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Block 9 Week 3 > AuCoin > Influenza & Viral Pneumonia > Flashcards

AuCoin > Influenza & Viral Pneumonia Flashcards

1
Q

what causes the inflammation in pneumonia?

A

infection w/ virus/bacteria
AND
immune response to infection

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2
Q

what is primarily affected in pneumonia?

A

the alveoli

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3
Q

who is most likely to get viral pneumonia?

A

young kids

oldies

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4
Q

WHY are the 2 age groups susceptible to viral pneumonia?

A

young kids have NAIVE immune systems

oldies have WEAK immune systems

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5
Q

what are the typical sx of pneumonia?

A

cough
fever
chills
SOB

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6
Q

what are the 3 common causes of viral pneumonia?

A
  1. influenza virus A & B
  2. RSV
  3. human parainfluenza virus
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7
Q

what are the 4 LESS common causes of viral pneumonia?

A
  1. adenoviruses
  2. rhinoviruses
  3. metapneumovirus
  4. SARS
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8
Q

which 5 viruses cause other diseases & MAY cause pneumonia?

A
  1. HSV
  2. VZV
  3. Measles
  4. Rubella
  5. CMV
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9
Q

what 2 pulmonary defense mechanisms prevent introduction of particulate matter in the lower airway?

A

epiglottis

cough reflex

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10
Q

what things work in the alveoli to defend against lower respiratory tract infections?

A

cell-mediated immunity
humoral factors
inflammatory response

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11
Q

which Ig plays a role in mucosal immunity?

A

IgA

more IgA is produced in mucosal linings than all other ab combined

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12
Q

what secretes mucin?

A

goblet cells

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13
Q

what does mucin do?

A

dissolves in water to form mucus

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14
Q

what type of cells are goblet cells?

A

glandular simple columnar epithelium

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15
Q

what type of virus is an orthomyxo virus?

A

(-) RNA

w/ envelope

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16
Q

how does an influenza pandemic occur?

A

a variant of influenza A w/ a new hemagglutinin that ppl don’t have pre-existing ab to is introduced into the pop

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17
Q

how is influenza transmitted?

A

respiratory droplets

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18
Q

which strain of influenza causes pandemics?

A

A

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19
Q

which strain of influenza causes outbreaks?

A

B

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20
Q

which strain of influenza causes milder infections?

A

C

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21
Q

how many types of hemagglutinin (HA) & neuraminidase (NA) are there in influenza A virus?

A

16 ag types of HA

9 types of NA

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22
Q

what is antigenic SHIFT?

A

REASSORTMENT of segments of the genome RNA

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23
Q

what is antigenic DRIFT?

A

small MUTATIONS in the genome RNA

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24
Q

antigenic changes to WHAT cause epidemics & pandemics?

A

HA & NA

hemagglutinin & neuraminidase

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25
Q

how long is the incubation period for influenza?

A

24-48 hours

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26
Q

T/F: influenza virus is an orthomyxovirus

A

TRUE

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27
Q

what happens after the incubation period of influenza virus?

A 
SUDDEN SX:
fever
myalgia
HA
sore throat
cough
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28
Q

who is at high risk of developing influenza virus infection?

A

elderly pts

pts w/ cardiac or pulmonary disease

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29
Q

how long does it take for influenza sx to resolve?

A

4-7 days

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30
Q

what can complicate the course of influenza?

A

pneumonia

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31
Q

what does immunity to influenza depend on?

A

secretory IgA targeting HA (hemagglutinin) in the respiratory tract

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32
Q

how do you dx influenza?

A

clinical grounds

lab tests are avail

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33
Q

what are the RXes for treatment AND prevention of influenza?

A

oseltamivir (tamiflu)

zanamivir (relenza)

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34
Q

what is the prevention of influenza based on?

A

vaccine

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35
Q

what does the influenza virus vaccine contain?

A

influenza A & B viruses

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36
Q

what happens to the influenza vax yearly?

A

it is reformulated to the current ag strains

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37
Q

how do relenza & tamiflu work?

A

neuraminidase inhibitors > inhibit the release of virus from infected cells

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38
Q

what is responsible for more than HALF of all acute illnesses each year in the US (general)?

A

respiratory illnesses

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39
Q

when does influenza circulate in the US?

A

fall & early spring

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40
Q

why is influenza hard to control?

A

MUTABILITY &
high frequency of REASSORTMENT
(so basically drift & shift)

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41
Q

which one is antigenically variable: influenza A, B, or C?

A

A

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42
Q

which one causes the majority of disease: influenza A, B, or C?

A

A

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43
Q

which strain is antigenically stable: A, B, or C?

A

C

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44
Q

which strain has intermediate antigenic changes: A, B, or C?

A

B

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45
Q

which strain can infect aquatic birds, chickens, ducks, & pigs?

A

A

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46
Q

where are HA & NA located on the virus?

