If sputem is present, it is scanty, thin, or white as opposed to that of typical pneumonia which is yellow, green, or rusty.
The X-Ray often surprises physician by showing infiltrates in mildly ill outpatient “Walking Pneumonia”
Atypical is less likely than typical to have pleuritic pain or pleural effusion.
It is a short rod, lacks a cell wall and has a long doubling time of about 6 hr.
Disease has an incubation period of 2-3 weeks, gradual onset of fever, malaise, dry cough
Spread by respiratory droplets.
Interstitial shows thickened septae and clear alveolar spaces.
Normal is on the right. Normally, the alveolis aren’t clear.
The bacterial are small Gram- bacillus but stains poorly, but better with Silver Stains. It is Aerobic.
It grows at high temperature and well in nature inside free-living amebae. In patients it is mostly intracellular especially in macrophages.
The virulence factors are related to LPS endotoxin, and flagellin. It is slow growing on charcoal years (3-5 days)
Sources are water sources
It is NOT contagious.
Smokers, COPD, elderly, immunocompromised people are especially susceptible.
Once inside, the elementary particle reorganizes into a larger noninfectious reticulate body which is osmotically fragile.
The Reticulate body is what reproduces continuously by binary fission.
After 48 hours, these stop multiplying and condense back into elementary bodies that will eventually burst out of the cell
Most adults have the antibodies against it, children rarely have the antibodies. Adolescense shows a rapid rise of them.
XRay shows nonspecific infiltrate. WBC is normal.
Causes atypical pneumonia and febrile illness like mono or influenza
The toxins are Pertussis toxin which elevate ICF cAMP which will activate Adenyl Cyclase. It also has adenylate cyclase toxin and tracheal cytotoxin.
There is intense coughing against closed vocal cords causing Valsalva-like maneuvers. This can cause hemorrhages in conjunctiva and the brain.
There is mainly Leukocytosis in which there is a predominance of lymphocytes.
Infection rarely extends to lung to cause pneumonia and the ear to cause otitis media.
IT NEVER CAUSES BACTEREMIA
Catarrhal (basic flu-like 1-2weeks)
Paroxysmal (2-4 weeks) Whooping Cough
Convalescent (3-4 weeks or longer) Secondary Complications
There is an inspiratory gasp with whoop as air passes turbulently through mucus.
Coughing may induce vomiting and cyanosis as well as cause mucus plugs.
In pre-vaccine times, mother’s antibody protected baby for 1 year. Most cases were 1-5 years old.
Vaccine is effective for 12 years, adults not protected.
Seizures in 3% of adults with long term, death in 1%.
What is recommended but not a current practice?
STUDIES INDICATE ADULTS NEED BOOSTER
Treatment is Erythromycin
Lower respiratory tract, has hilar lyphadenopathy and more prominent spleen enlargement.
Blastomyces are on cutaneous surfaces
For Histoplasma and Coccidioides, blacks, Fillipinos and Native Americans.
Non Contagious (no one close)
No Upper Respiratory Symptoms (hoarseness)
Not responding to bacteria.
Coccidiodomycosis are NOT used because it is very dangerous in the lab.
Paired Sera is used for systemic fungal serologies.
Do not do Histoplasmin skin tests until after 2nd sera is drawn to prevent positive Histo serology.
This causes problem in AIDS and cancer patients.
This can cause maternal death in the 3rd trimester.
2. Fungus balls growing free in old TB cavities
3. Allergic Bronchopulmonary Aspergillosis where the fungus grows in mucus plugs in asthmatic patients.
4. Farmer’s Lung (allergy)
Found in Asthmatic patients ith alergies to Aspergillus. They develop mucous plugs and then the organism grows in the plug.
This patient has high IgE and is treated with antifungals.
Pulmonary disease in urban homeless alcoholics. This is why it is called Alcoholic Rose Garden Sleeper’s Disease.
It looks like Tb!