Alcoholic Pneumonia that did not improve with Pencillin and Cephalosporin! - USMLE Forums
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  #1  
Old 08-02-2011
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Lungs Alcoholic Pneumonia that did not improve with Pencillin and Cephalosporin!

A 65-years-old chronic alcoholic presented with fever and night sweats since 2 weeks that did not improve on penicillin and cephalosporin therapy. History revealed prior episodes of severe drowsiness, night sweats, and foul smelling expectoration.
Which of the following is likely the cause of these symptoms?
a- Klebsialla pneumoniae
b- Streptococcus pneumoniae
c- Bacteroids
d- Staphylococcus aureus
e- Legionella pneumophila
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  #2  
Old 08-02-2011
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foul smelling expectoration = Bacteroids
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  #3  
Old 08-02-2011
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staph aureus...not sure
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i ll go with c
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  #5  
Old 08-02-2011
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A. K.Pnemoniae
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Old 08-02-2011
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klebsiella foul smelling expectoration and alcoholic
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Old 08-02-2011
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Quote:
Originally Posted by qurat21 View Post
klebsiella foul smelling expectoration n alcoholic
yup, but he received cephalosporin therapy
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  #8  
Old 08-02-2011
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Quote:
Originally Posted by bebix View Post
yup, but he received cephalosporin therapy
ohhhhhhhhhhhhh
thanx
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  #9  
Old 08-02-2011
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C) Bacteroides
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  #10  
Old 08-02-2011
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I think it is c ) bacteroides
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  #11  
Old 08-03-2011
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K pneumoniae
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  #12  
Old 08-03-2011
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bacteroides
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Old 08-03-2011
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What is the answer?
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Old 08-03-2011
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This is an aspiration pneumonia.....
Bacteroids....
treatment clindamycin coz it covers these anerobes.

gud luck...
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  #15  
Old 08-03-2011
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Correct Answer The answer is C

The answer is C
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  #16  
Old 08-03-2011
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Question

What if it was MRSA?? it would nt improve wid the given treatment , but what kind of sputum would it produce?
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  #17  
Old 08-04-2011
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If it would have ben mrsa.....u shud search for the following in the question..

patient would have been in the hospital for last 3 weeks....MRSA is mostly hosp accqiured.....or ventilator accquired( pt. on ventilator on icu)

we give vancomycin to cover mrsa....


for just staph pneumonia we shud look for post influenza patient....
these pts have cavitary leisions.....
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  #18  
Old 08-04-2011
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Post C

c- Bacteroids
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  #19  
Old 11-30-2011
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Default Legionella

The answer is Legionella.

Klebsiella is a trick but incorrect. Although it is a common cause of pneumonia in alcoholics, you can use first or second generation cephs against it.

Strep is the most incorrect out of any. Why? All four generations of cephs work against it. Not to mention, although it is an overall common cause of pneumonia, it is not specific to alcoholics.

Bacteroides is the second-most likely answer because of its relation to aspiration pneumonia in alcoholics, however it is wrong because SECOND generation cephs are known specifically to hit anaerobes, such as bacteroides. That's the biggest hole puncher there: 2nd gen cephs hit anaerobes and H. influenza hard. Bacteroides is not the answer. Cefoxitin is the big drug to know for this one.

S. aureus is more likely in IV-drug users (as the buzzword), although also possible in alcoholics, but all four ceph generations hit it, particularly the first two.

Legionella is the only one that is not specifically targeted by cephs, and that includes all four generations. First of all, it's a gram(-) coccobacilli-pleomorphic, so if ceph hit it, it would HAVE to be third or fourth generations, but cephs aren't typically used for Legionnaire's disease; the 3 and 4 gen cephs are used for severe gram(-) sepsis and meningitis.

--> I've gathered this information after having gone through the Lange pharmacology flashcards, as recommended by First Aid, in their resources section, as well as the Sanjiv Microcards.

The only real relation to ethanol that might be good to know is the ceph contraindications with disulfiram. Cefamandole, cefotetan and cephoperazone fall into that category and are contraindicated with disulfiram.

Best,

-jabaway

Last edited by jabaway; 11-30-2011 at 12:59 PM.
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  #20  
Old 11-30-2011
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Default Legionella (2)

However, here is a source suggesting bacteroides:

^ a b Moreira Jda S, Camargo Jde J, Felicetti JC, Goldenfun PR, Moreira AL, Porto Nda S (2006). "Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004". Jornal brasileiro de pneumologia : publicaša̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia 32 (2): 136–43. PMID 17273583.


--> It appears that the answer is in fact more likely bacteroides, not Legionella. Now that I've done additional research, foul-smelling sputum = anaerobes.

Thanks for posting this question. I'm glad I've learned from it.
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