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\author{gnvr (Guenevere)}
\pdfinfo{
  /Title (pneumonia.pdf)
  /Creator (Cheatography)
  /Author (gnvr (Guenevere))
  /Subject (Pneumonia Cheat Sheet)
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pneumonia Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{gnvr (Guenevere)} via \textcolor{DarkBackground}{\uline{cheatography.com/147429/cs/34538/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}gnvr (Guenevere) \\
  \uline{cheatography.com/guenevere} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 21st October, 2022.\\
   Updated 21st October, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Anatomic Alterations of the Lungs}}  \tn
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{\bf{{\emph{Pneumonia}}}} or {\bf{{\emph{pneumonitis with consolidation}}}} & The result of an inflammatory process that primarily affects the gas exchange area of the lung. \tn 
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\mymulticolumn{2}{x{5.377cm}}{\{\{ac\}\}{\bf{Sequence of Events}}} \tn 
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\mymulticolumn{2}{x{5.377cm}}{{\emph{Inflammation}}} \tn 
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{\emph{Effusion}} & Fluid (serum) and some red blood cells (RBCs) from adjacent pulmonary capillaries pour into the alveoli. \tn 
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{\emph{Surface Phagocytosis}} & Polymorphonuclear leukocytes move into the infected area to engulf and kill invading bacteria on the alveolar walls. \tn 
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{\emph{Consolidation}} & Increased numbers of macrophages also appear in the infected area to remove cellular and bacterial debris. \tn 
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 & If the infection is overwhelming, the alveoli become filled with fluid, RBCs, polymorphonuclear leukocytes, and macrophages. \tn 
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Anatomic Alterations of the Lungs (cont)}}  \tn
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\mymulticolumn{2}{x{5.377cm}}{{\emph{Atelectasis}} is often associated with patients who have {\bf{{\emph{aspiration pneumonia}}}}.} \tn 
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\mymulticolumn{2}{x{5.377cm}}{\{\{ac\}\}{\bf{Major pathologic or structural changes}}} \tn 
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 & Inflammation of the alveoli \tn 
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 & Alveolar consolidation \tn 
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 & Atelectasis (e.g., aspiration pneumonia) \tn 
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\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Etiology and Epidemiology}}  \tn
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{\bf{Pneumonia}} and {\bf{influenza}} & eighth leading cause of death among Americans \tn 
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 & sixth leading cause of death over the age of 65 years \tn 
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 & especially life threatening in individuals whose lungs are already damaged by chronic obstructive pulmonary disease (COPD), asthma, or smoking \tn 
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 & The risk of death from pneumonia orinfluenza is also higher among peoplewith heart disease, diabetes, or a weakened immune system. \tn 
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{\bf{Causes of pneumonia}} & bacteria, viruses, fungi, protozoa, parasites, tuberculosis, anaerobic organisms, aspiration, and the inhalation of irritating chemicals such as chlorine \tn 
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\SetRowColor{white}
Pneumonia & is an {\emph{insidious disease}} because its symptoms vary greatly, depending on the patient's specific underlying condition and the type of organism causing the pneumonia. \tn 
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\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Etiology and Epidemiology (cont)}}  \tn
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 & often mimics a common cold or the flu \tn 
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 & For example, the patient may suddenly experience chills, shivering, high fever, sweating, chest pain (pleurisy), and a dry and nonproductive cough. Often what initially appears to be a cold or the flu, however, can in fact be a much more serious pulmonary infection \tn 
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\mymulticolumn{2}{x{5.377cm}}{\{\{ac\}\} {\bf{Anatomic Location of the Inflammation}}} \tn 
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{\bf{Bronchopneumonia}} & patchy pattern of infection that is limited to the segmental bronchi and surrounding lung parenchyma \tn 
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 & usually involves both lungs and is seen more often in the lower lobes of the lung \tn 
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{\bf{Lobar pneumonia}} & widespread or diffuse alveolar inflammation and consolidation \tn 
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 & typically the end result of a severe or long-term bronchopneumonia in which the infection has spread from one lung segment to another until the entire lung lobe is involved \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Etiology and Epidemiology (cont)}}  \tn
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{\bf{Interstitial pneumonia}} & a diffuse and often bilateral inflammation that primarily involves the alveolar septa and interstitial space \tn 
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 & In contrast to alveolar pneumonia caused by bacteria, the polymorphonuclear leukocytes do not migrate into the alveoli—they remain in the alveolar interstitial spaces. \tn 
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 & {\emph{Mycoplasma pneumonia}} and other viruses cause interstitial pneumonias. \tn 
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 & most interstitial pneumonias cause only minor permanent alveolar damage and usually resolve without consequences \tn 
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% Row 17
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\mymulticolumn{2}{x{5.377cm}}{When both lungs are involved, the condition is sometimes called {\bf{double pneumonia}} by laypersons.} \tn 
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{\bf{"Walking pneumonia"}} & used to describe a mild case of pneumonia \tn 
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 & patients infected with {\emph{Mycoplasma pneumoniae}}, who generally have mild symptoms and remain ambulatory \tn 
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\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Because the distinction between lobar pneumonia and bronchopneumonia can often be hazy, it is generally best to classify pneumonias either by the specific etiologic agent or, when no specific pathogen can be identified, by the clinical setting in which  \newline the pneumonia occurs; for example, hospital-acquired pneumonia or community-acquired pneumonia (CAP).}  \tn 
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Risk Factors for Pneumonia}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{•	 Age over 65 years} \tn 
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% Row 1
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\mymulticolumn{1}{x{5.377cm}}{•	 Aspiration of oropharyngeal secretions} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Viral respiratory infections} \tn 
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% Row 3
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\mymulticolumn{1}{x{5.377cm}}{•	 Chronic illness and debilitation (e.g., diabetes mellitus, uremia)} \tn 
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% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	 Chronic respiratory disease (COPD, asthma, cystic fibrosis)} \tn 
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% Row 5
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\mymulticolumn{1}{x{5.377cm}}{•	 Cancer (especially lung cancer)} \tn 
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% Row 6
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\mymulticolumn{1}{x{5.377cm}}{•	 Prolonged bed rest} \tn 
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% Row 7
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\mymulticolumn{1}{x{5.377cm}}{•	 Tracheostomy or endotracheal tube} \tn 
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% Row 8
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\mymulticolumn{1}{x{5.377cm}}{•	 Abdominal or thoracic surgery} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Rib fractures} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Immunosuppressive therapy} \tn 
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% Row 11
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\mymulticolumn{1}{x{5.377cm}}{•	 AIDS} \tn 
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Clinical Settings and Pathogens}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Community-Acquired Pneumonia}}} \tn 
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% Row 1
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\mymulticolumn{1}{x{5.377cm}}{•	Streptococcus pneumonia} \tn 
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% Row 2
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\mymulticolumn{1}{x{5.377cm}}{•	{\emph{Staphylococcus aureus}} (also hospital-acquired pneumonia)} \tn 
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% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{•	{\emph{Haemophilus influenza}}} \tn 
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% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	{\emph{Legionella pneumophila}}} \tn 
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% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{•	Enterobacteriaceae ({\emph{Klebsiella}} pneumonia)} \tn 
