Medical Moment Ch.3 (Pneumonia, whooping cough, gangrene)

What bacteria causes pneumococcal pneumonia?
Streptococcus pneumoniae; pathogenesis due to capsule

What are the signs and symptoms of pneumonia?
fever, chills, congestion, cough, chest pain, and short, rapid breathing
-can move into blood stream (bacteremia) and brain (meningitis)

What is the pathogenesis of pneumonia?
-Virulence factors: adhesions, capsule, pneumolysin
-Portal of entry: Inhalation
Transmission: S. pneumoniae found in many (40%) people’s noses and throats and is spread by coughing , sneezing, or contact with respiratory secretions.
Why it suddenly invades the body and causes disease is unknown. It may be associated with pilli production.
-Incubation period: one to three days

What is the epidemiology?
-Most common in ages under 2 years or over 65
-Each year in the US, there are an estimated 400,000 hospitalized cases of pneumococcal pneumonia
-30% of adult-community acquired pneumonia
-Bacteremia in 25-30% of patients
-Invasive disease=more than 50,000 cases of bacteremia and 3,000 to 6,000 cases of meningitis annually
-case fatality of 5-7% (>50% among elderly persons)

What is the treatment and prevention for pneumonia?
Treatment=penicillin is the drug of choice, but resistant strains
Vaccination available
-polysaccaride vaccine for adults
-conjugate vaccine for children

What is the CA and characteristics of whooping cough?
Bordetella pertussis

What are the signs and symptoms of WC?
-Incubation period 7-10 (range of 4-21 days)
Symptoms come in three stages: catarrhal, paroxysmal stage, convalescent stages

What are signs and symptoms of the catarrhal stage?
Coryza (runy nose), sneezing, low-grade mild fever, and a mild, occasional cough
Cough gradually becomes more severe
After 1-2 weeks, the second, or paroxysmal stage begins

What are the signs and symptoms of the paroxysmal stage?
Bursts or paroxysms of numerous, rapid coughs
End of the paroxysm, a long inspiratory effort is usually accompanied by a characteristic high-pitched whoop
May become cyanotic, appear very ill and distressed
Vomiting and exhaustion commonly follow the episode
Does not appear to be ill between attacks
Occur more frequently at night
Average of 15 attacks per 24 hours
Paroxysmal stage usually lasts 1-6 weeks (up to 10 weeks)

What are signs and symptoms of the convalescent stage?
Gradually gets better
Cough becomes less paroxysmal and disappears in 2-3 weeks
Most common complication and the cause of most pertussis related deaths, is secondary bacterial pneumonia

What are complications from paroxysmal cough?
Neurologic complications such as seizures and encephalopathy hypoxia (more common among infants)
Less serious: otitis media, anorexia, and dehydration
Complications resulting from pressure effects of severe paroxysms include pneumothorax, nosebleeds, subdural hematomas, hernias, and rectal prolapse

What is the pathogenesis of pneumonia?
Inhalation of bacterium, adherence to tracheal cilia via adhesions
Primary a toxin-mediated disease
-filamentous hemaglutinin (adhesion)
-Pertussis toxin (adhesin and toxin) (increase mucus)
– Adenylate cyclase toxin (increased mucus, decreased phagocytosis of leukocytes)
Action of toxins
-paralyze the cilia
-cause inflammation of the respiratory tract, which interferes with the clearing of pulmonary secretions
Survival within phagocytes

What is the epidemiology of pneumonia?
World-wide distribution
Most infectious in cataharral stage
Human reservoir
May increase in summer and fall
In the US epidemics occur every 3-5 years
Endemic in US

What is the treatment for pnemonia?
Medical management is primarily supportive
Erythomycin is the drug of choice
Antibiotic prophylaxis should be administered to all close contacts of persons with pertussis, regardless of age and vaccination status

What is prevention for pneumonia?
Acellular pertussis vaccines
Pediatric formulations (DTaP) licensed for full series in 1996
Adolescent and adult formulations (Tdap) licensed in 2005

What are the signs, symptoms, and pathogenesis of gas gangrene?
Pain and swelling at injury site, fever, foul smelling drainage, tachycardia, crepitus
Pathogenesis: Incubation period is one to three days, portal of entry: introduction into dead tissue via traumatic, deep, lacerating wounds, and produces 20 exotoxins

What is the epidemiology of gas gangrene?
In the US: Clostridia species are ubiquitous and widely distributed in the soil, especially in cultivated land.
Civilian cases of gas gangrene are more common, with approx. 3000 cases per year.
Gas gangrene can be classified as posstraumatic, postoperative, or spontaneous.
Posttraumatic gas gangrene accounts for 60% of overall incidence; most cases involve automobile accidents

What are prevention and treatment methods for gas gangrene?
Treatment: antibiotic treatment (penicillin and clindamycin widely used), surgical removal of dead tissue, Hyperbaric oxygen (HBO) therapy
Prevention: Properly cleanse wounds, avoid suturing wounds that are related to a crash injury or open fractures with devitalized muscle and soil contamination

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