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BRS YEAR 2 > Resp - Resp tract infections and immunity > Flashcards

Resp - Resp tract infections and immunity Flashcards

1
Q

What happens as an infection travels further down the resp tract

A

Infection gets more and more severe

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2
Q

What are the signs of an upper tract infection

A 
Cough 
Sneezing
Runny nose
Sore throat
Headache
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3
Q

What are the signs of a lower tract infection

A 
Productive cough 
Muscle ache
Wheezing 
Breathlessness
Fever
Fatigue
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4
Q

What are the signs of pneumonia

A

Chest pain
Blue tinting of the lips
Severe fatigue
High fever

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5
Q

What is the global incidence of resp tract infection mortality

A

They caused around 5 million deaths in 2000 but then around 4 million in 2016 - this excludes TB which is much bigger than other infections

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6
Q

Describe the DALYs for acute respiratory infection

A

There are high DALYs for acute respiratory infection - this is because we often survive but many are left harmed or affected afterwards

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7
Q

Who is killed the most from respiratory tract infections

A

Adults over 70 (hot spots in Sub Saharan Africa)

Children under 5 in the developing world - e.g. Africa and India (not really in the developed world)

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8
Q

What is the leading cause of death in children under 1

A

Lower respiratory illness

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9
Q

What is the leading cause of death in children 1-5 globally

A

Malaria, followed by lower respiratory tract illness

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10
Q

What are the categories of risk factor for pneumonia

A 
Demographic/ lifestyle
Medication
PMHx
Social 
Specific risk factors for certain pathogens
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11
Q

Pneumonia RFs: demographic

A

65

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12
Q

Pneumonia RFs: medication

A

ICS
Immunosuppressants
PPIs

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13
Q

Pneumonia RFs: medical history

A 
COPD
Asthma
Heart disease
Lung disease
Diabetes mellitus
HIV
Malignancy
Hyposplenism 
Complement for IgG deficiencies 
Risk factor for aspiration 
Previous pneumonia
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14
Q

Pneumonia RFs: social

A

Contact with children under 15
Poverty
Overcrowding

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15
Q

Pneumonia RFs: specific for certain pathogens

A

Geographical location
Animal contact
Healthcare contacts

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16
Q

What are the common viral agents for respiratory infection

A 
Influenza A/B
RSV
Human metapneumovirus 
Human rhinovirus 
Coronavirus
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17
Q

What are the common bacterial agents for respiratory infection

A

Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Mycobacterium tuberculosis

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18
Q

What was the deadliest pandemic

A

H1N1 Influenza A - Spanish Flu

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19
Q

How often do pandemics happen

A

Every 20 years approx - present significant challenge to healthcare services

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20
Q

What are the main types of bacterial pneumonia

A

Community

Healthcare

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21
Q

What are the typical agents for causing pneumonia

A

Strep pneumoniae
Haemophilus influenzae
Morexella catarrhalis

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22
Q

What are atypical causative agents of pneumonia (walking pneumonia)