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% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	{\emph{Pseudomonas aeruginosa}} (also hospital-acquired pneumonia)} \tn 
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% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Community-Acquired Atypical Pneumonia}}} \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	 Mycoplasma pneumonia} \tn 
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% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{•	 {\emph{Chlamydia}} spp.—{\emph{C. pneumonia}}, {\emph{C. psittaci}}, {\emph{C. trachomatis}}, and {\emph{C. burnetii}} (Q fever)} \tn 
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% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	 Viruses: respiratory syncytial virus, parainfluenza virus (children); influenza A and B (adults); adenovirus (military recruits), human metapneumovirus} \tn 
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% Row 11
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Hospital-Acquired Pneumonia (Nosocomial Pneumonia)}}} \tn 
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% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	 Gram-negative bacilli belonging to Enterobacteriaceae ({\emph{Klebsiella}} spp., {\emph{Serratia marcescens}}, {\emph{Escherichia coli}}) and {\emph{Pseudomonas}} spp., and {\emph{Staphylococcus aureus}} (usually methicillin-resistant)} \tn 
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% Row 13
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\mymulticolumn{1}{x{5.377cm}}{•	 Ventilator-acquired pneumonia ({\emph{P. aeruginosa}}, {\emph{Klebsiella}}, and {\emph{S. aureus}})} \tn 
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% Row 14
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Aspiration Pneumonia}}} \tn 
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% Row 15
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{•	 Anaerobic oral flora (Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus), admixed with aerobic bacteria ({\emph{S. pneumonia}}, {\emph{S. aureus}}, {\emph{H. influenza}}, and {\emph{Pseudomonas aeruginosa}})} \tn 
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Clinical Settings and Pathogens (cont)}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Chronic Pneumonia}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Granulomatous: {\emph{Mycobacterium tuberculosis}} and atypical mycobacteria, {\emph{Histoplasma capsulatum}}, {\emph{Coccidioides immitis}}, {\emph{Blastomyces dermatitidis}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 {\emph{Candida albicans}}, {\emph{Cryptococcus neoformans}}, and {\emph{Aspergillus}}} \tn 
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\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{•	 Nocardia} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Actinomyces} \tn 
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% Row 21
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Necrotizing Pneumonia and Lung Abscess}}} \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{•	 Anaerobic bacteria (extremely common), with or without mixed aerobic infection {\emph{S. areus}}, {\emph{K. pneumonia}}, {\emph{Streptococcus pyogenes}}, and type 3 pneumococcus (uncommon)} \tn 
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\mymulticolumn{1}{x{5.377cm}}{{\bf{Pneumonia in the Immunocompromised Host}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Cytomegalovirus} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 {\emph{Pneumocystis jirovecii}}} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 {\emph{Mycobacterium avium}} complex (MAC)} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Invasive aspergillosis} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 Invasive candidiasis} \tn 
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\mymulticolumn{1}{x{5.377cm}}{•	 "Usual" bacterial, viral, and fungal organisms (listed above)} \tn 
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP)}}  \tn
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\mymulticolumn{2}{x{5.377cm}}{a pneumonia acquired from normal social contact} \tn 
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\mymulticolumn{2}{x{5.377cm}}{{\bf{Streptococcal pneumonia}}} \tn 
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\SetRowColor{LightBackground}
"Pneumococcal pneumonia" & {\emph{Streptococcus pneumoniae}} (+) \tn 
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\SetRowColor{white}
 & accounts for more than 80\% of all the bacterial pneumonias \tn 
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 & gram-positive, nonmotile coccus that is found singly, in pairs (called {\emph{diplococci}}), and in short chains \tn 
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 & cocci are enclosed in a smooth, thick polysaccharide capsule that is essential for virulence \tn 
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 & more than 80 different types of S. pneumoniae \tn 
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 & {\bf{Serotype 3}} organisms are the most virulent. \tn 
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 & transmitted by aerosol from a cough or sneeze of an infected individual \tn 
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 & Most strains of {\emph{S. pneumoniae}} are sensitive to {\bf{{\emph{penicillin}}}} and its derivatives. \tn 
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\end{tabularx}
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
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 & cultured from the sputum of patients having an acute exacerbation of chronic bronchitis \tn 
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\mymulticolumn{2}{x{5.377cm}}{{\bf{Staphylococcal pneumonia}}} \tn 
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two major groups of {\bf{{\emph{Staphylococcus}}}}: & (1) {\emph{Staphylococcus aureus}}, which is responsible for most "staph" infections in humans \tn 
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 & (2) {\emph{Staphylococcus albus}} and {\emph{Staphylococcus epidermidis}}, which are part of the normal skin flora \tn 
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\SetRowColor{LightBackground}
staphylococci & gram-positive cocci found singly, in pairs (called {\emph{diplococci}}), and in irregular clusters \tn 
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Staphylococcal pneumonia & often follows a predisposing virus infection and is seen most often in children and immunosuppressed adults \tn 
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 & transmitted by aerosol from a cough or sneeze of an infected individual and indirectly via contact with contaminated floors, bedding, clothes, and the like \tn 
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
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 & common cause of {\bf{hospital-acquired pneumonia}} or {\bf{nosocomial pneumonia}} \tn 
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\SetRowColor{white}
 & becoming increasingly antibiotic resistant—thus the term {\bf{multiple drug–resistant S. {\emph{aureus}} (MDRSA)}} organisms \tn 
% Row Count 10 (+ 6)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Haemophilus influenzae}}}}} \tn 
% Row Count 11 (+ 1)
% Row 20
\SetRowColor{white}
{\emph{Haemophilus influenzae}} & a common inhabitant of human pharyngeal flora \tn 
% Row Count 14 (+ 3)
% Row 21
\SetRowColor{LightBackground}
 & s one of the smallest gram-negative bacilli, measuring about 1.5 mm in length and 0.3 mm in width \tn 
% Row Count 19 (+ 5)
% Row 22
\SetRowColor{white}
 & It appears as coccobacilli on Gram stain. \tn 
% Row Count 22 (+ 3)
% Row 23
\SetRowColor{LightBackground}
 & There are six types of H. influenzae, designated A to F \tn 
% Row Count 25 (+ 3)
% Row 24
\SetRowColor{white}
 & only {\bf{type B}} is commonly pathogenic \tn 
% Row Count 27 (+ 2)
% Row 25
\SetRowColor{LightBackground}
 & transmitted via aerosol or contact with contaminated objects \tn 
% Row Count 30 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
% Row 26
\SetRowColor{LightBackground}
 & sensitive to cold and does not survive long after expectoration \tn 
% Row Count 4 (+ 4)
% Row 27
\SetRowColor{white}
 & y cultured from the sputum of patients having an acute exacerbation of chronic bronchitis \tn 
% Row Count 9 (+ 5)
% Row 28
\SetRowColor{LightBackground}
 & Additional risk factors for {\emph{H. influenzae}} infection include COPD, defects in B-cell function, functional and anatomic asplenia, and human immunodeficiency virus (HIV) infection. \tn 
% Row Count 18 (+ 9)
% Row 29
\SetRowColor{white}
{\emph{H. influenzae}} type B & Pneumonia caused by {\emph{H. influenzae}} type B is seen most often in children aged 1 month to 6 years old. \tn 
% Row Count 24 (+ 6)
% Row 30
\SetRowColor{LightBackground}
 & almost always the cause of {\bf{acute epiglottitis}} \tn 
% Row Count 27 (+ 3)
% Row 31
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Legionella pneumophila}}}}} \tn 
% Row Count 28 (+ 1)
% Row 32
\SetRowColor{LightBackground}
 & In July 1976, a severe pneumonia-like disease outbreak occurred at an American Legion convention in Philadelphia. \tn 
% Row Count 34 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
% Row 33
\SetRowColor{LightBackground}
 & an unusual and fastidious gram-negative bacillus with atypical concentrations of certain branched-chain lipids \tn 
% Row Count 6 (+ 6)
% Row 34
\SetRowColor{white}
 & More than 20 {\emph{Legionella}} species have now been identified \tn 
% Row Count 9 (+ 3)
% Row 35
\SetRowColor{LightBackground}
 & Most of the species are free-living in soil and water, where they act as decomposer organisms. \tn 
% Row Count 14 (+ 5)
% Row 36
\SetRowColor{white}
 & multiplies in standing water such as contaminated mud puddles, large air-conditioning systems, and water tanks \tn 
% Row Count 20 (+ 6)
