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Microbiology Exam 2 > 27 - Viral infections of the Respiratory Tract II > Flashcards

27 - Viral infections of the Respiratory Tract II Flashcards

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1
Q

What are the symptoms of influenza?

A

Symptoms

  • Myalgia
  • Headache
  • Fever
  • Shaking chills
  • Cough peaking between 3 & 5 days of illness.
  • Cough, fatigue, and generalized weakness may last 2-6 weeks – longer duration of illness than the common cold
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2
Q

When would you see increased severity of symptoms and an increased incidence of complication?

A

Usually seen in pandemic outbreaks (seasonal epidemic or outbreak)

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3
Q

What is the definition of a pandemic?

A

A pandemic is a world-wide epidemic when we are talking about influenza - During this time, the pandemic can lead to increased problems and increased complications with the influenza virus

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4
Q

During which season do we see a peak in influenza?

A

During the winter months, but ONLY in temperate climates (no “peaks” seen in the tropics)

Peak in Iowa = end Jan., beginning Feb.

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5
Q

What is the incubation period of influenza?

A

2 days

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6
Q

Which populations are more at risk for complications due to influenza?

A
  • Children younger than 2
  • Adults older than 65
  • Pregnant women (up until 2 weeks postpartum)
  • People with certain medical conditions (asthma, endocrine disorders, heart disease, etc.)
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7
Q

Influenza will go away on its own… The bigger concern is ___________.

A

Complications that arise from the influenza virus

Can lead to hospitalizations and be fatal

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8
Q

What is the biggest complication we worry about with influenza?

A

Pneumonia

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9
Q

What is pneumonia?

A

Inflammation of the lung parenchyma leading to abnormal gas exchange

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10
Q

What are symptoms of pneumonia?

A
  • Fever
  • Chills
  • Cough
  • Pleural chest pain
  • Increased respiratory rate
  • Wheezes and crackles
  • Hypoxia and cyanosis (severe cases – interfere with oxygen exchange)
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11
Q

Primary influenza virus pneumonia is usually the result of which influenza strain?

A

Influenza A

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12
Q

Primary influenza virus pneumonia occurs most frequently in which age groups?

A

Children and 40+ population

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13
Q

What are the symptoms of primary influenza virus pneumonia?

A
  • 1-4 days following influenza virus symptoms, patient gets progressively worse
  • Increased cough, tachypnea, dyspnea, acute respiratory distress
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14
Q

How will a sputum test stain in a gram stain?

A

Abundant PMN cells without a significant number of bacteria

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15
Q

What will a chest radiograph show in primary influenza virus pneumonia?

A

Bilateral mid lung and lower lung infiltration

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16
Q

What is the fatality rate for primary influenza virus pneumonia?

A

Approx. 50%

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17
Q

What accounts for the high fatality rate?

A

We are limited in how we can manage these patients

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18
Q

What is bacterial influenza-associated pneumonia?

A

This is “good news” because it is easily treatable - much easier to treat than influenza A pneumonia

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19
Q

When will symptoms of bacterial influenza-associated pneumonia begin?

A

About a week after influenza symptoms begin

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20
Q

What are the symptoms of bacterial influenza-associated pneumonia?

A

Basic influenza symptoms which lessen, then followed by increased cough, return of fever and respiratory distress

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21
Q

How will a gram stain of bacterial influenza-associated pneumonia stain?

A

The stain may contain a bacterial cause

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22
Q

Which types of bacteria is typically the cause of bacterial influenza-associated pneumonia?

A

1 - S. pneumoniae – most common
2 - S. aureus & H. influenzae – also common

Others: N. meningitidis, other Streptococcus, and Gram negative Bacillus

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23
Q

What is the cause of influenza?

A

The influenza virus - a member of the orthomyxovirus

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24
Q

What type of virus is the influenza virus?

A

ssRNA virus genome - Segmented

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25
Q

Is the influenza virus enveloped?

A

Yes!

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26
Q

What is the hemagglutinin (H) portion of the influenza virus?

A

Functions in attachment - it agglutinates to RBCs

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27
Q

What is the neuraminidase (N) portion of the influenza virus?

A

Functions to…

  • Cleaves sialic acid (it is an enzyme, cleaves sialic acid which is on the outside of the cell)
  • Allows for virion release
  • Allows for virion spread
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28
Q

What does antigenic DRIFT mean in terms of the influenza virus?

A

Antigenic Drift

  • Small changes in H and N
  • Driven by point mutations made by the polymerase during replication
  • Epidemiological significant changes every 2-3 years – the antigen “drifts” so much that it is no longer recognized as the parent
  • This is why we change the immunization every year
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29
Q

What does antigenic SHIFT mean in terms of the influenza virus?

