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HLB > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

Conducting and respiratory zones diagram

A

insert

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2
Q

In high income countries, acute respiratory infections are the —- cause of morbidity and mortality.

A

6th

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3
Q

What % decrease in global respiratory infections death since 1990? What can this decrease be attributed to?

A
  • 23% decrease since 1990
  • immunisation
  • access to antibiotics
  • reduced poverty
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4
Q

Highest risk of acute respiratory infection:

A
  • immune system (poor nutrition, young children, elderly)
  • poverty and poor access to basic amenities
  • smoke pollution
  • overcrowding
  • immunocompromised HIV
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5
Q

An opportunistic infection is one which:

1 = affects the immunocompromised
2 = cannot be treated
3 = causes a pneumonia
4 = invades healthy lung tissue
5 = overcomes the lung’s defences

A

1

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6
Q

Which of these is the commonest cause of community acquired pneumonia?

1 = Haemophilus influenza
2 = Legionella pneumophila
3 = Mycoplasma pneumoniae
4 = Staphylococcus aureus
5 = Streptococcus pneumoniae

A

5

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7
Q

Which of these organisms lives in asymptomatic, healthy individuals?

1 = Aspergillus fumigatus
2 = Escherichia coli
3 = Haemophilus influenza
4 = Legionella pneumophila
5 = Mycobacterium tuberculosis

A

3

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8
Q

Pathogenesis of respiratory infections:

A
  • lungs are constantly exposed to particulate material and microbes from the upper airway
  • lower airways are usually devoid of conventional pathogens
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9
Q

Lower airways are usually devoid of conventional pathogens: Innate Immunity:

A
  • cilia - mucociliary escalator (MCE) removes debris and pathogens
  • alveolar macrophages:
    - secrete antimicrobials
    - engulf and kill other pathogens
    - recruit other immune cells
    - process and present antigens to T cells
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10
Q

Lower airways are usually devoid of conventional pathogens: Acquired immunity:

A
  • B cell/ T cell: responses essential for intracellular pathogens, such as mycobacteria, viruses and fungi
  • IgA secreted by plasma cells interferes with adherence and viral assembly
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11
Q

Response to infection (4):

A
  • inflammation = bodys response to insult
  • macroscopic = redness, swelling, heat, pain and loss of function
  • microscopic = vasodilation, increased vascular permeability and inflammatory cell infiltration
  • acute or chronic
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12
Q

Commensals in respiratory tract: mouth:

A
  • staphylococcus aureus
  • streptococcus pneumoniae
  • anaerobes
  • bacteriodes
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13
Q

Commensals in respiratory tract: sinus/nasal passage:

A

Sinus/nasal passage:
strep pneumoniae
haemophilus influenzae
staph aureus (MRSA)
rhinovirus

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14
Q

Commensals in respiratory tract: throat:

A

candida (thrush)
strep pyogenes
MRSA

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15
Q

Viral infections of the respiratory tract:

A
  • adenovirus
  • cytomegalovirus
  • INFLUENZA
  • RHINOVIRUS
  • coronavirus
  • parainfluenza
    – RESPIRATORY SYNCYTIAL VIRUS (RSV)
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16
Q

Cold:
- name
- affects
- causes

A
  • rhinovirus
  • upper respiratory tract
  • causes nasal discharge
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17
Q

Tonsillitis:
- name
- affects
- causes

A
  • streptococcus Grp A
  • upper respiratory tract
  • inflamed tonsils
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18
Q

2 pathogens that can cause bronchitis are:

A
  • streptococcus pneumoniae
  • haemophilus influenzae
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19
Q

Bronchiolits occurs in

A

infants

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20
Q

A pathogen that causes bronchiolitis

A

Respiratory Syncytial Virus (RSV)

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21
Q

4 pathogens that cause pneumonia:

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • legionella pneumophila
  • mycoplasma pneumoniae
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22
Q

How often does the common cold occur a year in preschool children?

A

5-7x a year

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23
Q

How often does the common cold occur a year in adulthood?

A

2-3 a year

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24
Q

Most common pathogen causing cold? What % of common colds caused?

A
  • rhinovirus
  • 30-50%
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25
Q

Human coronaviruses cause what % of common colds?

