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Clinical Medicine II > Pertussis and RSV (quiz 2, exam 1) > Flashcards

Pertussis and RSV (quiz 2, exam 1) Flashcards

1
Q

Bordetella pertussis is also known as

A

whooping cough; in China its “the cough of 100 days”

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2
Q

Pertussis is a highly contagious, acute __ illness caused by __

A
  • respiratory

- gram negative coccobacillus, B. pertussis

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3
Q

Pertussis is strictly a __ pathogen

A

human (no known animal reservoir)

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4
Q

pertussis pre-vaccine ear is mainly affected for children __ years old

A

<10 years

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5
Q

pertussis is manifested as a prolonged __ illness with respiratory __, __ cough, and __ emesis

A
  • cough
  • whoop (upon inspiration)
  • paroxysmal
  • post-tussive
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6
Q

pertussis diagnostic highlights: predominantly in infants under the age of

A

2

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7
Q

pertussis diagnostic highlights: adolescents and adults are an important __ of infection

A

reservoir

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8
Q

pertussis diagnostic highlights: __ week prodromal catarrhal stage of __, __, __, and __

A
  • 2wk
  • malaise
  • cough
  • coryza
  • anorexia
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9
Q

pertussis diagnostic highlights: absolute__, often striking (rarely in adults)

A

lymphocytosis

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10
Q

pertussis diagnostic highlights: __ confirms the diagnosis

A

culture

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11
Q

pertussis epidemiology: epidemiology has changed since intro of vaccine, since 1990s, more than half of cases have been in __

A

adolescents and adults

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12
Q

pertussis epidemiology: infected adolescents and adults serve as a __ for infection of infants and children who have higher __ and __

A
  • reservoir
  • morbidity
  • mortality
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13
Q

pertussis epidemiology: incubation period is _-

A

7-10 days (can be > or = to 3 weeks)

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14
Q

pertussis epidemiology: spread via

A

respiratory droplets (by paroxyms of coughing)

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15
Q

pertussis epidemiology: pts with prior infenction or vaccine induced immunity may or may not have

A

classic symptoms

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16
Q

pertussis epidemiology: spread of infection unlikely without __ and pts are infectious until they have completed __ days of appropriate antibiotics

A
  • cough

- 5 days

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17
Q

pertussis epidemiology: most people have waxing immunity after __ years

A

5-10 years (rarely lasts more than 12 years)

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18
Q

pertussis epidemiology: groups at highest risk are

A
  • infants 65 yo more likely to be hospitalized
  • obesity
  • asthma
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19
Q

pertussis epidemiology: most infants acquire the infection from

A

adolescents and adults in their own household

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20
Q

pertussis epidemiology: booster vaccination is recommended for

A

adolescents (~10-11 years old) and adults

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21
Q

pertussis: between __ and __% of pts with cough persisting greater than 1 week post-URTI have pertussis

A

7-32% (common cause of acute cough among adults)

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22
Q

pertussis: adults with Bordetella pertussis infection may be asymptomatic, or present with these types of sypmptoms

A

non specific symptoms indistinguishable from URI

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23
Q

pertussis pathogenesis: transmitted by __ and adheres to __

A
  • aerosolized droplets
  • ciliated upper respiratory tract epithelial cells (the damage caused to ciliated epithelial cells has to heal for the cough to go away)
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24
Q

pertussis clinical manifestations: infection is characterized by these 3 phases __, __, and __, and the total duration of all 3 phases is often about __ months

A
  1. Catarrhal phase
  2. Paroxysmal phase
  3. Convalescent phase
    - 3 months
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25
Q

pertussis: catarrhal phase lasts __

A

1-2 weeks

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26
Q

pertussis: signs and symptoms in the catarrhal phase

A
  • non specific generalized symptoms that resembles the common cold
  • malaise
  • rhinorrhea
  • mild cough
  • possible low grade temps
  • excessive lacrimation (potentially)
  • conjunctival injection (potentially)
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27
Q

pertussis: the most contagious phase is the

A

catarrhal phase

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28
Q

pertussis: the paroxysmal phase begins in the __ week of illness and can last __ weeks