% Row 37
\SetRowColor{LightBackground}
 & transmitted when it becomes airborne and enters the patient's lungs as an aerosol \tn 
% Row Count 25 (+ 5)
% Row 38
\SetRowColor{white}
 & No convincing evidence suggests that the organism is transmitted from person to person \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
% Row 39
\SetRowColor{LightBackground}
 & can be detected in pleural fluid, sputum, or lung tissue by direct fluorescent antibody microscopy \tn 
% Row Count 5 (+ 5)
% Row 40
\SetRowColor{white}
 & rarely found outside the lungs, the organism may be found in other tissues \tn 
% Row Count 9 (+ 4)
% Row 41
\SetRowColor{LightBackground}
 & . The disease is most commonly seen in middle-aged men who smoke \tn 
% Row Count 13 (+ 4)
% Row 42
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Enterobacteriaceae {\emph{(Klebsiella pneumonia)}}}}} \tn 
% Row Count 14 (+ 1)
% Row 43
\SetRowColor{LightBackground}
{\emph{Klebsiella pneumoniae}} & {\bf{Friedl{\"a}nder's Bacillus}} \tn 
% Row Count 16 (+ 2)
% Row 44
\SetRowColor{white}
 & have long been associated with lobar pneumonia, particularly in men older than 40 years and in chronic alcoholics of both genders \tn 
% Row Count 23 (+ 7)
% Row 45
\SetRowColor{LightBackground}
 & a gram-negative bacillus that is found singly, in pairs, and in chains of varying lengths \tn 
% Row Count 28 (+ 5)
% Row 46
\SetRowColor{white}
 & normal inhabitant of the human gastrointestinal tract \tn 
% Row Count 31 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
% Row 47
\SetRowColor{LightBackground}
 & can be transmitted directly by aerosol or indirectly by contact with freshly contaminated articles \tn 
% Row Count 5 (+ 5)
% Row 48
\SetRowColor{white}
 & a common nosocomial, or hospital-acquired, disease \tn 
% Row Count 8 (+ 3)
% Row 49
\SetRowColor{LightBackground}
 & typically transmitted by routes such as clothing, intravenous solutions, foods, and the hands of health-care workers \tn 
% Row Count 14 (+ 6)
% Row 50
\SetRowColor{white}
 & mortality of patients with {\emph{K. pneumoniae}} is very high because septicemia is a frequent complication \tn 
% Row Count 20 (+ 6)
% Row 51
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Pseudomonas aeruginosa}}}}} \tn 
% Row Count 21 (+ 1)
% Row 52
\SetRowColor{white}
 & highly mobile, gram-negative bacillus \tn 
% Row Count 23 (+ 2)
% Row 53
\SetRowColor{LightBackground}
 & often found in the gastrointestinal tract, burns, and catheterized urinary tract and is a contaminant in many aqueous solutions \tn 
% Row Count 30 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Pneumonia (CAP) (cont)}}  \tn
% Row 54
\SetRowColor{LightBackground}
 & frequently cultured from the respiratory tract of patients who are chronically ill and tracheostomized, and is a leading cause of {\bf{hospital-acquired pneumonia}} \tn 
% Row Count 9 (+ 9)
% Row 55
\SetRowColor{white}
 & a particular problem for the respiratory therapist. Risk factors include neutropenia, HIV infection, preexisting lung disease, endotracheal intubation, and previous antibiotic use \tn 
% Row Count 18 (+ 9)
% Row 56
\SetRowColor{LightBackground}
 & thrives in dampness; it is often cultured from contaminated respiratory therapy equipment \tn 
% Row Count 23 (+ 5)
% Row 57
\SetRowColor{white}
 & transmitted by aerosol or by direct contact with freshly contaminated articles \tn 
% Row Count 27 (+ 4)
% Row 58
\SetRowColor{LightBackground}
 & very mucoid colonial form and the sputum is frequently green and sweet smelling \tn 
% Row Count 31 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The clinical presentation of the patient with community-acquired atypical pneumonia is often {\bf{subacute}}.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The patient typically presents with a variety of both {\bf{pulmonary}} and {\bf{extra-pulmonary}} findings (e.g., respiratory symptoms such as cough plus headache, general fatigue, or diarrhea).} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Mycoplasma pneumonia}}} \tn 
% Row Count 8 (+ 1)
% Row 3
\SetRowColor{white}
mycoplasma organism & most common cause of an acquired atypical pneumonia \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & tiny, cell wall–deficient organisms \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
 & smaller than bacteria but larger than viruses \tn 
% Row Count 16 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & The pneumonia caused by the mycoplasmal organism is commonly described as a {\emph{primary atypical pneumonia}} \tn 
% Row Count 22 (+ 6)
% Row 7
\SetRowColor{white}
The term {\emph{atypical}} refers to the fact that & (1) the organism escapes identification by standard bacteriologic tests \tn 
% Row Count 26 (+ 4)
% Row 8
\SetRowColor{LightBackground}
 & (2) there is generally only a moderate amount of sputum \tn 
% Row Count 29 (+ 3)
% Row 9
\SetRowColor{white}
 & (3) there is an absence of alveolar consolidation \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
 & (4) there is only a moderate elevation of white cell count \tn 
% Row Count 3 (+ 3)
% Row 11
\SetRowColor{white}
 & (5) there is a lack of alveolar exudate \tn 
% Row Count 5 (+ 2)
% Row 12
\SetRowColor{LightBackground}
mycoplasma organism (cont) & causes symptoms similar to both bacterial and viral pneumonia, although the symptoms develop more gradually and are often milder \tn 
% Row Count 12 (+ 7)
% Row 13
\SetRowColor{white}
 & Chills and fever are early symptoms \tn 
% Row Count 14 (+ 2)
% Row 14
\SetRowColor{LightBackground}
 & patient typically presents with a mild fever, and patchy inflammatory changes in the lungs that are mostly confined to the alveolar septa and pulmonary interstitium \tn 
% Row Count 23 (+ 9)
% Row 15
\SetRowColor{white}
 & common symptom of mycoplasma pneumonia is a {\bf{cough that tends to come in violent attacks}}, producing only a {\bf{small amount of white mucus}} \tn 
% Row Count 31 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 16
\SetRowColor{LightBackground}
 & Some patients experience nausea or vomiting \tn 
% Row Count 3 (+ 3)
% Row 17
\SetRowColor{white}
 & In some cases, the patients may experience a profound weakness that lasts for a long time. \tn 
% Row Count 8 (+ 5)
% Row 18
\SetRowColor{LightBackground}
 & {\emph{Mycoplasma pneumonia}} is commonly seen among children and young adults. \tn 
% Row Count 12 (+ 4)
% Row 19
\SetRowColor{white}
 & spreads easily in areas where people congregate, such as child-care centers, schools, and homeless shelters \tn 
% Row Count 18 (+ 6)
% Row 20
\SetRowColor{LightBackground}
 & e {\bf{"walking pneumonia"}} because the condition is mild and the patient is usually ambulatory \tn 
% Row Count 23 (+ 5)
% Row 21
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Chlamydia}}}} {\bf{spp.}} {\bf{{\emph{pneumonia}}}}} \tn 
% Row Count 24 (+ 1)
% Row 22
\SetRowColor{LightBackground}
 & {\emph{Chlamydia pneumonia}}, {\emph{Chlamydia psittaci}}, {\emph{Chlamydia trachomatis}} and {\bf{{\emph{Coxiella burnetii}}}} (Q fever) closely resemble the clinical manifestations of those caused by {\emph{M. pneumoniae}}. \tn 
% Row Count 34 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 23
\SetRowColor{LightBackground}
Chlamydia & a type of bacteria that may be found in the cervix, urethra, rectum, throat, and respiratory tract \tn 
% Row Count 5 (+ 5)
% Row 24
\SetRowColor{white}
 & also found in the feces of a variety of birds \tn 
% Row Count 8 (+ 3)
% Row 25
\SetRowColor{LightBackground}
 & The clinical manifestations of {\emph{C. psittaci}} closely resemble those caused by {\emph{M. pneumoniae}}. \tn 
% Row Count 13 (+ 5)
% Row 26
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Viruses}}} \tn 
% Row Count 14 (+ 1)
% Row 27
\SetRowColor{LightBackground}
 & 50\% of all pneumonias, and several are associated with a community-acquired atypical pneumonia \tn 
% Row Count 19 (+ 5)
% Row 28
\SetRowColor{white}
 & Although most viruses attack the upper airways, some can produce pneumonia. \tn 
% Row Count 23 (+ 4)
% Row 29
\SetRowColor{LightBackground}
 & Most of these pneumonias are not life threatening and last only a short time. \tn 
% Row Count 27 (+ 4)
% Row 30
\SetRowColor{white}
 & tends to start with flulike signs and symptoms. The early symptoms are a dry (nonproductive) cough, headache, fever, muscle pain, and fatigue. \tn 
% Row Count 35 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 31
\SetRowColor{LightBackground}
 & As the disease progresses, the patient may become short of breath, cough, and produce a {\bf{small amount of clear or white sputum}}. \tn 
% Row Count 7 (+ 7)
% Row 32
\SetRowColor{white}
 & {\emph{Viral pneumonia  always carries the risk of development of a secondary bacterial pneumonia.}} \tn 
% Row Count 12 (+ 5)
% Row 33
\SetRowColor{LightBackground}
 & minute organisms not visible by ordinary light microscopy \tn 
% Row Count 15 (+ 3)
% Row 34
\SetRowColor{white}
 & parasitic and depend on nutrients inside cells for their metabolic and reproductive needs \tn 
% Row Count 20 (+ 5)
% Row 35
\SetRowColor{LightBackground}
 & 90\% of acute upper respiratory tract infections are caused by viruses \tn 
% Row Count 24 (+ 4)
% Row 36
\SetRowColor{white}
 & most common cause of pneumonia in young children, peaking between the ages of 2 and 3 years \tn 
% Row Count 29 (+ 5)
% Row 37
\SetRowColor{LightBackground}
 & By school age, {\emph{M. pneumoniae}} become more prevalent \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 38
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Common viruses associated with community-acquired atypical pneumonia include{\emph{ respiratory syncytial virus}}, {\emph{parainfluenza virus}} (children); {\emph{influenza A and B}} (adults); {\emph{adenovirus}} (military recruits), and {\emph{human metapneumovirus}}.} \tn 
% Row Count 5 (+ 5)
% Row 39
\SetRowColor{white}
{\bf{Respiratory Syncytial Virus (RSV)}} & member of the paramyxovirus group \tn 
% Row Count 7 (+ 2)
% Row 40
\SetRowColor{LightBackground}
