Step I Pneumonia

[GiJoe]

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ok, so If I tell you an alcoholic comes in with resp. distress and xray film shows lobar consolidtion, what bug comes into mind???







I was thinkin Klebsiella until I remembered in FA it showed Strep Pneumo to be the first bug instead. I always learned that alcoholic = klebsiella... where did strep pneumo come from?

 

[NineSixteen]

The strep pneumo comes from the lobar consolidation. Klebsiella is a bronchopneumonia pattern of patchy distribution. But, you're right on the alcoholic = klebsiella thing! Just that alcoholics can get strep pneumo, too, and if it's lobar it's likely strep pneumo 🙂

 

[nuclearrabbit77]

strep pneumonia is the most likely community acquired lobar pneumonia. klebsiella is seen in higher in alcoholics, but an alcoholic isn't most likely going to get pneumonia from klebsiella. klebsiella clinical presentations will have some big hint like, "thick viscous red gelatinous mucous" etc.

 

[Idiopathic]

Remember Klebsiella cavitates also...if you see pneumonia/consolidation and cavitation (after ruling out CA and TB) think Klebsiella.

Also if your Px is in a nursing home, they will get Klebsiella.

 

[Stinger86]

strep pneumonia is the most likely community acquired lobar pneumonia. klebsiella is seen in higher in alcoholics, but an alcoholic isn't most likely going to get pneumonia from klebsiella. klebsiella clinical presentations will have some big hint like, "thick viscous red gelatinous mucous" etc.

This is analogous to how asbestos is much, much more likely to cause squamous cell carcinoma of the lung than mesothelioma, but it is practically the only substance that can cause mesothelioma (which is kinda rare anyhow), so people often equate asbestos with mesothelioma

 

[PACtoDOC]

Don't forget that alcoholics with pneumonia often have anaerobic abscesses from oral flora when they have poor dentition and spells of passing out.

 

[Kosmo]

It sounds like the question was merely asking for the most common type community acquired pneumonia, it's always strep pneumo.
Don't be fooled by the alcoholic thing, the most common cause of CAP in an alcoholic is still strep pneumo. If they're looking for Klebsiella as an answer they'll have to give you another clue, such as the classic 'black currant' sputum.
Another one that'll burn you is an HIV patient with CAP, they'll get you thinkin' it's PCP pneumonia but the most common cause of CAP in an HIV patient is, of course, strep pneumo. Like above, they'll have to give other clues if the correct answer is PCP: like 'diffuse interstitial infiltrates' on CXR, or a longer onset (e.g., 2-3 weeks of cough w/o sputum,) strep pneumonia tends to bring people into the hospital faster.

Just curious, are you preparing for step 1 or 2?

 

[Idiopathic]

Another one that'll burn you is an HIV patient with CAP, they'll get you thinkin' it's PCP pneumonia but the most common cause of CAP in an HIV patient is, of course, strep pneumo. Like above, they'll have to give other clues if the correct answer is PCP: like 'diffuse interstitial infiltrates' on CXR, or a longer onset (e.g., 2-3 weeks of cough w/o sputum,) strep pneumonia tends to bring people into the hospital faster.

I do like the AIDS Px presentation, as far as question quality. Everybody wants to hit PCP or something really weird like Aspergillus, but all things being equal, its S. Pneumo.