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!!!!! BRS YR2 !!!!! > Cardio - Respiratory Infections + Immunity > Flashcards

Cardio - Respiratory Infections + Immunity Flashcards

1
Q

What are the signs and symptoms of upper tract infection?

A 
→ Cough 
→ sneezing
→ Runny + stuffy nose
→ Sore throat
→ Headache
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2
Q

What are the signs + symptoms of lower tract infections?

A 
→ Productive cough w phlegm
→ Muscle aches
→ Wheezing
→ Breathlessness
→ Fever
Fatigue
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3
Q

What are the signs and symptoms of pneumonia?

A

→ Chest pain
→ Blue tinting of lips
→ Severe fatigue
→ High fever

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4
Q

What are the demographic and lifestyle risk factors for pneumonia?

A

→ Age <2 years and >65 years
→ Cigarette smoking
→ Excess alcohol consumption

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5
Q

What are social risk factors for pneumonia?

A

→ Contact with children aged <15 years
→ Poverty
→ Overcrowding

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6
Q

What are medical history risk factors for pneumonia?

A 
→ COPD
→ Asthma
→ Heart disease
→ Liver disease
→ Diabetes Mellitus
→ HIV
→ Malignancy
→ Hyposplenism
→ Complement or Ig deficiencies
→ Risks factors for aspiration
→ Previous pneumonia
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7
Q

What are medication risk factors for pneumonia?

A

→ Inhaled corticosteroids
→ Immunosuppressants
→ Proton pump inhibitors

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8
Q

What are specific risk factors for certain pathogens for pneumonia?

A

→ geographical variations
→ Animal contact
→ Healthcare contacts

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9
Q

What are the bacterial causative agents of respiratory infections?

A

→ Streptococcus pneumoniae
→ Myxoplasma pneumoniae
→ Haemophilus Influenza
→ Mycobacterium TB

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10
Q

What are the viral causative agents of resp infections?

A 
→ Influenza A or B virus
→ Respiratory Syncytial Virus
→ Human metapneumovirus
→ Human rhinovirus 
→ Coronaviruses
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11
Q

What are the 2 main ways of acquiring pneumonia?

A

→ Community acquired

→ Hospital acquired

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12
Q

What agents are the main bacterial causes of community acquired pneumonia?

A 
→ streptococcus pneumoniae (40%-50%)
→ myxoplasma pneumoniae
→ staphylococcus aureus
→ chlamydia pneumoniae
→ haemophilus influenzae
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13
Q

What 6 agents are the main causes of hospital acquired pneumonia?

A 
→ Staphylococcus aureus
→ Pseudomonas aeruginosa
→ Klebsiella species
→ E.coli
→ Acinetobacter spp.
→ Enterobacter spp.
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14
Q

What can community acquired pneumonia be further split into?

A

→ Typical

→ Atypical

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15
Q

What agents causes typical community acquired pneumonia? (Hint : SMH)

A

→ Streptococcus pneumoniae
→ Haemophilus influenzae
→ Moraxella catarrhalis

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16
Q

What agents cause atypical community acquired pneumonia? (hint : MCL)

A

→ Mycoplasma pneumoniae
→ Chlamydia pneumoniae
→ Legionella pneumophilia

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17
Q

What is the the most common method of hospital acquired pneumonia?

A

→ Ventilator associated pneumonia

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18
Q

What is pneumonia?

A

Inflammation and swelling of alveoli

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19
Q

What are the main mechanisms of damage of bacterial pneumonia?

A

→ Lung injury
→ Bacteremia
→ Systemic inflammation
→ Can all lead to organ injury or dysfunction

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20
Q

How is potential bacterial pneumonia graded?

A

CRB-65 or CURB-65 scoring (1 point per item)
→ Confusion
→ Urea = 7 mmol/L (only added in hospital)
→ Respiratory Rate > 30 breaths/min
→ Blood Pressure < 90 systolic / 60 diastolic
→ 65 or older

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21
Q

What are the supportive therapies for pneumonia?