 & Parainfluenza, mumps, and rubella viruses also belong to this group. \tn 
% Row Count 11 (+ 4)
% Row 41
\SetRowColor{white}
 & most often seen in children less than 12 months of age and in older adults with underlying heart or pulmonary disease \tn 
% Row Count 17 (+ 6)
% Row 42
\SetRowColor{LightBackground}
 & Almost all children will be infected with RSV by their second birthday. \tn 
% Row Count 21 (+ 4)
% Row 43
\SetRowColor{white}
 & infection is rarely fatal in infants \tn 
% Row Count 23 (+ 2)
% Row 44
\SetRowColor{LightBackground}
 & often goes unrecognized but may play an important role as a forerunner to bacterial infections \tn 
% Row Count 28 (+ 5)
% Row 45
\SetRowColor{white}
 & Early attempts to develop an RSV vaccine have been unsuccessful. \tn 
% Row Count 32 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 46
\SetRowColor{LightBackground}
 & transmitted by aerosol and by direct contact with infected individuals \tn 
% Row Count 4 (+ 4)
% Row 47
\SetRowColor{white}
 & most commonly seen in patients during the late fall, winter, or early spring months \tn 
% Row Count 9 (+ 5)
% Row 48
\SetRowColor{LightBackground}
 & Many times the virus is misdiagnosed in older children, who are given antibiotics that do not produce improvement. \tn 
% Row Count 15 (+ 6)
% Row 49
\SetRowColor{white}
{\bf{Parainfluenza viruses}} & related to mumps, rubella, and RSV \tn 
% Row Count 17 (+ 2)
% Row 50
\SetRowColor{LightBackground}
 & There are five types of parainfluenza viruses: types 1, 2, 3, 4A, and 4B. \tn 
% Row Count 21 (+ 4)
% Row 51
\SetRowColor{white}
 & {\bf{Types 1, 2, and 3}} are the major causes of infections in humans. \tn 
% Row Count 25 (+ 4)
% Row 52
\SetRowColor{LightBackground}
 & {\emph{Type 1}} is considered a {\bf{croup}} type of virus. \tn 
% Row Count 28 (+ 3)
% Row 53
\SetRowColor{white}
 & {\emph{Types 2}} and {\emph{3}} are associated with severe infections. \tn 
% Row Count 31 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 54
\SetRowColor{LightBackground}
 & Although type 3 is seen in persons of all ages, it usually is seen in infants younger than 2 months of age; types 1 and 2 are seen most often in children between the ages of 6 months and 5 years. \tn 
% Row Count 10 (+ 10)
% Row 55
\SetRowColor{white}
 & Types 1 and 2 typically occur in the fall, whereas type 3 infection most often is seen in the late spring and summer. \tn 
% Row Count 16 (+ 6)
% Row 56
\SetRowColor{LightBackground}
 & transmitted by aerosol droplets and by direct person-to-person contact \tn 
% Row Count 20 (+ 4)
% Row 57
\SetRowColor{white}
 & known for their ability to spread rapidly among members of the same family \tn 
% Row Count 24 (+ 4)
% Row 58
\SetRowColor{LightBackground}
{\bf{Influenza viruses A and B}} & most common causes of viral respiratory tract infections \tn 
% Row Count 27 (+ 3)
% Row 59
\SetRowColor{white}
 & In the United States, influenza A and B commonly occur in epidemics during the winter months. \tn 
% Row Count 32 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 60
\SetRowColor{LightBackground}
 & Children, young adults, and older individuals are most at risk. \tn 
% Row Count 4 (+ 4)
% Row 61
\SetRowColor{white}
 & transmitted from person to person by aerosol droplets \tn 
% Row Count 7 (+ 3)
% Row 62
\SetRowColor{LightBackground}
 & Often the first sign of an epidemic is an increase in school absenteeism. \tn 
% Row Count 11 (+ 4)
% Row 63
\SetRowColor{white}
 & survives well in conditions of low temperatures and low humidity \tn 
% Row Count 15 (+ 4)
% Row 64
\SetRowColor{LightBackground}
 & found in horses, swine, and birds \tn 
% Row Count 17 (+ 2)
% Row 65
\SetRowColor{white}
 & incubation period of 1 to 3 days and usually cause upper respiratory tract infections \tn 
% Row Count 22 (+ 5)
% Row 66
\SetRowColor{LightBackground}
 & Epidemiologists fear a pandemic of influenza, stating it is an issue of "when" and "where" rather than "if." The recent epidemic of H1N1 ("swine flu") is a case in point. \tn 
% Row Count 32 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 67
\SetRowColor{LightBackground}
{\bf{Adenovirus}} & serotypes 4, 7, 14, and 21 cause viral infections and pneumonia in all age groups \tn 
% Row Count 5 (+ 5)
% Row 68
\SetRowColor{white}
 & Serotype 7 has been related to fatal cases of pneumonia in children. \tn 
% Row Count 9 (+ 4)
% Row 69
\SetRowColor{LightBackground}
 & transmitted by aerosol \tn 
% Row Count 11 (+ 2)
% Row 70
\SetRowColor{white}
 & Pneumonia caused by adenoviruses generally occurs during the fall, winter, and spring. \tn 
% Row Count 16 (+ 5)
% Row 71
\SetRowColor{LightBackground}
{\bf{Human metapneumovirus (hMPV)}} & negative single-stranded RNA virus associated with a family of viruses that also includes respiratory syncytial (RSV) virus and parainfluenza virus \tn 
% Row Count 24 (+ 8)
% Row 72
\SetRowColor{white}
 & After the respiratory RSV, hMPV is the second most common cause of lower respiratory infections in young children. \tn 
% Row Count 30 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Community-Acquired Atypical Pneumonia (cont)}}  \tn
% Row 73
\SetRowColor{LightBackground}
 & In comparison to RSV, the hMPV tends to occur in older children and is less severe. \tn 
% Row Count 5 (+ 5)
% Row 74
\SetRowColor{white}
 & Most patients with hMPV infection have mild symptoms including cough, runny nose or nasal congestion, sore throat, and fever. \tn 
% Row Count 12 (+ 7)
% Row 75
\SetRowColor{LightBackground}
 & More severe cases demonstrate wheezing, difficulty breathing, hoarseness, cough, and pneumonia. \tn 
% Row Count 17 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Hospital-Acquired Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & •	 {\emph{Nosocomial pneumonia}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & •	 an infection whose development is caused by the hospital environment \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
 & •	 Common causes of hospital-acquired pneumonias include {\bf{Enterobacteriaceae}} ({\emph{Klebsiella}} spp., {\emph{Serratia marcescens}}, {\emph{Escherichia coli}}), {\bf{{\emph{Pseudomonas}}}} {\bf{spp.,}} and {\bf{{\emph{Staphylococcus aureus}}}} (usually \seqsplit{methicillin-resistant)}. \tn 
% Row Count 18 (+ 12)
% Row 3
\SetRowColor{white}
{\bf{Ventilator-acquired pneumonia (VAP)}} & {\emph{ventilator-associated pneumonia}} \tn 
% Row Count 21 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & a pneumonia that develops more than 48 to 72 hours after endotracheal intubation \tn 
% Row Count 25 (+ 4)
% Row 5
\SetRowColor{white}
 & Common \seqsplit{ventilator-associated} infections include {\emph{P. aeruginosa}}, {\emph{Enterobacter}}, {\emph{Klebsiella}}, and {\emph{S. aureus}} \tn 
% Row Count 31 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Hospital-Acquired Pneumonia (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
 & Concern that the occurrence of VAP is preventable lies as the root of possible reimbursement penalties for hospitals in which it occurs. \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Common pathogenic agents associated with {\emph{aspiration pneumonia}} include anaerobic oral flora ({\emph{Bacteroides}}, {\emph{Prevotella}}, {\emph{Fusobacterium}}, {\emph{Peptostreptococcus}}), admixed with aerobic bacteria such as {\emph{S. pneumonia}}, {\emph{S. aureus}}, {\emph{H. influenza}}, and {\emph{P.  aeruginosa}}.} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Aspiration of gastric fluid with a pH of 2.5 or less causes a serious and often fatal form of pneumonia.} \tn 
% Row Count 9 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Aspiration of oropharyngeal secretions and gastric fluids are the major causes of anaerobic lung infections.} \tn 
% Row Count 12 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Aspiration pneumonitis}} is commonly missed because acute inflammatory reactions may not begin until several hours after aspiration of the gastric fluid.} \tn 
% Row Count 16 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The inflammatory reaction generally increases in severity for 12 to 26 hours and may progress to {\bf{acute respiratory distress syndrome (ARDS)}}, which includes interstitial and intraalveolar edema, intraalveolar hyaline membrane formation, and atelectasis.} \tn 
% Row Count 22 (+ 6)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{In the absence of a secondary bacterial infection, the inflammation usually becomes clinically insignificant in approximately 72 hours.} \tn 
% Row Count 25 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{In 1946, Mendelson first described the clinical manifestations of tachycardia, dyspnea, and cyanosis associated with the aspiration of acid stomach contents.} \tn 
% Row Count 29 (+ 4)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The clinical picture he described is now known as {\bf{Mendelson's syndrome}} and is usually confined to aspiration pneumonitis in pregnant women} \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Aspiration pneumonia}}}}} \tn 
% Row Count 1 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & broadly defined as the pulmonary result of the entry of material from the stomach or upper respiratory tract into the lower airways \tn 
% Row Count 6 (+ 5)
% Row 11
\SetRowColor{white}
 & three distinctive forms of aspiration pneumonia, classified according to the {\bf{nature of the aspirate}}, the {\bf{clinical presentation}}, and {\bf{management guidelines}}, as follows: \tn 
% Row Count 12 (+ 6)
% Row 12
\SetRowColor{LightBackground}
 & 1.	 Toxic injury to the lung (such as that caused by gastric acid) \tn 
% Row Count 15 (+ 3)
% Row 13
\SetRowColor{white}
 & 2.	 Obstruction (by foreign body or fluids) \tn 
% Row Count 17 (+ 2)
% Row 14
\SetRowColor{LightBackground}
 & 3.	 Infection \tn 
% Row Count 18 (+ 1)
% Row 15
\SetRowColor{white}
\seqsplit{Aspiration} & the presumed cause of nearly all cases of anaerobic pulmonary infections \tn 
% Row Count 21 (+ 3)
% Row 16
\SetRowColor{LightBackground}
