Microbiology of Respiratory Tract Infections

Question 1

How does the flu clinically present?

Answer 1

Fever
Malaise
Myalgia
Headaches
Cough 
Prostration

Question 2

What is the aetiology of classical flu?

Answer 2

Influenza A or B virus

Question 3

What is the aetiology of ‘flu-like’ illness?

Answer 3

Parainfluenza viruses & many others

Question 4

Haemophilus influenza bacteria is a _______ invader

Answer 4

secondary

Question 5

When does primary influenzal pneumonia occur mostly and who is affected?

Answer 5

Most during pandemic years
Can be disease of young adults
Hight mortality

Question 6

In which demographic is secondary bacterial pneumonia most common?

Answer 6

Elderly
Infants
Debilitated
Those with pre-existing disease

Question 7

Secondary bacterial pneumonia is a cause of ______ in all influenzal epidemics

Answer 7

mortality

Question 8

What most commonly causes secondary bacterial pneumonia?

Answer 8

Haemophilus influenza

Question 9

Flu is treated ______

Answer 9

symptomatically

Question 10

Which antivirals can be used to treat flu?

Answer 10

Oseltamivir

Tanamivir

Question 11

What are the requirements to prescribe an antiviral for flu?

Answer 11

Only when there is a risk of complication of when the flu is circulating / sometimes given prophylactically

Question 12

Epidemiologically, when does flu occur?

Answer 12

Winter season

Question 13

What does antigenic drift mean?

Answer 13

Epidemics in association with minor mutations in the surface proteins of the virus

Question 14

What does antigenic shift mean?

Answer 14

Pandemics with rare, unpredictable, influenza A that come from an animal reservoir/mixing vessel

Question 15

What does endemic mean?

Answer 15

Occurs naturally in a population

Question 16

What does epidemic mean?

Answer 16

Outbreak of unexpected size (more than one area or country)

Question 17

What is a pandemic?

Answer 17

Global distribution of disease

Question 18

What about a flu pandemic/epidemic is often incorrectly predicted?

Answer 18

Site of origin

Question 19

What makes up the name of a virus?

Answer 19

Virus type
Geographic origin
Strain number
Year of isolation
Surface proteins / Antigens

Question 20

Influenza A H5N1 is a highly ________ _____ flu with observed _____ - _______ transmission and high mortality with less ready _____-______ transmission

Answer 20

pathogenic
avian
bird - human
human - human

Question 21

Lab confirmation of influenza can occur by which methods?

Answer 21

Direct detection by PCR
Antigen detection
Immunofluorescence
Virus culture

Question 22

How would a sample for lab confirmation of influenza by PCR be obtained?

Answer 22

Nasopharyngeal swabs in virus transport medium
Throat swabs in virus transport medium
Other respiratory samples

Question 23

Between direct detection of virus of PCR and Antigen detection, which is better?

Answer 23

Direct detection

Question 24

What are the methods to prevent flu via vaccine?

Answer 24

Killed virus

Live attenuated vaccine

Question 25

How is a killed virus produced for vaccination against flu?

Answer 25

Virus cultured > inactivated > combined with adjacent

Question 26

What does a killed virus vaccine against flu contain?

Answer 26

2 influenza A | 1 influenza B

Question 27

How is given a killed virus vaccine against flu?

Answer 27

High-risk adults for complications Hearth care workers Children aged 6 months - 2 years at risk of complications

Question 28

How is a live attenuated vaccine against flu administered?

Answer 28

Intra-nasally

Question 29

Who is offered a live attenuated vaccine against flu?

Answer 29

Primary and aged 2-5 children

Question 30

In which age group is the live attenuated vaccine against flu more effective than killed virus?

Answer 30

Children and young adults aged 2-17

Question 31

What does the protective efficacy of the flu vaccine depend on?

Answer 31

Vaccine to circulating virus match

Question 32

Why is the protective efficacy of the flu vaccine never greater than 70%?

Answer 32

Because the strains constantly change

Question 33

When is influenza most common?

Answer 33

In winter

Question 34

When is parainfluenza 1 most prevalent?

Answer 34

Summer

Question 35

When is Rhinovirus species A most common?

Answer 35

Found year-round

Question 36

How can pneumonia caused by Mycoplasma pneumonia, Coxiella burnetti, or Chlamydia be treated?