A

10-15%

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26
Q

Transmission of the common cold:

A
  • hand contact: virus remains viable for upto 2 hours on the skin or several hours on surfaces
  • droplet transmission from sneezing/ coughing/ breathing
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27
Q

The common cold:

  • incubation period
  • symptoms last
A
  • 2-3 days
  • 3-10 days
  • upto 2 weeks in 25% patients
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28
Q

What causes the symptoms of the common cold:

  • sore throat and nasal congestion
  • sneezing
  • nasal discharge
  • cough
  • systemic symptoms = fever
A
  • bradykinin accumulation in throat: causes a sore throat, nasal congestion due to vasodilation
  • sneezing is mediated by the stimulation of the trigeminal sensory nerves = histamine mediated
  • nasal discharge due to myeloperoxidase
  • cough is mediated by the vagus nerve, inflammation has to extend to the larynx to trigger this; hyper reactive response in URTI
  • cytokines responsible for systemic symptoms such as fever
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29
Q

bradykinin is

A

a peptide that produces inflammation by increase conc of prastocyclin, NO and other factors

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30
Q

Myeloperoxidase

A

a peroxidase enzyme in neutrophils used to attack pathogens

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31
Q

Nasal discharge changes colour (common cold) due to

A

increasing number of neutrophils (myeloperoxidase)
white to yellow to green

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32
Q

The common cold vs influenza:
- appearance
- affect
- symptoms
- fever
- work

A

insert slide

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33
Q

Influenza:

  • pathogens causing?
  • occurs in
  • usually at
A
  • influenza A or B
  • occurs in outbreaks and epidemics worldwide
  • usually during winter season so swaps hemispheres over the course of the year
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34
Q

Spanish flu occured when?
Caused by?

A
  • 1918 pandemic
  • influenza
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35
Q

Uncomplicated influenza generally lasts between

A

1-4 days

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36
Q

Influenza symptoms:

A
  • abrupt onset of fever (38-41 degrees C)
  • cough
  • headache
  • myalgia
  • malaise
  • sore throat
  • nasal discharge
  • can be acutely debilitating
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37
Q

Influenza: Risk groups for complications (5):

A
  • immunosuppression
  • chronic medical conditions (diabetes, COPD, asthma)
  • pregnancy or 2 weeks post partum
  • age: <2 or >65 yrs
  • BMI >40
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38
Q

Influenza Complications (4):

A
  • primary viral pneumonia
  • secondary bacterial pneumonia: bacteria that would normally not cause disease cause disease
  • Central Nervous System disease
  • death (estimated mortality among people infected in the US is 0.13%)
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39
Q

Coryzal symptoms

A
  • symptoms of a cold
40
Q

chellenges for the virus

A

insert table

41
Q

How does the influenza virus invade the cells?

A
  • influenza virus has a haemagglutinin surface protein (H) which binds to sialic acid receptors on the host cell in the respiratory tract, allowing the virus to enter the cell
  • reproduction using host cell mechanisms
  • the neuraminidase (N) (enzymes) on the surface of the virus allows the virus to escape by cleaving the sialic acid bonds - otherwise all the escaping virions clump together
  • the influenza virus has a segmented genome (8 parts) so can reassort if 2 different viruses infect the same cell
42
Q

Why influenza classified via the HN classification?

A
  • influenza virus haemagglutinin (H) surface protein allows entry into cell
  • neuraminidase (N) on the surface of the virus allows the virus to escape the cell after reproduction
43
Q

neuraminidase is an

A

enzyme

44
Q

Exact nature of H & N remain the same despite new strains of influenza.

True or False?

A

False
Influenza shift and drift

45
Q

Antigenic drift in influenza

A
  • neutralising antibodies against haemagglutinin (H) blocks binding of the virus to the host cells
  • virus mutates
  • mutations alter the haemagglutinin (H) epitopes (sequences of active site) so that the neutralising antibody no longer binds
  • hence multiple reassortment events occur
46
Q

Prevention of influenza

A
  • hand hygiene and droplet precautions (mask)
  • active immunisation - against haemagglutinin (H) and neuraminidase (N) components (annual vaccine against H1N1)
47
Q

Treatment of influenza:

A
  • Tamiflu = oseltamivir = neuraminidase inhibitor
  • neuraminidase inhibitor will block the enzyme neuraminidase so will prevent the replication of the virus
48
Q

Pneumonia

A

infection of the lung parenchyma
alveoli full of inflammation (infected fluid and pus) = reduces oxygen transfer

49
Q

Bacterial pneumonia:

  • inflammation of , which reduces
  • symptoms
  • signs
  • in elderly:
A
  • alveoli full of inflammation (infected fluid and pus) - reduces oxygen transfer
  • fever, breathlessness, cough, sputum production, pleuritic chest pain
  • tachpnoea (increased respiratory rate), reduced chest expansion and breath sounds, consilidation (dullness on percussion & increased TVR + VR) + bronchial breathing
  • hypoxia
  • in elderly: absence of typical symptoms, present with confusion, generally unwell, not eating, dehydrated
50
Q

Classification of penumonia

A
  • CAP = community acquired pneumonia
  • HAP = hospital acquired pneumonia
  • Healthcare Associate pneumonia if in hospital for 48 hours and then develop symptoms
  • ventilator associated pneumonia (VAP)
  • aspiritin pneumonia
51
Q

Both pneumonia and pleural effusion can result in dullness when percussing. What in the respiratory exam can differentiate?

