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Block 3 Found Sci > 4- Viral Respiratory Infections > Flashcards

4- Viral Respiratory Infections Flashcards

1
Q

how damage predisposes pt’s to super infections (baterial)

A

interrupt mucocilliary escalator (can’t expel bacteria or pollutants) + weaken immune system (fighting viruses instead of bacteria)

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2
Q

common cold symptoms

A
  1. rhinitis (inflamm of nasal mucosa)
  2. pharyngitis (sore throat)
  3. NO high fever, lower respir involvement, or respir distress

allergies can mimic symptoms

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3
Q

complications of common cold

A
  1. otitis media
  2. sinus infections
  3. exacerbation of asthma (rhinovirus C)
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4
Q

common cold treatments

A
  1. antihistamines
  2. decongestants
  3. NOT antibiotics
  4. no vaccines bc high variation of viruses

prevention by washing hands and covering coughs

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5
Q

common cold pathology
viruses

A
  1. attach in nasal epi
  2. replication in epi cells
  3. cell damage
  4. host defense activated to clear cell debris
  5. nasal epi regenerate
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6
Q

etiology of colds
viruses causing colds

A
  1. rhinovirus
  2. coronavirus
  3. other known (adenovirus, coxsackie)
  4. unidentified

all transmission thru contact/droplet except coxsackie fecal-oral

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7
Q

rhinoviruses

A

most common cause
-from picorna (small RNA) family non enveloped, +ssRNA
-species A, B,C but tons of diversity

shed in respir secretions so transmit contact or large droplets

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8
Q

coronavirus

A

coronaviridae family enveloped +ssRNA
-spike proteins to attach
-non SARS that causes common cold

aleviate symptoms to treat, no vaccine

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9
Q

non SARS coronavirus mechanisms

A

rep in epi cells of respir tract
-transmit thru large droplets
-usually infants and children

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10
Q

adenoviruses features

A

non enveloped dsDNA adrenovirus family
-fiber proteins protrude from vertices of capsid for attachment and toxic

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11
Q

adenovirus

A

serotypes 1,2,5 cause colds
-prevalent in children under 5
-can enter lymphoid tissue and stay for 18 mo
-no seasonal pattern

transmit via oral, droplet inhalation, conjuctiva

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12
Q

other illnesses of adenovirus

A
  1. pharyngoconjuctival fever
  2. severe respir infection (croup, pneumonia, bronchiolitis)
  3. GI disease (serotypes 40 and 41)
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13
Q

treatment adenovirus

A

-reduce symptoms
-immunity long lived but serotype specific
-military recruits get live oral vaccine for 4 and 7

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14
Q

coxsackieviruses

A

enterovirus family of picornaviruses
-non enveloped + ssRNA
-replicate in cytoplasm

fecal-oral transmission, no vaccine or treatment needed to recover
-lower sanitation places, children in daycare

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15
Q

herpangina

A

from coxsackie
-abrupt onset of fever + small vesicles/blisters on soft palate that can rupture

high in children 1-7

can lead to meningitis or encephalitis

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16
Q

hand-foot and mouth disease

A

fever + vesicular lesions on palms of hand and soles of feet

common in children, goes away on own

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17
Q

influenza viruses

A

B and C can cause cold symptoms instead of flu symptoms

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18
Q

croup symptoms

A

swelling in subglottic region of larynx ‘laryngotracheobronchitis’

nasal discharge + mild cough+ pharyngitis > fever + brassy cough (like seal bark) + inspiratory stridor rattling
-chest x ray shows narrowing of air shadow ‘steeple sign’
-worried about hypoxia

highest in kids under 6

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19
Q

croup treatment

A

alleviate symptoms
-if no stridor at rest then humidify air and hydrate
-if yes stridor at rest then oxygen, epinephrine, glucocorticoids

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20
Q

croup etiology

A
  1. parainfluenza virus
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21
Q

parainfluenza viruses

A

-paramyxovirus family

22
Q

parainfluenza mechanisms

A

large droplet and direct contact transmission
-infect/repl in ciliated epithelium of respir tract

can be reinfected more mildly, short lived immunity

23
Q

acute bronchitis

A

cough without pneumonia/alternative medical disorder/history of chronic lung
-from influenza A and B

cough lasting more than 5 days (median 18 days)

antibiotics (limited effective) or bronchodilators (if wheezing)

24
Q

bronchiolitis

A

expiratory wheezing + nasal flaring + air trapping + subcostal/intercostal retractions + fever

infants prevelent bc airways so small

25
Q

RSV

A

causes bronchiolitis and pneumonia

transmission thu inhale large droplets and direct contact
-nearly all children infected by 4, reinfection more mild like colds

