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CRRAB 2 Week 3 > Infections of the Upper Respiratory Tract > Flashcards

Infections of the Upper Respiratory Tract Flashcards

1
Q

What are the 3 general ways bacteria cause disease?

A
  1. bacterial proliferation an dinvasion
  2. toxin production
  3. host immmun response damage
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2
Q

What are the 3 general ways viruses cause diasease?

A
  1. cytopathic effect - disrupt normal cell physiology and lead to cell death
  2. host immune response damage
  3. tumorigenesis
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3
Q

What infections are considere upper respiratory tract infections?

A

otitis externa and media, sinusitis, rhinitis, pharyngitis, epiglottitis, laryngitis/croup

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4
Q

What infections are considered lower respiratoyr tract infections

A

bronchitis
bronchiolitis
pneurmonia

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5
Q

What are the 5 main features of the respiratory tract that help rid the system of potential pathogens?

A
  1. mucociliary lining of the nasal cavity
  2. change of direction of the airway from the sinuses to the pharynx (location of adenoids)
  3. The ciliary elevator
  4. Normal flora competition (in upper)
  5. Alveolar macropahges and IgA in the lungs (in lower)
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6
Q

What are the two main obstacles that a microorganism must overcome in order to initiate infection in the respiratory tract?

A
  1. avoid or survive in the mucous layers

2. Avoid phagocytosis or be able to survive/multiple in the phagocytic cell

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7
Q

Describe what the turbinates do for avoiding infection?

A

they’re battle plates covered in mucous that will collect particles not filtered by nasal hairs

their shape causes air to swirl as it passes over them, making pathogens more likely to hit the wall and stick

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8
Q

What are the two physical characteristics of hte mucociliary escalator that allow it to trap particles and get them out?

A

It two basic parts: mucous-producing goblet cells and ciliated epithelium

the cilia beat to push the ucous up and into the throat for swallowing

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9
Q

What effect does smoking seem to have on the mucociliary escalator?

A

it paralyzes the cilia, so you don’t get movement of mucous up and out

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10
Q

What are 4 infection conditions that must be met in order to establish a respiratory tract infection?

A
  1. must be sufficient “dose” or microorganism
  2. infectious particles must be airborne
  3. airborne particles must be viable in the air
  4. organism must be dpeosited on tissue susceptible to infection in the host
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11
Q

What is the most common upper respiratory infection?

A

rhinitis, or the common cold

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12
Q

What causes the vast majority of rhinitis?

A

they’re almost viral, with the majority being rhinoviruses

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13
Q

What are some other viruses that cause rhinitis?

A

next top two are coronarviruses and adenoviruses

also parainfluenza, influenza C virus, coxsackie A and B, and adenoviruses

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14
Q

Why do the rhinitis viruses typically cause only upper respiratory infections and not lower respiratory infections?

A

they preferentially replicate at 33 dC (tempr of the nose and upper airway) and not at 37 d C (temp of the lungs0

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15
Q

Descrive the symptoms of rhnitis.

A

Just a head cold - nasal congestion, sneezing, HA, tiredness, lacrimation, sore throat, slight fever, anorexia, cough

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16
Q

How to rhinoviruses adhere to the epithelium of the repsiratory tract?

A

they have receptors that can bind to ICAM-1 of the nasal passage and pharynx cells

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17
Q

What family of viruses are the rhoniviruses in?

A

the picornaviridea (pico RNA)

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18
Q

What happens to the cilliated epithelial cells in rhinovirus infections?

A

inflammation and lytic infection kills them - destroying the mucociliary escator

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19
Q

When do the ciliated epithelial cells become regenerated? What does this set you pu for?

A

it takes 14 days for them to regenerate

this means secondary bacterial infections by normal flora is possible in the time just after a head cold

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20
Q

What symptoms would suggest you have a secondary bacterial infection?

A

nasal secretion becomes more purulent and fever gets bad

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21
Q

For rhinovirus: DNA or RNA? Capsid? Envelope or nonenveloped? Genome?

A

RNA
icosahedral
nonenveloped
SS+ nonsegmented (class 4)

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22
Q

For Coronavirus: DNA or RNA? Capsid? Envelop or nonenveloped? Genome?

A

RNA
Helical (with corona)
Enveloped
SS+ nonsegmented (class 4)

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23
Q

FOr Adenovirus (mastadenovirus): DNA or RNA
Capsid?
Enveloped?
Genome?

A

DNA virus
icosahedral
nonenveloped
DS linear DNA (Group 1)

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24
Q

Parainfluenza viruses use what surface protein to form multinucleated giant cells?

A

Viral fusion (F) protein

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25
Q

Although paraifluenza is one of the causes of rhiitis in adults, what can it cause in chidlren?

A

croup and pneumonia

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26
Q

How does parainfluenza adhere to the respiratory tract to start infection?

A

infects the larynx mcuosa via contact of viral hemagglutinin envelop protein with sialic acid on cell surfaces (leads to endocytosis)

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27
Q

What protein does parainfluenza virus ahve to cleave the hemattlutinin bound to sialic acid in order for viral spead?

A

neuroaminidase

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28
Q

What is the treatment for parainfluenza rhinitis? Croup?

A

rinitis - just supportive

croup - supportive and corticosteroids and oxygen in severe cases

29
Q

How can you clinically distinguish a coronavirus rhinitis form a rhinovirus rhinitis?

A

you can’t

30
Q

What are the two big scary coronarviruses in the news?

A

SARS and MRS

31
Q

How does influenza C virus differ from influenza A and B?

A
  1. has 7 RNA segments instead of 8
  2. Less virulent than A
  3. No animal reservoir
  4. Doesn’t respond to amantadine or rimantadine
32
Q

How does influenza C establish and maintain an infection in the respiratory tract?

