Micro 4 Bacterial Pneumonia 1: Pseudomonas and Chlamydia

Four P/B pathogens
Pseudomonas/Burkholderia
P. aeruginosa
B. cepacia
B. pseudomallei
B. mallei

P. aeruginosa
P. aeruginosa
a common and serious nosocomial pathogen. Can grow in water

B. cepacia
B. cepacia
common, serious in context of CF, biofilms

B. pseudomallei and B. mallei
B. pseudomallei and B. mallei
rare in US but can be lethal. Travel outside the US, animals spread it to humans. Weaponizable, airborn.

Pseudomonas/Burkholderia
(P/B), description
Pseudomonas/Burkholderia
(P/B), description
Gram Negative
Rods
Aerobes, must breath oxygen
non-fermenters,
Oxidase positive,
Grow easily in culture.

why do Pseudomonas/Burkholderia infect skin and cause pneumonia
why do Pseudomonas/Burkholderia infect skin and cause pneumonia
Aerobes, must breath oxygen. They can infect anywhere if sepsis in vulnerable patient

Pseudomonas, complications
Pseudomonas, complications
septicemia/pneumonia with poor prognosis. Gram Negative endotoxins

Pseudomonas, diagnosis
culture and Gram stain
PCR and immuno-fluorescence at reference labs

Pseudomonas, treatment
Pseudomonas, treatment
latest combinations of antibiotics, test Ab (antibotic) sensitivity both before and during treatment.
remove/change catheters and IVs

Pseudomonas aeruginosa, virulence factor
Pseudomonas aeruginosa, virulence factor
produces green *pyocyanin* in culture. interferes with the terminal (ETC) electron transfer system.
*Glycocalyx* is anti-phagocytic, is like a biofilm glue.

What would be a big clue that a wound infection is P. aeruginosa?
What would be a big clue that a wound infection is P. aeruginosa?
bright green coloration

Pseudomonas, extreme antibiotic resistance because
Pseudomonas, extreme antibiotic resistance because
Outer membrane has low-permeability.
Efflux pumps.

P. aeruginosa and B. cepacia
P. aeruginosa and B. cepacia
minimal growth requirements, and contaminate hospital solutions

P. aeruginosa, community-acquired presentations
P. aeruginosa, community-acquired presentations
Endocarditis in IV drug addicts.
Otitis externa in underchlorinated hot tubs.
Osteochondritis in sneaker punctures.
Corneal infections under contact lenses

B. cepacia, common presentations for serious disease. Cepacia Syndrome:
in Cystic Fibrosis centers.
Accelerated pulmonary course with rapidly-fatal bacteremia.

What is SIMILAR about P. aeruginosa and B. cepacia infections?
Extreme antibiotic resistance and
Dangerous to CF patients

B. pseudomallei
B. pseudomallei
in previously-ill travelers/immigrants or Vietnam veterans. Attacks lung and liver, like Q fever. Symptoms like TB, but not acid fast.

Vietnam veterans and freeliving water microbes
B. pseudomallei and B. cepacia similarities

B. mallei
in previously-ill travelers/immigrants with animal handling history.

Chlamydia, description
Chlamydia, description
is a small, obligate intracellular bacterium. poorly staining

obligate intracellular bacterium
Chlamydia, must use drugs that penetrate the human cell membrane

Chlamydia, replication
Chlamydia, replication
beginning with tiny, infectious, rugged, elementary bodies which “unpack” into reticulate bodies after infection. Reticulate bodies form inclusions and multiply by binary fission within these inclusion.

Chlamydia, extracellular form. tiny, infectious, rugged.
elementary bodies

Chlamydia, intracellular form, unpacked
reticulate bodies

Reticulate bodies form intracellular inclusions
Reticulate bodies form intracellular inclusions
visible on microscopy
within these, making more via binary fission.

Chlamydia, complicates research
Unusual life cycle, obligate intracellular. Requires tissue culture for in-vitro.

Chlamydia, virulence factor
Chlamydia, virulence factor
T3SS used for entry & establishing inclusion body.

T3SS
T3SS
Chlamydia, virulence factor. used for entry & establishing inclusion body.

C. trachomatis
C. trachomatis
cause of several human diseases, particularly the common urogenital infection (safe sex practices!).

C. pneumoniae, C. psittaci, and C. trachomatis
C. pneumoniae, C. psittaci, and C. trachomatis
cause pneumonia

C. pneumoniae
C. pneumoniae
chlamydia most likely to cause pneumonia. usually self-limiting, not requiring treatment. elderly

C. psittaci
C. psittaci
birds spread it to humans, airborn and contact. Serious pneumonia, must treat.

C. pneumoniae, C. psittaci, and C. trachomatis, diagnosis
Serology or MIF. Treatment can often be initiated based on physical findings, additional diagnostics are available (tissue culture for C. trachomatis in rape victims; serology or MIF to differentiate pneumonias).

tissue culture
for rape victims, for C. trachomatis

serology or MIF/ micro-immuno-fluorescence
to differentiate pneumonias

C. pneumoniae, C. psittaci, and C. trachomatis, treatment
tetracyclines/doxycycline EXCEPT for pregnant/pediatric/allergic patients, who get erythromycin or other alternatives. Patients who get alternatives may need follow-up testing and retreatment

tetracyclines/doxycycline never use if
pregnant/pediatric/allergic

who get erythromycin or other alternatives. Patients who get alternatives may need follow-up testing and retreatment

pregnant/pediatric/allergic, chlamydia treatment
erythromycin or other alternatives. Patients who get alternatives may need follow-up testing and retreatment

Chlamydia patients who are not treated with tetracyclines/doxycycline
may need follow-up testing and retreatment

What is problematic about P. aeruginosa as a nosocomial infection?
-Extreme antibiotic resistance
-Propensity to grow in low-nutrient aqueous solutions
-Ability to cause bacteremia

To which patient(s) is a B. cepacia infection dangerous despite treatment?
pediatric CF patient. Cystic Fibrosis is the most important predisposition for poor outcomes of cepacia infection.

MANY Bacteria Can Cause Pneumonia
TB and mimicking atypical mycobacteria (last month)
Pneumococcus (Unit 3)
S. aureus (Unit 2)
H. influenzae (Unit 6)
Pseudomonads (this lecture)
Chlamydia (this lecture)
Klebsiella (Unit 6)
Anaerobes, particularly Actinomyces (Unit 2)
Legionella (tomorrow)
Coxiella (tomorrow)
Mycoplasma (tomorrow)
F. tularensis, B. anthracis, Y. pestis (Unit 2)
Enterococcus (Unit 5)
Nocardia (textbook)

atypical pneumonia
Legionella
Coxiella
Mycoplasma

no flowers in the burn unit
no flowers in the burn unit
P. aeruginosa is environmentally ubiquitous, in water and plants.

What are the most common causes of pneumonia in neonates (

common cause of pneumonia in immunocompromised patients Pneumocystis jirovecii most common cause of atypical/walking pneumonia Mycoplasma pneumoniae WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample common causative agent for …

What is Atypical Pneumonia? – pneumonia char by interstitial pattern of fibronodular or patchy infiltrate – dry cough*/ scanty & thin or white sputum – considered “walking pneumonia because most people don’t know they have it” T/F: It is more …

Common cause of pneumonia in immunocompromised patients Pneumocystis jirovecii Most common cause of atypical/walking pneumonia Mycoplasma pneumoniae WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Common causative agent for …

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streptococcus pneumoniae etiologic agent of pneumococcal pneumoniae gram positive diplococci the agent that causes this kind of pneumonia and is covered in a capsule WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE …

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