B3-030 CBCL URTI Flashcards
nasopharyngitis is typically caused by
rhinovirus
pharyngitis is typically caused by
GAS, C. diphtheriae
rhinosinusitis is typically caused by
M. catarrhalis
epiglottitis is typically caused by
M. catarrhalis, H. flu
lanryngotracheitis is caused by
B. pertussis, C. diphteriae, M. catarrhalis
Gram positive, aerobic bacilli
Corynebacterium
Gram +, B-hemolytic
GAS
Gram - cocci
moraxella
gram - bacilli
- growth on MacConkey
aerobic
bordetella
Streptococcus is serotyped via
Lancefield typing
Beta hemolytic streptococci
S. pyogenes (GAS)
S. agalactiae (GBS)
alpha hemolytic streptococci
Viridians
S. pneumoniae
gamma hemolytic streptococci
enterococcus
S. pyogenes is spread via
direct contact or respiratory droplets
a _________ inoculum leads to S. pyogenes infection
low
S. pyogenes invades
the mucous membranes
respiratory diseases caused by GAS
strep
pharyngitis
skin diseases caused by GAS
impetigo
erysipelas/cellulitis (dermis)
necrotizing faciitis (subq)
systemic infections caused by GAS
bacteremia
rheumatic fever
acute glomerulonephritis
TSS
most common bacterial infection of the throat
S. pyogenes
S pyogenes is _______ to differentiate from viral pharyngitis
difficult
without treatment, how long will S. pyogenes persist?
1-4 weeks
DOC: S. pyogenes
penicillins
Scarlet fever is caused by
SpeA/C exotoxins
sand paper rash
strawberry tongue
circumoral pallor
scarlet fever
scarlet fever can lead to
rheumatic fever or glomerulonephritis
impetigo usually occurs in
young kids (2-5)
raised, bright red plaques with sharply defined borders
erysipelas
TSS can progress to nec fas within
24 hours
adhesin virulence factor for S. pyogenes
M protein (>160 serotypes)
S. pyogenes possesses a _____________ capsule
hyaluronic acid
is the hyaluronic capsule of S. pyogenes antigenic?
No
Streptolysin O
pore forming toxin, lyses target cells
hyaluronidase is often ___________ in S. pyogenes
mutated/inactivated
Spe is a _________ that causes Scarlet fever and TSS
superantigen
streptokinases
activate plasminogen to dissolve clots
all isolates of S. pyogenes are susceptible to
penicillin
DOC strep throat
amoxicillin
DOC strep cellulitis
penicillin, ceftriaxone
DOC: strep bacteremia/TSS
penicillin + clindamycin (suppresses toxin production)
treatment failure of S. pyogenes is due to
re-infection
or colonization with a different bacteria that produce beta lactamase (S. aureus)
how to differentiate strep from viral pharyngitis
rapid antigen detection test
for group A capsule antigen
if the RADT is negative….
culture on SBA
club shaped with “volutin” granules
C. diphtheriae
grown on Loffler medium
C. diphtheriae
V and L shaped arrangments
C. diphtheriae
Diphtheriae toxin is an
AB exotoxin
the B subunit of Diphtheriae toxin targets
upper respiratory tract
heart
nerve cells
the A subunit of diphtheriae toxin
ADP ribosylates EF-2, shutting down protein synthesis
the C. diphtheriae vaccine is a _________ vaccine
toxoid
C. diphtheriae vaccine
DTap, Td, Tdap
pseudomembranous pharyngitis is cause by
C. diphtheriae
sudden onset of malaise, sore throat, low grade fever, exudative pharyngitis
C. diphtheriae
grayish pseudomembrane that can lead to asphyxiation
C. diphtheriae
“bull neck” cervical lymphadenopathy
C. diphtheriae
complications of C. diphtheriae include
myocarditis, neuropathies
cutaneous C. diphtheriae causes a
non-healing ulcer with a grayish membrane
C. diphtheriae is grown on
tellurite containing chocolate agar
tellurite inhibits
other URT bacteria
tellurite is reduced by C. diphtheriae, leaving a
black pigment
demonstration of toxin by agar diffusion with antitoxin
elek test (C. diphtheriae)
treatment of C. diphtheriae
immediate administration of antitoxin
does infection with C. diphtheriae generate protective antibodies?
