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Old 12-06-2012
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Lungs Peptostreptococcus and Fusobacterium in Pulmonary Lesion

Fine needle aspiration of a pulmonary lesion in a 35-year old Caucasian female is performed. The specimen is cultured and grows several bacterial species, including Peptostreptococcus and Fusobacterium. The factor most likely to predispose to this patient's condition is:

A. Intravenous drug use
B. Penetrating chest trauma
C. Seizure disorder
D. Urinary Infection
E. Occult malignancy
F. Mitral valve prolapse
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Old 12-06-2012
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C. Seizure disorder.
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C?

Seizure --> Aspiration ---> Pneumonia?
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Yes, You can also find it on Uworld Q533 if you go on search under utilities.
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Originally Posted by ReggieMiller View Post
C?

Seizure --> Aspiration ---> Pneumonia?
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Default my answer :)

C. Seizure disorder
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Old 12-07-2012
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seizure disorder
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Old 12-07-2012
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Correct Answer Correct Answer

The Correct Answer is C) Seizure disorder

Peptostreptococcus and Fusobacterium species are components of the normal flora. Patients experiencing decreased consciousness (e.g. patients with a seizure disorder) may aspirate oropharyngeal contents,causing a lung abscess. On chest x-ray, a lung abscess appears as a cavitary lesion with an air-fluid level. Lung abscesses arising as a complication of aspiration typically contain mixed flora,often including these two species. Lung abscesses cause fever, weight loss, cough and foul-smelling sputum. There may also be anorexia,malaise, chest pain and clubbing.

Lung abscesses may develop by the following mechanisms:
1. Aspiration of oropharyngeal contents is the mcc. These abscesses often contain Fusobacterium,Peptostreptococcus and Bacteroides species. Risk factors include all conditions associated with loss of consciousness, such as alcoholism, seizure disorders,prolonged anesthesia, and severe neurologic diseases. Aspiration associated abscesses are found in the dependent parts of the right lung.

2. Lung abscesses may also occur as a complication of bacterial pneumonia.Predisposing factors include immunosuppression,old age and underlying chronic disease. Necrotizing pneumonias are usually nosocomial, caused by S.aureus,E.coli, K.pneumoniae or S.pneumoniae type 3

3.In patients with septicemia or infectious endocarditis there may be hematogenous spread of infection to the lung. Lung abscesses that develop in this manner are often times multiple. The most common causative agents are staphylococcus and streptococcus species.E.coli and fungi may also be implicated.

(Choice A) Intravenous drug users develop staphylococcus endocarditis that can sometimes cause septic emboli and multiple lung abscesses

(Choice B) Lung abscesses may be associated with preceeding penetrating trauma. Staphylococcus and streptococcus species are usually responsible.

(Choice E) An abscess may occur secondary to broncogenic Ca. The bronchial obstruction can cause postobstructive pneumonia, which may lead to abscess formation. However,these abscesses do not contain oral anaerobic flora.

(Choice F) Mitral valve prolapse is a risk factor for development of subacute bacterial endocarditis (With Streptococcus species). Left side endocarditis could cause septic embolization to downstream organs such as the spleen, brain etc., but would not send septic emboli to the lungs.

Risk factors for lung abscesses: Alcoholism,Seizures,CVA, and dementia.
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