Infectious Disease

Question 1

acute bronchitis

Answer 1

-Self-limited inflammation of large airways -> cough without pneumonia
- ≈10% ambulatory care visits -> increased winter and fall
-Viruses most common:
-Influenza A and B
-Parainfluenza
-Coronavirus (types 1-3)
-Rhinovirus
-RSV

Question 2

pathophysiology acute bronchitis

Answer 2

-inflammatory response to infections of epithelium of the large bronchi
-inflamed areas of bronchial and tracheal mucosa thicken
-wide variations in anatomical distribution of many pathogens that cause acute bronchitis
-flemy cough (the epithelium)

Question 3

acute bronchitis symptoms

Answer 3

-Primary manifestation is cough +/- sputum
-50% purulent sputum
-Sloughed tracheobronchial epithelium and inflammatory cells
-Coughing persisting >5 days is suggestive rather than URI -> prolonged cough*
-signs- +/- wheezing and rhonchi**

Question 4

PFTs: acute bronchitis

Answer 4

-generally not indicated
-may become abnormal
-significant reductions in FEV1 -> obstructive pattern
-bronchial hyperreactivity

Question 5

bronchitis/pneumonia lung sounds

Answer 5

-bronchitis- lung sounds (ronchi) clears with a cough
-pneumonia- lung sounds dont clear with cough

Question 6

diff dx bronchitis

Answer 6

-URI- runny nose, sneezing, scratchy throat, headache
-bronchitis- no fever or systemic signs, no consolidations
-pneumonia- fever, tachy, consolidation
-post nasal drip- runny nose, need to clear throat
-GERD- heartburn, regurgitation, dysphagia
-asthma- wheezing, SOB, allergen exposure or exercise
-ACE inhibitors- nonproductive cough, scratchy throat
-heart failure- SOB, orthopnea, gallop rhythm, peripheral edema
-pulmonary embolism- tachy, SOB, pleuric chest pain, hemoptysis
-lung cancer- smoking hx, hemoptysis

Question 7

acute bronchitis dx

Answer 7

-physical exam!
-cough WITHOUT fever, tachycardia and tachypnea suggests bronchitis, rather than pneumonia
-normal vital signs and the absence of rales and egophony (e sounds like A, 99 sounds like yelling)
-chest x-ray- if cant distinguish by physical exam
-Rapid dx tests for several pathogens linked to acute bronchitis -> COVID-19, Influenza, RSV
-Rapid tests should be used:
-Suspected organism is treatable
-Infection circulating in the community
-pt has suggestive symptoms or signs

Question 8

treatment of acute bronchitis

Answer 8

-Antimicrobial agents are NOT recommended in most acute bronchitis **** -> Supportive Care
-Antimicrobial therapy beneficial if treatable pathogen ID: Influenza agents, Pertussis, COVID-19
-inhaled or oral corticosteroids for 7-14 days -> reasonable for troublesome cough (cough for more than 20 days)
-mucolytic or antitussive agents

Question 9

influenza

Answer 9

-Orthomyxovirus
-Highly contagious disease
-Transmitted by respiratory route via droplet nuclei
-Epidemics and pandemics appear at varying intervals, usually in fall or winter
-Affecting 10–20% of global population on average each year
-incubation period/viral shedding average 2 days -> contagious
-more contagious when symptomatic
-antigenic types: A and B produce clinically indistinguishable infections -> C is usually minor

Question 10

2022-2023

Answer 10

-In US there were
-26 to 50 million illnesses
-12 to 24 million medical visits
-290,000 to 670,000 hospitalizations
-17,000 to 98,000 deaths

Question 11

influenza signs and symptoms

Answer 11

-ABRUPT onset of fever, headache, myalgia*, arthralgias, malaise
-Cough, sore throat (no rales/crackles)
-Other presentations:
-Afebrile respiratory illnesses similar to common cold
OR
-S&S with little indication of respiratory tract involvement
-physical findings are FEW in uncomplicated -> hot and flushed, oropharyngeal hyperemia, mild cervical lymphadenopathy, respiratory exam generally unremarkable