A
  • 2nd week

- 2-6 weeks

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29
Q

pertussis: signs and symptoms in the paroxysmal phase

A
  • paroxysmal cough (hallmark symptom): series of severe, vigorous coughs during a single expiration (fits of cough)
  • vigorous inspiration causes the distinctive “whooping” sound (not always present, esp. adults and adolescents)
  • cyanosis, apnea, bradycardia, post-tussive syncope or emesis can occur in infants and young children
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30
Q

pertussis: complications more likely during what phase

A

paroxysmal phase

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31
Q

pertussis: whooping sound in infants and small children due to

A

small caliber trachea

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32
Q

pertussis: paroxysmal phase coughing can be triggered when pt __(4) or by __(2), can be worse at __, and pts may often feel __ between cough paroxysms

A
  • yawns, laughs, yells, or exercises
  • steam inhalation, mist
  • night
  • well between coughs and have few symptoms
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33
Q

pertussis: in the convalescent phase, there is a gradual reduction in the

A

frequency and severity of the cough

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34
Q

pertussis: the convalescent phase usually lasts __ weeks but may be prolonged

A

1-2 weeks

35
Q

pertussis: during the convalescent phase, episodic coughing may reappear with subsequent __ during this phase

A

URIs

36
Q

pertussis: atypical presentations in infants

A
  1. catarrhal stage is short or absent
  2. early symptoms include feeding difficulties, tachypnea, cough
  3. paroxysms of cough may be only sign of illness, with infant appearing deceptively well between episodes
  4. many do not have the whoop
  5. history of someone in household having a cough
37
Q

pertussis: atypical presentations in vaccinated children

A
  1. clinical presentation and course is usually less severe than in unvaccinated children
  2. shorter duration of cough than in unvaccinated
  3. decreased incidence of apnea and cyanosis
38
Q

pertussis: atypical presentations in older children, adolescents, and adults

A
  1. less severity and symptoms
  2. prolonged cough may be only symptom
  3. typically not the whoop
  4. may have sputum production, coryza, sweating episodes, sore throat
39
Q

pertussis: complications in young infants

A
  1. APNEA (<6 mos old)
  2. PNEUMONIA
  3. FEEDING DIFFICULTIES W/ SUBSEQUENT WEIGHT LOSS (FTT)
  4. POST-TUSSIVE VOMITING
  5. seizures/death
  6. difficulty sleeping
  7. pneumothorax
  8. epistaxis
  9. subconjuntival hemorrhage
  10. subdural hemorrhage
  11. rectal prolapse
  12. urinary incontinence
  13. rib fracture (pressure related)
40
Q

pertussis: complications in adolescents and adults

A
  1. pneumonia (due to infection itself)
  2. otitis media (due to infection itself)
  3. subconjuntival hemorrhage
  4. hernia
  5. rib fracture
  6. urinary incontinence (due to mechanical sequelae of severe cough)
41
Q

pertussis: is a __ diagnosis

A

clinical diagnosis (based on history and physical)

42
Q

pertussis, diagnosis: clinical suspicion usually arises only when

A

severe coughing persists after resolution of URI symptoms

43
Q

pertussis, diagnosis: early diagnosis is important to __, and antibiotics may __

A
  • decrease spread of infection

- shorten the duration of symptoms (if caught early)

44
Q

pertussis, diagnosis: consider diagnosis in all children, regardless of vaccination status, who present with cough for __ days

