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LRT infections Flashcards

1
Q

primary agent of viral croup (laryngotracheobronchitis)

A

hPIV (hum. parainfluenza v)

pk: 2-6yo

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2
Q

PIV

A

paramyxovirus, types: 1–>4, no grp. sp. Ag

Hamagglutinin and neuraminidase activity

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3
Q

causes of peds bronchitis and pneumonia

A
  1. RSV 2. PIV 3. Adenovirus 4. hMPV
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4
Q

agents of viral croup

A

PIV, influenza A/B, RSV, hMPB, Ad, non-polio enteroviruses, measles

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5
Q

viral croup is the most common cause of what in 6mo to 6 yo children

A

RT obstruction

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6
Q

croup presents with this..

in contrast to acute epiglottitis

A

SUBglottal edema vs. AE: SUPRAglottal edema

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7
Q

in croup..symptoms first manifest here, then migrate here

A

in URT 1st then larynx, trachea, bronchi

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8
Q

croup clin. manifest: Laryngotracheitis

A

rhinitis first, then sudden onset sore throat, hoarse/bark, stridor, SOB
steeple sign (not pathog.)
apprehension, rhonchi, crep, wheeze, dim. BS
*symps vary in intens. last 3-4d if mild

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9
Q

other croup clin. manifest:

A

bronchiolitis-bronchopneumonia

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10
Q

major complications of croup

A
  1. Secondary bac laryngotracheitis:
    as recov. from viral croup; px w. high fever, toxicity, RD
  2. OM
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11
Q

viral croup dx

A

DFA/EIA, viral Cx, direct exam/endoscopy (be careful), NXR (“steeple sign”) to ddx from virus-like, bac., AE, airway obstr, asthma

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12
Q

viral croup tx

A

supportive
oral/IM dexamethasone (better than neb. budesonide) or racemic epinephrine (bronchodilate)
NO VACCINE for viral croup

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13
Q

this is the most common infection of LRT in infants & leading cause of hosp. in childhood…
and the #1 agent is..

A

bronchiolitis

RSV

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14
Q

is chronic bronchitis an infectious disease?

A

no (inflamm), but low #s may be present

def: dyspnea, airflow limit, sputum production, chronic prod. cough (3mo/year for 2 yrs)

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15
Q

is COPD an infectious disease?

A

no (inflamm), but low #s may be present

reduction in FEV1:FVC

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16
Q

AE-CB or AE-COPD

A

acute exacerbation; frequently causes by viral/bacterial inf. disease

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17
Q

neonate acute inf. bronchiolitis (AIB) agents

A

Strep agalactiae, E. coli, Klebsiella pneumoniae, Ureaplasma urealyticum, and U. parvum, Chlamydia trachomatis

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18
Q

infants/young kids: inf. bronchiolitis (AIB) agents

A

primarily VIRAL:
RSV, hMPV, influenza v, PIV, Ad, HBoV, Rhinovirus, coronavirus
much less bac: B. pertussis, Mycoplasma pneumo, Chlamydia pneumo

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19
Q

sig. manifest. of AIB

A

tachypnea, wheezing

NO PNEUMONIA: only scattered wheezing at lung base, but clear lung field

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20
Q

bronchitis and bronchiolitis: infectious diseases?

A

may or may not be

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21
Q

bronchitis common etiology: viral or bac?

A

viral more common: (RSV, influenza, etc)

bac: Mycoplasma pneumo, Chlamydia pneumo, Bordetella pertussis

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22
Q

bronchitis prodrome

A

URT s/s: ha, sore throat, coryza then LRT symps: cough (if prod: sloughing of tracheobronch. epi) +/- bronchospasms, SOB, etc

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23
Q

distinct bronchitis negatives

A

NO FEVER (typically, or low)
NO tachycardia, tachypnea
NO pneumonia: clear CXR, no rales, no egophony, *scattered wheezing @ base

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24
Q

bronchitis tx: abx?