A
  • pneumonia = increased tactile vocal resonance and vocal resonance because fluid in the lungs, transmits better
  • pleural effusion = decreased tactile vocal resonance and vocal resonance as fluid outside the lungs
52
Q

CAP:

  • annual incidence
  • prevalence
  • mortality rate
  • hospital admissions in those who first go to GP with lower respiratory tract infection
  • more than half the pneumonia related deaths occur in those older than
A
  • community acquired pneumonia
  • common acute lung infection that affects those
  • incidence = 5-11/1000 adult population
  • prevalence: 0.5-1% of adults in the UK
  • 5-14% mortality rate
  • 22-42% of those who go to GP admitted to hospital
  • more than half the pneumonia related deaths occur in those older than 84 years
53
Q

Symptoms of CAP:

A
  • productive cough, green/rusty brown sputum
  • fevor
  • rigors
  • pleuritic chest pain
  • dyspnoea
  • haemoptysis, night sweats, headache, myalgia, nause, vomiting, diarrhoea, lethargy
  • elderly or immunocmprimised: above can be present or absent, new confusion
54
Q

Clinical signs of CAP:

A
  • coughing
  • temp (86%)
  • tachypnoae ( RR>20)
  • tachycardia (pulse>100bpm)
  • consolidation:
    - decreased air entry
    - dullness on percussion
    - increased vocal resonance
    - coarse crackles
    - bronchial breathing

elderly: absence of fever, confusion

55
Q

Radiological diagnosis of pneumonia

A
  • plain Chest X ray
  • consolidation - alveoli and bronchioles completley fillwed with inflammatory debris/pus/pathogens
  • heart borders or diaphragm obscured due to loss of solid gas interface
  • air bronchograms - air in larger bronchi outlined by surrounding consolidation
  • lobar pneumonia
  • bronchopneumonia
56
Q

Chest x ray

A

insert

57
Q

chest x ray

A

insert

58
Q

5 bacteria in CAP and do they live in us?

A
  • Streptococcus pneumoniae (lives in us)
  • Haemophilus influenzae (lives in us)
  • Mycoplasma pneumoniae (need to think about sources and outbreaks)
  • Legionella pneumophila (need to think about sources and outbreaks)
  • Staphylococcus aureus ( can become resistant to antibiotics)
59
Q

Bacteria in CAP: respiratory viruses are probably responsible for

A

1/3 CAP

60
Q

pneumocytis jiroveci (PCP) in cell-mediated immunodeficiency

A
  • occurs in severely immunocompromised pts: in people with HIV
61
Q

Fungal pneumonia pathogen example

A

aspergillus fumigatus

62
Q

Streptococcus pneumoniae:

  • how common
  • gram positive or negative
  • risk factors (6):
  • entry?
  • asymptomatic carriage
  • quick test
  • prevention
  • treatment
A
  • most common organism causing CAP
  • gram positive cocci
  • risk factors:
    - alcoholics, respiratory disease,
    smokers, hyposplenism (absent or reduced spleen function), chronic heart
    disease
    - HIV
  • acquired in nasopharynx
  • asymptomatic carriage in 40-50%: smokers>non-smokers
  • pneumococcal antigen in urine
  • prevention = vaccine every few years
  • treatment = amoxicillin, clarithromycin or co-amoxiclav if severe CAP
63
Q

HIV increases risk to invasive pneumococcal disease in HIV+

A

50 to 100 fold

64
Q

PCP must take a

A

bronchoscopy
look under microscope

65
Q

Haemophilus Influenzae Pneumonia:

  • gram positive or gram negative
  • asymptomatic carriage
  • type of pneumonia
  • affects
  • complications are common or rare?
  • example of complication?
  • mortality in adults?
  • treatment?
A
  • gram negative bacteria
  • asymptomatic carriage in healthy individuals
  • bronchopneumonia
  • affects those with co-morbidities
  • complications common (empyema)
  • mortality in adults 12-29%
  • Treatment: Tetracycline eg: doxycycline
66
Q

Mycoplasma Pneumonia:

  • most common cause of
  • generally in what age group
  • symptoms
  • labs
  • diagnosis
  • treatment
A
  • most common cause of ambulatory “atypical pneumonia”
  • classically presents in a young patient, vague constitutional upset, several weeks
  • extrapulmonary symptoms are very common
  • lacks a cell wall so:
    - resistant to penicillin
    - can not grow on normal lab plates
  • diagnosis: PCR of throat swab
  • treatment: macrolides or tetracyclines (erythromycin or doxycycline)
67
Q

Should penicillin be prescribed for mycoplasma pneumonia?

