KEY wk 5 lec 1 Flashcards
rhinitis is what cell inflammation and what Ig_
eosinophilic inflammation and IgE
what cytokines are made by activated T cell in allergic rhinitis (after sensitization + re-exposure)
IL-4, IL-5, IL-13
early phase response:
IgE –> mast cell degranulation –> release ____ —> allergic rhinitis sx (rhinorrhea, nasal congestion, sneeze)
histamine
histamine affects what nerve for sneezing
histamine, leukotrienes, prostaglandin cause secretion of ___ + what via blood vessels
trigeminal (V)
mucous (rhinorrhea) + nasal congestion
late phase of allergic rhinitis is ___ hours after
what makes late phase persist
4-6 hours after (up to 24hrs)
T cells, basophils, eosinophils releasing histamine, kinins, leukotrienes
mast cells secrete IL4, IL5, IL13
cytokines upregulate vascular cell adhesion molecule 1 (VCAM-1) on endothelial cells for T cells and eosinophils and basophils to enter nasal mucosa
common causes of allergic rhinitis and comorbidities
Food allergens such as milk, eggs, soy, and wheat, dust mites, and inhalant allergens such as pet dander (in infancy and childhood)
pollen (in older kids)
comorbidities such as atopic dermatitis, otitis media, and asthma.
dysbiosis causes abnormal allergic reactions by switch immune to Th_ and Ig_
Th2 and IgE
(from Th1, Treg, IgA)
changes in microbiome and association with allergic rhinitis
Increased Bacteroidetes; S. Shigella, E. coli, Parabacteroides, Lachnoclostridium, Dialister.
decreased Actinobacterium, Proteobacterium, and Escherichia coli. Oxalobacter and Clostridiales.
less diversity
- More abundant Bacteroidetes; reduced Firmicutes.
sx of allergic rhinitis vs non allergic rhinitis
Clear and watery nasal discharge, nasal congestion, postnasal drip, and itching of the nose, throat, and eyes.
nonallergic rhinitis are nasal obstruction and clear rhinorrhea. Sneezing and itchy, watery eyes are not common symptoms.
physical exam findings in allergic rhinitis
allergic shiners, transverse supra-tip nasal crease
blue inferior turbinates
cobble stoning of nasal mucosa
Eustachian tube dysfunction
dermatitis + asthma
seasonal vs perennial allergic rhinitis
seasonal: pollination
perennial i.e. dust mild, cockroaches, animal dander, food allergens, irritants (tobacco, chemicals, pollution)
intermittent vs persistent allergic rhinitis
intermittent (< 4 days/week or < 4 weeks’ duration) or
persistent (> 4 days/week or > 4 weeks’ duration)
complications of allergic rhinitis
-adenoid hypertrophy
-Eustachian tube dysfunction
-chronic rhinosinusitis
-nasal polyps
-obstruction of osteomeatal drainage
-sleep disruption (OSA)
-learning disturbances (cognitive, memory, fatigue)
symptoms of neoplasm in nose
epistaxis (nose bleed), pain, and unilateral symptoms
types of non allergic rhinitis
viral (sx: headaches, malaise, aches, cough)
occupational (i.e. dust, cigarette, garden spray, wood particles)
vasomotor
nonallergic rhinitis with eosinophilia (NARES)
rhinitis medicamentosa
rhinitis during pregnancy
vasculitides, autoimmune and granulomatous diseases
most common nonallergic rhintiis
vasomotor or idiopathic
vasomotor rhinitis cause
PNS and SNS and nociceptive nerve dysregulation
PNS: mucous secretion and rhinorrhea via acetylcholine
SNS: vascular tone of nasal mucosa via norepinephrine and neuropeptide Y
mast cell degranulation –> sneezing reflux via neuropeptides and noccipeptive type C fibers of trigeminal nerve
what exacerbates vasomotor rhinitis
seasonal changes in barometric pressure, temperature, or humidity
strong odors, cold air exposure, alcohol consumption, and spicy foods.
Nonallergic Rhinitis with Eosinophilia (NARES)
nasal obstruction and cogngestion with sinusitis and polyposis
> 25% eosinophilia ut not allergic to inhalant allergens
rhinitis medicamentosa
from overuse of topical nasal decongestants (oxymetazoline, phenylephrine)
“rebound congestion”
rhinitis during pregnancy pathophysiology
increase estrogen –> increase hyaluronic acid in nose –> congestion and edema
decerase nasal cilia and increase mucous glands
2nd and 3rd trimester
Vasculitides, Autoimmune, and Granulomatous Diseases (non allergic rhinitis)
systemic diseases with inflammation –> turbinates, rhinorrhea, polyposis ??