A

surface (they’re glycoproteins)

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47
Q

what are the 7 steps of influenza virus replication? (this is a long one)

A
  1. receptor-mediated endocytosis
  2. release segmented RNPs into cytoplasm
  3. transport genome into nucleus
  4. replication & transcription
  5. transport viral mRNAs to cytoplasm for translation
  6. transport early viral replication proteins back to nucleus
  7. assembly & budding at plasma membrane
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48
Q

what receptor mediates the endocytosis of influenza?

A

sialic acid receptor

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49
Q

why is influenza virus unusual among RNA viruses?

A

because RNA transcription and replication occur in the NUCLEUS

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50
Q

what does the low pH of the endosome allow?

A

membrane fusion & release of the viral RNPs in the cytosol

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51
Q

what happens shortly after infection?

A

host cell protein synthesis is shut OFF

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52
Q

what is RNA polymerase composed of?

A

3 viral P proteins

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53
Q

what does RNA polymerase do?

A

transcription > produces a (+) sense mRNA from the (-) sense RNA genome

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54
Q

what purpose does the (+) sense mRNA serve?

A

translated to viral proteins
AND
used as a template to make viral (-) sense RNA genomes

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55
Q

how is a RNP formed?

A

nucleoprotein (NP) associates w/ viral RNA

56
Q

what 3 encoded proteins are bound to the viral NP?

A

PA
PB1
PB2
(pennsylvania peanut butter)

57
Q

what do PA, PB1, & PB2 do?

A

RNA transcription & replication

58
Q

what forms a shell below the viral membrane which is important in particle assembly?

A

M1

matrix protein

59
Q

what surrounds the viral particle derived from the plasma membrane of the host cell?

A

lipid envelope

60
Q

what gets inserted into the envelope of orthomyxoviruses?

A

hemagglutinin & neuraminidase

61
Q

T/F: HA & NA are embedded into the surface of the virus so that they don’t protrude

A

FALSE

they are exposed as SPIKES

62
Q

what do NA & HA determine?

A

antigenic variation of influenza viruses

63
Q

T/F: 2 distinct influenza viruses may infect a single host cell

A

TRUE

64
Q

when 2 distinct influenza viruses infect a cell, what happens?

A

the RNA genomes are shuffled so you get a NEW influenza virus (REASSORTMENT)

65
Q

what is the consequence of RNA mixing from 2 diff influenza viruses?

A

sudden CHANGE in viral SURFACE ANTIGENS

66
Q

why is it a challenge to produce only 1 influenza vax?

A

bc if 2 distinct influenza viruses infect a cell, the RNA genomes reassort & change their stupid surface antigens

67
Q

what do you use to divide influenza viruses into A, B, & C?

A

antigenic diffs btwn NUCLEOCAPSID (NP) & MATRIX (M) proteins

68
Q

what are the 2 internal structural proteins that determine ag diffs?

A

nucleocapsid (NP)

matrix (M)

69
Q

what is used to subtype the influenza viruses?

A

ag variation among surface glycoproteins HA & NA

70
Q

what is the nomenclature system for orthomyxoviruses?

A 
type
host of origin
geo origin
strain #
year of isolation
HA & NA subtype
(example: A/swine/Iowa/15/30(H1N1) )
71
Q

if the orthomyxovirus has a host origin in humans, do you put that in the nomenclature?

A

nope

72
Q

do nucleocapsid & matrix proteins drift MORE OR LESS than the glycoproteins (HA & NA)?

A

LESS

73
Q

how many subtypes of HA are there?

A

15

74
Q

how many subtypes of NA are there?

A

9

75
Q

what species are the HA & NA subtypes in diff combos isolated in?

A

birds
animals
humans

76
Q

how many HA & NA subtypes have been recovered from humans?

A 
4 HA (1 2 3 & 5)
2 NA (1 & 2)
77
Q

what is tropism?

A

HA protein of influenza binds virus particles to susceptible cells

78
Q

what is the major ag on flu that neutralizing ab are directed against?

A

HA

79
Q

what is primarily responsible for the continual evolution of new strains & subsequent influenza epidemics?

A

variability of HA

80
Q

when does NA function?

A

at the END of the viral replication cycle

81
Q

what does NA facilitate?

A

the release of viral particles from infected cell surface during the budding process

82
Q

antigenic variants have a (BLANK) over parental virus in the presence of ab directed against the original strain

A

selective advantage

83
Q

what are MINOR ag changes considered?

A

antigenic DRIFT

84
Q

what are major changes in HA & NA termed?

A

antigenic SHIFT (bc they form new subtypes via reassortment)

85
Q

what does antigenic shift reflect?

A

drastic changes in the sequence of viral glycoproteins

86
Q

what is antigenic drift due to?

A

accumulation of POINT MUTATIONS in the gene

87
Q

what can alter antigenic sites on glycoproteins?

A

sequence changes

88
Q

what is the mechanism for the shift of orthomyxoviruses?

A

genetic reassortment btwn human & avian influenza viruses

89
Q

how does influenza virus spread?