A

Antigenic Shift

  • Large changes in H and N
  • Driven by reassortment of two viruses
  • Co-infection of the same cell
  • Risk for pandemics
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30
Q

Where does reassortment occur?

A

“MIXING VESSELS”

  • What we worry about is when a virus reassorts in different animals
  • Pigs, for example, are easily infected by both human and bird influenza
  • Pigs are therefore considered a dangerous “mixing vessel”
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31
Q

What is unique about influenza B viruses?

A
  • ***ONLY humans, not animals
  • ***Can undergo antigenic drift, but NOT antigenic shift
  • It can occasionally become severe, but not usually
  • Causes outbreaks and sometimes epidemics
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32
Q

What is unique about influenza A viruses?

A
  • Can infect human, swine, avian, mammals, etc.
  • ***The ONLY type of influenza virus that can undergo antigenic SHIFT (as well as drift)
  • ***Probably why it is the ONLY one we see causing pandemics (and frequent epidemics)
  • Often a very severe disease
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33
Q

What is unique about influenza C?

A
  • Infects human and swine
  • Usually a mild infection
  • Limited outbreaks
  • Demonstrates antigenic drift, but not shift
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34
Q

How do we name influenza strains?

A

We change the names of H and N… H1N1, H3N2, etc.

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35
Q

How did the novel 2009 H1N1 virus pandemic occur?

A
  • Multiple reassortments, meaning there were parts from many different viruses included in the H1N1 strain
  • Most cases of influenza worldwide were being caused by the same strain
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36
Q

When should we treat a patient with influenza with antivirals?

A

It depends on whether or not they exhibit risk factors and when they experienced onset

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37
Q

How should you treat an influenza patient with no risk factors?

A
  • If you see them within 48 hours of onset, prescribe antivirals
  • Treat symptoms
  • Infection control
  • Return if no improvement in 72 hours
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38
Q

How should you treat an influenza patient with risk factors?

A
  • Treat with antiviral regardless of onset
  • Treat symptoms
  • Infection control
  • Return if no improvement in 72 hours
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39
Q

What are two ion-channel blocker antivirals?

A

Amantadine and rimantadine

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40
Q

What do ion-channel blocker antivirals do?

A

They block replication prior to genome release (M2)

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41
Q

What is a major concern when prescribing ion-channel blocker antivirals?

A

The current strains of influenza A virus are RESISTANT to this drug

Not recommended by the CDC at this time

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42
Q

What are the names of the 3 neuraminidase inhibitor antiviral drug?

A

1 - Zanamivir (oral inhalation)
2 - Oseltamivir - Tamiflu (oral administration)
3 - Peramivir (IV administration)

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43
Q

Is there any current resistance to tamiflu?

A

No

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44
Q

How do neuraminidase inhibitors work?

A

They inhibit viron release and spread

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45
Q

Which type of influenza are neuraminidase inhibitors effective against?

A

Influenza A and influenza B

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46
Q

What is the “time restriction” on neuraminidase inhibitors?

A

For uncomplicated influenza, they must be given early (first 48 h) to reduce disease symptoms/duration

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47
Q

What is the best way to help with the influenza problem?

A

VACCINATE

Antivirals typically only shorten symptoms by about a day, so the best way to help with influenza is to VACCINATE

48
Q

There are three types of influenza vaccines. What are they?

A

1 - Inactivated influenza vaccines (IIV)
2 - Live attenuated influenza vaccines (LAIV)
3 - Recombinant influenza vaccines (RIV)

49
Q

What is the agent in the inactivated influenza vaccine (IIV)?

A

Formaldehyde-inactivated influenza viruses

50
Q

What is the administration for Inactivated influenza vaccines (IIV)?

A

IM (intramuscular) or ID (intradermal)

51
Q

Which patients are eligible for inactivated influenza vaccines (IIV) given IM?

A
  • Older than 6 months
  • Includes those with chronic medical conditions

Very safe!

52
Q

Are Inactivated influenza vaccines (IIV) that are given IM trivalent or quadralent?

A

Can be either

53
Q

Which patients are eligible for inactivated influenza vaccines (IIV) given ID?

A

Adults ages 18-64

54
Q

Are Inactivated influenza vaccines (IIV) that are given ID trivalent or quadralent?

A

Trivalent

55
Q

What is the agent in Live Attenuated Influenza Vaccines (LAIV)?

A

Attenuated influenza viruses

56
Q

What is the administration route for Live Attenuated Influenza Vaccines (LAIV)?

A

Intranasal inhalation

57
Q

What populations are eligible for Live Attenuated Influenza Vaccines (LAIV)?

