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BRS Year 2 > CVR Resp Infection > Flashcards

CVR Resp Infection Flashcards

1
Q

Types of respiratory tract infections

A
  1. upper respiratory tract infections
  2. lower respiratory tract infections
  3. pneumonia
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2
Q

symptoms of upper resp tract infection (5)

A
  1. coughing
  2. sneezing
  3. running/blocked nose
  4. sore throat
  5. headache
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3
Q

symptoms of lower resp tract infection (6)

A
  1. productive cough (phlegm)
  2. muscle aches
  3. wheezing
  4. breathlessness
  5. fever
  6. fatigue
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4
Q

symptoms of pneumonia (4)

A
  1. chest pain
  2. bluetinting of the lips
  3. severe fatigue
  4. high fever
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5
Q

how significant is the impact of respiratory infection?

A

in the top 10 causes of death globally

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6
Q

what are DALYs?

A

disability adjusted life year

-> a sum of years of life lost and years lost to disability

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7
Q

where does acute lung infection rank for global burden of disease when using DALYs lost?

A

first

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8
Q

why are respiratory infections not the leading cause of death globally, when they rank so highly for DALYs lost?

A
  • the age of respiratory disease occurrence

- more likely to cause mortality in people >70

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9
Q

risk factors for pneumonia

-> demographic and lifestyle (3)

A
  1. 2>age or age>65
  2. cigarette smoking
  3. excess alcohol consumption
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10
Q

risk factors for pneumonia

-> social factors (3)

A
  1. contact with children aged <15 yrs
  2. poverty
  3. overcrowding
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11
Q

risk factors for pneumonia

-> medications (3)

A
  1. inhaled corticosteroids
  2. immunosuppressants (e.g.steroids)
  3. proton pump inhibitors
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12
Q

risk factors for pneumonia

-> medical history (11)

A
  1. COPD
  2. asthma
  3. <3 disease
  4. liver disease
  5. diabetes mellitus
  6. HIV
  7. Malignancy
  8. Hyposplenism
  9. complement or Ig deficiencies
  10. Risk factors for aspiration
  11. previous pneumonia
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13
Q

risk factors for pneumonia

-> RFs for certain pathogens (3)

A
  1. geographical location
  2. animal contact
  3. healthcare contacts
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14
Q

bacterial causative agents of resp infection (4)

A
  1. streptococcus pneumoniae
  2. mycoplasma pneumoniae
  3. haemophilus influenzae
  4. mycobacterium tuberculosis
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15
Q

viral causative agents of resp infection (5)

A
  1. influenza A/B
  2. respiratory syncytial virus
  3. human metapneumovirus
  4. human rhinovirus
  5. coronavirus
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16
Q

Which respiratory infection causes the highest annual mortality?

A

mycobacterium tuberculosis

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17
Q

What is the most commonly identified pathogen in individuals with respiratory illness?

A

rhinovirus

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18
Q

examples of community acquired pneumonia bacteria (5)

A
  1. streptococcus pneumoniae
  2. myxoplasma pneumoniae
  3. staphylococcus aureus
  4. chlamydia pneumonia
  5. haemophilus influenzae
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19
Q

examples of typical cause of pneumonia

A
  1. streptococcus pneumoniae
  2. haemophilus influenzae
  3. moraxella catarrhalis
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20
Q

examples of hospital acquired pneumonia bacteria (5)

A
  1. staphylococcus aureus
  2. pseudomonas aeruginosa
  3. kilebsiella species
  4. acinobater spp
  5. enterobacter spp
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21
Q

ventilator associated pneumonia

A
  1. pseudomonas aeruginosa (25%)
  2. staphylococcus aureus (20%)
  3. enterobacter
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22
Q

examples of atypical pneumonia bacterial causes

A
  1. mycoplasma pneumoniae
  2. chlamydia pneumoniae
  3. legionella pneumophilia
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23
Q

features of streptococcus pneumoniae

A
  1. gram positive

2. extracellular, opportunistic pathogen

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24
Q

what happens as a infection spreads lower into respiratory tract?

A
  1. bronchitis
  2. Bronchiolitis
  3. Pneumonia
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25
Q

What four things does pneumonia cause?

A
  1. lung injury
  2. bacteremia
  3. systemic inflammation
  4. immune response
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26
Q

what can lung damage cause?

A

acute respiratory distress syndrome (ARDS)

-> hypoxemia

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27
Q

what can bacteremia cause?

A

sepsis and deterioration

-> also organ infection

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28
Q

what can systemic inflammation influence

A

immune response and bacteremia

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29
Q

treatment for bacterial pneumonia

-> supportive (3)

A
  1. oxygen (for hypoxia)
  2. fluids (for dehydration)
  3. analgesia (for pain)
    - > may also provide nebulised saline for expectoration and chest physiotherapy
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30
Q

treatment for bacterial pneumonia

-> ABs (2)

A
  1. penicillins e.g. amoxicillin
  2. macrolides e.g. clarithromycin
    - > follow guidelines from local NHS trust
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31
Q

what type of AB in amoxicillin?

How does it work?

A
  1. beta lactam

2. binds proteins in the bacterial cell wall to prevent transpeptidation

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32
Q

How does clarithromycin work?

A

binds to the bacterial ribosome to prevent protein synthesis

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33
Q

what can be used to score pneumonia severity and guide treatment?

A

CURB-65

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34
Q

what type of bacteria do penicillins work against?

A

gram+

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35
Q

most important factor for increasing AB success

A

time of administration

-> then using an effective antibiotic

36
Q

How many months of antibiotics are required (on average) to treat someone with TB?

A

3-6 months

37
Q

what causes pneumonia when it’s not ‘caught’?