 & Studies suggest that anaerobic bacteria are the most common causative agents of lung abscesses; they are also commonly isolated in cases of empyema. \tn 
% Row Count 26 (+ 5)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{There is a difference between the aspiration of gastric contents and the aspiration of food. Aspiration of gastric contents causes initial hypoxemia regardless of the pH level of the aspirate.} \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Consequently, {\bf{oximetry}} is a good measurement if aspiration is suspected.} \tn 
% Row Count 2 (+ 2)
% Row 19
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{If the pH of the aspirate is relatively high (greater than 5.9), the initial injury is rapidly reversible. Such aspiration occurs in patients who receive antacids or proton pump inhibitors (PPIs).} \tn 
% Row Count 6 (+ 4)
% Row 20
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{If the pH is low (pH of unbuffered gastric contents normally ranges from 1 to 1.5), parenchymal damage may occur, with inflammation, edema, and hemorrhage.} \tn 
% Row Count 10 (+ 4)
% Row 21
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{When food is aspirated, obliterative bronchiolitis with subsequent granuloma formation occurs.} \tn 
% Row Count 12 (+ 2)
% Row 22
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 12 (+ 0)
% Row 23
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Gastroesophageal reflux disease (GERD)}}} \tn 
% Row Count 13 (+ 1)
% Row 24
\SetRowColor{LightBackground}
 & regurgitation of stomach contents into the esophagus \tn 
% Row Count 15 (+ 2)
% Row 25
\SetRowColor{white}
 & causes disruption in nerve-mediated reflexes in the distal esophagus, resulting in alteration of the primary and secondary peristaltic wave and reflux \tn 
% Row Count 20 (+ 5)
% Row 26
\SetRowColor{LightBackground}
 & Therefore "to-and-fro" peristalsis can result from spasticity at the distal esophageal sphincter and retropulsion of middle and upper esophageal contents. \tn 
% Row Count 25 (+ 5)
% Row 27
\SetRowColor{white}
 & This may result in aspiration, although not necessarily. \tn 
% Row Count 27 (+ 2)
% Row 28
\SetRowColor{LightBackground}
 & three times more prevalent in patients with asthma than in other patients \tn 
% Row Count 30 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 29
\SetRowColor{LightBackground}
 & a frequently unrecognized cause of asthma \tn 
% Row Count 2 (+ 2)
% Row 30
\SetRowColor{white}
 & Presumably, acid reflux into the esophagus causes vagal stimulation, resulting in a reflexive increase in bronchial tone in patients with asthma. \tn 
% Row Count 7 (+ 5)
% Row 31
\SetRowColor{LightBackground}
 & Recent literature suggests that asymptomatic reflux does not contribute to worsening lung function, although it and chronic sinusitis are the two most unrecognized causes of chronic cough. GERD causes chronic cough in 10\% to 20\% of patients. \tn 
% Row Count 15 (+ 8)
% Row 32
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Normal {\bf{swallowing mechanics}} has four phases, as follows:} \tn 
% Row Count 17 (+ 2)
% Row 33
\SetRowColor{LightBackground}
 & 1.	 Oral preparatory \tn 
% Row Count 18 (+ 1)
% Row 34
\SetRowColor{white}
 & 2.	 Oral \tn 
% Row Count 19 (+ 1)
% Row 35
\SetRowColor{LightBackground}
 & 3.	 Pharyngeal \tn 
% Row Count 20 (+ 1)
% Row 36
\SetRowColor{white}
 & 4.	 Esophageal \tn 
% Row Count 21 (+ 1)
% Row 37
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The first two phases are considered voluntary stages (cerebral). These phases occur as the food or liquid is prepared for entry to the pharynx and esophagus. The airway is open while food is prepared in the oral cavity. Adequate tongue function is important for the manipulation and propulsion of the prepared food or liquid (called a bolus) into the pharynx. Spillage of liquid into the pharynx during the chewing of food is usually not a problem in patients with good airway protection.} \tn 
% Row Count 31 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 38
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The pharyngeal phase (involuntary brain stem function) of swallowing involves numerous physiologic actions that direct the bolus into the esophagus:} \tn 
% Row Count 3 (+ 3)
% Row 39
\SetRowColor{white}
 & •	 Elevation and retraction of the velopharyngeal port (velum closure) \tn 
% Row Count 6 (+ 3)
% Row 40
\SetRowColor{LightBackground}
 & •	 Pharyngeal muscle contraction \tn 
% Row Count 8 (+ 2)
% Row 41
\SetRowColor{white}
 & •	 Elevation and forward excursion of the larynx (epiglottic closure) \tn 
% Row Count 11 (+ 3)
% Row 42
\SetRowColor{LightBackground}
 & •	 Closure of the laryngeal vestibule, false vocal folds, and true vocal folds (laryngeal closure) \tn 
% Row Count 15 (+ 4)
% Row 43
\SetRowColor{white}
 & •	 Relaxation of the upper esophageal sphincter (UES) \tn 
% Row Count 17 (+ 2)
% Row 44
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Airway closure progresses inferiorly to superiorly in the larynx as the food bolus is directed laterally around the airway and into the esophagus.} \tn 
% Row Count 20 (+ 3)
% Row 45
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Respiration is halted during the pharyngeal phase for an approximately 1-second apneic period, although duration varies with bolus volume and viscosity.} \tn 
% Row Count 24 (+ 4)
% Row 46
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Bolus transit in the esophageal phase (under both brain stem and intrinsic neural control) lasts 8 to 20 seconds.} \tn 
% Row Count 27 (+ 3)
% Row 47
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{In this phase, the UES relaxes to receive the bolus with a peristaltic wave from the pharyngeal superior constrictor muscles, forcing the bolus through the relaxed UES.} \tn 
% Row Count 31 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 48
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The primary peristalsis propels the bolus through the esophagus and lower esophageal sphincter and into the stomach.} \tn 
% Row Count 3 (+ 3)
% Row 49
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Six cranial nerves carry motor signals generated by cerebral and brain stem swallowing centers:} \tn 
% Row Count 5 (+ 2)
% Row 50
\SetRowColor{LightBackground}
 & •	 V (trigeminal) \tn 
% Row Count 6 (+ 1)
% Row 51
\SetRowColor{white}
 & •	 VII (facial) \tn 
% Row Count 7 (+ 1)
% Row 52
\SetRowColor{LightBackground}
 & •	 IX (glossopharyngeal) \tn 
% Row Count 8 (+ 1)
% Row 53
\SetRowColor{white}
 & •	 X (vagus) \tn 
% Row Count 9 (+ 1)
% Row 54
\SetRowColor{LightBackground}
 & •	 XI (spinal accessory {[}minor involvement{]}) \tn 
% Row Count 11 (+ 2)
% Row 55
\SetRowColor{white}
 & •	 XI (spinal accessory {[}minor involvement{]}) \tn 
% Row Count 13 (+ 2)
% Row 56
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The relationship between respiration and swallowing is not random.} \tn 
% Row Count 15 (+ 2)
% Row 57
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Expiration before and after the pharyngeal phase in normal swallowing is believed to serve as an inherent closure and clearance mechanism against penetration of food or liquids into the airway entrance.} \tn 
% Row Count 20 (+ 5)
% Row 58
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 20 (+ 0)
% Row 59
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Dysphagia}}} \tn 
% Row Count 21 (+ 1)
% Row 60
\SetRowColor{LightBackground}
 & result of an abnormal swallow that can involve the oral, pharyngeal, and esophageal phases \tn 
% Row Count 24 (+ 3)
% Row 61
\SetRowColor{white}
 & Penetration into the laryngeal vestibule occurs when food or liquid (or both) enters the larynx but does not pass through the vocal cords into the trachea. \tn 
% Row Count 29 (+ 5)
% Row 62
\SetRowColor{LightBackground}
 & Aspiration is the passage of food or liquid into the trachea via the vocal cords. \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 63
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Diagnostic tests for dysphagia include the modified barium swallow (MBS), video-fluoroscopy, video-fiberoptic endoscopy, and the modified Evan's blue dye tests.} \tn 
% Row Count 4 (+ 4)
% Row 64
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The {\bf{Evan's blue dye test}} involves instilling a deep blue dye into the gastrointestinal tract and seeing if it can be suctioned from the trachea. If it can, it suggests a communication between the two structures, such as a fistula.} \tn 
% Row Count 9 (+ 5)
% Row 65
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The MBS and video-fluoroscopy tests are most definitive for identification of the particular phase of the swallow that is dysfunctional.} \tn 
% Row Count 12 (+ 3)
% Row 66
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The modified Evan's blue dye test can be unreliable (as much as 40\% of the time) as a test suggesting aspiration in a patient who is tracheostomized.} \tn 
% Row Count 16 (+ 4)
% Row 67
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Both false-positive and false-negative test results occur} \tn 
% Row Count 18 (+ 2)
% Row 68
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{A compromised respiratory system can cause dysphagia and, conversely, dysphagia may cause respiratory complications. COPD can result in a slowed oral and pharyngeal transit time, reduced coordination and strength of the oral and pharyngeal musculature, and reduced airway clearance by coughing.} \tn 
% Row Count 24 (+ 6)
% Row 69
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Treatment of dysphagia is specific to the nature of the disorder.} \tn 
% Row Count 26 (+ 2)
% Row 70
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Varied methods of presentation of foods and liquids, bolus volumes and consistency, postural movements, and food temperature can affect the dynamics of the relation between respiration and swallowing.} \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 71
