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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
Q

What are the main differences between typical and atypical pneumonia

A

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

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26
Q

What is pneumonia

A

Inflammation and swelling of the alveoli

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27
Q

What is bronchitis

A

Inflammation and swelling of the bronchi

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28
Q

What is bronchiolitis

A

Inflammation and swelling of the bronchioles

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29
Q

What is the mechanism of damage for pneumonia

A

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

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30
Q

What are the consequences of pneumonia

A

ARDS

Sepsis

31
Q

What do we use to grade pneumonia

A

CRB (primary care)

CURB-65 (secondary care

32
Q

What is the criteria for CURB-65

A

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
Q

What does score 0 mean CURB-65

A

Low severity therefore can treat at howe with antibiotics

34
Q

What does score 1-2 mean CURB-65

A

Moderate severity therefore consider hospital referral

35
Q

What does 3-4 mean CURB-65

A

High severity therefore urgent hospital admission needed, and empirical ABx needed if life threatening

36
Q

What supportive therapy do we have for pneumonia

A 
Oxygen 
Fluids 
Analgesia 
Nebulised saline (expectoration) - gets rid of excess sputum 
Chest physio therapy to clear lungs
37
Q

What ABx do we use for CAP CURB-65: 0

A

Amoxicillin (if allergic to penicillin - give doxycycline or clarithromycin)

38
Q

What ABx do we use for CAP CURB-65: 1-2

A

Amoxicillin + calrithromycin (or doxycycline)

39
Q

What ABx do we use for CAP CURB-65: 3-5

A

Benzylpenicillin IV + oral clarithro. (or calrithro + teicoplanin)

40
Q

How long do we give ABx for CAP

A

5-7 days, but 7-14 days if atypical

41
Q

What ABx do we use for HAP Curb-65: 0

A

Oral doxycycline

Give for 5-7 days

42
Q

What ABx do we use for HAP Curb-65: 1-2

A

Oral doxycycline

Give for 5-7 days

43
Q

What ABx do we use for HAP Curb-65: 3-5

A

Tazocin IV ± gentamicin IV

Give for 5-7 days

44
Q

What does viral infection lead to

A

Cellular inflammation
Local immune memory
Mediator release
Damage to epithelium

45
Q

What does damage to epithelium lead to

A

Loss of chemoreceptors
Poor barrier protection
Bacterial growth
Loss of cilia

46
Q

What do almost all viruses cause disease but not all bacteria

A

Disease - this is because viruses are not pathobionts like many bacteria, which only some pathological in a state of dysbiosis

47
Q

How does H1N1 cause severe disease

A

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
Q

Where do viruses usually bind

A

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
Q

Where does H1N1 bind

A

haemogluttinin binds to a2,6 sialic acids found in the nasal cavity

50
Q

Where does H5N1 (avian flu) bind

A

Haemogluttinin binds to a2,3 sialic acids found in the bronchi

51
Q

Where does SARS-CoV-2 bind and how is this affected by lifestyle

A

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
Q

What defence mechanisms does the respiratory epithelium have

A 
Tight junctions 
Mucus lining and cilia 
Interferon pathways 
Pathogen recognition receptors (intra+extra cellular)
Antimicrobials
53
Q

What are serotypes

A

Viruses which cannot be recognised by serum that recognises other viruses - this has implications on protective immunity

54
Q

What is an antigen

A

Any molecule against which antibodies can be generated

55
Q

What plasma cells are found in the nasal cavity

A

IgA - ECs express poly IgA receptors allowing for the export of IgA to the mucosal surface - Homodimer is stable in protease rich environment

56
Q

What plasma cells are found in the alveoli

A

IgG - thin alveolar walls allow for the transfer of IgG into the alveolar space

57
Q

Describe the immunity we have for influenza

A

We have no reinfection by the same strain

58
Q

Describe the vaccine for influenza

A

Imperfect - the immunity form the vaccine rapidly wains, and provides us with mainly homotypic immunity therefore an annual jab is needed

59
Q

Describe the immunity we have for RSV

A

Recurrent infection by similar strain - no vaccine

60
Q

Describe the immunity we have for SARS-CoV-2

A

No prior immunity

61
Q

Describe the vaccine we have for SARS-CoV-2

A

New - waning immunity, re-infection is possible but the regime for the vaccine is not clear

62
Q

Describe RSV in children

A

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
Q

What are the risk factors for severe bronchiolitis from RSV in children

A

Premature birth

Congenital heart and lung disease

64
Q

What are the signs of severe bronchiolitis from RSV in children

A 
Nasal flaring
Chest wall retractions 
Hypoxemia 
Cough 
Cyanosis 
Tachypnoea 
Expiratory wheeze
65
Q

Describe the age dependence of RSV in young children

A

Infantile bronchiolitis
Related with wheeze
Older siblings act as spreaders

66
Q

Describe the age dependence of RSV in caring adults

A

Repeated colds
Transmitters
Rarely severe

67
Q

Describe the age dependence of RSV in older people

A

Major cause of progressive lung disease and winter death

68
Q

What supportive therapy do we have for RSV

A

Same as pneumonia - oxygen, fluids, analgesia, nebulised saline, chest physio

69
Q

What prophylactic therapy do we have for RSV

A

Vaccines and antivirals

70
Q

What therapeutic drugs do we have for RSV

A

Anti-virals (remdesivir)

Anti-inflammatory (dexamethasone, tocilizumab)

71
Q

What are the most common causes of asthma and COPD exacerbations

A

Rhinoviruses

72
Q

What are the CAP bacteria

A 
Strep pneumoniae
Mycoplasma pneumoniae
Staph aureus 
Chlamydia pneumoniae
Haemophilus influenzae
73
Q

What are the HAP bacteria

A 
Staph aureus
Pseudomonas aeruginosa 
Enterobacter spp 
Kelbsiella
E.Coli 
Acinetobacter spp
74
Q

What the general difference between CAP and HAP

A

CAP tend to be more gram positive whereas HAP tend to be more gram negative

BRS YEAR 2 (37 decks)

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