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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=William J Gibson
|QuestionAuthor=William J Gibson (Reviewed by  {{Rim}} and  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|Prompt=A 25-year-old woman presents to her primary care physician with complaints of worsening dyspnea, dry cough, and myalgia for the past 8 days. Her past medical history is significant for migraines, for which she occasionally takes over-the-counter NSAIDs. She denies smoking, drinking alcohol, or illicit drug use. She has no known allergies. Her blood pressure is 116/82 mmHg, heart rate is 72/min, temperature is 101 °F (38.3 °C), and respiratory rate is 24/min. Physical examination is remarkable for diffuse crackles over both lung fields. Chest xray shows bilateral bronchial wall thickening and centrilobular nodules. Which of the following is a characteristic finding of the organism responsible for this patient's symptoms?
|SubCategory=Pulmonology
|Explanation=[[Atypical pneumonia]] is a lower respiratory tract infection which often causes non-specific symptoms such as [[fever]], [[headache]], and [[myalgia]]. Atypical pneumonia differs from typical pneumonia in that [[atypical pneumonias]] often have a milder course, do not respond to common antibiotics (eg sulfonamides, or beta-lactams), and do not show signs of focal consolidation, and do not exhibit [[leukocytosis]]. Chest xray of patients with atypical pneumonia classically shows bilateral bronchial wall thickening and centrilobular nodules, which may falsely convey the appearance of a more severe infection. Because patients often have mild symptoms, [[atypical pneumonia]] is alternatively referred to as “walking pneumonia.”  
|MainCategory=Microbiology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Pulmonology
|Prompt=A 20 year old woman presents to her primary care physician complaining of dyspnea and malaise. Over the past week she has experienced increasing dyspnea, bronchitis and fatigue which limits her otherwise vigorous exercise but does not interfere with daily activities. She denies abnormal sputum production and any significant past medical history. On physical examination, she has a pulse of 72, temperature of 101 F (38.3 C), respiratory rate of 22 and oxygen saturation of 94% on room air. Cardiac examination is normal but respiratory exam reveals diffuse crackles. Which of the following is true of the most likely causal organism?
|Explanation=The patient is suffering from a case of [[atypical pneumonia]], a respiratory infection which often causes systemic symptoms such as fever, headache and myalgia. Atypical pneumonia differs from typical pneumonia in that atypical pneumonias often do not respond to common antibiotics (eg sulfonamides, or beta-lactams), do not show signs of consolidation, nor give rise toe leukocytosis. On chest X-ray, patients often show a diffuse interstitial infiltrate which conveys the appearance of a more severe infection than the patient’s symptoms suggest. Because patients often have mild symptoms, atypical pneumonia is alternatively referred to as “walking pneumonia.” While walking pneumonia due to mycoplasma infection is a distinct entity, the more general distinction between typical and atypical pneumonias is largely historical and has more recently been de-emphasized.
 
Atypical pneumonia is most often caused by [[Mycoplasma Pneumonia]] which usually infects older children and young adults (patients <30 years old).  Mycoplasma Pneumonia is a mere 0.3 um in size and is the only bacteria which does not possess a cell wall.  Mycoplasma pneumoniae can be cultured on Eaton's agar.
 
'''Educational Objective:''' 
Mycoplasma Pneumonia is the most common cause of atypical pneumonia.
 
'''References:'''
 
First Aid 2014 page 145


Note: This question is linked to WBR0044
Atypical pneumonia is most often caused by ''[[Mycoplasma pneumoniae]]'', which usually infects older children and young adults less than 30 years of age. ''Mycoplasma pneumoniae'' is a small bacteria that does not contain a cell wall. Instead, it contains a cell membrane that has a high sterol content, which decreases its fluidity and supports its osmotically fragile membrane. It is difficult to culture, but may be cultured on Eaton's agar.
|AnswerA=Pili undergo antigenic variation
|AnswerA=Pili undergo antigenic variation
|AnswerAExp='''Incorrect:'''  The pili of Neisseria Gonnorhea undergo antigenic variation.
|AnswerAExp=The pili of ''[[Neisseria gonorrheae]]'' undergo antigenic variation.
|AnswerB=Cell wall contains cholesterol
|AnswerB=Cell wall that contains high sterol content
|AnswerBExp='''Incorrect:''' Mycoplasma Pneumonia does not have a cell wall.  Its cell '''membrane''' however, incorporates sterol compounds such as cholesterol. It is the only bacterial membrane which contains cholesterol.
|AnswerBExp=''[[Mycoplasma pneumoniae]]'' does not have a cell wall.  Its cell "membrane" however, incorporates [[sterol]] compounds such as [[cholesterol]]. It is the only bacterial membrane which contains cholesterol.
|AnswerC=Acid fast bacilli
|AnswerC=Acid fast bacilli
|AnswerCExp='''Incorrect:''' Mycobateria species stain positive in acid fast stain, but mycoplasma are not identified in this manner.Inc
|AnswerCExp=''[[Mycobateria spp.]]'' stain positively in acid fast stain. ''Mycoplasma spp.'' are not identified using acid fast stain.
|AnswerD=Positive silver stain
|AnswerD=Positive silver stain
|AnswerDExp='''Incorrect:''' The causal organism in this vignette is Mycoplasma Pneumonia which is not detected by silver stain. Organisms which are positive on silver stain include Pseudomonas, Legionella, Leptospira, H. Pylori, and fungi such as Pneumocystis, and Candida.
|AnswerDExp=The infectious agent of this patient's atypical pneumonia is ''[[Mycoplasma pneumoniae]]'', which is not detected by silver stain. Organisms which are positive on silver stain include ''[[Pseudomonas spp.]]'', ''[[Legionella spp.]]'', ''[[Leptospira spp.]]'', ''[[H. pylori]]'', and [[fungi]] such as ''[[Pneumocystis jirovecii]]'', and ''[[Candida spp.]]''
|AnswerE=No cell wall
|AnswerE=Presence of cell membrane with increased osmotic fragility
|AnswerEExp='''Correct:''' Mycoplasma pneumonia is the most common cause of [[atypical pneumonia]] and has no cell wall.
|AnswerEExp=''[[Mycoplasma pneumoniae]]'' is the most common cause of [[atypical pneumonia]] and has no [[cell wall]]. It contains cell membranes with high sterol content that decrease its membrane fluidity and increase its osmotic fragility.
|EducationalObjectives=''[[Mycoplasma pneumoniae]]'' is the most common cause of [[atypical pneumonia]]. It is characterized by the absence of cell wall, and presence of cell membranes with high sterol content that decrease its membrane fluidity and help support its osmotically fragile membrane.
|References=Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin. Microbiol. Rev. 2004;17(4):697-728.
First Aid 2014 page 145.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Microbiology, Mycoplasma, Bacteria, Pneumonia, infection
|WBRKeyword=Microbiology, Mycoplasma, pneumoniae, Bacteria, Pneumonia, infection, atypical, walking, cell, membrane, sterol
|Approved=Yes
|Approved=Yes
}}
}}