A

14 or more days

45
Q

pertussis, diagnosis: diagnostic testing is important for these 2 reasons

A
  1. to confirm an uncertain diagnosis

2. public health considerations

46
Q

pertussis: 3 groups of people you should concerned when they present with cough

A
  1. pregnant women (esp. if in 3rd trimester)
  2. healthcare worker
  3. someone who works with kids
47
Q

pertussis: a clinical case is defined as a person

A

who has a cough illness lasting at least 2 weeks with one of the following: paroxysms of coughing, inspiratory “whoop”, or post-tussive vomiting, and without other apparent cause (as reported by a health professional)

48
Q

pertussis: the laboratory criteria for diagnosis are

A
  1. the isolation of B. pertussis from a clinical specimen OR

2. positive polymerase chain (PCR) reaction assay for B. pertussis

49
Q

pertussis: a confirmed case is defined as a person

A
  1. with an acute cough illness of any duration who is culture pos. form nasopharyngeal secretions
  2. who meets the clinical case def. with lab confirmation by PCR from nasopharyngeal secretions
  3. who meets the clinical case def. and is epidemiologically linked directly to a case confirmed by either culture or PCR from nasopharyngeal secretions
50
Q

pertussis: a probable case is defined as a person

A

who meets the clinical case definition without lab confirmation or an epidemiologic link to a lab confirmed case

51
Q

pertussis, diagnosis: the appropriate diagnostic evaluation includes __ and __; __ may yield the diagnosis if performed early in the disease course; __ is the current diagnostic standard

A
  • serology
  • PCR
  • culture of a throat swab
  • PCR
52
Q

pertussis, timeline for diagnosis: weeks of cough onset when culture, PCR, and serology should be done

A
  • culture: 0-2 weeks
  • PCR: 0-3 weeks (and 3-4 weeks)
    serology: 2-8 weeks (and 8-12 weeks)
53
Q

pertussis: specimens must be collected by swab or aspiration from __

A

ciliated respiratory epithelium of the posterior nasopharynx where B. pertussis resides

54
Q

pertussis: suspect pertussis in

A
  1. infants and children w/ paroxysmal cough (kids present earlier)
  2. infants and children w/ severe cough for more than 5-7 days
  3. infants and children who develop apnea, cyanosis, or gagging cough
  4. infants with persistent cough, post-tussive emesis
  5. lab confirmation recommended
55
Q

pertussis: first line treatment

A

macrolides: erythromycin, azithromycin, clarithromycin (side effects include GI upset)

56
Q

pertussis: alternative treatment

A

TMP-SMZ DS

57
Q

pertussis: Abx during catarrhal phase effects

A

decrease severity and duration of cough

58
Q

pertussis: Abx later in the course of disease effects

A

wont effect course of symptoms but will decrease spread of disease (wait until 5 days of treatment)

59
Q

pertussis: T or F, there is proven effective treatment for pertussis cough

A

false

60
Q

pertussis: treatment of infants and children should include

A
  • supportive care (may include hospitalization for monitoring of respiratory status, fluid and nutritional support)
  • avoidance of triggers for coughing paroxysms
61
Q

pertussis, treatment of infants and children: indications for hospitalizations include

A
  1. respiratory distress
  2. pneumonia
  3. inability to feed
  4. cyanosis
  5. apnea
  6. seizures
  7. hospitalization for infants < 3mos old usually required (clinical decomposition can be rapid)
62
Q

pertussis: prevention

A
  1. erythromycin (macrolide) prophylaxis to household, day care worker, healthcare worker, high risk close contact
  2. vaccine (DTaP = diptheria, tetanus and pertussis) for children
  3. vaccine booster (Tdap = tetanus, lower diptheria antigens, and lower pertussis antigens) for adolescents and adults (Boostrix and ADACEL)
63
Q

RSV (respiratory syncytial virus), epidemiology: it is this type of virus

A

paramyxovirus

64
Q

RSV (respiratory syncytial virus), epidemiology: causes __ in persons of all ages

A

acute respiratory tract illnesses

65
Q

RSV (respiratory syncytial virus), epidemiology: seasonal outbreaks

A

Nov. - Apr. (with peaks in Jan. or Feb.)

