EXAM #2: VIRAL INFECTIONS OF THE RESPIRATORY TRACT Flashcards
What two viruses cause the majority of common colds?
1) Rhinovirus
2) Coronavirus
What viruses cause the more severe lower respiratory tract infections (5)?
1) RSV
2) Parainfluenza virus
3) Influenza
4) HSV
5) CMV
Describe the epidemology of the SARS virus. How does the severity of infection compare to MERS?
SARS virus is a coronavirus associated with a BAT reservoir. Compared to MERS, it generally is:
- More common
- Less lethal
Describe the epidemology of the MERS virus.
MERS virus is a coronavirus associated with a CAMEL reservoir. Compared to SARS, it generally is:
- Less common
- More lethal
What are the typical symptoms associated with influenza?
1) Fever
2) Myalgias
3) Headache
4) Rigors
5) Cough
*All peaking within 3-5 days of illness
What are the four main patient groups associated with increased risk for influenza complications?
1) Children under 2 y/o
2) Adults over 65
3) Pregnant women and women up to 2 weeks post-partum
4) Laundry list of medical conditions, including DM
Compare and contrast the characteristics of the 4 influenza antiviral agents.
Neurominidase inhibitors= still used today for influenza A and B
1) Zanamivir= Inhalation
2) Oseltamivir= Oral
Adamatanases= M2 inhibitors that are NOT routinely used today b/c of high drug resistance
3) Amantadine
4) Rimantadine
List the characteristics of secondary bacterial pneumonia complicating influenza infection.
- Biphasic pattern of sx.
- Onset 7 days post influenza
- Gram stain= positive for bacteria
*S. pneumoniae, S. aureus, H. influenza
List the characteristics of primary influenza pneumonia.
- Progressively worsening
- Onset 1-4 days post sx. onset
- No bacterial on gram stain
- Interstitial pattern on CXR
What are the categories of influenza vaccines?
1) Inactivated= formalin inactivated
2) Live attenuated= attenuated
3) Recombinant= hemagglutinin protein
What are the different routes of administration for the three types of influenza vaccines?
1) Inactivated= IM or intradermal
2) Live attenuated= Intranasal
3) Recombinant= IM
What are the eligibility requirements for the different influenza vaccines?
1) Inactivated
- IM= Greater than 6 months w/ chronic medical conditions
- Intradermal= 18-64 years
2) Live attenuated= healthy and non-pregnant between 2-49
3) Recombinant= 18-49 y/o
What are the symptoms of CMV pneumonitis?
1) Spiking fever
2) Malaise
3) Lethargy
4) Myalgia
5) Arthralgia
What clinical exam findings are associated with CMV penumonitits?
1) Pneumonitis
2) Leukopenia
3) Hepatitis
4) Thrombocytopenia
Describe the incidence of CMV in the following patient populations: Immunocompetent, Immunocompromised, Neotates.
1) Immunocompetent
- Asymptomatic infection
- OR, mono-like disease
2) Immunocompromised
- Transplant= CMV pneumonitis or gastritis
- Advanced HIV= CMV retinitis
3) Neonates= Cytomegalic Inclusion disease
How is CMV transmitted?
1) Intrauterine
2) Breast milk
3) Saliva or genital secretions
4) Blood transfusion
5) Organ transplant
How are ganciclovir, valganciclovir, cidofovir, and foscarnet used in the treatment and prevention of CMV infection?
1) Ganciclovir and valganciclovir= first line (val= higher oral bioavalibility)
2) Cidofovir and foscarnet= 2nd line for resistant CMV infection
What respiratory diseases are associated with HSV?
Can become disseminated in neonates and immunocompromised, leading to pneumonitis
What respiratory diseases are associated with VZV?
- Can spread to the lungs as a complication of chicken pox
- Secondary bacterial pneumonia is seen after chicken pox
What respiratory diseases are associated with EBV?
Mononucleosis
What is Flucelvax?
Inactivated influenza vaccine
What is unique about Flucelvax?
Produced in Madin Darby Canine Kidney cell line (MDCK)
*This is the inactivated vaccine that is NOT produced in egg
What type of vaccine is Fluzone High-Dose?
Inactivated vaccine that is high dose to increase efficacy in adults over 65–more robust immune response
What Fluzone Intradermal?
Quadrivalent intradermal injection
What is FluBlok? What is unique about FluBlock?
IM recombinant influenza vaccine produced in insect eggs; thus, EGG FREE
*This is the best choice for a patient OVER 18 with an egg allergy
What is “owl eye nuceli” pathognomonic for?
Herpes virus, specifically CMV
What is the rule of thumb regarding antiviral treatment in influenza?
- No risk factors= consider antiviral if within 48 hrs of sx.
- Risk factors= treat with antiviral
What is the difference between the trivalent and quadrivalent influenza vaccines?
Tri= 2x A and 1x B Quad= 2x A and 2xB