A

NO! not for immuncomp pts, also NO antivirals
*if Dr. decides on abx: macrolide, may decided on antivirals for susp. influenza otherwise tx: bed, fluids, cough suppressants, expectorants

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25
AE-CB and AE-COPD bac pathogens:
NTHi**, Moraxella catarrhalis, Strep pneumo
26
AE-CB, AE-COPD: more commonly exacerbated by bacteria or virus?
bacteria! freq. a new strain if virus: influenza*, RSV other cause: allergies, immpath
27
how to dx AE-CB/COPD
bronchoscopy spec. collection: Cx, sens. | >10^3 CFU/mL of agent needs to be det.
28
AE-CB/COPD: abx?
no evidence that can prevent, complex decision
29
the most important agent of LRT infections in infants? | characteristics...
RSV: paramyxovirus, F and G surface glycoproteins strain A* and B (A is the more virulent strain) danger!: high attack rate (95%), no vaccine
30
ped. pneumonia, bac or viral more common?
90% viral (50% of that is RSV) | all kids have been inf. w/ RSV by 2-3 yrs
31
RSV is #1 cause of these in infants
LRT diseases: bronchitis, bronchiolitis, pneumo | RSV bronchiolitis can lead to asthma
32
these kids are especially at risk for RSV-caused pulm disease
premature and underlying disease(cardiac, resp, cong: pulm HTN, CLD edt.), American Indian infants and disease will be more severe
33
RSV affects adults as
reinfection: common cold, minor URT disease
34
RSV affects elderly w/
COPD/CB, immune comp. (organ transplant), LRT disease | *cause bronchopneumonia
35
LBW VLBW ELBW
36
RSV patho. (bronchiolitis)
virus replicates in resp. epi (nasal, throat, bronchi)-->syncytia formation-->necrosis-->sloughing of epi-->inflammation, edema-->inc. sec. or mucus from epi-->obstr. airflow *immpath exacerbations: type 1 hypersent. to viral AG (IgE) and rel. of mediators
37
RSV bronchiolitis manifestations (infant)
rhinorrhea, cough, NO/LOW GRADE FEVER( + suggests 2 bac inf), dyspnea, cyanosis +/- exp. wheezing/emphysema, hyperinflation, atelectasis -inc. AP chest diameter, tachy x2, wheezing (whistling), retraction, hepatosplenomegaly
38
RSV bronchiolitis CXR findings
inc. AP diameter | loose floppy diaphragm
39
RSV bronchiolitis: self-lim? tx?
is self-limited, but do tx
40
reinfect. pres
children: sev. rhinitis and pharyngitis (lim. bronchi) adults: afebrile rhinitis, viral pharyngitis elderly: ARDS-->viral pneumo
41
RSV bronchiolitis lab collections
nasopharyngeal sec, resp asp. w/ epi cells-->DFA/IF/ELISA
42
RSV bronchiolitis tx: antiviral?
YES: Ribavirin: broad-spec. antiviral (inhib capping and elong. of viral RNA): improv. O2 also: aeorosolized bronchodil. w/ IV theophylline corticosteriods, mucolytics (Dornase alpha) *MAINTAIN AIRWAYS* keep air moist`
43
give passive immunization therapy to pt. presenting w/ RSV bronchiolitis?
NO! it only works for prevention RSV-IGIV, Anti-RSV MoAb (Palivizumab, Motavizumab)*to replace the IGIV -give ev. mo. to premie infants/infants w. CLD *NO VACCINE CANDIDATES
44
hMPV (hum. Metapneumovirus)
paramyxovirus | causes dis. sim to RSV, but more mild
45
HBoV (hum. Boca virus)
family: Parvoviridae (B19) causes both URT/LRT inf. *pk incidence MARCH-MAY no inf. Aug-Sept. -pertussis-like syndrome, diarrhea*
46
causes of whooping cough.. where affected? when?
Bordetella pertussis ("pertussis") tracheobronchial tree *LATE SUMMER/EARLY FALL high attack rate! affects infants*/y. kids
47
Bordetella pertussis
sm. aerobic G-rod, ox + Pertussis TOXIN (PT)-->ADP ribosylation of GTP BP-->LYMPHOCYTOSIS-->PT induces prot. Ab (7-16 d incubation) non-invasive and exotoxin (exc. PT) remain localized