Question 12

influenza diff dx

Answer 12

-Common cold
-Primary bacterial pneumonia
-Infectious mononucleosis
-Mycoplasma infection
-Early Legionnaires
-Chlamydophila pneumoniae infection
-Acute HIV infection
-Meningitis
-RSV, COVID

Question 13

influenza dx/labs

Answer 13

-labs- not helpful
-leukopenia is common
-x-ray normal in uncomplicated illness
-Rapid lab tests for influenza antigens from nasal or throat swabs are widely available
-Reverse-transcriptase polymerase chain reaction (RT-PCR) is the most sensitive and specific modality

Question 14

influenza complications

Answer 14

-Pneumonia (MC)
-High risk groups:
-Cardiovascular or pulmonary ds
-Diabetes mellitus, renal disease, hemoglobinopathy, or immunosuppression
-Nursing homes or chronic care facilities
-Over age 50, pregnant, young kids

Question 15

primary viral pneumonia

Answer 15

-from the influenza
-is the flu itself
-not alveoli affected -> interstitial tissue is affected
-Symptoms persist and increase **
-High fever, dyspnea, and progression to cyanosis can be seen
-x-ray - hazy everywhere (not focused to an area)

Question 16

secondary bacterial pneumonia

Answer 16

-from bacterial infection not from flu -> flu is getting better and then bacterial infection -> relapse (get better then worse)
-in addition to the viral flu
-Relapse **
-Higher fevers, cough, purulent sputum, and pulmonary infiltrates* (alveolar) on cxr
-consolidation
-Streptococcus pneumoniae (MC)
-Staphylococcus aureus(2nd MC)- much worse infection
-Haemophilus influenzae

Question 17

influenza complications

Answer 17

-Acute sinusitis
-Otitis media
-Myositis
-Rhabdomyolysis
-Pericarditis
-Myocarditis
-Reye syndrome**- assoc with kids and aspirin use -> dont give aspirin to kids -> encephalopathy
-flu + aspirin = assoc with reye syndrome

Question 18

prevention of influenza

Answer 18

-The trivalent inactivated influenza virus vaccine provides partial immunity (about 85% efficacy) for a few months to 1 year.
-3 formulations
-October and November
-immunity about 2 weeks after vaccine
-Vaccine recommended FOR ALL > 6 mos of age
-immunity takes about 2 weeks after vaccine
-Especially:
-50 & older
-Children receiving long-term aspirin therapy
-Nursing home residents
-Patients with chronic medical problems
-Including lung or heart disease, diabetes, renal failure and immunodeficiencies (such as HIV); pregnant
-Contacts of these high-risk groups including health care workers, service personnel, and caretakers of children younger than 2 years

Question 19

influenza:chemoprophylaxis

Answer 19

-oseltamivir, zanamivir, baloxavir
-given to high risk OR unvaccinated individuals if begun within 48 hours after influenza exposure

Question 20

influenza treatment

Answer 20

-Bedrest, Analgesics (no asa)
-Cough meds
-The neuraminidase inhibitors:
-Zanamivir (two 5mg inhalations twice daily for 5 days) - cant give to pts with asthma
-Oseltamivir (75 mg twice daily for 5 days) -> tamaflu
-Baloxavir (40 mg single dose*)
-Most effective when within 48 hrs of symptom onset

Question 21

who to treat: influenza

Answer 21

-Illness requiring hospitalization
-Progressive, severe, or complicated illness, regardless of previous health or vaccination status
-High risk pts regardless of timing (after 48 hrs)

Question 22

influenza prognosis

Answer 22

-Duration of uncomplicated illness is up to 7 days
-Prognosis is excellent in healthy, nonelderly adults
-Most fatalities are due to bacterial pn (secondary):
-Pneumococcal pneumonia MC
-Staphylococcal pneumonia MS (most severe)

