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Respiratory infections Flashcards

1
Q

What 3 things are required of a disease to cause successful infection?

A

Susceptible host
Virulent pathogen
Favourable environment

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2
Q

What are the 6 links in the chain of infection?

A

Pathogen
Reservoir
Portal of exit
Mode of transport
Portal of entry
Susceptible host

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3
Q

What is meant by colonisation?

A

The presence of a microbe in the human body without an inflammatory response

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4
Q

What is meant by infection?

A

Inflammation due to a microbe

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5
Q

What is meant by bacteraemia?

A

The presence of a viable bacteria in the blood

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6
Q

What is meant by sepsis?

A

The dysregulated host response to infection

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7
Q

What is meant by a differential diagnosis?

A

The process of differentiating between two or more conditions which share similar signs or symptoms

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8
Q

What are some examples of tests that can be carried out to diagnose infection?

A

Blood cultures
Stool cultures
Urine sampling
Cerebrospinal fluid
Sputum cultures
Serology
Antigen detection
PCR
Chest X-ray

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9
Q

What is tested for by an RNA PCR quad swab upon first admission with an upper respiratory infection?

A

Influenza A
Influenza B
Respiratory Syncytial Virus (RSV)
Coronavirus

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10
Q

What viruses will be tested for using RNA PCR swabbing, in case of a negative RNA PCR quad swab?

A

Metapneumovirus
Rhinovirus
Parainfluenza
Adenovirus
Enterovirus
Parechovirus

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11
Q

What are some bacteria that can be tested for using DNA PCR testing?

A

Mycoplasma pneumoniae
Haemophilus influenza
Streptococcus pneumoniae

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12
Q

What is strep throat?

A

An infection of the pharynx. usually with a viral aetiology, resulting in the formation of a characteristic pus exudate at the back of the throat

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13
Q

What are some symptoms of strep throat?

A

Pus exudate on the throat
Sore throat
Dysphonia (Hoarse voice)
Dysphagia (Difficulty swallowing)

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14
Q

What is a recent, common bacterial aetiology of strep throat?

A

Group A Streptococcus

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15
Q

How is strep throat usually managed?

A

It is usually self limiting and so requires no treatment
Antibiotics can be given in cases of severe cases with a bacterial aetiology

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16
Q

What is tonsillitis?

A

The inflammation of the tonsils due to infection

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17
Q

What are the most common viral causes of tonsillitis?

A

Epstein-Barr virus
Rhinovirus
Influenza A and B
Parainfluenza
Enterovirus
Adenovirus

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18
Q

What percentage of tonsillitis cases are caused by bacteria?

A

5% - 30%

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19
Q

What are the most common bacterial causes of tonsillitis?

A

Streptococcus progenies (GAS)
Haemophilus influenza
Staphylococcus aureus
Streptococcus pneumoniae

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20
Q

What are some common symptoms of viral tonsillitis?

A

Malaise
Sore throat
Pyrexia
Possible lymphadenopathy

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21
Q

How long does viral tonsillitis usually last?

A

3-4 days

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22
Q

What are some common symptoms of bacterial tonsillitis?

A

Systemic upset
Fever
Odynophagia (Painful swallowing)
Halitosis
Lymphadenopathy
Erythematous swelling of tonsils
Dysphonia

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23
Q

How long does bacterial tonsillitis usually last?

A

It lasts around a week and leads to much more prolific symptoms

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24
Q

How can recurrent tonsillitis be treated?

A

Tonsillectomy (not common)

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25
Q

What are some complications of tonsillitis?

A

Otitis media
Quinsy
Lemierre syndrome

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26
Q

What is quinsy?

A

Quinsy is a possible complication of tonsillitis, characterised by the formation of peritonsillar abscesses

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27
Q

What is Lemierre syndrome?

A

Lemierre syndrome is a possible complication of tonsillitis, characterised by suppurative inflammation of the jugular vein, leading to the formation of a thrombus

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28
Q

What are some possible complications of quinsy?

A

This can cause airway obstruction, sepsis, glomerulonephritis and rheumatic fever

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29
Q

How can quinsy be treated?

A

Drainage of peritonsillar abscesses

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30
Q

What is epiglottitis?

A

A possibly life-threatening infection, characterised by inflammation of the epiglottitis

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31
Q

What are the current, most common causes of epiglottitis?

A

Streptococcus pneumoniae
Streptococcus pyogenes
Staphylococcus aureus

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32
Q

Why is Haemophilus influenza no longer the most common cause of epiglottitis?

A

Most children now are vaccinated against Haemophilus influenza by the HiB vaccine

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33
Q

What are some common clinical presentations of epiglottitis?

