Pulmonology: Types of Pneumonia

Streptococcus Pneumoniae “strep pneumo” -typical

“Strep +” gram positive diplocci, rust color sputum, most common cause of CAP

Haemophilus Influenza B (HIB)- typical

Pleomorphic gram-negative coccobacillus

Transmitted through direct contact… mother to child during birth

Asplenia, babies, COPD, uncommon d/t vaccinations

Staphylococcus aureus-typical

Gram-positive cocci in clusters

Salmon pink sputum

LTC, hospitals, post-influenza, injection drug use, immunosuppressed

MSSA (methicillin sensitive): beta lactam (penicillin) MRSA (methicillin resistant): vancomycin

Pseudomonas aeruginosa-typical

Gram negative rod w/ a single flagellum

Cystic fibrosis, ventilator use, wounds… rarely CAP (hot tubs would be the culprit), more likely hospital acquired

Pip-tazo OR cefepime and fluroquinolone

Klebsiella -typical

Gram negative encapsulated rod

Currant jelly sputum

Immunosuppressed, diabetes, alcoholics, lung disease

When gram-negative is suspected, use broad spectrum ABX initially

Moraxella catarrhalis- typical

Gram negative cocci

Underlying lung disease (esp. COPD), immunosuppression

NO beta-lactams, doxycycline or augmentin

Group B strep -typical

Gram positive coccus w/ a tendency to form chains

#1 cause in neonates

Mycoplasma pneumoniae-atypical

Extrapulmonary (pharyngitis, otitis media, myringitis bullosa, tonsillitis)

Common in young patients

Macrolides (azithromycin) or doxycycline (NO beta lactams!)

“walking pneumonia”

Chlamydia pneumoniae -atypical

Pharyngitis, hoarseness, extrapulmonary symptoms

people who live and work in crowded settings

Macrolide or doxycycline x 3 weeks

Causes CAP in 65+

Legionella pneumophilia-atypical 

Headache, diarrhea

CAP from WATER SOURCE

Fluroquinolone or azithromycin

Aspiration pneumonia-atypical

Most often found in RLL d/t more upright R main bronchus Foul smelling sputum, anaerobes

Augmentin, if HAP, use imipnenem/meropnem

Who are fungal pneumonias most common in?

The immunocompromised

PJP/PCP

pneumonia common in HIV/AIDS patients, greater risk w/ a CD4 below 200

Coccidiodes- atypical fungal 

“valley fever” in SW states

Skin sx, takes a few weeks

Fluconazole

Cryptococcus-atypical fungal

Soil and pigeon feces

Can cause meningitis

Amphotericin B, lifelong fluconazole

Histoplasmosis-atypical fungal

Cavitary (like TB)

Bird/bat droppings, River Valley

Itraconazole