no
DOC C. diphtheriae
erythromycin or penicillin
boosters of C. diphtheriae are required
every 10 years
moraxella catarrhalis is commensal in the
nasopharynx
in otherwise healthy, M. catarrhalis causes
otitis media
sinusitis
laryngitis
in those with chronic lung disease, M catarrhalis causes
bronchitis
pneumonia
small, gram negative coccobacilli in diplococci
M. catarrhalis
transmission: M. catarrhalis
direct contact, respiratory droplet
adhesins: M catarrhalis
pili/fimbriae
endotoxin: M catarrhalis
LPS
3rd most common cause of otitis media and sinusitis
M catarrhalis
M. catarrhalis can cause _______ as a complication of balloon angioplasty
endocarditis
risk factors for M. catarrhalis infection
immunodeficiency and chronic respiratory conditions
M. catarrhalis looks just like ________ on gram stain
neisseria
pink-brown coloration of colonies on chocolate agar
M. catarrhalis
asaccharolytic
M. catarrhalis
M catarrhalis treatment
> 95% penicilin resistant!
use with B lactamase inhibitor
M catarrhalis is univerally susceptible to
all other antibiotics used for respiratory therapy
B. pertussis causes
whooping cough
B. pertussis binds to
ciliated epithelials cells and PMNs
adhesins: B pertussis
filamentous hemagglutinin (Fha)
pertactin
pertussis toxin B subunit
binds to glycolipids on ciliated respiratory cells or phagocytes
pertussis toxin A subunit
ADP ribosylates Gi to increase cAMP levels
increased cAMP from the pertussis toxin causes
increased respiratory secretion and mucus production —> paroxysmal cough
pertussis is highly infectious in the
catarrhal stage
transmission: B. pertussis
respiratory droplets
pertussis is mainly seen in children
<1
pertussis can be seen in adults/adolescents due to
waning immunity
**can have classic pertussis or just mild respiratory disease
the pertussis vaccine is
acellular
the pertussis vaccine contain
purified proteins
pertussis toxiod, Fha, fimbriae, pertactin
DTap is administered
under 5
Tdap is administered
single dose
7-65 years of age
macrolides are effective against pertussis in the
catarrhal stage
three stages of pertussis
catarrhal
paroxysmal
convalescent
treatment for pertussis after the paroxysmal stage
supportive
prophylaxis can be administered to close contacts of
pertussis
pertussis requires a ________ for culture
special transport medium
B. pertussis can be cultured using a nasopharyngeal swab during the
catarrhal stage
growth medium for B. pertussis
regan-lowe
B. pertussis can be diagnosed via PCR or serology in the
catarrhal/early paroxysmal stage
symptoms of URTI
congestion, rhinorrhea, sore throat, cough, fever, fatigue
transmission URTI
typically contact with RT secretions, incubate 24-72 hrs
common, undifferentiated syndrome that is typically benign/self-limiting lasting several to 10 day of the nose, sinuses, pharynx, larynx
URTI
infection of the bronchi, bronchioles, lung parenchyma
LRTI
inflammation or infection of bronchi
bronchitis
inflammation of lung parenchyma with alveolar infiltrate
pneumonia
transmission: LRTIs
mucous membranes, inhalation
symptoms: LRTIs
cough, shortness of breath, fever
RVP
respiratory panel
nasal washing and swab
adenovirus is [genetic material]
dsDNA
is adenovirus enveloped
no
adenovirus is acid
stable
adenovirus can remain infectious at room air for
3 weeks
transmission: adenovirus
person to person
water
fomites
intruments
adenovirus is _______ in the pediatric population
endemic
symptoms: adenovirus
pharyngitis
acute respiratory disease in military recruits
pneumonia
pertussis-like
prevention: adenovirus
hand hygiene
treatment: adenovirus
self limiting
cidofovir in immunosuppressed
is there a vaccine for adenovirus?
