Respiratory Infections Flashcards
What is the upper respiratory tract comprised of?
Nose, mouth, nasal cavity, throat and voice box
What is the lower respiratory tract comprised of?
Windpipe, lungs and bronchus
Name some tiers of defence which are used to protect the respiratory tract against infection.
Anatomical barriers such as cilia and mucous.
Tight network of dendritic cells within the respiratory mucousa.
Alveolar macrophages
Inflammatory cells, specifically neutrophils which are rapidly recruited.
Memory T-cells found in the interstitium around the bronchi, alveoli and vessels
What reflex are cilia of the respiratory tract associated with and what do they use.
The cilia are associated with the cough reflex and use mucociliary apparatus with immunoglobulin A.
Describe the cilia of smokers and how this affects risk of respiratory infection.
Smokers have slower moving cilia so movement of mucus is slowed. This increases risk of respiratory infections.
Describe the purpose of mucus in the respiratory tract.
Any foreign particles are entrapped in mucus and travel to the back of the throat by ciliary action.
Describe the purpose of dendritic cells within the respiratory mucosa.
Detect and catch any invading organisms and bring them to the draining lymph nodes. This generates an adaptive immune response.
What are the purpose of alveolar macrophages in the respiratory tract ?
o Catch particles that reach the alveoli.
o These are environments rich in defence elements; IgG, complement, surfactant and fibronectin.
Describe the purpose of rapidly recruiting inflammatory cells in the respiratory trac.
o Depending on the load of pathogens and the innate immune processes locally involved.
When will memory T-cells be found in the intersitium around the bronchi and vessels ?
Once adaptive immunity is involved.
Is the respiratory tract a sterile environment? Explain.
The respiratory tract is not a sterile environment.
Many microbiome are present, with many bacterial species.
How can the flora of the respiratory tract help diagnose respiratory tract infections.
Healthy microbiome can allow prediction of the likely causative pathogen as species tend to grow in specific niches.
Describe when a nasal swab may be the best method of sample collection and what diagnostic methods will be used.
Swabs can be used to collect samples when an upper respiratory tract infection is suspected. They will then be used in culture-based or molecular diagnostic methods.
Describe when a throat swab may be the best method of sample collection and what diagnostic methods will be used.
Swabs can be used to collect samples when an upper respiratory tract infection is suspected. They will then be used in culture-based or molecular diagnostic methods.
Where is sputum secreted from and found?
o Sputum is secreted from goblet cells found in the surface epithelium lining the respiratory tract and from seromucous glands in the connective tissue layer beneath the mucosal epithelium
What is sputum used to diagnose?
Lower respiratory tract infections.
Outline the features used to describe sputum and what each of them mean.
o Mucoid – containing or resembling mucous Purulent – containing pus Mucopurulent – containing pus and mucous Frothy – visible froth Viscous – thick and sticky Blood-stained – visible blood present
What is a bronchoalveolar lavage and what are they used to diagnose?
o A bronchoalveolar lavage is when a measured amount of fluid is introduced to the respiratory tract using a bronchoscope and then collected for examination. They are used in the diagnosis of lower respiratory tract infections.
Outline some diagnostic methods for respiratory infections.
Culture Microscopy Serology Antigen detection assays PCR
What does serology detect.
o Serology is based around the detection of IgM and IgG.
What are the advantages of PCR over culture based techniques?
Faster turnaround time, the ability to detect low levels of a pathogen, a lack of dependence on the viability of the target microorganism, little influence of antimicrobial therapy on diagnostic sensitivity, and the ability to be automated.
What is whooping cough?
A bacterial disease of the lungs and airways.
Describe the symptoms and progression of whooping cough.
o Paroxysms of many rapid coughs followed by a high-pitched “whoop” sound.
o Vomiting during or after coughing fits is likely.
o Exhaustion after coughing fits.
Describe the organism Bordetella pertussis
- Gram -ve
- Aerobic
- Coccobacillus
- Multiple virulence factors
Name some of the virulence factors of Bordetella pertussis.
o Pertussis toxin (these are thought to mediate whooping cough) , adenylate cyclase toxin, filamentous hemagglutinin and haemolysin.