Question 23

bordetella pertussis infection

Answer 23

-whooping cough
-Acute infection of respiratory tract by B pertussis
-Transmission: respiratory droplets
-Incubation period: 7–21 days
-50% < 2yo
-Adults are important reservoir (waning immunization)
-vaccine or past disease does not give lasting immunity to pertussis**

Question 24

bordetella pertussis clinical findings

Answer 24

-symptoms of classic pertussis last about 6 weeks
-divided into 3 consecutive stages
-1. Catarrhal stage- feels like a respiratory infection
-2. Paroxysmal stage- whooping cough
-3. Convalescent stage- recovery

Question 25

bordetella pertussis: Catarrhal stage

Answer 25

-7-10 days
-insidious onset
-Lacrimation, sneezing, coryza, anorexia, malaise, and hacking night cough that becomes diurnal (during day) -> like URI

Question 26

bordetella pertussis: paroxysmal stage

Answer 26

-1-6 wks but up to 10
-fits of coughing that you need to gasp for breath
-Bursts of rapid, consecutive coughs followed by a deep, high-pitched inspiration (whoop), posttussive emesis & fatigue

Question 27

bordetella pertussis: convalescent stage: 1-3 weeks

Answer 27

-Decrease in frequency and severity of paroxysms of cough

Question 28

bordetella pertussis: diff dx

Answer 28

-The differential diagnosis of a prolonged cough includes:
-1. Viral infections — Adenovirus, Parainfluenza virus, Influenza A and B, Respiratory syncytial virus, Coronavirus, Rhinovirus
-2. Bacterial infections — Bordetella parapertussis, Bordetella bronchiseptica, Chlamydophila (formerly Chlamydia) pneumoniae, Mycoplasma pneumoniae, tuberculosis, acute exacerbations of chronic bronchitis
-3. Noninfectious causes — Asthma, foreign body, postnasal drip, GERD, and malignancy

Question 29

bordetella pertussis labs and CXR

Answer 29

-WBC usually 15,000–20,000/mcL
-CXR: Subtle changes
-Peribronchial cuffing (walls of bronchi are edematous -> donut sign), perihilar infiltrates, interstitial edema, or atelectasis
-Pulmonary consolidation (20 %)
-primary or Secondary bacterial pneumonia

Question 30

bordetella pertussis complications

Answer 30

-Pneumonia (primary and secondary)
-Reactive airway disease
-Lumbar strain, rib fracture, inguinal hernia
-Syncope, pneumothorax/pneumomediastinum
-Subconjunctival hemorrhage, subdural hematoma
-Encephalopathy (secondary to diffuse hypoxia)
-Seizures
-Wt loss/failure to thrive
-Pulmonary hypertension
-Hearing loss

Question 31

pertussis diagnosis

Answer 31

-Diagnosis: combinations of diagnostic tests to identify persons with pertussis, based upon the duration of cough
-Within 2 wks of onset of cough -> order bacterial culture and PCR
-Cough present 3-4 wks -> PCR and serologic test
-Cough > 4weeks -> a single serologic test

Question 32

pertussis prevention

Answer 32

-Acellular pertussis vaccine: infants, combined with diphtheria and tetanus toxoids (DTaP)
-Booster vaccination: adolescents/adults
-Post exposure:
-Infants and susceptible adults with significant exposure should receive prophylaxis with an oral macrolide (azithromycin)
-Even if vaccinated*

Question 33

tx and post exposure tx for pertussis

Answer 33

-adults - ZPAC- azithromycin

Question 34

respiratory panel

Answer 34

-done in ER usually bc expensive
-tests for various diseases
-viruses- pertussis, RSV, influenza
-bacterial- mycoplasma pneumonia, chlamydophila pneumonia