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Z YEAR 2 BRS CARDIO > Respiratory Infection > Flashcards

Respiratory Infection Flashcards

1
Q

What are signs of an upper respiratory tract infection?

A
  1. A cough
  2. Sneezing
  3. A runny or stuffy nose
  4. A sore throat
  5. Headache
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2
Q

What are signs of a lower respiratory tract infection?

A
  1. A “productive” cough - phlegm
  2. Muscle aches
  3. Wheezing
  4. Breathlessness
  5. Fever
  6. Fatigue
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3
Q

What are the signs of pneumonia?

A
  1. Chest pain
  2. Blue tinting of the lips
  3. Severe fatigue
  4. High Fever
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4
Q

How common are respiratory infection?

A
  1. 5 million deaths annually between 1990 and 2015 (upper)
  2. 3 million deaths annually from acute lower respiratory infection
  3. More common death in Africa and SA
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5
Q

What is DALY?

A

Disability-adjusted Life Year

A sum of Years of Life Lost (YLL) and Years Lost to Disability (YLP)

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6
Q

What are demographic and lifestyle risk factors for pneumonia?

A
  1. Age <2 years or >65 years
  2. Cigarette smoking
  3. Excess alcohol consumption
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7
Q

What are the social factors that are risk factors for pneumonia?

A
  1. Contact with children aged <15 years
  2. Poverty
  3. Overcrowding
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8
Q

What are medications that are a risk factor for pneumonia?

A
  1. Inhaled corticosteroids
  2. Immunosuppresants (e.g steroids)
  3. Proton pump inhibitors
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9
Q

What is medical history that is a risk factor for pneumonia?

A
  1. COPD, Asthma
  2. Heart disease
  3. Liver disease
  4. Diabetes mellitus
  5. HIV, Malignancy, Hyposplenism
  6. Complement or Ig deficiencies
  7. Risk factors for aspiration
  8. Previous pneumonia
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10
Q

What is the specific risk factor for certain pathogens that increase risk factors for pneumonia?

A
  1. Geographical variations
  2. Animal contact
  3. Healthcare contacts
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11
Q

What types of pathogens cause respiratory illness?

A
  • Mix of viral and bacterial

- pneumonia and broncholitis present in children

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12
Q

Can you detect what pathogen causes respiratory infection?

A

Yes but most don’t

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13
Q

What are the common causative bacterial agents?

A
  1. Bacterial
  2. Streptococcus pneumoniae
  3. Myxoplasma pneumoniae
  4. Haemophilus Influenzae
  5. Mycobacterium tuberculosis
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14
Q

What are the common viral causative agents?

A
  1. Influenza A or B virus
  2. Respiratory Syncytial Virus
  3. Human metapneumovirus
  4. Human rhinovirus
  5. Coronavirus
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15
Q

What is SARS-Cov-2?

A

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2)
•Causative agent of coronavirus disease first observed in 2019 (COVID-19)
•Asymptomatic respiratory pneumonia and lung failure.
•Up to November 2020
53 million cases – 1.5 million deaths

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16
Q

What are the community acquired pneumonia (CAP) bacterial agents?

A
  • most common type of pneumonia
    1. Streptococcus pneumoniae (40-50%)
    2. Myxoplasma pneumoniae
    3. Staphylococcus aureus
    4. Chlamydia pneumoniae
    5. Haemophilus Influenzae
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17
Q

What are the hopsital acquired bacterial agents?

A
  1. Staphylococcus aureus
  2. Psuedomonas aeruginosa
  3. Klebsiella species
  4. E. Coli
  5. Acinetobacter spp.
  6. Enterobacter spp.
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18
Q

What are the bacterial agents associated with ventilator associated pneumonia?

A
  1. Psuedomonas aeruginosa (25%)
  2. Staphylococcus aureus(20%)
  3. Enterobacter
    - so if put on ventilator usually given antibiotics to
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19
Q

What are atypical bacteria pneumonia?

A
  1. Mycoplasma pneumoniae
  2. Chlamydia pneumoniae
  3. Legionella pneumophilia
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20
Q

What are typical bacteria pneumonia?

A
  1. Streptococcus pneumoniae 2. Haemophilus influenzae
  2. Moraxella catarrhalis
    - easier to culture and identify e..g because atypical are slow growing and are mostly intracellular bacterial pathogens
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21
Q

What is it important to know if typical or atypical?

A

Change treatment regime

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22
Q

What type of bacteria is streptococcus pneumoniae?

A
  1. Gram-positive
  2. Extracellular
  3. Oppurtunistic pathogen
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23
Q

What is the difference between typical and atypical bacteria?

A
  1. Atypical pneumonias present with slightly different symptoms (some with longer milder symptoms for instance)
  2. Atypical pneumonias are often more difficult to culture (hence atypical) and may require a different antibiotic regime to treat them
  3. Penicillins often given for typical pneumonia, additional macrolides may be administered for atypical
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24
Q

What is bronchitis?

A

inflammation and swelling of the bronchi

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25
Q

What is bronchiolitis?

A

inflammation and swelling of the bronchioles

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26
Q

What is pneumonia?