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophilia

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23
Q

What are the ventilator associated agents for pneumonia

A

Pseudomonas aeruginosa
Staph aureus
Enterobacter

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24
Q

Describe strep pneumoniae

A

Gram positive, extracellular, opportunistic pathogen

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25
What are the main differences between typical and atypical pneumonia
Typical are common therefore easier to treat, they present more rapidly and have more aggressive symptoms. Atypical are more difficult to culture therefore we may need different ABx regimes, they typically take longer to develop and thus may have milder symptoms
26
What is pneumonia
Inflammation and swelling of the alveoli
27
What is bronchitis
Inflammation and swelling of the bronchi
28
What is bronchiolitis
Inflammation and swelling of the bronchioles
29
What is the mechanism of damage for pneumonia
Lung injury leads to arterial hypoxemia. Bacteria leads to organ infection Systemic inflammation causes swelling and fluid accumulation and damage therefore impairment of gas exchange
30
What are the consequences of pneumonia
ARDS | Sepsis
31
What do we use to grade pneumonia
CRB (primary care) | CURB-65 (secondary care
32
What is the criteria for CURB-65
1 point for each of the following: ``` Confusion Urea >7 mmol/L Resp rate >30/min Blood pressure: SBP <90, DBP ≤60 Over 65 years old ```
33
What does score 0 mean CURB-65
Low severity therefore can treat at howe with antibiotics
34
What does score 1-2 mean CURB-65
Moderate severity therefore consider hospital referral
35
What does 3-4 mean CURB-65
High severity therefore urgent hospital admission needed, and empirical ABx needed if life threatening
36
What supportive therapy do we have for pneumonia
``` Oxygen Fluids Analgesia Nebulised saline (expectoration) - gets rid of excess sputum Chest physio therapy to clear lungs ```
37
What ABx do we use for CAP CURB-65: 0
Amoxicillin (if allergic to penicillin - give doxycycline or clarithromycin)
38
What ABx do we use for CAP CURB-65: 1-2
Amoxicillin + calrithromycin (or doxycycline)
39
What ABx do we use for CAP CURB-65: 3-5
Benzylpenicillin IV + oral clarithro. (or calrithro + teicoplanin)
40
How long do we give ABx for CAP
5-7 days, but 7-14 days if atypical
41
What ABx do we use for HAP Curb-65: 0
Oral doxycycline Give for 5-7 days
42
What ABx do we use for HAP Curb-65: 1-2
Oral doxycycline Give for 5-7 days
43
What ABx do we use for HAP Curb-65: 3-5
Tazocin IV ± gentamicin IV Give for 5-7 days
44
What does viral infection lead to
Cellular inflammation Local immune memory Mediator release Damage to epithelium
45
What does damage to epithelium lead to
Loss of chemoreceptors Poor barrier protection Bacterial growth Loss of cilia
46
What do almost all viruses cause disease but not all bacteria
Disease - this is because viruses are not pathobionts like many bacteria, which only some pathological in a state of dysbiosis
47
How does H1N1 cause severe disease
Highly pathogenic strain infects you. Absence of prior immunity e.g. IFITM3 gene variant leads to immune deficiency Predisposing illness/ conditions e.g. being frail, old or having COPD mean you are more likely to be subject to severe disease
48
Where do viruses usually bind
Tend to preferentially bind to the upper respiratory tract if they have existed in humans for a prolonged time, however viruses can infect cells throughout the respiratory tract.
49
Where does H1N1 bind
haemogluttinin binds to a2,6 sialic acids found in the nasal cavity
50
Where does H5N1 (avian flu) bind
Haemogluttinin binds to a2,3 sialic acids found in the bronchi
51
Where does SARS-CoV-2 bind and how is this affected by lifestyle
Spike protein binds to ACE2 which is found in the nasal epithelium and the type 2 pneumocytes - the numbers of ACE2 are increased by smoking
52
What defence mechanisms does the respiratory epithelium have
``` Tight junctions Mucus lining and cilia Interferon pathways Pathogen recognition receptors (intra+extra cellular) Antimicrobials ```
53
What are serotypes
Viruses which cannot be recognised by serum that recognises other viruses - this has implications on protective immunity
54
What is an antigen
Any molecule against which antibodies can be generated
55
What plasma cells are found in the nasal cavity
IgA - ECs express poly IgA receptors allowing for the export of IgA to the mucosal surface - Homodimer is stable in protease rich environment
56
What plasma cells are found in the alveoli
IgG - thin alveolar walls allow for the transfer of IgG into the alveolar space
57
Describe the immunity we have for influenza
We have no reinfection by the same strain
58
Describe the vaccine for influenza
Imperfect - the immunity form the vaccine rapidly wains, and provides us with mainly homotypic immunity therefore an annual jab is needed
59
Describe the immunity we have for RSV
Recurrent infection by similar strain - no vaccine
60
Describe the immunity we have for SARS-CoV-2
No prior immunity
61
Describe the vaccine we have for SARS-CoV-2
New - waning immunity, re-infection is possible but the regime for the vaccine is not clear
62
Describe RSV in children
RSV is the leading cause of infant hospitalisation in the developed world - affects 100% of children by the time they are 3 however 1% will develop severe bronchiolitis
63
What are the risk factors for severe bronchiolitis from RSV in children
Premature birth | Congenital heart and lung disease
64
What are the signs of severe bronchiolitis from RSV in children
``` Nasal flaring Chest wall retractions Hypoxemia Cough Cyanosis Tachypnoea Expiratory wheeze ```
65
Describe the age dependence of RSV in young children
Infantile bronchiolitis Related with wheeze Older siblings act as spreaders
66
Describe the age dependence of RSV in caring adults
Repeated colds Transmitters Rarely severe
67
Describe the age dependence of RSV in older people
Major cause of progressive lung disease and winter death
68
What supportive therapy do we have for RSV
Same as pneumonia - oxygen, fluids, analgesia, nebulised saline, chest physio
69
What prophylactic therapy do we have for RSV
Vaccines and antivirals
70
What therapeutic drugs do we have for RSV
Anti-virals (remdesivir) | Anti-inflammatory (dexamethasone, tocilizumab)
71
What are the most common causes of asthma and COPD exacerbations
Rhinoviruses
72
What are the CAP bacteria
``` Strep pneumoniae Mycoplasma pneumoniae Staph aureus Chlamydia pneumoniae Haemophilus influenzae ```
73
What are the HAP bacteria
``` Staph aureus Pseudomonas aeruginosa Enterobacter spp Kelbsiella E.Coli Acinetobacter spp ```
74
What the general difference between CAP and HAP
CAP tend to be more gram positive whereas HAP tend to be more gram negative

BRS YEAR 2 (37 decks)

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