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Large volumes of liquid requiring uninterrupted swallowing result in longer apneic periods and can be difficult for patients with shortness of breath and dyspnea.} \tn 
% Row Count 4 (+ 4)
% Row 72
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Small-volume bites and swallows make sense in this setting.} \tn 
% Row Count 6 (+ 2)
% Row 73
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Unilateral cerebrovascular accidents (strokes) and hemorrhage tend to cause hypopharyngeal hemiparesis.} \tn 
% Row Count 9 (+ 3)
% Row 74
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Difficulty in swallowing (with impairment of the oral phase) and aspiration of thin fluids therefore may follow.} \tn 
% Row Count 12 (+ 3)
% Row 75
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The facial and tongue weakness can result in poor bolus control in the oral cavity.} \tn 
% Row Count 14 (+ 2)
% Row 76
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 14 (+ 0)
% Row 77
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Silent aspiration}}} \tn 
% Row Count 15 (+ 1)
% Row 78
\SetRowColor{white}
 & aspiration that does not evoke clinically observable adverse symptoms such as overt coughing, choking, and immediate respiratory distress \tn 
% Row Count 20 (+ 5)
% Row 79
\SetRowColor{LightBackground}
 & Some patients have silent aspiration after a stroke. \tn 
% Row Count 22 (+ 2)
% Row 80
\SetRowColor{white}
 & Evidence also suggests that some sequelae of stroke include laryngopharyngeal sensory deficits with no subjective or objective evidence of dysphagia, such as choking, gagging, or cough. \tn 
% Row Count 28 (+ 6)
% Row 81
\SetRowColor{LightBackground}
 & Some patients with severe and bilateral sensory deficits develop aspiration pneumonia. \tn 
% Row Count 31 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 82
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The clinical findings of {\bf{dysphonia}}, {\bf{dysarthria}}, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow all significantly relate to aspiration and are predictors of silent aspiration.} \tn 
% Row Count 5 (+ 5)
% Row 83
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Conversely, a normal reflex cough after a stroke indicates an intact laryngeal cough reflex, a protected airway, and low risk for developing aspiration pneumonia with oral feeding.} \tn 
% Row Count 9 (+ 4)
% Row 84
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The cough reflex is significantly reduced in older patients.} \tn 
% Row Count 11 (+ 2)
% Row 85
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Patients with a {\bf{tracheostomy}} are at high risk for silent aspiration.} \tn 
% Row Count 13 (+ 2)
% Row 86
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Perhaps 55\% to 70\% of intubated or tracheostomy patients aspirate.} \tn 
% Row Count 15 (+ 2)
% Row 87
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{A tracheostomy tube has a direct effect on the pharyngeal phase of a swallow because of the alteration of normal respiratory function (exhalation timing) as well as the anatomic alteration and the physical resistance imposed by the tracheostomy tube itself.} \tn 
% Row Count 21 (+ 6)
% Row 88
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Normal laryngeal elevation is reduced, particularly with the cuff inflated, which leads to inadequate airway closure and increased pharyngeal residue.} \tn 
% Row Count 24 (+ 3)
% Row 89
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Poor sensory response to material entering the larynx contributes to the slowing of an uncoordinated laryngeal closure.} \tn 
% Row Count 27 (+ 3)
% Row 90
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The protective cough may be lessened because of the impaired laryngeal sensation. Subglottic air pressure (coordinated exhalation with swallow) helps prevent entry of material into the trachea and is reduced in patients with a tracheostomy. An inflated cuffed tracheostomy can cause complications that can anchor the larynx to the anterior wall of the neck and desensitize the pharynx. Delayed triggering of the swallowing response and increased pharyngeal residue are prevalent.} \tn 
% Row Count 37 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Aspiration Pneumonia (cont)}}  \tn
% Row 91
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Recommendations for oral feeding}} include considerations of dietary consistency, specifically defined for solids and liquids; skilled supervision with oral intake; safe swallowing strategies; positioning requirements; cuff deflation; and tracheal occlusion issues. It may be necessary to coordinate mealtime with ventilator weaning attempts to optimize more positive pressure generation to aid in expelling laryngeal residue and creating subglottic pressure.} \tn 
% Row Count 10 (+ 10)
% Row 92
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The dynamic changes a patient may experience clinically necessitate a coordinated team approach, including physical, occupational, and respiratory therapists; a speech-language pathologist; registered dietitian; and nurse.} \tn 
% Row Count 15 (+ 5)
% Row 93
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{This approach allows for effective management of tracheostomy and non-tracheostomy patients and avoidance of aspiration} \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Chronic Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{A localized lesion in patients with a normal immune system, with or without regional lymph node involvement.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Patients with chronic pneumonia usually have {\bf{granulomatous inflammation}}, which is often due to bacteria (e.g., {\emph{M. tuberculosis}}) or fungi.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{In patients whose immune system is compromised, the dissemination of the causative organism throughout the body is the usual presentation.} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Tuberculosis is by far the most important organism within the category of chronic pneumonias.} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The World Health Organization (WHO) estimates that tuberculosis causes 6\% of all deaths worldwide, making it the {\emph{most common cause of death resulting from a single infectious agent}}.} \tn 
% Row Count 15 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Chronic pneumonias associated with {\bf{granulomas}} include tuberculosis and fungal diseases of the lung.} \tn 
% Row Count 18 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\seqsplit{Tuberculosis} & an infectious disease caused by {\emph{Mycobacterium tuberculosis}}. \tn 
% Row Count 21 (+ 3)
% Row 7
\SetRowColor{white}
 & {\emph{M. tuberculosis}} is a slender, rod-shaped aerobic organism. \tn 
% Row Count 24 (+ 3)
% Row 8
\SetRowColor{LightBackground}
 & Predisposing factors of tuberculosis include homelessness, drug abuse, and acquired immunodeficiency syndrome (AIDS). \tn 
% Row Count 29 (+ 5)
% Row 9
\SetRowColor{white}
 & The initial response of the lung is an inflammatory reaction that is similar to any acute pneumonia. \tn 
% Row Count 33 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Chronic Pneumonia (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Because most fungi are aerobes, the lung is a prime site for fungal infections.} \tn 
% Row Count 2 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Primary fungal pathogens}} include {\emph{Histoplasma capsulatum}}, {\emph{Coccidioides immitis}}, and {\emph{Blastomyces dermatitidis}}.} \tn 
% Row Count 5 (+ 3)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{In addition, the {\bf{opportunistic yeast pathogens}} {\emph{Candida albicans}}, {\emph{Cryptococcus neoformans}}, and {\emph{Aspergillus}} may also cause pneumonia in certain patients.} \tn 
% Row Count 9 (+ 4)
% Row 13
\SetRowColor{white}
{\emph{C. albicans}} & occurs as normal flora in the oral cavity, genitalia, and large intestine \tn 
% Row Count 12 (+ 3)
% Row 14
\SetRowColor{LightBackground}
 & rarely seen in the tracheobronchial tree or lung parenchyma \tn 
% Row Count 15 (+ 3)
% Row 15
\SetRowColor{white}
 & In patients with AIDS, however, {\emph{C. albicans}} commonly causes an infection of the mouth, pharynx, esophagus, vagina, skin, and lungs. \tn 
% Row Count 20 (+ 5)
% Row 16
\SetRowColor{LightBackground}
 & A {\emph{C. albicans}} infection of the mouth is called {\bf{{\emph{thrush}}}}; it is characterized by a white, adherent, patchy infection of the membranes of the mouth, gums, cheeks, and throat. \tn 
% Row Count 27 (+ 7)
% Row 17
\SetRowColor{white}
{\emph{C. neoformans}} & proliferates in pigeon droppings, which have a high nitrogen content, and readily scatters into the air and dust \tn 
% Row Count 31 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Chronic Pneumonia (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
 & Today, the highest rate of cryptococcosis occurs among patients with AIDS and persons undergoing steroid therapy. \tn 
% Row Count 4 (+ 4)
% Row 19
\SetRowColor{white}
{\emph{Aspergillus}} & The molds of the genus {\emph{Aspergillus}} may be the most pervasive of all fungi—especially {\bf{{\emph{Aspergillus fumigatus}}}}. \tn 
% Row Count 9 (+ 5)
% Row 20
\SetRowColor{LightBackground}
 & found in soil, vegetation, leaf detritus, food, and compost heaps \tn 
% Row Count 12 (+ 3)
% Row 21
\SetRowColor{white}
 & Persons who breathe the air of granaries, barns, and silos are at the greatest risk. \tn 
% Row Count 15 (+ 3)
% Row 22
\SetRowColor{LightBackground}
 & {\emph{Aspergillus}} infection usually occurs in the lungs. \tn 
% Row Count 17 (+ 2)
% Row 23
\SetRowColor{white}
 & almost always an opportunistic infection and lately has posed a serious threat to patients with AIDS \tn 
% Row Count 21 (+ 4)
% Row 24
\SetRowColor{LightBackground}
 & When fungal organisms are inhaled, the initial response of the lung is an inflammatory reaction similar to that produced by any acute pneumonia. \tn 
