resp tract infection and immunity

Question 1

what is DALY – Disability-adjusted Life Year

Answer 1

Years of Life Lost (YLL) + Years Lost to Disability (YLP)

Question 2

common cause of infant mortality in under 1y.o compared to 1-5y.o

Answer 2

under 1=LRTI (RSV-Respiratory syncytial virus)

1-5y.o= malaria

Question 3

risk factors for pneumonia

Answer 3

-under 2, over 65
-close contact with kids (<15)
-overcrowding
-ICS
-immunosuppressants
-COPD/Asthma
-animal contact

Question 4

Causative agents or respiratory infections: bacterial vs viral

Answer 4

Bacterial
Streptococcus pneumoniae
TB

Viral
Influenza A or B virus
Respiratory Syncytial Virus

Question 5

Community acquired pneumonia- cause

Answer 5

Bacterial =Streptococcus pneumoniae

Question 6

what is streptococcus pneumoniae

Answer 6

gram +ve
extracellular
opportunistic pathogen

Question 7

common hospital acquired pneumonia

Answer 7

Staphylococcus aureus
Psuedomonas aeruginosa
E. coli
Acinetobacter spp.

Question 8

Ventilator associated pneumonia
common causes

Answer 8

Psuedomonas aeruginosa

Staphylococcus aureus

Question 9

what is atypical pneumonia

Answer 9

-Less frequent
-Mycoplasma pneumoniae
-different symptoms (ie. longer, milder symptoms)

different treatment:
-Penicillins= typical pneumonia,
+macrolides for atypical.

Question 10

what is pneumonia

Answer 10

Inflammation and swelling of the alveoli

Question 11

grading of potential bacterial pneumonia

Answer 11

CURB-65 (1 point each)
Confusion
Urea 7mmol/L+
Resp 30breaths/min+
BP: SBP< 90 OR DBP<60 mmHg
65 y.o +

Question 12

Grading potential bacterial pneumonia- CURB 65. results meaning

Answer 12

0=low severity. Home treatment with Ab

1-2=moderate severity. consider hospital referral

3-4= high severity. Urgent hospital admission-> empirical ab

Question 13

Treatments for bacterial pneumonia- supportive therapy

Answer 13

Oxygen
Fluids
Analgesia
Nebulised saline (may help sputum production)

Question 14

Treatments for bacterial pneumonia- antibiotics in CAP and duration

Answer 14

CURB-65=0
Amoxicillin (or clarithromycin/doxycycline if pen. allergic)

CURB-65=1-2
Amoxicillin + clarithromycin (or clarithro./doxy.)

CURB-65=3-5
benzylpenicillin IV + clarithro. PO

5-7days (7-14 days for atypical)

Question 15

Treatments for bacterial pneumonia- antibiotics in HAP and duration

Answer 15

CURB-65=0
doxycycline PO

CURB-65=1-2
Amoxicillin + clarithromycin (or clarithro./doxy.)

CURB-65=3-5
tazocin IV +/- Gentamycin IV

5-7days

Question 16

what is Commensal

Answer 16

Commensal microorganisms are those that live in a symbiotic relationship with their host, providing benefits to the host without causing harm.

Question 17

what is microbiota

Answer 17

collection of microorganisms that make up the ecological communities living inside a multicellular organism, such as humans.

Question 18

what is Human microbiome:

Answer 18

100 trillion microbial cells populate our bodies at every barrier surface

Question 19

what is opportunistic pathogen

Answer 19

microbe that takes advantage of a change in conditions (often immuno -suppression).

Question 20

what is pathobiont

Answer 20

A microbe that is normally commensal, but can cause pathology if found in the wrong environment (e.g. anatomical site)

Question 21

what causes severe disease in viral resp infection

Answer 21

1. highly pathogenic strains (zoonotic)
   2.absence of prior immunity
2. predisposing illness/conditions- (ie. fail, elderly, COPD)

-RNA sequence
-viral load
-DNA
-Environment

Question 22

viral resp infection- resp Epithelial cells – the target and first line of defence for tight junction, mucous lining and antimicrobials. Explain how

Answer 22

Tight junctions – prevents systemic infection

Mucous lining and cilial clearance – prevents attachment, clears particulates

Antimicrobials – recognise, neutralise microbes and their products

Question 23

most common cause of cold- viral resp infection

vs atypical bacteria

Answer 23

rhinovirus - in all ages

atypical= mycoplasma

Question 24

what is a serotype

Answer 24

unique pathogen strains with outer surface differences that may evade antibodies from other strains

Question 25

where do you find a lot of IgA-plasma cells vs Ig-G

Answer 25

nasal cavity
-Epithelial cells express many IgA receptor, allowing export of IgA to the mucosal surface

lungs
Thin-walled alveolar space allows transfer of plasma IgGs into the alveolar space

Question 26

RSV, compared to Influenza, when does viral load peak

Answer 26

around day 7 in RSV- LATER,

compared to around day 3 in influenza

Question 27

Recurrent re-infection with similar strains

No vaccine
Poor immunogenicity

what does this indicate

Answer 27

RSV

Question 28

what does RSV stand for

Answer 28

Respiratory syncytial virus

Question 29

RSV bronchiolitis in infants- symptoms

Answer 29

nasal flaring,
cyanosis,
croupy cough,
expiratory wheeze,
chest wall retraction

Question 30

RSV bronchiolitis in infants- risk factors

Answer 30

Premature birth

Congenital heart and lung disease

Question 31

RSV treatment-supportive and preventative

Answer 31

supportive therapy: oxygen, fluids, analgesia

preventative: vaccine- mRNA

Question 32

therapeutic treatment for RSV

Answer 32

anti-inflammatory
-dexamethasone (steroid)

anti-viral
-remdesivir- broad spectrum antiviral
//Paxlovid

-monoclonal ab??