yes-available for military recruits
metapneumovirus is [genetic material]
ss -sense RNA
hMPV is transmitted via
droplet, fomite
hMPV infects
type 2 alveolar and bronchiolar cells
hMPV is characterized by
alveolar and interstitial inflammation in lungs
symptoms: hMPV
fever, myalgia, rhinorrhea, cough, SOB
rhinovirus is a member of the
picornavirus family
rhinovirus genetic material
ss +sense RNA virus
implicated in 1/3-1/2 of all colds
rhinovirus
> 100 serotypes
rhinovirus
symptoms: rhinovirus
rhinorrhea, congestion, cough, scratchy throat, persists 5-7 days
rhinovirus can cause the common cold but also
otitis media and trigger asthma
treatment: rhinovirus, hMPV, common coronvirus
supportive
analgesics
antihistamines/decongestants
intranasal cromolyn sodium
intranasal ipratropium
parainfluenza has ____ main serotypes
4
parainfluenza reinfection is
common
can cause severe disease in hematopoietic stem cell transplants and SOT recipients
parainfluenza
parainfluenza infects
ciliated epithelial cells
cause croup, bronchiolitis, pneumonia
parainfluenza
treatment: croup
supportive
treatment of parainfluenza in immunocompromised
steroids
RSV genetic material
ss - sense RNA virus
is RSV enveloped?
yes
RSV has two subgroups (A and B) that can
circulate at any one time causing an epidemic
serious disease in newborns and immunocompromised
RSV
otitis, croup, bronchiolitis, pneumonia, asthma exacerbation in peds
RSV
URI fever, sinusitis, asthma, otitis, acute exacerbation of chronic bronchitis, 4% of adult pneumonias
in healthy adults
RSV
RSV is diagnosed via
PCR
RSV treatment: healthy people
supportive
ribavirin aerosolized can treat
adults with RSV
palivizumab is used for
prophylaxis of RSV in at risk newborns
“gold standard” for diagnosis of URTI
isolation of virus in tissue culture
coronavirus genetic material
positive sense RNA
is coronavirus enveloped?
yes
alpha coronaviruses cause
common cold
beta coronaviruses cause
MERS
SARS-1
SARS-2
MERS-CoV
middle east respiratory syndrome identified 2012
MERS is transmitted from
camels
case definition: MERS
febrile respiratory illness with radiographic confirmation of ARDS or pneumonia
AND
link with confirmed MERS case or area of endemic
treatment: MERS
maybe ribavirin
prevention: MERS
avoid camels :)
hand hygiene
airborne and contact precautions
SARS-CoV
severe acute respiratory disease identified china 2003
SARS-CoV case definition
fever
AND
1 or more respiratory symptoms
AND
radiographic evidence of ARDS
AND
no alternate diagnosis
WITH
diagnostic test x2
SARS-CoV-2
betacoronavirus identified 2019 in china
S glycoprotein
allows COVID to bind to ACE-2 for viral entry
transmission: covid
large respiratory droplets, maybe airborne
____________ is an important cause of spread of Covid
asymptomatic spread
covid ranges from
mild to severe disease
increased risk for severe disease from covid
CVD, DM, HTN, lung disease, cancer, CKD, obesity, immunocompromised
later imaging of covid shows
ground glass infiltrates, pleural thickening, septal thickening
poor outcomes from covid can be associated with particular labs
elevated LDH, CRP, ferritin, D-dimer, LFTs, etc
covid prevention
mask, social distancing, handwashing, quarantine
covid mrna vaccination
pfrizer, moderna
covid adenovirus vector vaccine
J&J
investigational therapy: covid
monoclonal antibodies
shown to benefit covid treatment
dexamethasone
anticoagulation
studies show some benefit in covid treatment
remdesivir
JAK inhibitors
MERS is associated with a
high case fatality
SAR-CoV-1 did not circulate due to
stringent public health efforts
treatment of covid: most effective to least
prevent>monoclonal ab> remdesivir+steroids+anticoagulants