A 
→ Oxygen (for hypoxia)
→ Fluids (for dehydration)
→ Analgesia (for pain)
→ Nebulised saline (may help expectoration = coughing up sputum)
→ Chest physiotherapist?
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22
Q

What are the antibiotics classes mainly given for resp tract infections?

A

→ penicillins

→ macrolides

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23
Q

How does penicillin work?

A

→Beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

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24
Q

How do macrolides work?

A

Bind to bacterial ribosome to prevent protein synthesis

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25
Q

What is treatment is given for a CAP patient with a CURB-65 score of 0?

A

Amoxicillin or clarithromycin / doxycycline if penicillin allergic

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26
Q

What is treatment is given for CAP and a CURB-65 score = 1 or 2 ?

A

Amoxicillin + Clarithromycin (or doxycycline)

27
Q

What is given for a patient with CAP and a CURB-65 score of 3-5?

A

Benzyl penicillin IV + clarithromycin. PO (or teicoplanin + clarithromycin)

28
Q

What is given for a patient with a HAP and a CURB-65 score of 0-2?

A

Not severe

Doxycycline PO

29
Q

What is given to a patient with HAP and a CURB-65 score of 3-5?

A

Severe so give tazocin (piperacillin-tazobactam) IV +/- gentamicin IV

30
Q

What is present in our oropharynx?

A 
→ Strep viridans
→ Coagulase neg. Staph
→ Veronella
→ Fusiforms
→ Treponena spp.
→ Beta-haem
→ Strep (Haemophilus spp. Staph. Aureus Strep. Pneumoniae)
31
Q

What is present in our nose?

A 
→ Coagulase neg. Staph
→ Haemophilus spp.
→ Staph. aureus
→ Strep. Viridans
(Strep. Pneumoniae)
32
Q

What is our human microbiome?

A

the microbial cells that populate our body at every barrier surface

33
Q

What is our microbiota?

A

Ecological communities of microbes found inside multicellular organisms

34
Q

What is commensal?

A

→ Microbes that live in a “symbiotic” relationship with their host
→ Providing vital nutrients to the host in the presence of a suitable ecological niche

35
Q

What is an opportunistic pathogen? What is a pathobiont?

A

→ microbe that takes advantage of a change in conditions (often immuno-suppression)
→ microbe that is normally commensal, but if found in the wrong environment (e.g. anatomical site) can cause pathology.

36
Q

How do viral infections result in disease?

A

→ mediator release
→ cellular inflammation
→ local immune memory
→ damage to epithelium: which results in loss of cilia, bacterial growth, poor barrier to antigen, loss of chemoreceptors

37
Q

How do viruses result in severe disease?

A

→ Highly pathogenic strains
→ Absence of prior immunity
→ Predisposing illness/conditions

38
Q

What determines where a virus infects the respiratory tract?

A

Depends on what cell it binds to?

they like to bind to upper tract if they have existed in humans for a prolonged time

39
Q

What is the first line of defence in the respiratory tract?

A

Respiratory Epithelium

40
Q

What features of epithelium are useful as the first line of defence against resp epithelium?

A

→ Tight junctions – prevents systemic infection
→ Mucous lining and cilial clearance – prevents attachment, clears particulates
→ Antimicrobials – recognise, neutralize and/or degrade microbes and their products
→ Pathogen recognition receptors – recognise pathogens either outside or inside a cell.
→ Interferon pathways – activated by viral infection. Promotes upregulation of anti-viral proteins and apoptosis.

41
Q

What are serotypes?

A

pathogens which cannot be recognized by serum (really antibodies) that recognize another virus – implications for protective immunity

42
Q

What is anti-body mediated immunity?

A

→ Humoral immunity
→ Adaptive, so dependent on prior
exposure
→ B cells activated to differentiate into antibody secreting plasma
cells
→ Different antibody classes provide different biochemical properties and functions

43
Q

What antibodies are common in the upper tract? What features make it so?

A

IgA :
→ High frequency of IgA-plasma cells
→ ECs express poly IgA receptor, allowing export of IgA to the mucosal surface
→ Homodimer is extremely stable in protease rich environment

44
Q

What antibodies are common in the lower resp tract? What features make it so?

