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LRI-Jin-bw - Case#1 A 45 year old female with previous...

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Case #1 z A 45 year old female with previous rhinorrhea, pharyngitis, and cough visits her doctor with a 39 o C fever which appeared abruptly after a sudden shaking chill episode. She has chest pain and a productive cough with rust colored sputum . Auscultation demonstrates inspiratory rales and "tubular" breath sounds in the right lung. X-ray shows diffuse lobar consolidation of the right lung. WBC were 52,400/mm 3 with 86% neutrophils.
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Case #2 z The 16 year old girl complained of headache, dry cough , malaise, and temperature of 38 o C for a couple of weeks . She denies smoking or drug use and has an unremarkable history, and has continued to attend school at her mother's insistence. No sputum could be obtained, and chest X-ray showed very poorly defined infiltrate in posterior sections.
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Questions z Major causes of pneumonia? z Host defenses? z Causes of the disease symptoms? z How to diagnose pneumonia? z How to treat such infections?
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Pneumococcal pneumonia ( Streptococcus pneumoniae) z Gram-positive diplococcus Encapsulated (>80 serotypes) z Susceptible population Elderly Previously ill Phagocytic dysfunction e.g., asplenic, sickle cell z Also cause meningitis, otitis media z Sensitive to optichin z Autolysis by bile
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Stages of pathogenesis z Encounter - humans only, by respiratory droplet z Entry - colonization of the oropharynx, aspiration into lung (pneumonia) z Spread (extracellular) Pneumonia - blood culture can be positive Meningitis - penetration of mucous membrane Otitis media- eustachian tube to middle ear z Multiplication Grows well in serous fluid in alveoli space z Evade defenses Capsule--antiphagocytic sIgA protease
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S. pneumoniae z Damage Pneumolysin (binds cholesterol in the host cell
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