A

inflammation and swelling of alveoli - limit gas exchange

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27
Q

What can pneumonia lead to?

A
  1. Lung injury
  2. Bacteremia
  3. Systemic inflammation
  4. Treatment
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28
Q

What can lung injury lead to?

A

Arterial hypoxemia:
1. Organ injury / dysfunction
2. Acute respiratory distress
syndrome

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29
Q

What can bacteremia lead to?

A

organ infection:

1. Organ injury or dysfunction

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30
Q

What can systemic inflammation lead to?

A

organ injury or dysfunction

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31
Q

What can organ injury or dysfunction lead to?

A
  • deterioration

- sepsis

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32
Q

What is deterioration?

A

decrements in pulmonary, cardiovascular, neuromuscular, hematologic, cognitive, psychologic, and other functions

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33
Q

What are examples of some supportive therapy for bacterial pneumonia?

A
  1. Oxygen (for hypoxia)
  2. Fluids (for dehydration)
  3. Analgesia (for pain)
  4. Nebulised saline (may help expectoration) - clear mucus
  5. Chest physiotherapy
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34
Q

How can penicillin help and work for bacterial pneumonia?

A

e.g. amoxicillin – beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

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35
Q

How can macrolides help and work for bacterial pneumonia?

A

e.g. clarithromycin – bind to the bacterial ribosome to prevent protein synthesis

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36
Q

What is the key to increasing the success of antibiotics?

A
  1. Time to administration (for every hour in septic shock survival is reduced by 7.9%
  2. Using an effective antibiotic – typical CAPs may respond to penicillins, Atypical CAPs require macrolides
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37
Q

How do you treat bacterial pneumonia at CURB-65 0 for CAP?

A

Amoxicillin (or clarithromycin / doxycycline if pen.allergic)

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38
Q

How do you treat bacterial pneumonia at CURB-65 0 for HAP?

A

NOT SEVERE: doxycycline PO

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39
Q

How do you treat bacterial pneumonia at CURB-65 1-2 for CAP?

A

Amoxicillin + clarithromycin (or clarithro/doxy)

40
Q

How do you treat bacterial pneumonia at CURB-65 1-2 for HAP?

A

N/A

41
Q

How do you treat bacterial pneumonia at CURB-65 3-5 for CAP?

A

BenzylPenicillin IV + clarithro. PO (or teicoplanin + clarithro)

42
Q

How do you treat bacterial pneumonia at CURB-65 3-5 for HAP?

A

SEVERE: tazocin (piperacillin - tazobactam) IV +/- gentamicin IV

43
Q

What is the duration for CAP bacterial pneumonia?

A

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

44
Q

What is the duration for HAP bacterial pneumonia?

A

5-7 days

45
Q

What bacteria is found in oropharynx?

A
  • Strep. viridans
  • Coagulase neg. staph
  • Veronella
  • Fusiforms
  • Treponena spp.
  • Beta-haem. strep
  • Haemophilus spp.
  • Staph. aureus
  • Strep. pneumoniae
46
Q

What bacteria is found in nose?

A
  • Coagulase neg. staph
  • Haemophilus spp.
  • Staph. aureus
  • Strep. viridans
  • Strep. pneumoniae
47
Q

What is the human microbiome?

A

100 trillion microbial cells populate our bodies at every barrier surface

48
Q

What is the microbiota?

A

Ecological communities of microbes found inside multi-cellular organisms

49
Q

What are commensal?

A

Microbes that live in a “symbiotic” relationship with their host. Providing vital nutrients to the host in the presence of a suitable ecological niche

50
Q

What is an opportunistic pathogen?

A

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

51
Q

What is a pathobiont?

A

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

52
Q

How common is latent TB?

A

Estimated that 1 in 4 people have latent TB

53
Q

How many deaths are caused by TB?

A
  • 10 million active TB cases per year

* 1.4 million deaths from TB in 2019

54
Q

What are the risk factors for active TB?

A
  • HIV (18-fold)
  • alcohol (3.3 fold)
  • smoking (1.6 fold)
55
Q

Is latent TB resistant?

A

Latent Mtb is highly resistant to the immune system

56
Q

What is the standard treatment of TB?

A

combination of 4 antibiotics for a 6 month period

57
Q

How common is multidrug resistant TB?

A

(e.g. commonly rifampicin) accounted for 206,000 cases of TB in 2019, up 10% from 2018

58
Q

Is there such a thing as a commensal respiratory virus?

A

No

59
Q

What is a serotype?

A

Viruses. which cannot be recognized by serum (antibodies) that recognise another - implications for protective immunity

60
Q

What does viral infection lead to?

A
  1. Mediator release
  2. Cellular inflammation
  3. Local immune memory
  4. Damage to epithelium
61
Q

What does damage to epithelium lead to?

A
  1. Loss of cilia
  2. Bacterial growth
  3. Poor barrier to antigen
  4. Loss of chemoreceptors
62
Q

What does the major group of human rhinovirus bind?

A

bind ICAM-1

63
Q

What does the minor group of human rhinovirus bind?