66
Q

RSV (respiratory syncytial virus), epidemiology: most common cause of __ in children less than 1 yo

A

LRTI

  • bronchiolitis (60-90%)
  • pneumonia (25%)
67
Q

RSV (respiratory syncytial virus), epidemiology: it is a major cause of __ infections

A

nosocomial

68
Q

RSV: most children infect by age __ and __ are common

A
  • 2

- reinfections

69
Q

RSV: dominant strains __ yearly; subtypes include __

A
  • shift

- A (causes more severe disease) and B

70
Q

RSV: spread mainly by

A

direct contact but also aerosol droplets

71
Q

RSV: ca remain alive on hands and surface up to __

A

4 hours

72
Q

RSV: viral shedding usually __, but can be up to __ in young infants

A
  • 3-8 days

- 4 weeks

73
Q

RSV: incubation period is

A

2-8 days

74
Q

RSV: risk factors of RSV related LRTI include

A
  1. infants <6mos old (esp. if born during first half of RSV season)
  2. day care
  3. infants and children w/ underlying pulmonary disease, cardiovascular or neuromuscular disease
  4. premature infants
  5. infants exposed to second hand smoke exposure
  6. immunocompromised
  7. severe asthmatics
75
Q

RSV, clinical manifestations in older children and adults usually with URI

A
  1. rhinorrhea
  2. cough
  3. coryza
  4. conjunctivitis
  5. sinusitis
  6. OM
76
Q

RSV, clinical manifestations in infants and young children with primary infection usually present with LRTI

A
  1. cough
  2. fever
  3. wheezing (due to infection resulting in inflammation of bronchioles)
  4. tachypnea
  5. thick nasal congestion
  6. labored respirations (as evidenced by grunting, nasal flaring, intercostal retractions)
  7. apnea
  8. hypoxia
77
Q

RSV: increased incidence of __ later in life

A

reactive airway disease (like asthma): unclear whether viral respiratory infection causes asthma or if wheezing with these infections is a predictor of childhood asthma

78
Q

RSV: DDx

A
  1. parainfluenza virus
  2. adenovirus
  3. influenza virus
  4. rhinovirus
  5. coronavirus
  6. human bocavirus
79
Q

RSV: DDx in infants, elderly, and immunocompromised

A
  • metapneumovirus in infants
  • influenza in elderly
  • parainfluenza in immunocompromised
80
Q

RSV, diagnosis: __ diagnosis and __ not routinely recommended

A
  • clinical diagnosis

- labs

81
Q

RSV, diagnosis: diagnostic tests

A
  • rapid antigen tests (90% sensitivity and specificity for most)
  • PCR (alternative to culture for confirming rapid antigen test)
  • simulfuor respiratory screen for influenza A and B, parainfluenza, adenovirus, RSV (uses DFA with results in a few horus and costs about $30)
  • in adults, almost universal presence of sinusitis on radiological studies (xray)
82
Q

RSV: treatment

A
  1. maintenance of oxygenation and hydration
  2. albuterol nebulizer commonly used for wheezing in bronchiolitis if clinical response
  3. ribavirin has been used in hospitalized immunosuppressed pts with severe RSV
  4. syngais (palivizumab) used to prevent RSV in preemies (ab = antibodies)
83
Q

RSV: children with these symptoms usually require hospitalization for supportive are and monitoring

A

(moderate to sever respiratory distress)

  1. > 70 bpm
  2. dyspnea
  3. cyanosis
  4. nasal flaring
  5. retractions
  6. grunting
  7. poor feeding
  8. lethargy
  9. apnea
  10. hypoxemia (check pulse ox)
84
Q

RSV: prognosis

A
  • most children recover unenventfully and do not have further wheezing episodes
  • up to 40% with bronchiolitis develop further wheezing episodes up to 5 yo and 10% beyond that
  • mortality in hospitalized pts is < 2%

Clinical Medicine II (11 decks)

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