26
Q

RSV season

A

october-may but varies by part of country
-since covid shifted more towards august

27
Q

RSV treatment

A

aerosolized ribavirin
-guanosine analgoue so inhibits nucleotide syn

consider if severe lower tract RSV in premature infants, chronic lung diease, congenital heart disease, immunocompromised

28
Q

RSV passive immunoprophylaxis

A

palivizumab (monoclonal anti-RSV antibody) injected monthly for 5 mo during RSV season

prophylaxis of infants in first year if premature, chronic lung dz, or heart dz

up to 2nd year if immunocompromised

29
Q

influenza symptoms

A

-myalgia
-headache
-fever
-shaking chills
-cough
-fatigue, general weakenss

inc severity during pandemic outbreaks
peak during winter

30
Q

risk complications influenza

A

kids under 2,
adults over 65,
preg women or up to 2 weeks post partum
certain med conditions (anything that affects respiratory, metabolic disorders)

31
Q

pneumonia

A

inflamm of lung parenchyma > abnormal gas exchange

fever + chills + cough + pleuritic chest pain + inc respir rate + wheezes/crackles

32
Q

primary influenza virus pneumonia

A

usually influ A
-inc cough, tachypnea, dyspnea, acute respir distress
-sputum gram stain shows abundant pmn cells, not much bacteria
-radiograph shows lung infiltrtion with interstitial pattern of opacities

33
Q

bacterial influenza associated pneumonia

A

onset a week after influ symptoms begin
-biphasic pattern so symps lessen for little while then progress worse (cough, fever, respir distress)

gram stain may show bacteria (S. pneumoniae, S. aureus, H influenze)

34
Q

influ virus

A

segmented -ssRNA orthomyxovirus enveloped

agglutinates RBCs (hemagglutinin) + neuraminidase (virion release and spread)

35
Q

antigenic drift

influ

A

small changes in H and N driven by point muts (from polymerase during rep)

epidemiological significant changes every 2-3 years

36
Q

antigenic shift

influ

A

large changes in H and N driven by reassortment of two viruses

co-infection of same cell by diff virus strains, risk for pandemics

37
Q

reassortment barriers

A

-specialize for the host so human strains spread in humans but not thru animals and v/v
-mixing vessel animals that can support infection from diff species (avian and human can infect swine) allow transmission b/t species

38
Q

anti-virals for influenza

A
  1. ion channel blockers-block rep prior to genome release
  2. neuraminidase inhibitors- inhib virion release and spread of A and B
  3. endonuclease inhibitor- target cap dependent endonuclease to cleave, single oral dose vs A and B
39
Q

types of neuramindase

A
  1. zanamivir- inhalation admin
  2. oseltamivir- oral admin
  3. peramivir- IV admin
40
Q

ion channel blockers

A

amantadine or rimantadine, was only effective vs A but now A has resistance,

41
Q

when to use antivirals

A

-if no risk factors and within 48 hours otherwise limited effectiveness
-if yes risk factors then at anytime

42
Q

influenza vaccines

A
  1. inactivated-dead virus via intramuscular injection
  2. live attenuated- intranasal inhalation
  3. recombinant - hemagglutinin protein instead of virus, intramuscular
43
Q

production methods of vaccine influ

A
  1. classic- chicken eggs
  2. novel- mammalian cells (faster than eggs) like MDCK cells

recombinant made by purifying baculovirus that infects a fermenter (faster and egg free)

44
Q

vaccine components

A

2 influ A + 2 influ B strains

45
Q

dosing and timing

A

offer vaccine by late october
-antibody resp within 2 weeks
-1 dose per/year except under 9 then 2

46
Q

COVID diagnosis

A
  1. nucleic acid detection/PCR, most sensitive
  2. antigen test
47
Q

COVID antivirals

A
  1. remdesivir- targets RdRp of CoV, peds and adults can recieve if pos, hospitalized pts
  2. ritonavir boosted nirmatrelvir/paxlovid- inhibits cyctochrome enzymes, mild to moderate symptoms, oral, not for hospitalized
  3. molnupiravir- induces hypermutation so interrupt normal fxn, oral deilvery, not for preg or hospitalized
48
Q

COVID vaccines

A
  1. mRNA based, intramuscular, invoke antibodies vs spike protein, Phizer and Moderna
  2. rep defective adenovirus vector encodes spike, J and J
  3. recombinant spike protein, Novavax, has adjuvant
49
Q

cytomegalovirus

A

respir illness in immunocomp indivs

50
Q

measles and varicella

A

Block 3 Found Sci (60 decks)

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