Where do Bordetella pertussis colonise?
Ciliates cells of the mucosa.
How is bordetta pertussis transmit?
- Transmission via droplets from the respiratory mucous membranes of infected individuals.
What is the causative agent of whooping cough?
Bordetella pertussis
Outline the steps in the diagnosis of whooping cough.
- Regan-Lowe Agar
- Bordet-Gengou Agar
Describe how Regan-Lowe agar is used to diagnose whooping cough.
Regan-Lowe Agar consists of charcoal agar with defibrinated horse blood. Charcoal, along with starch, neutralises fatty acids and peroxides, which are toxic to B. pertussis. Horse blood is an added enrichment which supports the growth. Cephalexin inhibits the growth of normal flora of the nasopharynx. Yeasts and fungi are inhibited by the inclusion of amphotericin B. Beef extract and enzymatic digest are incorporated to supply amino acids and other nitrogenous substances that are necessary for growth. Osmotic equilibrium is maintained by the addition of sodium chloride. Niacin (nicotinic acid) is a vitamin which is added for growth promotion.
Describe the use of Bordet-Gengou agar to diagnose whooping cough.
Bordet-Gengou agar contains blood, potato extract, and glycerol, with an antibiotic such as cephalexin or penicillin and sometimes nicotinamide. The potato extract provides nitrogen and vitamins, and potato starch absorbs fatty acids; glycerol is used as a carbon source. Regan-Lowe medium has however has replaced Bordet-Gengou medium as the medium of choice for routine diagnosis.
How is whooping cough treated?
- Treat persons older than 1 year within 3 weeks of cough onset
- Infants younger than 1 and pregnant women within 6 weeks of cough onset.
Generally treated with antibiotics such as azithromycin, clarithromycin and erythromycin (antibiotic). These are macrolide antibiotics. - Penicillin antibiotic can also be used.
o Beta lactam antibiotic.
What are macrolide antibiotics and how do they work to treat whooping cough ?
These are macrolide antibiotics that work by inhibiting bacterial protein synthesis by preventing peptidyltransferase from adding the peptide chain attached to tRNA to the next amino acid.
How does penicillin and other beta lactam antibiotics work to treat whooping cough?
Inhibits bacterial cell wall synthesis by binding and inactivating penicillin binding proteins in the cell wall.
Also inhibit the transpeptidation reaction and block cross-linking of the cell wall.
What is Diptheria and what is it caused by?
- Bacterial disease caused by Corynebacterium diphtheriae
Describe the symptoms and effects caused by Diptheria.
- Sort throat and low grade fever within the first few days
- Development of a dense membrane in more severe cases
o This could be local (e.g. just on the tonsils or pharynx)
o This could be widespread (could cover a wide area of the patient’s respiratory tract). - ‘Bull’s neck’ in severe cases.
Describe the organism Corynebacterium diptheriae.
- Aerobic
- Gram +ve
- Bacillus
Where is Corynebacterium diptheriae found?
Inner lining of the throat, mouth and nose.
How is Corynebacterium diptheriae transmitted.
Airborne or via close contact with discharge from an infected person’s eyes, nose, throat or skin.
How do bacteria infect a person and cause diptheria.
When infected by a specific bacteriophage, the bacteria produce a toxin that kills cells in the throat. These cells then join to form the grey-white membrane that is typically seen in cases of diphtheria.
Outline the steps used for diagnosis of Diptheria.
Nose/throat swab
Loeffler agar
Mueller-miller tellurite agar
Tinsdale tellurite agar
Toxigenic tests
How is Loeffler agar used to diagnose Corynebacterium diptheria?
Contains horse serum, beef extract, dextrose and proteose peptones which supply the complex nitrogenous substances and nutrients necessary to support growth of C. diptheriae.
Sodium chloride is added to supply essential oils.
The medium enhances the development of metachromatic granules as seen in the methylene blue stains.
Formation of granules demonstrates the characteristic celllar morphology of C. diphtheriae.