A

Sore throat
Odynophagia (Painful swallowing)
Inability to swallow secretions, leading to drooling
Muffled voice
Pyrexia

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34
Q

What is the gold standard investigation in epiglottitis?

A

A laryngoscopy, but this should only be performed in an operating theatre, where an anaesthetist is ready to allow insertion of an endotracheal tube

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35
Q

What are some antibiotics used in the treatment of epiglottitis?

A

Ceftrioxone
Vancomycin
Clindamycin

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36
Q

What is coryza?

A

Coryza is anotehrname for the common cold, an acute viral infection of the nasal passages

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37
Q

What are the most common causes of coryza?

A

Adenovirus
Rhinovirus
Respiratory Syncytial Virus (RSV)
Coronavirus (30%) - Mostly HK-01

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38
Q

What are some common symptoms of coryza?

A

Sore throat
Rhinorrhoea
Sneezing
Cough
Fever
Malaise

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39
Q

What are some complications that can arise from coryza?

A

Sinusitis and acute bronchitis

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40
Q

How is coryza spread?

A

By droplets and foamites, expelled by coughing, sneezing and speaking

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41
Q

What is sinusitis?

A

Inflammation of the tissue lining the sinuses due to infection with a mostly viral aetiology

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42
Q

What are the risks of fungal sinusitis?

A

This can be life threatening as the fungus can erode through the sinus wall and skull, to enter the brain

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43
Q

Who is at risk of fungal sinusitis?

A

Those who are heavily immunosuppressed, including those on chemotherapy, those with HIV and those on heavy duty immunosuppressant drugs

44
Q

What are some symptoms of sinusitis?

A

Frontal headache
Retro-orbital pain
Maxillary sinus pain
Tooth ache
Pus in sinus cavities

45
Q

What is a rare complication of bacterial sinusitis?

A

Bacteria can move down the cavernous sinus and lead to a sub-dural empyema

46
Q

How can acute sinusitis be treated?

A

This can be treated using nasal douching, nasal decongestants such as pseudoephedrine and oxymetazoline, and painkillers for pain management

47
Q

What is diphtheria?

A

Diphtheria is a possibly life-threatening bacterial infection of the throat

48
Q

How can diphtheria be life-threatening?

A

The bacteria present release toxins, which can cause death and causes a characteristic pseudo-membrane at the back of the throat

49
Q

Why is diphtheria rarely seen in the UK?

A

It is mostly vaccinated against

50
Q

What is croup?

A

Croup is a common childhood illness, characterised by inflammation of the URT and caused by viral infection

51
Q

What are the most common viral causes of croup?

A

Parainfluenza virus I (Most common)
Parainfluenza II, III and IV
Respiratory Syncytial Virus (RSV)
Adenovirus

52
Q

What can occur in croup infection?

A

A viral URT infection causes nasopharyngeal inflammation, that may spread to the larynx or trachea, which can cause sub glottal inflammation, oedema and airway compromise

53
Q

How does croup cause its characteristic cough?

A

Infection can impair the movement of the vocal cords

54
Q

What is the use of FeverPAIN?

A

This is an antibiotic checklist used s guidance for antibiotic prescription in URT infections, especially tonsillitis

55
Q

What does FeverPAIN stand for?

A

Fever - fever during past 24 hours
P - Purulence/Pus on tonsils
A - Attended rapidly within 3 days of symptom
I - Inflamed tonsils
N - No cough or coryza

56
Q

What is the chance of streptococcus infection in someone with a feverPAIN score of 0-1?

A

18% chance of isolating streptococcus

57
Q

What is the chance of streptococcus infection in someone with a feverPAIN score of 2-3?

A

40% chance of isolating streptococcus

58
Q

What is the chance of streptococcus infection in someone with a feverPAIN score of 4-5?

A

65% chance of isolating streptococcus

59
Q

What is the incubation time for Rhinovirus?

A

1-5 days

60
Q

What is the incubation time for Group A Streptococcus?

A

1-5 days

61
Q

What is the incubation time for influenza and parainfluenza?

A

1-4 days

62
Q

What is the incubation time for Respiratory Syncytial Virus?

A

7 days

63
Q

What is the incubation time for pertussis?

A

7-21 days

64
Q

What is the incubation time for Diphtheria?

A

1-10 days

65
Q

What is the incubation time for Epstein-Barr virus?

A

4-6 weeks

66
Q

What is the incubation time for Covid?

A

5-7 days

67
Q

What is whooping cough?

A

An acute trachea bronchitis caused by the bacteria Bordetella pertussis

68
Q

What is the common clinical presentation of whooping cough?