48
hallmark of pertussis
LYMPHOCYTOSIS (entrapment in vasc/lymph compartments): 12-20,000 per mm3
49
other factors of pertussis: FHA, Pertactin, TCT
FHA (filamentous hemagglytinin): adherence factor, acts w/ PT to induce leukocytosis/ prot. Abs Pertactin (69 kDa protein): adhesion, ind. Ab TCT: (Tracheal cytotoxin) + endotoxin induce NO production-->kills ciliated epi cells
50
pertussis epidemics occur every 2-5 yrs despite vaccinations! main reason:
circulating strains w. INCREASED VIRULENCE ("breakthru" strains) other reasons: vaccine failure, failure to comply w/ immun., waning adult immunity
51
the most commonly rep. vaccine-prev. dx in kids
Pertussis
52
damage by pertussis exotoxin
to ciliated epithelium: aggr bac in cilia, sticky mucus, PMN accum. dec. act/loss of cil. epi, prod. of fluid/mucus/eduma
53
does pertussis vaccination/disease confer immunity?
YES: prolonged (7-20 yrs) but not permanent
54
Pertussis stages: Cartarrhal
highly inf., URT cold-like disease (cough, slight fever, etc) 1-2 wks Cx/abx effective here but NOT INDICATED Cx would be done via aspiration > Dacron nasopharyngeal swab, DFA
55
Pertussis stages: Paroxysmal/spasmodic
classic, 4-6 wks, 5-10 coughs + mucus then inspirational "whoooop"!, +/- vomiting, apnea, lymphocytosis* in kids, NO FEVER** (unique for bac inf) few syt. signs--> need hosp.
56
Pertussis stages: Convalescent
gradual, cough dec. (may continue 2-6 wks) | superimposed viral resp inf. can trigger recurrence
57
differences in adult pertussis
paroxysmal cough (>14d), NON-PRODUCTIVE, worse at night, PERIPH. LYMPHOCYTOSIS IS RARE
58
breakthrough pertussis infections in vaccinated children due to
high virulence of B. pertussis
59
complications of pertussis
secondary bac. pneumo (main cause of mort) toxic enceph. or anoxia substn. weight loss/sleeping problems
60
pertussis tx: abx?
YES, but only effective @ catarrhal stage | eryth, clarith, azithromycin or TMP-SMZ
61
pertussis: vaccine?
YES: DTP: P: whole cell (SE: fever, NOT rec. for kids w. seizure/neuro risk), 5 doses, last 4-12 yrs DTaP/dTaP: aP: acellular, 5 doses: 2,4,6 mos then 12-15 mos and 4-6 yrs, 6 yr duration (need adult booster) *protective by 1 wk post vaccine*
62
pertussis close contacts: vaccine or abx?
abx ppx
63
influenza virus | + typing
orthomyxovirus, 3 types: A*, B*, C : all have both envelope glycoproteins (H and N), but stereotyping only done for A (Hemagglutinin: attachment, Neuraminidase: entry into uninf. cells, del of new virus from infected cells) H1,2,3 and N1,2 (so 6 variants total)
64
antigenic drift
minor change: point mutation for H or N genes, occurs in both A and B types may cause epidemics
65
antigenic shift
MAJOR change due to recombin. event for H genes ONLY in type A (mult. animal hosts-->new viruses for which humans have no herd immunity) may cause pandemics
66
influenza deaths occur most in...
the young and the old (65) | and medically compromised
67
variant viruses
typ. circulate in swine but cause sporadic human infection H1N1v, H3N2v*, H1N2v *most do not result in human to human spread
68
influenza and kiddos
2-10x more susc. than adults BUT typ. less ill and rarely die, so not vaccinated -serve as reservoirs-->infect adults/elderly (higher mortality)
69
other influenza risk factors (besides age)
pulm/CV disease (COPD, CD, CHF), pregnancy, neurological, neumomuscular disorders (aspiration)
70
influenza comprimesse this imp. defense mech of RT
destruction of ciliated columnar resp. epi (esp. lg airways)
71
immunity in influenza