Answer 36

All respond to tetracycline and macrocodes (e.g. clarithromycin)

Question 37

Mortality through mycoplasma pneumonia, coxiella bunetti or chlamydia induced pneumonia is typically ____ than classical bacterial penumonia

Answer 37

lower

Question 38

How can Mycoplasma pneumonia, coxiella brunette or Chlamydia be confirmed in the lab?

Answer 38

``` Serology (actue / convalescent bloods to lab in gold-top vacutainers) Virus detection (PCR on respiratory swabs or secretions - only Mycoplasma in Tayside) ```

Question 39

Mycoplasma pneumoniae is a common cause of _____-______ _____ and has it's highest incidence in ____________

Answer 39

Community-Acquired pneumonia | Children ü young adults

Question 40

How is mycoplasma pneumoniae transmitted?

Answer 40

Person - Person

Question 41

Coxiella brunetti curasse _____/______ of unknown origin

Answer 41

pneumonia / pyrexia

Question 42

What is pyrexia?

Answer 42

Fever / Raised temperature

Question 43

What does Chlamydophila psittaci cause?

Answer 43

Psittacosis (usually presents as pneumonia)

Question 44

What do Coxiella burnetti and Chlamoydophila psittaci have in common?

Answer 44

Uncommon sporadic zoonosis

Question 45

Where is chlamoydophila psittaci caught from?

Answer 45

Pet birds

Question 46

What is the clinical presentation of bronchiolitis?

Answer 46

1st or 2nd year of life Fever Cough Wheeze

Question 47

What does the clinical presentation of bronchiolitis in severe cases include?

Answer 47

Grunting Low PaO2 Intercostal or sternal in-drawing

Question 48

What are the possible complications of bronchiolitis?

Answer 48

Respiratory and cardiac failure

Question 49

What are the risk factors for developing complications of bronchiolitis?

Answer 49

Premature birth | Pre-existing respiratory or cardiac disease

Question 50

What is the aetiology of bronchiolitis?

Answer 50

``` (resp.) Syncytial virus (most common, > 80%) Human rhinovirus Parainfluenza Human metapneumovirus Coronavirus Adenovirus Influenza virus Enterovirus ```

Question 51

How can aetiology of bronchiolitis be confirmed in the lab?

Answer 51

PCR on that / perusal swabs

Question 52

How is bronchiolitis treated?

Answer 52

Supportively

Question 53

What is the epidemiology of bronchiolitis?

Answer 53

Epidemics every winter | Very common

Question 54

How is bronchiolitis controlled?

Answer 54

No vaccine Nosocomial spread in hospital wards Passive immunisation > poor efficacy/cost-effectiveness

Question 55

What is the epidemiology of metapneumovirus?

Answer 55

Most children positive by age 5 Found in wide age range World-wide distribution Winter seasonality

Question 56

Metapneumovirus may be second to respiratory virus in ______

Answer 56

bronchiolitis

Question 57

Metapneumovirus causes similar symptoms as RSV in _______

Answer 57

children and adults

Question 58

How is metapneumovirus confirmed in the lab?

Answer 58

PCR

Question 59

What is sampled to confirm metapneumovirus in the lab?

Answer 59

samples by throat swabs in viral transport medium Bronchoalveolar lavage Endotracheal aspirate

Question 60

What current panels are run for PCR for lab confirmation of pneumonia?

Answer 60

``` Flu A and B Parainfluenza 1-4 4 coronavirus species Metapneumovirus Adenovirus RSV Rhinovirus Mycoplasma pneumonia ```

Question 61

Chlamydia trachomitis is an STI that can cause _____ _____

Answer 61

infantile pneumonia

Question 62

How is infantile pneumonia caused by chlamdia trachomitis diagnosed?

Answer 62

PCR on urine from mother or child pernasal/throat swabs

Question 63

How is Chlamoydophila pneumoniae transmitted?

Answer 63

Person - person

Question 64

How is chlamoydophila pneumoniae picked up?

Answer 64

Possibly by test for Psittacosis

Question 65

Where is MERS CoV most common?

Answer 65

Saudi Arabia

Question 66

What does MERS CoV stand for?

Answer 66

Middle East Respiratory Syndrome coronavirus

Question 67

What is the fatality rate of MERS CoV?

Answer 67

35%