A

from person to person via airborne droplets or by contact w/ contaminated surfaces

90
Q

which cells get infected w/ orthomyxoviruses?

A

respiratory epithelial cells

91
Q

what happens to the cells that get infected w/ orthomyxoviruses?

A

they are killed

then the virus spreads to other cells

92
Q

what is the explanation for the incubation period of influenza?

A

viral dose

host immune system

93
Q

what is detectable in respiratory secretions ~1 day post-infection?

A

interferon

94
Q

what is detectable in 1-2

A

ab & cell mediated immunity

95
Q

T/F: resistance to secondary bacterial infections is common

A

TRUE
bc cellular destruction is widespread
(resistance to staph, strep, H. flu)

96
Q

who should get the influenza vax?

A

anyone over 6 mo

ANNUALLY

97
Q

what 3 kinds of flu viruses commonly circulate among people today?

A
  1. influenza A (H1N1) viruses
  2. influenza A (H3N2) viruses
  3. influenza B viruses
98
Q

which strains are included in the 2014-2015 trivalent flu vax?

A

A/California/7/2009 (H1N1) pdm09-like virus
A/Texas/50/2012 (H3N2)-like virus
B/Massachusetts/2/2012-like virus
some also protects against addn’l B/Brisbane/60/2008-like virus

99
Q

what indicates a highly pathogenic avian influenza?

A

H5 or H7 surface protein

100
Q

what are most common flu deaths d/t?

A

opportunistic infections (like bacterial pneumonia)

101
Q

what flu strain can kill pts w/o secondary opportunistic infection?

A

H5N1

102
Q

T/F: RSV is an orthomyxovirus

A

FALSE

it’s a PARAmyxovirus

103
Q

what is the most common cause of pneumonia & bronchitis in infants?

A

RSV

104
Q

who is susceptible to RSV?

A

neonates
preemies
babies w/ cardiopulmonary diseases

105
Q

how is RSV transmitted?

A

respiratory droplets

106
Q

what does RSV cause in adults?

A

common cold

bronchitis

107
Q

what does RSV cause in oldies?

A

pneumonia

108
Q

what sx do infants get w/ RSV?

A

pronounced COUGH

expiratory WHEEZING

109
Q

T/F: there is a rapid ag test for RSV

A

TRUE!

detects virus in respiratory secretions

110
Q

what can you give to severely ill hospitalized infants if they have RSV?

A

ribavirin

111
Q

other than meds, what’s another option to fight RSV?

A

passive immunization w/ ab

112
Q

what are the surface spikes on RSV?

A

FUSION proteins (not HA & NA like in influenza)

113
Q

what do the surface fusion proteins of RSV do?

A

cause cells to fuse, forming a multinucleate giant cell&raquo_space;> syncytia (thus the name)

114
Q

when does RSV cause outbreaks?

A

every winter

115
Q

T/F: virtually everyone has been infected w/ RSV by 2-3 yo

A

TRUE

116
Q

what group gets outbreaks of respiratory infections from RSV?

A

hospitalized infants

117
Q

how can you control RSV outbreaks?

A

wash your hands

use gloves

118
Q

what CXR finding is suggestive of RSV?

A

perifular fullness (perihilar?)

119
Q

what are the 3 key things in a case presentation of RSV?

A

6-week-old infant
distress
wheezing

120
Q

what do parainfluenza viruses (PIV) cause in children?

A

croup
laryngitis
bronchiolitis
pneumonia

121
Q

what do parainfluenza viruses (PIV) cause in adults?

A

common cold

122
Q

how are parainfluenza viruses (PIV) transmitted?

A

respiratory droplets

123
Q

what is the main cause of croup in children under 5 yo?

A

PIV 1 & 2

124
Q

what is croup characterized by?

A

barking cough

hoarseness

125
Q

other than croup, what can PIV cause?

A 
variety of respiratory diseases
common cold
pharyngitis
laryngitis
otitis media
bronchitis
pneumonia
126
Q

where can you see PIV 3?

A

lower respiratory infections in children

127
Q

how do you diagnose PIV?

A

clinically

128
Q

T/F: parainfluenza virus is a paramyxovirus

A

TRUE (parapara)

129
Q

what are the surface spikes of parainfluenza?

A

HA
NA
AND fusion (all 3!)

130
Q

how are the parainfluenza spikes grouped?

A

HA & NA proteins are on the same spike

F protein is on a separate spike

131
Q

parainfluenza viruses cause upper & lower respiratory tract disease without (blank)

A

viremia

132
Q

what neutralizes PIV infectivity?

A

ab to either HA or F protein

133
Q

is there a vax or RX for PIV?

A

nope

neither

134
Q

what AP x-ray finding is suggestive of croup?

A

steeple sign > tracheal narrowing

135
Q

what sx should be a dead giveaway for croup?

A

BARKING COUGH

Block 9 Week 3 (8 decks)

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