CMI (CTLs+ IFN prod)-->recovery | Humoral (IgA2 to HA and NA)-->protects against reinfection
72
influenza distinct manifestations
ABRUPT onset (no prodrome) (vs. M/C pneumo) infants 1: URT dis ***HALLMARK: PERSISTENT HIGH FEVER*** (>100) -non-prod cough, chest discomfort, ha, myalgias, prol. convalescence (1-2 wks)
73
major cause of mortality in influenza
secondary bac. pneumonia: asp. of throat flora orgs: Strep pneumo, Staph aureus, Hib another complication: primary influenza viral pneumonia
74
influenza: abx?
NO! will predispose pt to sec. bac pneumo!!
75
influenza complication in kids admin. ASA
Reye's syndrome : hepatitis, encephalopathy
76
DO NOT give ASA to tx
influenza virus A or B, VZV | use acetaminophen instead
77
other complications of influenza
CNS (enceph.) or PNS (Guillain-Barre's) | cerebrovascular, cardiac, OM*, sinusitis
78
influenza lab dx
EIA/DFA, Cx, Hemagglutination inhibition
79
vaccination will not end outbreak if..
incubation period is LESS than time needed for primary immune response (7-10 days for flu) ALSO antiviral tx is NOT effective for vaccination (resistance may occur)
80
no longer recommended antivirals for influenza
Amantadine, Rimantadine (against A, block m2 protein)
81
influenza antivirals against which types? | inhibit what?
A and B (7yo, ppx>5 yrs (less resistance to Zanamivir) Oseltamivir (Tamiflu): tx/ppx >1yo
82
influenza: vaccine?
YES: "good fit" vaccines, Oct-mid Nov (wanes by summer, Feb for elderly) heterosubtypic immunity is poor; vacc. ind. can still get flu (diff subtype then vacc. for)
83
influenza vaccine types
-killed/inactivated: trivalent (BAA) quad (BBAA) double strength for oldies, prod. in eggs -split virus (subvirion): for egg hypersn -LAIV: intranasal (BA) approv. for 2-49 yo
84
if incubation period is less than time req for primary immune response (7-10d) then..
OUTBREAK 1st defense: anti-infective therapy 2nd: vaccination (so ppx can be stopped in about 14 d) 3rd: barrier
85
how to tx influenza preggos
if confirmed: Oseltamivir x5 (w/in 2 d onset) | if exposed: ppx Zanamivir or Oseltamivir x 10
86
Bacillus anthracis
``` G+ boxcar, spore forming, non-motile rod aerobic, catalase +, encapsulated gamma hemolysis facultative IC pathogen of *MACROPHAGES* (member of Bacillus cereus complex) B. cereus gen. non-encaps ```
87
B. anthracis potency
produces exotoxins: cause edema and death
88
anthrax common in US?
NO; disease of herbivores, humans dir. contact spores in soil, animals, an. prod contact w/ sick/dying animals
89
3 types of anthrax
cutaneous GI pulm(inhal): spores in alv. spaces-->phago by macros-->migr. to mediastinal and peribronchial LNs where spores germinate-->lyse macro veg. cells prod. exotoxins-->toxemia, hem. LM and massive septicemia (local and syst.)
90
length of anthrax course
(10d incubation) | fulminant 3-6 days!
91
anthrax prodrome: specific?
no: FEVER, myalgia, N/V * no rhinitis or pharyngitis (unlike flu) - ->rapid prog. to alt. ment stat (conf/coma), seizures, resp distr, cyanosis (pulm. consol. may be absent)-->death
92
anthrax hallmark on CXR
``` WIDENING mediastinum and pleural effusions +/- pulmonary involvement ACUTE onset (unlike influenza, TB, syst. mycoses) ```
93
other anthrax sp. s/s
raised HCT | diaphoresis
94
anthrax tx: abx?
YES: oral cipro, doxy for 60 DAYS
95
anthrax: vaccine?
YES: for ppx after potential exposure (3 dose) LAV for animals AVA (BioThrax): subunit purified Ag (induction of Ab to B. anthracis proteins: PA*, EF, LF)

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