A

the bacteria that naturally reside your respiratory tract

-> opportunistic pathogens

38
Q

what is the microbiota?

A

ecological communities of microbes found inside multi-cellular organisms

39
Q

what are commensal microorganisms?

A

microbes that live in a symbiotic relationship with their hot. Provide vital nutrients to the host in the presence of a suitable ecological niche

40
Q

what is a pathobiont?

A

a microbe that is normally commensal, but if in wrong environment can cause pathology

41
Q

what is latent TB?

A

bacteria are living but inactive -> just not found inside granulomas within the resp tract

42
Q

how many ABs are required and for what period to treat TB?

A

4 ABs, period of 6 months

43
Q

is there such thing as a commensal respiratory virus?

A

nope

44
Q

what does serotypes mean?

A

viruses which can’t be recognised by serum ABs

45
Q

different viruses that cause upper respiratory infections (typical) (7)?

A
  1. rhinovirus
  2. coronavirus
  3. influenza
  4. parainfluenza
  5. respiratory syncytial virus
  6. adenoviruses
  7. enteroviruses
46
Q

different viruses that cause upper respiratory infections (atypical) (2)?

A
  1. mycoplasma

2. chlamydia

47
Q

why do viral infections cause disease? (7)

A

cause

  1. cellular inflammation
  2. local immune memory
  3. loss of chemoreceptors
  4. poor barrier to antigen
  5. bacterial growth
  6. loss of cilia
  7. mediator release
48
Q

what is often causing the symptoms you see in respiratory infections?

A

the body’s immune response

49
Q

what do influenza viruses bind to?

A

alpha sialic acids

50
Q

what enzyme does SARS-CoV-2 affect?

A

Spike proteins binds angiotensin converting enzymes 2

51
Q

why is avian flu (H5N1 more severe than influenza A (H1N1)?

A

avian flu binds alpha 2 and 3 sialic acids - flu A binds alpha 2 and 6 sialic acids. -
-> the 2 and 3 types are found deeper in the respiratory tracts (E.g. lungs vs trachea)

52
Q

where is ACE2 found in resp system?

A
  1. nasal epithelium
  2. pneumocytes
    - > raised in smokers
53
Q

What do rhinoviruses bind?

A

ICAM-1 -> minor group LDL family of receptors

-> found in upper resp tract (trachea is lowest point)

54
Q

What does respiratory syncytial virus F and G proteins bind?

A

glycosaminoglycans in receptors like IGFR1 and nucleolin

55
Q

can you get re-infected with the same strain of RSV?

A

yes

56
Q

can you get re-infected with the same strain of influenza?

A

no

57
Q

what can indicate a severe lower resp infection on an xray

A

diffuse bilateral opacities

58
Q

what leads to severe respiratory disease?

A
  1. innate differences
  2. immunodeficiency e.g. IFITM3 gene variant
  3. B cell
  4. T cells
  5. predisposing illness/conditions e.g. elderly, diabetes, obesity
59
Q

what family of cytokines is v important in viral immune response?

A

interferons

60
Q

How many groups of IFNs are there?

A

3 (I, II, III)

61
Q

example of type I IFN

A

IFN-alphas

IFN-betas

62
Q

example of type II IFN

A

IFN-gamma

63
Q

example of type III IFN

A

IFN-lambda(?)

64
Q

why are interferons named as such?

A

their ability to interfere with viral infection in vitro

65
Q

who produces intereferons?

A

infected cells, activated immune cells

66
Q

example of a receptor that interferons signal through

A

IFNAR1/2

67
Q

what are induced when IFNAR1/2 are stimulated?

A

Interferons signalling genes (ISGs)

68
Q

what immune compartment provides long term protection after vaccination and natural infection?

A

b cells

69
Q

what is the leading cause of infant hospitalisation in the work, and what % of children are infected in year 1 and 3?

A

RSV
50% of children in year 1
All by year 3`

70
Q

what percentage of children hospitalised with RSV develop severe bronchiolitis?

A

1%

71
Q

can RSV repeatedly infect children?

A

yes

72
Q

viruses similar to RSV but are at lower prevalence?

A

hMPV and PIV

73
Q

risk factors for RSV in kids

A
  • premature birth
  • cogenital heart
  • lung disease
74
Q

presentation of RSV in babies (

A
  1. chest wall infection
  2. nasal flaring
  3. hyoxaemia/cyanosis
  4. croupy cough
  5. expiratory wheezing, prolonged expiration, rales and rhonchi
  6. tachypnea with apneic episodes
75
Q

is RSV worse with inc/dec age?

A

dec

76
Q

treatment options for RSV

A
  1. vaccines
    2 monoclonal ABs
  2. antivirals
77
Q

what happens to RSV ABs after infection?

A

the wane very rapidly

-> same with corona

78
Q

what type of infection can interact with viral infection?

A

bacterial coinfections

79
Q

which sialic acids does influenza A bind in the respiratory tract?

A

alpha 2 and beta 3 sialic acids

80
Q

How does the CURB-65 criteria work?

A

1 point for each parameter:

Confusion
Urea: BUN >7mmol/L
Respiratory rate: .30
Blood pressure: systolic <90 OR diastolic = 60

65: Age >65 yrs

81
Q

What would the curb 65 score indicate?

A

0 or 1: outpatient care
2: inpatient
3 + : ICU

82
Q

What is the leading cause of mortality in children under 1?

A

Lower resp infections- RSV most common

83
Q

How many individuals are believed to have latent TB?

A

1 in 4

84
Q

What pathogen accounts for majority for resp infections?

A

Rhinovirus

85
Q

Why is there no RSV vaccine?

A 
Poor immunogenicity (can get infected again)
Vaccine-enhanced disease

BRS Year 2 (110 decks)

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