A

IgG:

→ Thin-walled alveolar space allows transfer of plasma IgGs into the alveolar space

45
Q

How is does our immunity hold up against influenza?

A

No re-infection by the same strain

46
Q

Do we have vaccinations for influenza?

A

Imperfect vaccines:
• Vaccine-induced immunity rapidly wanes
• Mainly homotypic immunity
• Annual vaccination required

47
Q

How does our immunity hold up against RSV?

A

recurrent re-infection with similar strains

48
Q

Do we have vaccines for RSV?

A

No vaccine
• Poor immunogenicity
• Vaccine-enhanced disease
• Very active research field

49
Q

How does our immunity hold up against COVID-19?

A

no prior immunity

50
Q

Do we have vaccines for COVID-19?

A

Newly licensed vaccine
• Waning immunity
• Potential for re-infection
• Unclear what vaccination regime will be required

51
Q

What effect does RSV bronchiolitis have on infants?

A
  • Leading cause of infant hospitalization in the developed world
  • 50% of children infected in year 1 of life, all children by year 3.
  • 1% develop severe bronchiolitis.
  • Can repeatedly infect children.
52
Q

What are the risk factors for infants for RSV?

A
  • Premature birth

* Congenital heart and lung disease

53
Q

List UR tract infections, LR tract infections and pneumonia in order of most frequent to least.

A

→ Upper Resp TI
→ Lower Respiratory
→ Pneumonia

54
Q

List UR tract infections, LR tract infections and pneumonia in order of most severe to least.

A

→ Pneumonia
→ Lower Resp
→ Upper Resp

55
Q

What is the breakdown of viral + bacterial causes of lower respiratory tract infection mortality in 28-365 days old?

A 
Out of 20.1% :
→ Rhinovirus = 6.7%
→ Hib = 4.4%
→ Pneumonia = 3.4%
→ Influenza = 2.8%
→ Other = 2.8%
56
Q

What is the breakdown of viral + bacterial causes of lower respiratory tract infection mortality in 2-5 year olds?

A 
Out of 12.4% :
→ Pneumonia = 3.4%
→ Other = 3%
→ Hib = 2.7%
→ Influenza = 1.8%
→ RSV = 1.6%
57
Q

Wha tare the symptoms of RSV bronchitis in an infant?

A 
→ nasal flaring
→ chest wall retractions
→ hypoxemia
→ cyanosis
→ croupy cough
→ expiratory wheezing + prolonged expiration
→ rales + rhonci
→ tachypnea with apneic episodes
58
Q

How does RSV affect adults?

A

→ Repeated colds.
→ Transmitters.
→ Very rarely severe

59
Q

How does RSV affect young children?

A

→ infantile bronchiolitis
→ casually related to wheeze
→ older siblings are transmitters usually

60
Q

What are the supportive therapies available for COVID?

A 
• Oxygen (for hypoxia)
• Fluids (for dehydration)
• Analgesia (for pain)
• Nebulised saline (may
help expectoration)
• Chest physiotherapy?
61
Q

What are the vaccination options for COVID?

A
  • Major surface antigen – spike protein
  • Viral vector (e.g. adenovirus vaccine e.g. Oxford/AZ)
  • mRNA vaccines (e.g. BioNtech/Pfizer)
62
Q

What anti-inflammatory treatments are used for COVID?

A
  • Dexamethasone (steroids)
  • Tocilizumab (Anti-IL6R) or
    Sarilumab (anti-IL6)
63
Q

What anti-virals are used to treat COVID?

A
  • Remdesivir – broad spectrum antiviral – blocks RNA- dependent RNA polymerase activity
  • Paxlovid – antiviral protease inhibitor
  • Casirivimab and imdevimab - monoclonal neutralising
    antibodies for SARS-CoV-2
64
Q

How do respect infections interplay with chronic lung disease?

A

• Viral bronchiolitis is associated with the development of asthma
• Rhinoviruses are the most common cause of asthma and COPD
exacerbations
• High likelihood of secondary bacterial pneumonia after viral
infection
• 55% of rhinovirus-infected COPD patients also have bacterial infections

!!!!! BRS YR2 !!!!! (72 decks)

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