Which is not associated with community acquired pneumonia
Correct Answer: Klebsiella
Description: Klebsiella REF: Jawetz's Medical Microbiology, 24th Edition Section VII. Diagnostic Medical Microbiology & Clinical Correlation > Chapter 48, http://en.wikipedia.org/wiki/Community-acquired pneumonia Respiratory viruses are the single most impoant cause of community-acquired pneumonia in pediatric age group. Typical bacterial pathogens that cause CAP include Streptococcus pneumoniae (both penicillin-sensitive and -resistant strains), H influenzae (both ampicillin-sensitive and -resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant). These 3 pathogens account for approximately 85% of CAP cases. S pneumoniae remains the most common agent responsible for CAP The most common combination of pathogens is Streptococcus pneumoniae (pneumococcus) with either respiratory syncytial virus (RSV) or Mycoplasma pneumoniae Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa are not typical causes of CAP in otherwise healthy hosts. S aureus may cause CAP in individuals with influenza (eg, human seasonal influenza and H1N1 influenza). K pneumoniae CAP occurs primarily in individuals with chronic alcoholism. P aeruginosa is a cause of CAP in patients with bronchiectasis or cystic fibrosis. Atypical community-acquired pneumonia pathogens: Atypical pneumonias can be divided into zoonotic and Nonzoonotic atypical pathogens. Zoonotic atypical CAP pathogens include Chlamydophilia (Chlamydia) psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever). Nonzoonotic atypical CAP pathogens are caused by Legionella species, M pneumoniae, or Chlamydophilia (Chlamydia) pneumoniae. These 3 organisms account for approximately 15% of all CAP cases. Organism Clinical Setting Gram-Stained Smears of Sputum Laboratory Studies Preferred Antimicrobial Therapy Streptococcus Chronic Gram-positive Gram-staining smear of Penicillin G pneumoniae cardiopulmonary disease; follows upper respiratory tract infections diplococci sputum; culture of blood, pleural fluid; urinary antigen (or V, oral); fluoroquinolones or vancomycin for highly penicillin resistant Hemophilus influenzae Chronic cardiopulmonary Small gram- negative Culture of sputum, blood, pleural fluid Ampicillin (or amoxicillin) if disease; follows upper respiratory tract infections coccobacilli fi-lactamase? negatie; cefotaxime or ceftriaxone Staphylococcus aureus Influenza epidemics; nosocomial Gram-positive cocci in clumps Culture of sputum,blood, pleural fluid Nafcillin Klebsiella pneumoniae Alcohol abuse,diabetes mellitus; nosocomial Gram-negative encapsulated rods Culture of sputum, blood, pleural fluid A cephalosporin; for severe infection, add gentamicin or tobramycin Escherichia col/ Nosocomial; rarely, community acquired Gram-negative rods Culture of sputum, blood, pleural fluid A third? generation cephalosporin Pseudomonas Nosocomial; cystic Gram-negative rods Culture of sputum, blood Antipseudomonal aeruginosa fibrosis cephalosporin or carbapenem or -lactam/fi? lactamae inhibitor plus an aminogycoside Anaerobes Aspiration, periodontitis Mixed flora Culture of pleural fluid or of material obtained by transthoracic aspiration; bronchoscopy with proected specimen brush Clindamycin iwycopiasma pneumoniae Young adults; summer and fall PMNs and monocytes; no bacterial pathogens Complement fixation titre, cold agglutinin serum titres are not helpful as they lack sensitivity and specificity; PCR Erythromycin, azithromycin, or clarithromycin; doxycycline, fluoroquinolones Legionella species Summer and fall; exposure to Few PMNs; no bacteria Direct immunofluorescent examination of sputum or Erythromycin, azithromycin, or contaminated construction site, water source, air tissue; immunofluorescent antibody titre; culture of sputum or tissue; Legionella clarithromycin, with or without rifampin; conditioner; community acquired or nosocomial urinary antigen (L prieumophila serogroup 1 only); PCR fluoroquinolones Chlamydophilia pneumoniae Clinically similar to M pneumoniae pneumonia, but Nonspecific Isolation very difficult; microimmunofluorescence with TWAR antigens is the Doxycycline, erythromycin, clarithromycin; prodromal symptoms last longer (up to 2 weeks); sore throat with hoarseness common; mild pneumonia in teenagers and young adults recommended assay fluoroquinolones Moraxella Pre-existing lung Gram-negative Gram stain and culture of Trimethoprim? catarrhalis disease; elderly; diplococci sputum or bronchial sulfamethoxazole coicosteroid or immunosuppressive th therapy aspiration or amoxicillin- clavulanic acid or second or third generation cephalosporin Pneurnocystis jiroveci AIDS, immunosuppressive Not helpful in diagnosis Cysts and trophozoites of P firoveci on methenamine Trimethoprim? sulfameth- th erapy silver or Giemsa stains of sputum or bronchoalveolar lavage fluid; direct immunofluorescent antibody on BAL fluid oxazole, pentamidine isethionate
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