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Respiratory > Pneumonia symposium - upper airway infections > Flashcards

Pneumonia symposium - upper airway infections Flashcards

1
Q

name some upper airway infections

A 
sinusitis
tonsilitis
pharyngitis
tracheitis
laryngitis
bronchiolitis
bronchitis
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2
Q

Which parts of the body are sterile?

A

urinary system

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3
Q

What are the innate immune system barriers to infection in the gut?

A 
acid in the stomach
enzymes
commensal bacteria 
thick mucosal barrier
GALT - gut associated lymphoid tissue
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4
Q

What are the innate immune system barriers in the vagina?

A

acidic pH
commensal bacteria
thick mucosal barrier
mucosal associated immune system

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5
Q

Which part of the resp tract is FAIRLY sterile if any?

A

the lower resp tract is FAIRLY sterile but the upper resp tract has some colonising organisms

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6
Q

What are the factors that promote colonisation of the resp tract with pathogens?

A
  1. thin barrier for gas exchange
  2. not a lot of immune cells as a heavy immune response in that area would be damaging
  3. large SA for gas exchange - 75m squared
  4. pathogens from the gut can enter the resp system in aspiration
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7
Q

How does the upper resp tract resist infection?

A
  1. commensal flora

2. normal swallowing reflex (neurological and anatomical)

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8
Q

What virulent bacteria can colonise individuals resp tract asymptomatically?

A 
S. aureus 
S. pneumoniae
H. influenzae
S. pyogenes 
Neisseria spp
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9
Q

What are the commensals of the upper resp tract?

A

in upper resp tract eg S. aureus, S. epidermidis and Corynebacterium ( a gram +ve rod), colonisation of the oral cavity with streptococci, lactobacilli, colonisation of pharynx by streptococci and G- rods (sinuses are sterile)

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10
Q

What are the factors that aim to prevent infection of the lower resp tract?

A
  1. mucociliary escalator - ie cilia and mucus production
  2. cough reflex - nerve endings in the lungs
  3. sneezing
  4. soluble and cellular factors - eg IgA, defensins, lysozyme, surfactants (a direct bacteriocidal), alveolar macrophages, B and T cells, neutrophils
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11
Q

What factors make you susceptible to resp tract infection?

A 
impaired swallowing 
change in colonisation of the upper airway
immune dysfunction
altered lung physiology 
comorbidities
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12
Q

What factors may cause an impaired swallow?

A

Stroke
MND
tumour obstructing the nerve
surgery

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13
Q

What factors cause an altered lung physiology?

A

instrinsic:
- CF
- Bronchiectasis
- emphysema
- ILD

extrinsic to airways (may affect ability to breathe and cough):

  • spinal disease
  • weakness
  • obesity
  • surgery eg difficult to breathe due to pain
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14
Q

What factors lead to immune dysfunction in the lung?

A

primary immunodeficiency eg complement deficiency

secondary immunodeficiency - HIV, immunosuppressant therapy

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15
Q

What are the viral causes of URTIs?

A 
Rhinoviruses (45-50%)
Influenza A virus (25-30%)
Coronaviruses (10-15%)
Adenoviruses (5-10%)
Parainfluenza viruses (5%)
Respiratory Syncytial viruses (5%)- causes bronchiolitis
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16
Q

What are some secondary complications from an URTI?

A 
sinusitis
pharyngitis
otitis media
bronchitis 
pneumonia
these may be due to secondary bacterial infections ie bacterial superinfection
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17
Q

What is a key feature of influenza A?

A

muscle and joint pain
headache
GI symptoms eg diarrhoea

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18
Q

What are the indications for tamiflu?

A 
the person is in an at-risk group:
chronic respiratory disease - asthma, COPD
heart disease
renal disease 
liver disease 
neurologicalsymptoms 
DM
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19
Q

When is tamiflu given?

A

start treatment within 48 hours of the first sign of symptoms

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20
Q

Why is tamiflu given?

A

can help people at risk of severe flu

prophylaxis against spread of flu in a hospital

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21
Q

When does tamiflu not make a difference?

A

when a person has mild flu and they are otherwise healthy

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22
Q

How does tamiflu work?

A

interacts with key molecules on the surface of the influenza virus which prevent the virus from attaching to the resp epithelium, so virus is much less likely to replicate in the epithelial cells

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23
Q

Why should you do a HIV test for sb with suspected glandular fever?

A

as glandular fever looks like primary HIV

24
Q

What are the causes of pharyngitis?

A

mostly viral - rhinovirus, adenovirus etc can also be EBV
bacterial:
- group A beta haemolytic strep - ie Strep pyogenes
- other streptococci and - M. pneumoniae -
- Neiserria gonorrhea due to oral sex
- Fusobacterium necrophorum is an anaerobic bacterium in the mouth and a cause of Leimierre’s disease - inflammation nda clotting in IJV enters RHS of heart and into the lungs, can cause embolic infection in the lung (give metronidazole)
- corynebacterium dipetheria

25
Q

What are the secondary sequelae of strep. pyogenes infection?