% Row Count 26 (+ 5)
% Row 25
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Nocardia}}} \tn 
% Row Count 27 (+ 1)
% Row 26
\SetRowColor{LightBackground}
 & gram-positive, rod-shaped bacteria that can be found worldwide in soils that are rich with organic matter \tn 
% Row Count 31 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Chronic Pneumonia (cont)}}  \tn
% Row 27
\SetRowColor{LightBackground}
 & It has a total of 85 species. \tn 
% Row Count 1 (+ 1)
% Row 28
\SetRowColor{white}
 & also found in healthy gingiva and periodontal pockets \tn 
% Row Count 3 (+ 2)
% Row 29
\SetRowColor{LightBackground}
 & Most {\emph{Nocardia}} infections occur as an opportunistic infection in patients with weak immune systems, such as small children, the elderly, and the immunocompromised (most common in patients with HIV). \tn 
% Row Count 10 (+ 7)
% Row 30
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Actinomyces}}} \tn 
% Row Count 11 (+ 1)
% Row 31
\SetRowColor{LightBackground}
 & normally present in the gingival area and are common opportunistic pathogens of humans, particularly in the oral cavity (e.g., infections associated with dental procedures and oral abscesses) \tn 
% Row Count 18 (+ 7)
% Row 32
\SetRowColor{white}
 & In rare cases, these bacteria can cause {\bf{{\emph{actinomycosis}}}}, a disease characterized by the formation of abscesses in the mouth, lungs, or the gastrointestinal tract. \tn 
% Row Count 24 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Cytomegalovirus (CMV)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & a member of the herpesvirus family, is the most common viral pulmonary complication of AIDS \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
 & CMV infection commonly coexists with {\bf{{\emph{Pneumocystis carinii}}}} infection. \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 9 (+ 0)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Pneumocystis jirovecii}}}}} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
 & also known as {\emph{Pneumocystis carinii}} \tn 
% Row Count 12 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & an opportunistic, often fatal, form of pneumonia seen in patients who are profoundly immunosuppressed \tn 
% Row Count 17 (+ 5)
% Row 7
\SetRowColor{white}
 & Although the {\emph{Pneumocystis}} organism has been identified as a protozoan, recent information suggests that it is more closely related to fungi. \tn 
% Row Count 23 (+ 6)
% Row 8
\SetRowColor{LightBackground}
{\emph{Pneumocystis}} & can normally be found in the lungs of humans, but it does not cause disease in healthy hosts, only in individuals whose immune systems are critically impaired \tn 
% Row Count 30 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
{\emph{Pneumocystis pneumonia}} & the major pulmonary infection seen in patients with AIDS and HIV infection \tn 
% Row Count 4 (+ 4)
% Row 10
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{In vulnerable hosts the disease spreads rapidly throughout the lungs.} \tn 
% Row Count 6 (+ 2)
% Row 11
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Before AIDS, {\emph{P. carinii}} pneumonia was seen primarily in patients with malignancy, in organ transplant recipients, and in patients with diseases requiring treatment with large doses of immunosuppressive agents.} \tn 
% Row Count 11 (+ 5)
% Row 12
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Today, most cases of {\emph{P. carinii}} pneumonia are seen in patients with AIDS.} \tn 
% Row Count 13 (+ 2)
% Row 13
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The {\bf{early clinical manifestations}} of {\emph{Pneumocystis}} in patients with AIDS are indistinguishable from those of any other pneumonia.} \tn 
% Row Count 16 (+ 3)
% Row 14
\SetRowColor{white}
{\bf{Signs and Symptoms}} & include progressive exertional dyspnea, a dry cough that may or may not produce mucoid sputum, difficulty in taking a deep breath (not caused by pleurisy), and fever with or without sweats. \tn 
% Row Count 24 (+ 8)
% Row 15
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{The therapist may hear {\bf{normal breath sounds on auscultation}} or {\bf{end-inspiratory crackles}}.} \tn 
% Row Count 26 (+ 2)
% Row 16
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{The chest x-ray film may be {\bf{normal at first}}; later it will show {\bf{bilateral interstitial infiltrates}}, which may progress to {\bf{alveolar filling}} and {\bf{"white out"}} of the chest x-ray film.} \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
% Row 18
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Mycobacterium avium}}}} {\bf{complex (MAC)}}} \tn 
% Row Count 1 (+ 1)
% Row 19
\SetRowColor{LightBackground}
 & a serious opportunistic infection that is caused by the following two similar bacteria: {\emph{Mycobacterium avium}} and {\emph{Mycobacterium intercellulare}} \tn 
% Row Count 7 (+ 6)
% Row 20
\SetRowColor{white}
 & found in the soil and dust particles \tn 
% Row Count 9 (+ 2)
% Row 21
\SetRowColor{LightBackground}
 & MAC is commonly found in patients with AIDS. \tn 
% Row Count 11 (+ 2)
% Row 22
\SetRowColor{white}
 & The {\bf{mode of infection}} is usually {\bf{inhalation}} or {\bf{ingestion}}. \tn 
% Row Count 14 (+ 3)
% Row 23
\SetRowColor{LightBackground}
 & can spread through the bloodstream to infect lymph nodes, bone marrow, the liver, the spleen, spinal fluid, the lungs, and the intestinal tract \tn 
% Row Count 20 (+ 6)
% Row 24
\SetRowColor{white}
 & Typical symptoms of MAC include fever, night sweats, weight loss, fatigue, anemia, diarrhea, and enlarged spleen. \tn 
% Row Count 25 (+ 5)
% Row 25
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 25 (+ 0)
% Row 26
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Invasive Aspergillosis}}} \tn 
% Row Count 26 (+ 1)
% Row 27
\SetRowColor{LightBackground}
 & general term used for a wide variety of infections caused by the fungi of the genus {\emph{Aspergillus}} \tn 
% Row Count 31 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 28
\SetRowColor{LightBackground}
 & The most common forms are {\bf{allergic bronchopulmonary aspergillosis}}, {\bf{pulmonary aspergilloma}}, and {\bf{invasive aspergillosis}}. \tn 
% Row Count 6 (+ 6)
% Row 29
\SetRowColor{white}
 & Most humans inhale {\emph{Aspergillus}} spores every day \tn 
% Row Count 9 (+ 3)
% Row 30
\SetRowColor{LightBackground}
 & However, in individuals who are immunocompromised, an aspergillosis pneumonia often develops. \tn 
% Row Count 13 (+ 4)
% Row 31
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 13 (+ 0)
% Row 32
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Invasive Candidiasis}}} \tn 
% Row Count 14 (+ 1)
% Row 33
\SetRowColor{white}
 & general term describing fungal infections caused by a variety of species of the genus {\emph{Candida}}, most often by {\emph{Candida albicans}}, a {\bf{yeastlike fungus}} \tn 
% Row Count 21 (+ 7)
% Row 34
\SetRowColor{LightBackground}
 & These fungi are normally found in the mouth, vagina, and intestines of healthy individuals. \tn 
% Row Count 25 (+ 4)
% Row 35
\SetRowColor{white}
 & Under normal circumstances, the normal bacteria in these areas keep the amount of {\emph{Candida}} species in balance. \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 36
\SetRowColor{LightBackground}
 & However, in patients with a weakened immune system (such as people with HIV/AIDS), the fungi can invade tissue that normally would be resistant to infection—thus, producing an opportunistic infection. \tn 
% Row Count 9 (+ 9)
% Row 37
\SetRowColor{white}
 & {\emph{Candida}} infections can involve any part of the body \tn 
% Row Count 12 (+ 3)
% Row 38
\SetRowColor{LightBackground}
 & In some cases, the fungus enters the bloodstream and causes invasive disease affecting internal body organs such as the kidneys, spleen, lungs, liver, eyes, meninges, brain, and heart valves. \tn 
% Row Count 20 (+ 8)
% Row 39
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 20 (+ 0)
% Row 40
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{\{\{ac\}\}{\bf{Other Causes}}} \tn 
% Row Count 21 (+ 1)
% Row 41
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Rickettsiae}}} \tn 
% Row Count 22 (+ 1)
% Row 42
\SetRowColor{LightBackground}
 & small, pleomorphic coccobacilli \tn 
% Row Count 24 (+ 2)
% Row 43
\SetRowColor{white}
 & Most rickettsiae are intracellular parasites possessing both ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). \tn 
% Row Count 29 (+ 5)
% Row 44
\SetRowColor{LightBackground}
 & There are several pathogenic members of the {\emph{Rickettsia}} family: {\emph{Rickettsia rickettsii}} (Rocky Mountain spotted fever), {\emph{Rickettsia akari}} (rickettsialpox), {\emph{Rickettsia prowazekii}} (typhus), and {\emph{Rickettsia burnetii}}, also called {\emph{Coxiella burnetii}} (Q fever). \tn 
% Row Count 40 (+ 11)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 45
\SetRowColor{LightBackground}
 & All species of the genus {\emph{Rickettsia}} are unstable outside of cells except for {\emph{R. burnetii}} (Q fever), which is extremely resistant to heat and light. \tn 
% Row Count 7 (+ 7)
% Row 46
\SetRowColor{white}
 & Q fever can cause pneumonia as well as a prolonged febrile illness, an influenza-like illness, and endocarditis. \tn 
% Row Count 12 (+ 5)
% Row 47
\SetRowColor{LightBackground}
 & The organism is commonly transmitted by arthropods (lice, fleas, ticks, mites). It may also be transmitted by cattle, sheep, and goats and possibly in raw milk. \tn 
% Row Count 19 (+ 7)
% Row 48
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Varicella (Chickenpox)}}} \tn 
% Row Count 20 (+ 1)
% Row 49
\SetRowColor{LightBackground}
varicella virus & usually causes a benign disease in children aged 2 to 8 years, and complications of varicella are not common \tn 
% Row Count 25 (+ 5)
% Row 50
\SetRowColor{white}
 & In some cases, however, varicella has been noted to spread to the lungs and cause a serious secondary pneumonitis. \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 51