A
  • Healthy
  • Non-pregnant
  • Ages 2-49
58
Q

How many strains are included in the Live Attenuated Influenza Vaccines (LAIV)?

A

Quadrivalent

59
Q

What is the agent in recombinant influenza vaccines (RIV)?

A

Hemagglutinin protein

60
Q

What is the administration rout for recombinant influenza vaccines (RIV)?

A

Intramuscular (IM)

61
Q

What patients are eligible for recombinant influenza vaccines (RIV)?

A

Adults ages 18-49

62
Q

How many influenza strains are included in recombinant influenza vaccines (RIV)?

A

Trivalent

63
Q

What is the classic method of producing influenza vaccines?

A

Production in embryonated chicken eggs

Some of the problems could be egg supply, takes time to grow in eggs, etc.

64
Q

What is the new method of producing influenza vaccines?

A

Production in mammalian cells - Madin Darby Canine Kidney (MDCK) cells

65
Q

What are the advantages of the new mammalian cell method?

A

1 - rapid scale up of vaccine production

2 - reduced likelihood of egg protein carry over - allergies

66
Q

What is the method of making the recombinant influenza vaccine?

A

Baculovirus expression vector system technology

  • Create a recombinant protein
  • Infect the cells
  • Purify the protein
  • Formulate it into a vaccine
67
Q

What are the advantages of the recombinant influenza vaccine type?

A
  • Rapid production

- Egg-free system

68
Q

What does trivalent include?

A

2 influenza A

1 influenza B

69
Q

What does quadravalent include?

A

2 influenza A

2 influenza B

70
Q

When is the ideal time to vaccinate?

A

2 - 4 months before flu season

71
Q

Who do you vaccinate first when there is limited availability?

A

1st - People at highest risk for complications & health care workers

2nd - Anyone who wishes to reduce the likelihood of becoming ill from influenza

72
Q

When would someone require two doses of the vaccine?

A

2 doses for children younger than 9 years of age being vaccinated for the first time

73
Q

When would you prophylactically treat with anti-virals?

A
  • Those at high risk for complications, which are vaccinated after the flu season has begun.
  • Non immune health care workers and family members who care for those at high risk for influenza complications.
  • Poor match between vaccine and currently circulating strains.
74
Q

What is the SARS coronavirus?

A

A virus of the coronavirus family that has caused recent pandemics

75
Q

Is the SARS coronavirus enveloped?

A

Yes

76
Q

What type of genome does the SARS coronavirus have?

A

+ ssRNA

77
Q

Is the SARS coronavirus more or less resistant to environmental conditions than the non-SARS form?

A

MORE resistant - more severe also

78
Q

Describe the course of the SARS coronavirus disease

A

1 - Fever, malaise, and myalgia
2 - Dry cough & shortness of breath
3 - Most severe cases - adult respiratory distress syndrome (ARDS) & death within weeks

Other - diarrhea, abnormal liver function, and lymphopenia

79
Q

How is the SARS coronavirus transmitted?

A
  • Fecal-oral route
  • Close contact
  • Aerosol routes
80
Q

What is the incubation period for SARS coronavirus?

A

2-10 days

81
Q

How many cases have we seen of the SARS coronavirus?

A

8000 probable cases

82
Q

Are these cases severe?

A

Yes

  • Almost all of required hospitalization
  • 20% intensive care
  • Fatality rates were 10% overall, approximately 50% in elderly
83
Q

When did we begin to control SARS?

A

June 2003

84
Q

When was the last case of SARS?

A

November 2004

85
Q

How did we control SARS?

A

MAIN WAY: Isolation and infectious control measures ***

  • Medical workers all suited up
  • Screen for fever – sign of when someone was infected
  • One reason they think this was successful is because this occurred by having a fever for a day or so before you started having the coughing and sneezing, and that’s when they actually started spreading the virus a lot
  • They were able to identify people that may be infected and control them
86
Q

What is bronchiolitis?

A

Inflammation of the bronchioles

87
Q

What are the symptoms of bronchiolitis?

A
  • Expiratory Wheezing
  • Nasal flaring
  • Air Trapping
  • Subcostal Retractions
  • Variable fever
88
Q

Why can bronchiolitis be a severe disease in infants?

A

Because their structure are so small that inflammation can easily close them

89
Q

What would be on your differential diagnosis list?

A
  • Allergic asthma

- Foreign body inhalation

90
Q

What is Respiratory Syncytial Virus (RSV)?

A

A virus from the paramyxovirus family that is the most common cause of bronchiolitis and pneumonia in children less than 1 year old

91
Q

Is the Respiratory Syncytial Virus (RSV) enveloped?

A

YES

92
Q

What type of genome does the Respiratory Syncytial Virus (RSV) have?