A
  1. scarlet fever - immune mediated response to strep infection and this gives you a rash
  2. antibody mediated glomerulonephritis, can cause significant renal impairment, can be prevented if treat early with antibiotics
  3. rheumatic fever - AB mediated due to molecular mimickry - Abs against the linings of the joints = synovitis, against heart valves = endocarditis, brain = chorea or heart = heart murmur , skin = rash
26
Q

What is peculiar about mycoplasma?

A

it is an intracellular pathogen that is hard to grow on culture

27
Q

What is the appearance of Corynebacterium diphtheriae on gram stain?

A

gram positive rod

28
Q

What is the characteristic appearance of the pharynx in C. diptheriae infection?

A

Thick greyish membrane on tonsils

29
Q

How do we treat C. diptheriae infection?

A

anti-toxin injection (a preformed Ab to the toxin) and erythromycin

30
Q

What are the symptoms of C. diptherae?

A

low fever
sore throat
malaise

31
Q

What are the points of the Centor criteria and what are they used for?

A

give an indication of the likelihood of a sore throat being due to a bacterial infection:
1. tonsilar exudate
2. tender anterior cervical adenopathy
3. fever over 38˚C
4. absence of cough
absence of these indicates viral infection - has a high NPV of bacterial infection

32
Q

How does sinusitis present?

A

fever
facial pain
purulent nasal discharge
cold in the previous days ie viral infection (usually)

33
Q

What are the causes of sinusitis?

A

viral usually

less often bacterial - Strep pneumoniae, H. influenzae, Moraxella catarrhalis

34
Q

What are some complications of sinusitis?

A

brain abscess
venous sinus thrombosis
orbital cellulitis (infection of the orbital septum)

35
Q

How does acute epiglottis present?

A

pain on swallowing (odynophagia)
sore throat
febrile
inspiratory stridor

36
Q

What pathogen is acute epiglottitis due to?

A

H. influenzae

37
Q

What type of bacterium is H.. influenzae?

A

gram negative cocobacillus

38
Q

What antibiotics are given for H. influenzae?

A

amoxicillin

Co-amoxiclav or doxycycline may be needed if bacteria produces beta-lactamase

39
Q

What feature of the eyes is present with Bordatella pertussus infection?

A

sub-conjunctival haemmorhage

40
Q

What type of bacteria is Bordatella pertussus?

A

Gram negative bacillus

41
Q

How is Bordatella pertussus diagnosed?

A

culture
PCR
ELISA for IgG against pertussus toxin

42
Q

What are the virulence factors of B. pertussus?

A

Haemagluttinin and fibriae aid adherence
Adenylate cyclase toxin (ACT) inhibits phagocyte chemotaxis and T-cell activation
Pertussis toxin inhibits alveolar macrophage host defence
Tracheal cytotoxin and dermonecrotic toxin cause epithelial necrosis

43
Q

What are the phases of the B. pertussus infection?

A
  • incubation period - 5-21 days
  • catarrhal phase: 1-2 weeks; runny nose, -
  • conjunctivitis, low grade fever, lymphocytosis
    paroxysmal phase: 1-6 weeks; coughing spasms, inspiratory ‘whoop’ post-ptussive vomiting, cough>14 days
  • Convalescent phase; ie recovery but still infectious
44
Q

what are the complications of pertussus infection?

A

pneumonia
encephalopathy
subconjunctival haemorrhage

45
Q

What antibiotic is used to treat B. pertussus infection?

A

clarithromycin

chemoprophylaxis given to household contacts

46
Q

What vaccine is given to people to prevent pertussus?

A

dTaP - diptheria, tetanus, acellular pertussus

47
Q

How does croup present?

A 
child 
braking cough
crying 
febrile 
cyanosed 
intercostal recessions/retractions 
inspiratory stridor
48
Q

what is croup?

A

acute laryngotracheaobronchitis - inflammation of the upper respiratory tract (predominantly the larynx and trachea but it may affect the bronchi) as a result of viral infection. A disease of children

49
Q

Which viruses cause croup?

A

mainly parainfluenza virus

RSV, influenza A and other resp virsuses

50
Q

what do we use to treat group A strep infection?

A

Amoxicillin

51
Q

How do we treat sinusitis?

A

stream inhalation
can try inhaled anti-inflammatories
but if due to bacterial infection, need antibiotics

52
Q

Which form of H. influenza is not protected against by the vaccine?

A

unencapsulated form (NTHi) is not protected against, but protects against the capsular form as the vaccine targets the capsular antigens. This form is called HiB

53
Q

Which media do we use to promote the growth of H. influenzae?

A

chocolate agar

54
Q

What type of cough does whooping cough give?

A

paroxysms of coughing

55
Q

The bordatella pertussus vaccine gives lifelong immunity? T or F?

A

False

Respiratory (12 decks)

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