\SetRowColor{LightBackground}
 & The mortality rate of varicella pneumonia is about 20\%. \tn 
% Row Count 3 (+ 3)
% Row 52
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Rubella (Measles)}}} \tn 
% Row Count 4 (+ 1)
% Row 53
\SetRowColor{LightBackground}
 & Measles virus spreads from person to person by the respiratory route. \tn 
% Row Count 7 (+ 3)
% Row 54
\SetRowColor{white}
 & Respiratory complications are often encountered in measles because of the widespread involvement of the mucosa of the respiratory tract (e.g., excessive bronchial secretions and infection). \tn 
% Row Count 15 (+ 8)
% Row 55
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Severe Acute Respiratory Syndrome}}} \tn 
% Row Count 16 (+ 1)
% Row 56
\SetRowColor{white}
 & In 2002, China reported the first case of {\bf{severe acute respiratory syndrome (SARS)}}. \tn 
% Row Count 20 (+ 4)
% Row 57
\SetRowColor{LightBackground}
 & Shortly after this report, the disease was documented in numerous countries, including Vietnam, Singapore, and Indonesia. Both the United States and Canada have reported imported cases. \tn 
% Row Count 28 (+ 8)
% Row 58
\SetRowColor{white}
 & Health officials believe that the cause of SARS is a newly recognized virus strain called a {\bf{coronavirus}}. \tn 
% Row Count 33 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 59
\SetRowColor{LightBackground}
 & Other viruses, however, are still under investigation as potential causes. \tn 
% Row Count 4 (+ 4)
% Row 60
\SetRowColor{white}
 & Coronaviruses are a group of viruses that have a halolike or corona-like appearance when observed under an electron microscope. \tn 
% Row Count 10 (+ 6)
% Row 61
\SetRowColor{LightBackground}
 & Known forms of coronavirus cause common colds and upper respiratory tract infections. \tn 
% Row Count 14 (+ 4)
% Row 62
\SetRowColor{white}
 & SARS is highly contagious on close personal contact with infected individuals. \tn 
% Row Count 18 (+ 4)
% Row 63
\SetRowColor{LightBackground}
 & It spreads through droplet transmission by coughing and sneezing. \tn 
% Row Count 21 (+ 3)
% Row 64
\SetRowColor{white}
 & SARS might be transmitted through the air or from objects that have become contaminated. \tn 
% Row Count 25 (+ 4)
% Row 65
\SetRowColor{LightBackground}
 & The incubation period for SARS is typically 2 to 7 days \tn 
% Row Count 28 (+ 3)
% Row 66
\SetRowColor{white}
 & Initially, the patient usually develops a fever (\textgreater{}100.4 °F or \textgreater{}38.0 °C), followed by chills, headaches, general feeling of discomfort, and body aches. \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 67
\SetRowColor{LightBackground}
 & Toward the end of the incubation period, the patient with SARS usually develops a dry, nonproductive cough, shortness of breath, and malaise. \tn 
% Row Count 6 (+ 6)
% Row 68
\SetRowColor{white}
 & In severe causes hypoxemia develops. \tn 
% Row Count 8 (+ 2)
% Row 69
\SetRowColor{LightBackground}
 & According to the Centers for Disease Control and Prevention (CDC), 10\% to 20\% of patients with SARS require mechanical ventilation. \tn 
% Row Count 14 (+ 6)
% Row 70
\SetRowColor{white}
 & In spite of this fact, death from SARS is rare. \tn 
% Row Count 16 (+ 2)
% Row 71
\SetRowColor{LightBackground}
 & No specific treatment recommendations exist at this time. \tn 
% Row Count 19 (+ 3)
% Row 72
\SetRowColor{white}
 & The CDC, however, recommends that patients with SARS receive the same treatment used for any patient with serious community-acquired atypical pneumonia of unknown cause \tn 
% Row Count 26 (+ 7)
% Row 73
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Lipoid Pneumonitis}}} \tn 
% Row Count 27 (+ 1)
% Row 74
\SetRowColor{white}
 & The aspiration of mineral oil, used medically as a lubricant, has also been known to cause {\bf{pneumonitis–lipoid pneumonitis}}. \tn 
% Row Count 33 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 75
\SetRowColor{LightBackground}
 & The severity of the pneumonia depends on the type of oil aspirated. \tn 
% Row Count 3 (+ 3)
% Row 76
\SetRowColor{white}
 & Oils from animal fats cause the most serious reaction, whereas oils of vegetable origin are relatively inert. \tn 
% Row Count 8 (+ 5)
% Row 77
\SetRowColor{LightBackground}
 & When mineral oil is inhaled in an aerosolized form, an intense pulmonary tissue reaction occurs. \tn 
% Row Count 12 (+ 4)
% Row 78
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Avian Influenza A}}} \tn 
% Row Count 13 (+ 1)
% Row 79
\SetRowColor{LightBackground}
 & (also called {\bf{{\emph{bird flu}}}} and {\bf{{\emph{H5N1}}}}) \tn 
% Row Count 15 (+ 2)
% Row 80
\SetRowColor{white}
 & a subtype of the A strain virus and is highly contagious in birds. \tn 
% Row Count 18 (+ 3)
% Row 81
\SetRowColor{LightBackground}
 & Historically, bird flu has not been known to infect humans. \tn 
% Row Count 21 (+ 3)
% Row 82
\SetRowColor{white}
 & However, in Hong Kong in 1997 the first avian influenza virus to infect humans directly was reported. \tn 
% Row Count 26 (+ 5)
% Row 83
\SetRowColor{LightBackground}
 & This outbreak was linked to chickens and classified as avian influenza A (H5N1). \tn 
% Row Count 30 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.89126 cm} x{3.08574 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Necrotizing Pneumonia and Lung Abscess (cont)}}  \tn
% Row 84
\SetRowColor{LightBackground}
 & Since the Hong Kong outbreak, the bird flu virus has been reported in parts of Europe, Turkey, Romania, the Near East, and Africa. \tn 
% Row Count 6 (+ 6)
% Row 85
\SetRowColor{white}
 & Many of the infected people have died. \tn 
% Row Count 8 (+ 2)
% Row 86
\SetRowColor{LightBackground}
 & Experts are concerned that if the avian flu virus continues to spread, a worldwide pandemic outbreak could occur. \tn 
% Row Count 13 (+ 5)
% Row 87
\SetRowColor{white}
 & People with bird flu may develop life-threatening complications,such as viral pneumonia and ARDS (the most common cause of bird flu–related deaths). \tn 
% Row Count 20 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.84149 cm} x{3.13551 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{General Management of Pneumonia}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{treatment of pneumonia is based on} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & (1) the specific cause of the pneumonia, and \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & (2) the severity of symptoms demonstrated by the patient \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
For bacterial pneumonia & first line of defense is usually an antibiotic prescribed by the attending physician \tn 
% Row Count 10 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Although there are a few viral pneumonias that may be treated with antiviral medications, the recommended treatment is usually the same as for the flu—bed rest and plenty of fluids.} \tn 
% Row Count 14 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{In addition, over-the-counter medications are often helpful to reduce fever, treat aches and pains, and depress the dry cough associated with pneumonia.} \tn 
% Row Count 18 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{In severe pneumonia, hospitalization may be required.} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Care Treatment  Protocols}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Oxygen Therapy Protocol}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• & used to treat hypoxemia, decrease the work of breathing, and decrease myocardial work \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
• & Because of the hypoxemia associated with pneumonia, supplemental oxygen may be required. \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
• & The hypoxemia that develops in pneumonia is most commonly caused by alveolar consolidation and capillary shunting associated with the disorder. \tn 
% Row Count 11 (+ 4)
% Row 4
\SetRowColor{LightBackground}
• & Hypoxemia caused by capillary shunting is at least partially refractory to oxygen therapy. \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Lung Expansion Therapy Protocol}}} \tn 
% Row Count 15 (+ 1)
% Row 6
\SetRowColor{LightBackground}
• & Lung expansion therapy may be administered to attempt to offset the atelectasis associated with some pneumonias, but its effects are not consistently good. \tn 
% Row Count 20 (+ 5)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Thoracentesis}}} \tn 
% Row Count 21 (+ 1)
% Row 8
\SetRowColor{LightBackground}
• & Diagnostic and therapeutically, thoracentesis may be used if a pleural effusion is present \tn 
% Row Count 24 (+ 3)
% Row 9
\SetRowColor{white}
• & From a diagnostic standpoint, fluid samples may be examined for the following: \tn 
% Row Count 27 (+ 3)
% Row 10
\SetRowColor{LightBackground}
 & •	 Color \tn 
% Row Count 28 (+ 1)
% Row 11
\SetRowColor{white}
 & •	 Odor \tn 
% Row Count 29 (+ 1)
% Row 12
\SetRowColor{LightBackground}
 & •	 RBC count \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Care Treatment  Protocols (cont)}}  \tn
% Row 13
\SetRowColor{LightBackground}
 & •	 Protein \tn 
% Row Count 1 (+ 1)
% Row 14
\SetRowColor{white}
 & •	 Glucose \tn 
% Row Count 2 (+ 1)
% Row 15
\SetRowColor{LightBackground}
 & •	 Lactic dehydrogenase (LDH) \tn 
% Row Count 3 (+ 1)
% Row 16
\SetRowColor{white}
 & •	 Amylase \tn 
% Row Count 4 (+ 1)
% Row 17
\SetRowColor{LightBackground}
 & •	 pH \tn 
% Row Count 5 (+ 1)
% Row 18
\SetRowColor{white}
 & •	 Wright's, Gram, and acid-fast bacillus (AFB) stains \tn 
% Row Count 7 (+ 2)
% Row 19
\SetRowColor{LightBackground}
 & •	 Aerobic, anaerobic, tuberculosis, and fungal cultures \tn 
% Row Count 9 (+ 2)
% Row 20
\SetRowColor{white}
 & •	 Cytology \tn 
% Row Count 10 (+ 1)
% Row 21
\SetRowColor{LightBackground}
• & Therapeutic thoracentesis may be used to encourage lung reexpansion when atelectasis is part of the clinical prese \tn 
% Row Count 14 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}