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Pulmonology > Bordetella Pertussis and Influenza > Flashcards

Bordetella Pertussis and Influenza Flashcards

1
Q

Agent that causes pertussis

A

Bordetella pertussis

Gram negative

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2
Q

Mode of transmission and incubation period of pertussis

A

Transmission by respiratory droplets (5ft)

Humans are the only reservoir

Incubation 1-3 weeks

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3
Q

Method of infection by pertussis

A

Organism is inhaled, adheres to ciliated epithelium in nasopharynx

Disseminated through lower respiratory airways, but does not go into alveoli

Does not invade farther than epithelium

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4
Q

Epidemiology

A

MC in developing countries

In US, mostly affects infants

Adults/adolescents important reservoir

Increasing since 2001–increased diagnosis, waning immunity, increased circulation

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5
Q

Phases of pertussis

A

catarrhal

paroxysmal

convalescent

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6
Q

Catarrhal Phase

A

Indistinguishable from viral URI

Rhinorrhea, lacrimination, conjunctival injection, malaise, low grade fever, mild cough

First 7-10 days

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7
Q

Paroxysmal phase

A

1-6 weeks, up to 10 weeks

Cough becomes more severe, plateauing at week 2-3, decreases gradually

Paroxysms of cough (bursts of numerous coughs in one inspiration) followed by a long inspiratory gap with high pitched whoop

May have posttussive emesis and exhaustion

Sputum may be purulent or non-purulent

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8
Q

Convalescent phase

A

paroxysms less common

cough resolves over 2-3 weeks

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9
Q

Clinical Presentation and Complications in Children

A

Typially have prolonged respiratory illness with paroxysmx of cough followed by whoop

atypical presentation frequent in young infants and children who have been vaccinated

Complications:

  • MC and deadly: secondary bacterial pneumonia
  • Post tussive vomitting and hypoxia–>seizure
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10
Q

Clinical Presentation and Complications in Adults

A

Frequently only have prolonged, persistent paroxysms of cough 36-48 days

Post tussive vomiting MC than whoop.

More likely to have atypical presentation because of previous immunization or previous infection

Complications: uncommon

  • Rib fracture
  • hernia
  • back pain
  • pneumothorax
  • atypical pneumonia
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11
Q

Hopitalization in pertussis

A

Admit if have signs of respiratory distress, signs of pneumonia, inability to feed, cyanosis or apnea, seizures

Provide supportive care. Close monitoring of respiratory and nutritional status

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12
Q

DDx of Pertussis

A

Viral- influenza, adenovirus, rhinovirus, etc

Bacterial - M. pneumonia, C. pneumonia, TB

NonInfectious - asthma, foreign body, GERD, PND, malignancy

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13
Q

Diagnostics for Pertussis

A

Increased WBC

CXR- r/o pneumonia

Clinical Case Definition

**Bacterial culture **

  • Gold standard
  • Nasopharyngeal swab
  • Most sensitive early on

PCR

  • MC used for pertussis
  • Retains specificity and sensitivity through 3-4weeks

Serology

  • Used late in illness
  • Not practical in clinic

<2 weeks: culture+ PCR
>2 weeks: PCR+ serology
>4 weeks: only serology

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14
Q

Pertussis must be reported to the department of health within how many days?

A

1 day

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15
Q

When is it best to treat pertussis?

A

During the catarrhal phase to decrease transmission and severity.

Antibiotics

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16
Q

Post exposure prophylaxis is recommended for who?

A

For close contacts

Especially if at risk for severe complications: if around kids

17
Q

Isolation for pertussis

A

Isolate until 5 days of tx or 21 days of sxs

MDH will help

18
Q

Principles of Immunization

A

DIsease prevention: form of primary prevention

Immunization: cause an immune response without causing disease

Vaccine safety: Adverse reactions are rare and are reportable

19
Q

Types of vaccinations

A

Live attenuated

  • Weakened whole cell organism
  • MMR, varicella, influenza, zoster

Inactivated

  • Inactivated whole cell organism - polio
  • Inactivated toxin - tetanus

Acellular

  • Subunit - Fragment of microorganism – pertussis influenza
  • Recombinant – genetic engineering – HBV, HPV
  • Conjugate – carrier protein - pneumococcus
20
Q

Common adverse reactions to vaccines

A

fever

injection site sensitivity

rash

injection site edema

vasodilation

21
Q

Pertussis Vaccination

A

Acellular toxin

Lasts 5-10 years

DTaP: series for children

Tdap: booster for adults

22
Q

Influenza virus classified by

A

core proteins A, B, or C

subtypes of A are classified by glycoproteins
H: hemagluttinin binds to respiratory epithelium
N: neuraminidase involved with propogation of new virus

species of origin

geographic location

23
Q

Influenza A

A

Seasonal outbreaks during winter months

Morbidity and mortality most affect those at high risk

24
Q

Influenza can reassort at high rates because of what characteristic?

A

segmented genome

25
Q

Antigenic shift vs. drift

A

antigenic shift: major change can lead to epidemic and pandemic

epigenic drift: minor change leads to localized outbreaks

26
Q

Epidemic

Pandemic

A

Epidemic: new cases exceed what is expected in a certain population

Pandemic: global epidemic. Primarily affects those not at the extremes of age. Due to significant antigenic shift.

Outbreak: epidemic restricted to one locale

27
Q

Influenza B

A

Outbreaks less extensive

Disease less severe

28
Q

Clinical Presentation of Influenza

A

Systemic: F, myalgias, HA, malaise

Upper respiratory tract: sore throat

Lower respiratory tract: cough

PE: hyperemia, +/- cervical LAD

29
Q

Clinical course: uncomplicated

A

Incubation 1-2 days

Abrupt onset of systemic and respiratory symptoms

Gradual improvement, lasts up to 1 week

Self limited

30
Q

High Risk Groups - Flu

A

Nursing home residents

Individuals with chronic medical conditions

Native American

Adults older than 65 yrs

Young children <1 and <5

Children with comorbid conditions

31
Q

Diagnostic Testing

A

Rapid antigen testing

Reverse transciptase PCR: most sensitive and specific but sendout

32
Q

Treatment

A

Give antivirals within 24-36hrs

33
Q

Flu Vaccines

A

Each year changes to reflect envelope glycoproteins

trivalent

IM: inactivated

Intranasal: live attenuated (not for immunocompromised)

Pulmonology (17 decks)

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