BMS 232 Concept Map Project #2
Citations
BMS 232 Lecture Slides
Tiffany Yuen
Student ID: D25142
bacterial pneumonia
Types:
lobar pneumonia
Usually caused by Streptococcus pneumoniae
Acute exudative inflammation of one or more lobes of the lung
4 stages of inflammatory response if untreated:
1. congestion / consolidation
2. Red hepatization/early consolidation
3. Grey hepatization/late consolidation
4. Resolution and restoration of the pulmonary
bronchopneumonia (atypical)
pneumonia involving acute inflammation of the bronchi
pneumonia caused by "atypical" bacteria, which are hard to detect through standard methods
includes
Chlamydia pneumoniae
most common in children
Chlamydia psittaci
Psittacosis
transmission from infected birds and poultry
Legionella pneumophila
Legionnaires' Disease
Mycoplasma pneumoniae
walking pneumonia
History: "Atypical" due to having different features compared to "typical pneumonia"
different symptoms
appears different on chest x-ray
responds differently to antibiotics
Can cause CAP
nosocomial pneumonia
severity may increase depending on if the patient is already sick or if the bacterial strain is antibiotic-resistant
transmitted during a hospital stay and/or health-care visit (hospital-acquired)
ex. long-term care facility, outpatient clinics (like dialysis centers)
Increased Risk Factors
Recent surgery or trauma to the individual can increase risk
patients on ventilators or in the ICU
community acquired pneumonia
Atypical bacteria can cause CAP (community-acquired pneumonia)
Not acquired in a hospital or health-care facility (nursing home, rehabilited setting)
Overall Risk factors:
- children 2 and younger
- people 65 and over
being hospitalized, or having a breathing apparatus (ventilator)
chronic disease
asthma, COPD, heart disease, bronchiectasis, cystic fibrosis
smoking
brain injury / disorder
dementia, stroke, cerebral palsy
Serious illness
heart disease, liver cirrhosis, diabetes
weakened or suppressed immune system
Patients who are HIV + or AIDS+
patients who had an organ transplant
Patients on chemotherapy, or long-term medication / steroids / treatment
Diagnostics
Physical exam
(listen for abnormal breathing sounds, crackles)
percussion (tapping on chest wall to hear abnormal sounds)
Test
measuring arterial blood gases
saliva, blood and sputum cultures
CBC (check complete blood cell count)
X-rays, CT scan
bronchoscopy
Thoracentesisbtopic
Symptoms
Severe acute lower respiratory tract lung infection affecting the pulmonary parenchyma
bacteremia
chills, cough, fever
Difficulty breathing and/or shortness of breath
pleural effusion (fluid around the lungs)
chest pain, malaise, fatigue
Fatal Complications
meningitis, encephalitis
Hemolytic anemia
lung abscess
respiratory failure
Prevention
avoid smoking
Vaccination
Good Hygiene
practice good dental and overall health habits
Get at least 6 hours of sleep
exercise
take vitamins, eat balanced meals
Streptococcus pneumoniae
Pseudomonas aeruginosa
Chlamydia spp.
Mycoplasma pneumonaie
Haemophilus influenzae
Streptococcus pneumoniae (pneumococcus)
transmission
Spread by individual contact and respiratory droplets from person-person, which can enter the blood through lacerations or tissue damage
habitat
Part of the normal flora of upper respiratory system (human nasopharynx)
virulence factors
Polysaccharide capsule (94 pneumococcal capsular serotypes), pneumolysin, Secretory IgA protease, PsA, Psp (PspA and PspC), Pneumolysin,
Treatment
Usually treatable with antibiotics (Penicillin)
resistant strains with mutated PBP could be treated with vancomycin instead
Prevention
pneumococcal vaccine targets multiple capsule polysaccharide types and neutrophils via antibodies (PPSV & PCV)
most common cause of bacterial pneumonia in the US
Pseudomonas aeruginosa
habitat
In soil, decaying organic matter, vegetation and water.
In hospitals: food, cut flowers, sinks, toilets, floor mops, equipment for respiratory therapy and dialysis.
Also in hexachlorophene-containing soap solutions and disinfectant solutions.
transmission
opportunistic pathogen that is common in hospitalized patients
Spread from contaminated water, medical devices, or surfaces or from infected individual contact
virulence factors
Adhesins, bacterial neuraminidase, polysaccharide capsule, endotoxin, exotoxin A, exoenzymes S and T, elastases, phospholipase C, pyocyanin, bacterial and phagocyte proteases.
Also has antibiotic resistance factors like mutation of porin proteins and b-lactamase production
Treatment
Because of resistance to most antibiotics and how resistance can develop during therapy, a combination of aminoglycosides (poor activity in the acidic environment of an abscess) and ß-lactam antibiotics with beta lactamase inhibitors: [ (ticarcillin + clavulanic acid = timentin) or (piperacillin + tazobactam = “Zosyn”) ]
Other methods are hyperimmune serum, and granulocyte transfusions
Chlamydia spp
habitat
Obligate intracellular pathogen in humans
Inhabit epithelial tissue in multiple locations within the body. Entering the cytosol of a host cell is required for its life-cycle.
transmission
Spread via sexual transmission and can be transmissible by exposure to bodily fluids close to the infected epithelial tissue.
virulence factors
2 stage bodies
Their Elementary Bodies can form into Reticulate Bodies, which protects them from host degradation (they also can modulate host immune response).
They can enter a "persistent" state which allows CT to go undetected inside the cell
Treatment
generally resistant to antibiotics in the penicillin and cephalosporin class
Use macrolides (Azithromycin), lincosamides (Clindamycin), and fluoroquinolones (Cipro)
Mycoplasma pneumoniae: walking pneumonia
habitat
Primary habitat: mucous surfaces of the respiratory and urogenital tracts of humans and animals
transmission
Transmission through contact with droplets from the nose and throat of infected people especially as they cough or sneeze.
virulence factors
Secretes community acquired respiratory disease syndrome (CARDS) toxin
Intracellular structure and the membrane bound P1 adhesin proteins form its attachment organelle which anchors MP to the host cell, for motility, and nutrient uptake.
Treatment
Bacterium has no cell wall so they are therefore resistant to beta-lactam antibiotics (which target a bacteria's cell wall)
Oral steroid rinse to reduce inflammation
macrolide or tetracycline class antibiotic therapy to treat MP infection
Haemophilus influenzae
transmission
Bacterial infection spread bydirect person-to-person contact as well as coughing and sneezing.
habitat
colonize the mucous membranes of humans and some animals.
virulence factors
most strains have phagocyte-resistant capsules, which contains ribose, ribitol, and phosphate (known as polyribitol phosphate or PRP)
Treatment
Broad-spectrum cephalosporins used for initial empiric therapy
use of alternative antibiotics should be guided by in vitro susceptibility tests
Most infections of H. influenzae are from strain H. influenzae type b
Prevention
The capsules are an antigen used to prepare the vaccine (widespread immunization with the Hib vaccine has almost eliminated disease from this pathogen in the US).