A
  • ssRNA genome
93
Q

Is Respiratory Syncytial Virus (RSV) highly infectious or more challenging to transmit?

A

Highly infectious – something that can be transmitted quite easily

94
Q

How is Respiratory Syncytial Virus (RSV) transmitted?

A
  • Inhalation of large droplets ***

- Direct contact with respiratory secretions

95
Q

What is the incubation period of Respiratory Syncytial Virus (RSV)?

A

4-5 days

96
Q

How common is Respiratory Syncytial Virus (RSV) in children?

A

Nearly ALL children have been infected by age 4

97
Q

How common is it to develop a secondary infection from Respiratory Syncytial Virus (RSV)?

A

Between 25-40% of primary infections result in pneumonia or bronchiolitis

98
Q

Do you experience life-long immunity to RSV?

A

No - You do NOT have life-long immunity but reinfection leads to less severe disease (colds in adults)

99
Q

When would you see severe infections arise from RSV?

A

In the elderly and immunocompromised populations

100
Q

How do you treat RSV?

A

Aerosolized ribavarin

101
Q

What is the mechanism of action of the aerosolized ribavarin treatment?

A
  • It is a guanosine analogue

- Inhibits nucleotide biosynthesis and mRNA capping and promotes hypermutation of the genome

102
Q

When is this treatment indicated for RSV infections?

A

Indicated for severe lower respiratory tract RSV infections in special populations

  • Premature infants
  • Patients with chronic lung disease
  • Patients with congenital heart disease
  • Immunocompromised patients
103
Q

How can you prevent RSV?

A

Prophylactic treatment for some patient groups

104
Q

When is it indicated to treat a patient prophylactically for RSV?

A
  • Birth before 32 weeks (sometimes before 35)

- Less than 2 years old when on therapy for chronic lung disease within 5 months of RSV season

105
Q

How do you treat patients prophylactically for RSV?

A

Two agents

  • Palivizumab (pah lih VIH zyou mab)
  • RSIG
106
Q

What is Palivizumab?

A

A chimeric human-mouse monoclonal anti-RSV antibody

107
Q

What is RSIG?

A

A pooled human immunoglobin, enriched for anti-RSV antibodies ( not quite as specific)

108
Q

What other viruses can cause respiratory illness?

A
  • Avian Influenza
  • Cytomegalovirus
  • Measles and Varicella-Zoster virus
109
Q

What should you know about the avain influenza?

A

There is bird-to-human, NOT human-to-human transmission

110
Q

What should you know about cytomegalovirus?

A

It occurs in immunocompromised individuals

111
Q

What should you know about measles and varicella-zoster virus?

A

It is usually associated with distinct skin lesions = chicken pox

112
Q

What percentage of measles can lead to pneumonia?

A

6% - it is the number 1 cause of measles related deaths

113
Q

What percentage of chicken pox (VZV) can lead to pneumonia?

A

20% - it is the most serious complication of chicken pox

114
Q

A number of your fellow survivors are suffering from rhinitis, pharyngitis, and a hacking cough. You suspect this is caused by a coxsackievirus outbreak. Observing which of the following illnesses in group members would best support your diagnosis?

A. Walt, a 10 year old child presenting with fever and vesicular lesions on his palms, soles of his feet, and around his mouth.

B. Kate, a 31 year old female presenting with pharyngitis, conjunctivitis, and fever.

C. Shannon, a 22 year old female, indicates her asthma attacks have been more severe and frequent in the last few days.

A

A. Walt, a 10 year old child presenting with fever and vesicular lesions on his palms, soles of his feet, and around his mouth.

Young kids usually get this

115
Q

Aaron, a 2 month old male born on the island presents to your makeshift clinic with fever and a cough that sounds like a seals bark. You can hear a vibrating sound when he tries to take in air. You tell the rest of the survivors that the virus causing these symptoms is transmitted through ____________.

A. The fecal-oral route

B. Being bitten by an infected insect.

C. The respiratory secretions

A

C. The respiratory secretions

116
Q

An outbreak of influenza-like illness strikes the island. An stockpile of oseltamivir is found in a previously hidden storage cellar. Barring the development of antiviral resistance, this drug would be expected to be effective against ____________ viruses.

A. Influenza type A

B. Influenza type B

C. Influenza type A and B

A

C. Influenza type A and B

117
Q

Rose, a 62 year old female who received chemotherapy for advanced stage cancer 2 days before Oceanic flight 815 crash landed on the island is suffering from a severe cough, fever, and is having difficulty breathing. You suspect that RSV may be the cause. If this is true, antiviral treatment would be administered through the ____________.

A. Oral route

B. Aerosol route

C. Intramuscular injection

A

B. Aerosol route

Microbiology Exam 2 (8 decks)

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