough and confusion, smoker, very high fever
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*Legionella Pneumophila
- causes Legionaire's Disease
- water droplet transmission
- cruise ships, hospital, air conditioning
- have hypocalcemia
-
Young Adults and Mycoplasma Pneumonia
- Mycoplasma is by far the most common form of pneumonia in young adults
- young adult with CXR and ilfiltrates WAY WORSE than clinical symptoms
--> Mycoplasma pneumonia = walking pneumonia until proven otherwise
- Mycoplasma has NO CELL WALL, only single layer with same cholesterol as us
--> anti NAG-NAM glycosyltransferase / beta lactam PBPs are useless
- Tx = protein synthesis inhibition
--> Macrolides and Tetracyclines
Cold Agluttinins in mycoplasma Pneumonia = walking pneumonia
- IgM to mycoplasma l-antigens
--> l-antigens are on RBCs also
- cross react with RBC antigen and caus erythrocytosis and possible anemia
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Virulence and Tx of Mycoplasma Pneumonia
- Mycoplasma has NO CELL WALL, only single layer with same cholesterol as us
--> anti NAG-NAM glycosyltransferase / beta lactam PBPs are useless
- Tx = protein synthesis inhibition
--> Macrolides and Tetracyclines
-
3 main types of pneumonia
- lobar
- interstitial
- bronchial
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