July 13, 2010

MRCP 1 Question 17

Septic pulmonary embolism in an intravenous drug abuser is likely to be secondary to:
a) P carinii
b) Nocardia spp
c) M avium-intracellulare
d) klebsiella
e) Pseudomonas aeruginosa

The correct answer is E


In pulmonary complications of intravenous drug abuse, septic pulmonary emboli are the most common complication, followed by community-acquired pneumonia and mycobacterium tuberculosis infection.

Most pulmonary infections are community acquired episodes of pneumonia caused by common respiratory pathogens.

In one series of febrile IVDUs, pneumonia was the most common cause of fever 7. In a second series, pneumonia was second only to cellulitis as a cause of fever.
  1. The usual pathogens in bacterial pneumonia include Streptococcus pneumonia, oral anaerobes, S.aureus or P. aeruginosa. Lung abscesses may arise from aspiration pneumonia, necrotizing pneumonitis or septic emboli. Pulmonary tuberculosis is a major problem even in non-HIV-1-infected drug abusers

  2. Streptococcus pyogenes appears to have become an uncommon cause of pneumonia
Catheter infection with S aureus, P aeruginosa, or Candida species can lead to septic pulmonary embolism, as can intravenous drug abuse.

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