A

like parainfluenza….

inhaled via aerosols
infects the larynx mucosa via contact between viral hemagglutinin envelop protein with sialic acid on cell surface

replicates inside and kills cell

viral neuroaminidase cleaves HA bound to sialic acid permitting viral spread

33
Q

Most viruses cause rhinitis more in the fall and winter. which is more common in the summer and fall?

A

coxsackie A and B

34
Q

Why are adenoviruses called that?

A

latent virus can often be found in the tonsillar adenoids following infection

35
Q

Done with rhinitis….

What is sinusitis defined as?

A

inflammation/infection of the mucosa of the nasal passages and at least one of the paranasal sinuses that typically lasts no longer than 4 months

36
Q

What are the two most common causes of community acquired acute BACTERIAL sinusitis? WHat are two other possibilities?

A

streptococcus pneumoniae
haemophilus influenzae

streptococcus pyogenes and straph aureu

37
Q

Fungal sinusitis is rare and usually identified after antibiotics fail. What’s the most ocmmon cause of fungal sinusitis?

A

aspergillus fumigatus

38
Q

How do you deal with a fungal sinusitis?

A

you have to mechanically remove it

39
Q

Is sinusitis usually bacterial or viral?

A

usually just viral at first

40
Q

What percentage of adults and kids have viral rhinosinusitis that progresses to bacterial infection?

A

2% of adults and 10% of kids

41
Q

When do you usually give a diagnsis of bacterial rhinosinusitis as opposed to viral?

A

THey’re hard to differentiate

Bacterial if an adult has moderate symptoms that persist beyond 7 days or severe symptoms of any duration with facial swelling or tooth pain

Bacterial if kid has moderate symptoms longer than 10-14 days or when there’s severe symptoms including a fever over 102 degrees with facial swellign or pain

42
Q

Do we typically use narrow or broad spectrum antibiotics for bacterial sinuitis?

A

broad spectrum - amoxicillin or azithromycin

43
Q

Describe the morphology and characteristics of Srep pneumoniae.

A 
gram positive diplococci
catalase negative
alpha hemolytic
bile-sculin negative
optochin susceptible

quellung reaction

44
Q

90% of pharyngitis in adults and 60-75% of pharyngitis in children are caused by what?

A

viruses

45
Q

What is the most common bacterial cause of acute pharyngitis?

A

streptococcus pyogenes

46
Q

What are some symptoms that suggest a viral cause for a pharyngitis?

A 
counjunctivitis
cough
hoarseness
inflammation fo the mucous membrane
diarrhea
47
Q

How do patients with strep pyogenes pharyngitis commonly present?

A

with fever and sudden onset severe pain upon swallowing

HA, N/V, Adb pain may be present
red tonsils with/wouthout exudate and enlarged tender cervical lymph nodes often present

48
Q

What test do we do if we susepct strep pyogenes pharyngitis?

A

rapid strep test

49
Q

Even though strep pyogenes pharyngitis is usually self limited, we always try to treat with ABx within 9 days of the first signs of infection. Why?

A

to avoid development of glomerulonephritis and rheumatic fever

50
Q

What are some of strep pyogenes virulence factors?

A

streptokinase to ocnvert plasminogen to plasmin for fibrinolysis

M protein to resist pahgocytosis

hyaluronidase to break down CT

DNAse to break down DNA

51
Q

What is the morphology and characteritics of strep pyogenes?

A

gram positive cocci in chains
catalase negative
beta hemolytic
bacitracin sensitive

52
Q

What antibiotics do we typically give for a bacterial pharyngitis?

A

penicillin or erythromycin

53
Q

How do certain strains of S pyogenes cause scarlet fever?

A

they secrete streptococcal pyogenic exotosins SPeA, SpeB, SpeC and SpeF - encoded by a lysogenized bacteriophages (not be the bacteria itself)

54
Q

What do these streptococcal pygoeni exotosins do?

A

they’re superantigens that will trigger diffuse overactivation of T cells

55
Q

What are the typical symptoms of scarlett fever?

A

1

56
Q

If staph bacteria use catalase to deal with hydrogen peroxide, what do step bacteria use?

A

peroxidase

57
Q

What is the morphology and characteristics of corynebacterium diphtheriae?

A

gram positive bacillia
non-spore forming
non-motile

58
Q

What kind of toxin does diphtheriae have?

A

an A-B exotosin from genes on a lysogenized phage

59
Q

What will diphtheria toxin do?

A

It disrupts EF-2 which is necessary for protein synthesis in cells

if it reaches the blood it can cause myocarditis, heart failure, and neuritis with temporary paralysis of limbs, soft palate and diaphragm

60
Q

What forms in the back of the throat in diphtheria? What should you do with it?

A

a pseudomembrane of bacterial cells WBCs and dead tissue

don’t disrupt it because that could cause bleeding ad allow the diptheria toxin to get in the blood

61
Q

What medium do we grow C. diphtheria on to identify?

A

potassium tellurite

it will reduce the postassium tellurite, making it change color to black

62
Q

What is the bigger term for croup?

A

laryngotracheobronchitis

63
Q

What are the symptoms of croup?

A

mild fever, restlessness, SOB, nasal congestion, sore throat, harsh bark-like cough, respiratory stridor

64
Q

Are most croup infections viral or bacterial?

A

viral

65
Q

What is the most common viral cause of croup?

A

respiratory syncytal virus

66
Q

What protein is important for viral ttachment in RSV?

A

G surface protein

67
Q

What RSV protein makes infected cells fuse to form syncytia?

A

F protein

68
Q

For RSV: DNA or RNA, envelope? genome?

A

RNA
helical
enveloped
SS- nonsegmented

CRRAB 2 Week 3 (10 decks)

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