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Respiratory: Patient History, etc > Respiratory Infection - 1 > Flashcards

Respiratory Infection - 1 Flashcards

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1
Q

What are the clinical presentations of influenza?

A
  • Fever: high, abrupt onset (up to 40oC)
  • Malaise
  • Myalgia (muscle pain)
  • Headache
  • Cough
  • Prostration (weakness)
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2
Q

What pathogens is classical flu caused by?

A
  • influenza A viruses

* influenza B viruses

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3
Q

What pathogens ar flu-like illnesses caused by?

A
  • parainfluenza viruses

* many others

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4
Q

What pathogens cause haemophilia influenzae?

A
  • bacterium - not a primary cause of ‘flu

* may be a secondary invader

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5
Q

How is influenza transmitted?

A

Transmission is by droplets, or through direct contact with respiratory secretions of someone with the infection

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6
Q

During which procedures should aerosol protection transmission precautions be adopted?

A

Aerosol generating procedures only e.g.

  • Intubation, extubation
  • Cardiopulmonary resuscitation
  • Bronchoscopy
  • Many others
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7
Q

What are complications of influenza?

A
  • Primary influenzal pneumonia
  • Secondary bacterial pneumonia
  • Bronchitis
  • Otitis media
  • Influenza during pregnancy may also be associated with perinatal mortality, prematurity, smaller neonatal size and lower birth weight
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8
Q

What is primary influenzal pneumonia?

A
  • seen most during pandemic years
  • can be disease of young adults
  • high mortality
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9
Q

What is secondary bacterial pneumonia?

A
  • more common in infants, elderly and debilitated, pre-existing disease, and pregnant women
  • cause of mortality in all influenza epidemics
  • Most common cause of death in fatal influenza, even in pandemic years
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10
Q

What are treatments for influenza?

A
  • Sympptomatic - bed rest, fluids, paracetamol

* Antivirals - oseltamivir, zanamivir

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11
Q

Why are pregnant women encouraged to get flu vaccine?

A

Influenza during pregnancy may be associated with perinatal mortality, prematurity, smaller neonatal size and lower birth weight

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12
Q

Describe the epidemiology of influenza virus

A
  • Epidemics - winter epidemics, epidemics seen in association with minor mutations in the surface proteins of the virus (antigenic drift)
  • Pandemics - rare, unpredictable, influenza A only
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13
Q

What causes flu pandemic?

A

Influenza A only

* antigenic shift - segmented genome, animal reservoir/mixing vessel

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14
Q

Explain the process of antigenic shift

A
  • Pig (for example) simultaneously infected with human-adapted influenza virus and duck-adapted influenza virus
  • The pig’s cells will be infected with human and duck influenza gene segments
  • The human can then be infected with a combination of the human-adapted virus and duck-adapted virus contracted form pig
  • Human will have no immunity to virus at all as it has duck-adapted influenza proteins on its surface
  • Virus is not slightly different version of human adapted virus ( antigenic drift), it is completely different (antigenic shift)
  • Results in pandemic
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15
Q

What is an example of an influenza virus that has undergone antigenic shift?

A

H1N1

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16
Q

What are future threats for influenza pandemics?

A
  • Highly pathogenic avian flu
  • Bird to human transmission seen
  • High mortality
  • Not readily transmitted human to human
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17
Q

How can the presence of influenza virus be confirmed in a lab?

A

Direct detection of virus

  • PCR - nasopharyngeal swabs /throat swabs
  • Immunofluorescence
  • Antigen detection
  • Virus culture
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18
Q

How is a nasopharyngeal swab taken?

A

Putting swab down patients nose until touches back of nasopharynx

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19
Q

How is influenza prevented?

A

Vaccines

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20
Q

What are the 2 types of flu vaccines?

A
  • Killed vaccines

* Live attenuated vaccines

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21
Q

What are killed vaccines?

A
  • Virus grown in hen’s eggs or cell culture then inactivated and combined with an adjuvant
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22
Q

Who receives killed vaccines?

A
  • given annually to adult patients at risk of complications
  • Health care workers
  • Children aged 6 months to 2 years at risk of complications
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23
Q

Who receives live attenuated vaccines?

A
  • More effective than killed vaccine in children aged 2-17

* Offered this year to ALL children aged 2-5, and all primary school children

24
Q

How are live attenuated vaccines administered?

A

Administered intra-nasally

25
Q

What does efficacy of a vaccine depend on?