A

No
resistant to penicillin due to lack of cell wall

68
Q

Legionella Penumophila:

  • occurs as a
  • how common?
  • causes
  • risk factors
  • diagnosis
  • treatment
A
  • can occur as a sporadic infection or in outbreaks associated with a contaminated water source
  • uncommon - 350 cases a year
  • causes severe, life-threatening infection
  • RFs = smoking and chronic lung disease
  • diagnosis:
    - don’t grow on routine culture; needs
    special conditions and longer
    - urinary legionella antigen
  • treatment: macrolides or quinolones ( erythromycin or ciprofloxacin)
69
Q

Clinical assessment and management of CAP:

A
  • CURB-65 score
  • C= confusion R= respiratory rate B = blood pressure U = urea

Management:
- oxygen for type 1 respiratory failure
- antibiotics

  • mortality 2-40%
70
Q

Hospital Acquired Pneumonia:

A

pneumonia that develops more than 48 hours after admission to hospital in someone who did not have pneumonia on admission

71
Q

Risk factors for hospital acquired pneumonia:

A
  • elderly
  • co-morbidities
  • immunocompromised
72
Q

HAP associated with more virulent organisms (4):

A
  • pseudomonas aeruginosa
  • klebsiella pneumoniae
  • escherichia coli
  • MRSA
73
Q

HAP accounts for what percentage of all infections acquired in hospital?

A

1.5%

74
Q

HAP accounts for —– infection-associated deaths in hospital

A

most

75
Q

HAP has a higher morbidity and mortality than CAP.

True or False?

A

True

76
Q

HAP morbidity and mortality between

A

30-70%

77
Q

Multi-drug resistance is common in hospital acquired pneumonia.

True or False?

A

True

78
Q

Hospital acquired pneumoniae patients often develop type 2 respiratory failure.

True or False?

A

False
Type 1

79
Q

Ventilator associated pneumonia develops in what % of patients who are intubated and ventilated through either micro-aspiration or through contamination of the ventilator equipment

A

50%

80
Q

VAP multi-drug resistance is common?

A

Yes

81
Q

Risk factors for VAP:

A
  • hospitalisation for more than 48 hours
  • antibiotic therapy in the last 6 months
  • underlying lung disease
  • immunosuppression
  • significant other co-morbidities (diabetes, cardiovascular, renal)
82
Q

Empyema:

  • is
  • complication
  • complication
  • incidence
  • mortality
A
  • infection (pus) in the pleural space
  • complication of pneumoniae
  • complication of pleural intervention eg pleural aspiration
  • 80,00 cases a year in the UK
  • mortality is 20%
83
Q

Risk factors for empyema (4):

A
  • elderly
  • immunocompromised
  • alcoholics
  • diabetes mellitus
84
Q

Diagnosis of empyema:

A
  • chest x ray, thoracic ultrasound, CT thorax
  • pleural aspiration: pus, low pH, exudate, bacteria
85
Q

Management of empyema:

A
  • long course of antibiotics (at least 6 weeks)
  • intrapleural fibronolytic drugs (streptokinase)
  • pleural drainage
  • surgery (VATS= video assisted thorascopy)
86
Q

Opportunistic infections risk factors (5):

A
  • HIV (most)
  • immunosuppression (chemotherapy, steroids)
  • haematological malignancies (leukaemia)
  • solid organ transplantation
  • primary immunodeficiencies
87
Q

Opportunistic infections: Organisms (4):

A
  • Pneumocystis jiroveci (PCP)
  • Atypical mycobacteria
  • Fungal: aspergillus, candida,
    histoplasmosis, cryptococcus
  • Viral pneumonia eg CMV
88
Q

PNEUMOCYSTIS JIROVECI:

  • type of pathogen
  • in environment
  • route of infection
  • lung colonisation
  • results from
A
  • P jiroveci (formerly P carinii)
  • Atypical fungus (previously a protozoan)
  • Ubiquitous in the environment
  • Airborne route of infection, person to
    person spread
  • Asymptomatic lung colonization in
    immunocompetent
    PCP may result from reactivation or new
    exposure
89
Q

PCP can affect patients with HIV and a CD4 count of

A

< 200/mm^3

90
Q

PCP Symptoms (4):

A
  • cough
  • severe breathlessness
  • hypoxia
  • chest x ray will show bilateral, interstitial ground glass shadowing in a bats wing appearance
91
Q

PCP treatment:

A

Co-trimoxazole

92
Q

CD4 count is

A

T cells which are reduced in HIv

93
Q

covid 19 gains access to host cells via

A

spike protein and ACE receptor protein
ACE protein found in pneumocytes and lymphocytes

94
Q

Incubation period of Covid-19

A

6.4 days

95
Q

supportive management of covid-19 pneumoniae

A
  • O2therapy (high flow O2, CPAP, intubation and ventilation)
96
Q

Recovery trail: Covid-19 Pneumoniae:

A
  • dexamethasone
  • remdesivir
  • tocilizumab

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