chronic rhinosinusitis
timeline
sx
> 12 weeks
nasal obstruction, facial congestion, pressure + fullness, discolored nasal discharge, hyposmia, fatigue, myalgia
pathophysiology in chronic rhinosinusisits
inflame, reduce oxygen, bacteria grow, ciliary dysfunction, hyperplasia of mucus glands, lymphocyte infiltrate
2 factors causing chronic rhinosinusitis
biofilms (from bacteria and toxins)
bacterial superantigens (nasal polyps causes by exotoxins from s. aureus)
pathophysiology of chronic rhinosinusitis
osteitis (inflamed bone)
allergy
barrier and innate immune dysregulation; impaired tight junctions, dysbiosis, less AMPs
genetics and systemic diseases; granulomatosis with polyangitis, aspirin exacerbated respiratory disease, cystitis fibrosis
dysfunctional mucocillairy clearance
features of chronic rhinosinusitis
-purulent discharge (yellow or green)
facial/dental pain
nasal obstruction
hyposmia (smell), headaches, ear pain, halitosis (bad breath), fatigue, fever
nasal endoscopy: 1+ of purulent drainage, polyps, polypoid changes in the mucosa, and edema or erythema.
nasal polyps develop from ____ and contain ______-
sinonasal mucosa
plasma cells, lymphocytes, eosinohpils
nassal polyps from Th_ driven eosinophilia, Ig_ and high IL_
Th2, IgE, IL5
clinical presentation of nasal septal deviation
headaches, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds
pharyngotonsillitis
viral (~80% - mostly acute) or bacteria infection (GABHS in kids) of pharynx and tonsils
sx of acute pharyngotonsillitis
fever, malaise, odynophagia (pain when swallow), dysphagia, and foul breath.
airway obstruction –> mouth breathing, snoring, sleep problems
viruses that cause phayngotonsillitis
adenoviruses, rhinoviruses, Coronaviruses, Epstein-Barr viruses (EBVs), cytomegaloviruses (CMVs), Coxsackieviruses, herpes simplex viruses, HIVs, and influenza viruses.
EBV causing pharyngotonsillits
part of herpes family; infections mononucleosis (via oral)
infect B cells then T cells
links to lymphomas and carcinomas
EBV causing phayngotonsillitis sx
high fever, generalized malaise, lymphadenopathy, hepatosplenomegaly, and pharyngitis.
exudate and obstruct airways on tonsils
typhoid hypertrophy (esp posterior nodes)
HIV causing phayngotonsillitis
acute retroviral syndrome
sx of HIV causing phayngotonsillitis
fever, nonexudative pharyngitis, lymphadenopathy, and systemic symptoms such as arthralgia, myalgia, and lethargy.
Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS) causing pharyngotonsillitis
sx
fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia.
Tonsillar and pharyngeal erythema with purulent exudate
nonsuppurative complications of Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS)
scarlet fever (endotoxin causes rash, fever, dysphagia, strawberry tongue)
acute rheumatic fever (cross reactive antibodies cause Endo,myo or pericarditis)
post streptococcal glomerulonephritis (acute nephrotic syndrome)
suppurative complications of Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS)
Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection (causes compulsive tics and behaviours from anti neuronal antibodies cross reacting in basal ganglia)
Peritonsillar abscess (unilateral pain, odynophagia, dysphagia, voice, trsimus/lock jaw, uvular deviation)
parapharyngeal abscess (peritonsillar abscess spreads- trsimus, decreased neck ROM)
retropharyngeal abscess (from peritonsilar abscess spread to lymph- cervical lymphadenopathy, stiff neck)
causes of peritonsillar abscess
GABHS, s. aureus, H influenza….
non group A streptococcal pharyngitis causing pharyngotonsillits
which group
group C and G stretocococci
similar sx but less severe
pharyngeal diphtheria causing pharyngotonsillitis
what type of diphtheria and cause and sx
Corynebacterium diphtheria
from childhood immunization
gray pseudomembrane on tonsils, compromised airway, cardiac toxicity and neurotoxicity from exotoxins
STIs that cause pharyngotonsillitis
sx
n. gonorrhoea and t. pallidum
exudative pharyngitis, oral syphillis (chancre, ulcers)
fungal infections causing pharyngotonsillitis
cause
sx
Candida albicans –> oropharyngeal candidiasis “thrush”
cottage cheese like plaques
recurrent acute tonisilits vs chronic tonsillitis causing pharyngotonsillitis
Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae
CHRNOIC
> 3 months with halitosis (bad breath) and cervical adenopathy
Staphylococcus aureus, Haemophilus influenza, and Bacteroides
tonsilloliths causing phayrngotonsillitis
microbial biofilms formed in tonsillar crypts –> hard white masses
aphthous ulcers (canker sores) caused by
appearance
risks
human herpesvirus 6
yellow-gray fibrinoid center with red halo
stress, bedtime after 11pm, ulcerative stomatitis
supraglottitis (epiglottitis)
cause
sx
haemophilus influenza type B
fever, odynophagia, drooling, muffled voice, inspiratory stridor
laryngitis
causes
mostly viral (parainfluenza viruses)
bacterial (neumoniae, H influenzae, and M catarrhalis)
fungal (if immunosuppressed or on antibiotics)
non infectious (vocal trauma like screaming, allergies, GERD, asthma, smoking)
laryngitis sx
raspy, hoarse voice or loss of voice
dry cough
bacterial tracheitis
cause
SX
staphylococcus aureus
airway obstruction, fever, (no drooling or dysphagia like in supraglottitis(