A

Protective efficacy depends on match of vaccine to circulating virus and on patient group, but is never better than 70% effective in preventing clinical infection

26
Q

What are causes of community acquired pneumonia?

A

Bacteria: -

  • Mycoplasma pneumoniae
  • Coxiella burnetii
  • Chlamydia
27
Q

What are the characteristics of mycoplasma, coxiella and chlamoydophila psittaci?

A
  • Therapy - all respond to tetracycline and macrolides (eg clarithromycin)
  • Mortality - varies with pathogen, but generally lower than classical bacterial pneumonia
  • Often known as “atypical pneumonia” - relates to presentation and response to therapy in the pre-antibiotic era
28
Q

How can mycoplasma, coxiella and chlamydophila psittaci be confirmed in the lab?

A
  • By serology - send acute and convalescent bloods to lab, gold top vacutainer
  • By virus detection- PCR on respiratory swabs / secretions
29
Q

What is mycoplasma pneumoniae?

A

Bacteria which is a common cause of community acquired pneumonia

30
Q

Who have the highest incidences of mycoplasma pneumoniae?

A

Children and young adults have highest incidences

31
Q

How is mycoplasma pneumoniae transmitted?

A

Person to person spread

32
Q

What diseases are caused by coxiella burnetti?

A
  • Pneumonia

* Pyrexia of unknown origin (Q fever)

33
Q

How is coxiella burnetti spread?

A
  • Uncommon, sporadic zoonosis

* Sheep and goats

34
Q

What is a complication of coxiella burnetti?

A

Endocarditis

35
Q

What is endocarditis?

A

A rare and potentially fatal infection of the inner lining of the heart (the endocardium)

36
Q

What pathogen causes psittacosis?

A

Chlamydophila psittaci

37
Q

What is psittacosis caught from?

A

Pet birds

38
Q

What does psittacosis usually present as?

A

Pneumonia

39
Q

What individuals are at risk of bronchiolitis?

A

Children in their 1st or 2nd year of life

40
Q

What are the symptoms of bronchiolitis?

A
  • Fever
  • Coryza
  • Cough
  • Wheeze
41
Q

What are the signs of severe cases bronchiolitis?

A
  • grunting
  • decreased PaO2
  • Intercostal / sternal indrawing
42
Q

What are complications of bronchiolitis?

A

Respiratory and cardiac failure

43
Q

When is respiratory and cardiac failure likely to occur as a result of bronchiolitis?

A
  • prematurity

* pre-existing respiratory or cardiac disease

44
Q

What is the aetiology of bronchiolitis?

A

Up to 80% cases due to Respiratory Syncytial Virus (RSV)

45
Q

How is the presence of RSV (bronchiolitis) confirmed in the lab?

A
  • By PCR on throat or pernasal swabs
    or
  • Immunofluorescence on nasopharyngeal aspirate
46
Q

What is the therapy for bronchiolitis?

A
  • Supportive

* Previously nebuliser ribavirin but no longer used as no real effect

47
Q

What is the epidemiology of bronchiolitis?

A
  • Epidemics every winter

* Very common

48
Q

How is spread of bronchiolitis prevented?

A
  • No vaccine
  • Prevent nosocomial spread in hospital wards by cohort nursing and handwahsing, gowns, gloves
  • Passive immunisation (monoclonal antibodies) - poor efficacy and cost-efffectiveness
49
Q

What is metapneumovirus?

A

Virus that causes lower respiratory tract infection (bronchiolitis, pneumonia)

50
Q

What is the epidemiology of metapneumovirus?

A
  • Most children antibody positive by age 5
  • Found in a wide range of ages
  • World-wide distribution
  • Highest incidence in winter
51
Q

What diseases are caused by metapneumovirus?

A
  • Bronchiolitis (although RSV is main cause of bronchiolitis)
  • 2% of cases of influenza-like illness
52
Q

How is presence of metapneumovirus confirmed in the lab?

A
  • PCR
53
Q

What is chlamydia trachomatis?

A

STI which can cause infantile pneumonia

54
Q

How is chlamydia trachomatis diagnosed?

A

Diagnosed by PCR on urine of mother or pernasal / throat swabs of child

55
Q

What is chlamydophilia pneumoniae?

A

Type of bacteria that can cause lung infections such as pneumonia

56
Q

How is chlamydophilia pneumoniae transmitted?

A

From person to person

57
Q

How is presence of chlamydophilia pneumoniae confirmed in the lab?

A

May be picked up by test for psittacosis

Respiratory: Patient History, etc (10 decks)

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