Latest revision as of 23:09, 27 October 2020

 
Author [[PageAuthor::William J Gibson (Reviewed by Rim Halaby, M.D. [1] and Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Microbiology
Sub Category SubCategory::Pulmonology
Prompt [[Prompt::A 25-year-old woman presents to her primary care physician with complaints of worsening dyspnea, dry cough, and myalgia for the past 8 days. Her past medical history is significant for migraines, for which she occasionally takes over-the-counter NSAIDs. She denies smoking, drinking alcohol, or illicit drug use. She has no known allergies. Her blood pressure is 116/82 mmHg, heart rate is 72/min, temperature is 101 °F (38.3 °C), and respiratory rate is 24/min. Physical examination is remarkable for diffuse crackles over both lung fields. Chest xray shows bilateral bronchial wall thickening and centrilobular nodules. Which of the following is a characteristic finding of the organism responsible for this patient's symptoms?]]
Answer A AnswerA::Pili undergo antigenic variation
Answer A Explanation [[AnswerAExp::The pili of Neisseria gonorrheae undergo antigenic variation.]]
Answer B AnswerB::Cell wall that contains high sterol content
Answer B Explanation [[AnswerBExp::Mycoplasma pneumoniae does not have a cell wall. Its cell "membrane" however, incorporates sterol compounds such as cholesterol. It is the only bacterial membrane which contains cholesterol.]]
Answer C AnswerC::Acid fast bacilli
Answer C Explanation [[AnswerCExp::Mycobateria spp. stain positively in acid fast stain. Mycoplasma spp. are not identified using acid fast stain.]]
Answer D AnswerD::Positive silver stain
Answer D Explanation [[AnswerDExp::The infectious agent of this patient's atypical pneumonia is Mycoplasma pneumoniae, which is not detected by silver stain. Organisms which are positive on silver stain include Pseudomonas spp., Legionella spp., Leptospira spp., H. pylori, and fungi such as Pneumocystis jirovecii, and Candida spp.]]
Answer E AnswerE::Presence of cell membrane with increased osmotic fragility
Answer E Explanation [[AnswerEExp::Mycoplasma pneumoniae is the most common cause of atypical pneumonia and has no cell wall. It contains cell membranes with high sterol content that decrease its membrane fluidity and increase its osmotic fragility.]]
Right Answer RightAnswer::E
Explanation [[Explanation::Atypical pneumonia is a lower respiratory tract infection which often causes non-specific symptoms such as fever, headache, and myalgia. Atypical pneumonia differs from typical pneumonia in that atypical pneumonias often have a milder course, do not respond to common antibiotics (eg sulfonamides, or beta-lactams), and do not show signs of focal consolidation, and do not exhibit leukocytosis. Chest xray of patients with atypical pneumonia classically shows bilateral bronchial wall thickening and centrilobular nodules, which may falsely convey the appearance of a more severe infection. Because patients often have mild symptoms, atypical pneumonia is alternatively referred to as “walking pneumonia.”

Atypical pneumonia is most often caused by Mycoplasma pneumoniae, which usually infects older children and young adults less than 30 years of age. Mycoplasma pneumoniae is a small bacteria that does not contain a cell wall. Instead, it contains a cell membrane that has a high sterol content, which decreases its fluidity and supports its osmotically fragile membrane. It is difficult to culture, but may be cultured on Eaton's agar.
Educational Objective: Mycoplasma pneumoniae is the most common cause of atypical pneumonia. It is characterized by the absence of cell wall, and presence of cell membranes with high sterol content that decrease its membrane fluidity and help support its osmotically fragile membrane.
References: Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin. Microbiol. Rev. 2004;17(4):697-728. First Aid 2014 page 145.]]

Approved Approved::Yes
Keyword WBRKeyword::Microbiology, WBRKeyword::Mycoplasma, WBRKeyword::pneumoniae, WBRKeyword::Bacteria, WBRKeyword::Pneumonia, WBRKeyword::infection, WBRKeyword::atypical, WBRKeyword::walking, WBRKeyword::cell, WBRKeyword::membrane, WBRKeyword::sterol
Linked Question Linked::
Order in Linked Questions LinkedOrder::