A

low density lipoprotein family of receptors

64
Q

Can you get reinfection by the same strain in influenza?

A

No

65
Q

Can you get recurrent reinfection with similar stains in RSV?

A

yes (only 2 serotypes A and B)

66
Q

What are the imperfect vaccine for influenza?

A
  • Vaccine-induced immunity rapidly wanes
  • Mainly homotypic immunity
  • Annual vaccination required
67
Q

Why is there no vaccine for RSV?

A
  • Poor immunogenicity
  • Vaccine-enhanced disease
  • Very active research field
68
Q

What does latent to active TB involve?

A

latent bacteria to reactivate causing bacteria to proliferate and inflammation surrounding that bacteria which can rupture causing inflammation to spread through your lungs and also cause systemic damage

69
Q

Why does pneumonia usually affect elderly?

A

Movement into lower respiratory tract from other areas due to poor health

70
Q

What binds in H1N1 influenza A?

A

Haemogglutinin binds 𝛂2,6 sialic acids which are

71
Q

When are 𝛂2,6 sialic acids present?

A

expressed primarily in upper respiratory tract with decreasing concentration in lower respiratory tract

72
Q

What does H5N1 avian flue bind?

A

Haemogglutinin binds 𝛂2,3 Salic acids

73
Q

Where are 𝛂2,3 sialic acids present?

A

primarily located in lower respiratory tract with decreasing concentration in upper respiratory tract (why avian flu causes severe disease but struggle to transmit in humans)

74
Q

What does SARS-CoV-2 bind?

A

Spike (S) protein binds Angiotensin converting enzyme 2 (ACE2)

75
Q

Whereis ACE2 found?

A
  • Nasal epithlium (a lot in smokers)

- In type 2 pneumocytes (a lot in smokers)

76
Q

Where does respiratory Syncytial Virus (RSV) bind?

A

F and G proteins bind glycosaminoglycans in receptors like IGFR1 and nucleolin

77
Q

Where are RSV receptors found?

A

distributed around the lungs (RSV all parts of respiratory tract)

78
Q

What causes severe disease?

A
  1. Highly pathogenic strains (zoonotic)
  2. Absence of prior immunity
  3. Predisposing illness/conditions
79
Q

What does absence of prior immunity mean?

A
  1. Innate immunodeficiency (e.g. IFITM3 gene variant)
  2. B cells (antibody- presumably local)
  3. T cells (correlate with peripheral levels?)
80
Q

What are some predisposing illness/conditions?

A

Frail elderly
COPD/asthma
Diabetes, obesity, pregnancy etc.

81
Q

What can host defence be provided by?

A

interferons

82
Q

What are interferons?

A
  • Family of cytokines

* Named for ability to “interfere” with viral infection

83
Q

What are the 3 groups of interferons?

A
  1. type I (IFN-αs/IFN-βs)
  2. type II (IFN-γ)
  3. type III (IFN-λ)in vitro
84
Q

How are interferons produced?

A
  • directly by infected cells which sense virus through TLR3
  • or by immune cells that can sense viral proteins by IRF7
  • Production of interferons very rapidly and early on infection
  • Interferons signal on those receptors e.g. type 1 signal through IFNAR 1/2
  • To stimulate ISGs - inihibit viral replication in a cell
85
Q

So what happens in upper respiratory tract infection?

A

epithelial cells upregulate ISGs to inhibit further viral replication

86
Q

What immune compartment provides long term protection after vaccination and natural infection?

A

B cells

87
Q

Why is RSV dangerous?

A
  • Leading cause of infant hospitalization in the developed world
  • 50% of children infected in year 1 of life, all children by year 3.
  • 1% develop severe bronchiolitis.
  • Can repeatedly infect children.
88
Q

What are similar viruses to RSV with lower prevelance?

A

hMPV and PIV

89
Q

What are risk factor for RSV?

A
  • Premature birth

* Congenital heart and lung disease

90
Q

What are the symptoms of RSV?

A
  1. Nasal flaring
  2. Chest wall retractions
  3. Hypoxemia and cyanosis
  4. Croupy cough
  5. Expiratory wheezing, prolonged expiration, rales and rhonchi
  6. Tachypnea with apneic episodes
91
Q

How are children affected by RSV?

A

Infantile bronchiolitis

Causally related to wheeze and older siblings are spreaders

92
Q

How are the old affected by RSV?

A

Major cause of progressive lung disease and winter deaths

93
Q

How are adults affected by RSV?

A

Repeated colds, transmitter, very rarely severe

94
Q

What are treatment options for RSV?

A
  1. Vaccines (non)
  2. Monoclonal antibodies (prophylactically can be used not really therapeutic)
  3. Anti-virals (prophylactic not really therapeutic)
95
Q

What is the difference between RSV and influenza?

A
  1. Symptoms of influenza and RSV similar in scale, primarily upper respiratory with lower respiratory tract following, influenza a bit more rapid as faster replication.
  2. To infect human with flue need to select for sero-negativity (those who have not seen that strain of flue) but cannot do the same thing for RSV as all infected by age of 3 and serum type doesn’t change

Z YEAR 2 BRS CARDIO (18 decks)

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