A

Whooping cough causes cold-like symptoms for two weeks, followed by paroxysmal, characteristic coughing, with residual coughing for over a month
Vomiting is also common

69
Q

What are some common investigations for whooping cough?

A

Investigation involves pernasal swab to carry out cultures, PCR and serology

70
Q

How is whooping cough treated?

A

Antibiotics
Vaccination to prevent

71
Q

What is meant by a non-tuberculous mycobacteria?

A

This refers to mycobacterial species other than those that cause tuberculosis or leprosy

72
Q

Where are non-tuberculous mycobacteria (NTM) usually found?

A

They are found in infected water and soil, and are only contracted through the environment, they are not transmitted person to person

73
Q

What are the main bacteria in pulmonary non-tuberculous mycobacteria infection?

A

Mycobacterium avium
Mycobacterium intracellulare
Mycobacterium chimerae

74
Q

Who is more at risk of non-tuberculous mycobacteria?

A

Those with previous lung conditions such as COPD or bronchiectasis
Those in hot, wet climates such as the swamplands of Florida

75
Q

How is Non-Tuberculous Mycobacteria diagnosed?

A

An diagnosis of NTM requires respiratory symptoms and some red flag symptoms such as haemoptysis, as well as 2 positive sputum cultures, or a positive PCR or BAL
Acid fast staining can also be performed for mycobacteria

76
Q

What is the treatment regime for non-tuberculous mycobacteria?

A

Treatment entails 18 months of relevant antibiotics as per the severity
Treatment usually consist of differing lengths and strengths of:
- Rifampicin
- Ethambutol
- Azithromycin
- Clarithromycin

77
Q

Why can non-tuberculous mycobacteria not be treated with just 1 drug?

A

NTM can quickly become resistant to one drug, so many drugs are required at once to attempt to completely clear the infection

78
Q

What are some examples of common fungal diseases?

A

Aspergillosis (Most common)
Histoplasmosis
Coccidiomycosis
Cryptococcosis
Mucomycosis
Pneumocystis

79
Q

How is Aspergillosis usually diagnosed?

A

Aspergillus PCR
Cultures
Galactomannan - Detects hyphal growth of aspergillum
Aspergillus IgG and IgE
CT scanning shows ground glass appearance

80
Q

What are some examples of aspergillus related conditions?

A

Allergic broncho-pulmonary aspergillosis
Aspergilloma
Invasive aspergillosis
Severe chronic pulmonary aspergillosis
Aspergillus empyema

81
Q

What is meant by allergic broncho-pulmonary aspergillosis?

A

This is an allergic response to aspergillum fungus in the lungs, causing mucus plugging and proximal bronchiectasis

82
Q

How does allergic broncho-pulmonary aspergillosis present?

A

It presents with wheezing and high serum levels of IgE and eosinophils

83
Q

How is allergic broncho-pulmonary aspergillosis treated?

A

It is usually treated with steroids and itraconazole (Anti-fungal)

84
Q

What is an aspergilloma?

A

A thin walled, cavitating mass of fungus in the lungs

85
Q

How can an aspergilloma be treated?

A

They can be treated using itraconazole or with surgery

86
Q

What is meant by invasive aspergillosis?

A

The damaging and erosion of lung tissue by aspergillum fungus

87
Q

What is the treatment for invasive aspergillosis?

A

Strong anti-fungal agent such as votriconazole or posaconazole

88
Q

What is aspergillus empyema or sub-acute invasive aspergillosis?

A

Fungal erosion of the pleura, leading to the spread of fungus and pus into the pleural cavity

89
Q

What are some complications of severe chronic pulmonary aspergillosis?

A

Fibrosis and cavity formation

90
Q

What are some side effects associated with itraconazole?

A

Increased thirst
Decreased urine output
Dysrrhythmia

91
Q

What are some side effects associated with votriconazole?

A

Visual disturbances and photosensitivity

92
Q

What is meant be endemic?

A

A disease that occurs naturally in a population

93
Q

What is meant by an epidemic?

A

An outbreak of disease of unexpected size (More than one area or country)

94
Q

What is meany by a pandemic?

A

The global distribution of disease

95
Q

What are the phases of a pandemic?

A

Phases 1-6
Post peak
Post pandemic

96
Q

What occurs in phases 1-3 of a pandemic?

A

The disease is predominantly animal infections, with few human interactions

97
Q

What occurs in phase 4 of a pandemic?

A

The disease moves to sustained human to human transmission

98
Q

What occurs in phase 5-6 of a pandemic?

A

Widespread human infection with the disease

99
Q

What are some common presentations of influenza infection?

A

High, abrupt onset fever
Malaise
Myalgia
Headache
Cough
Prostration (Wiped out feeling)

100
Q

What are some common aetiologies of the classic flu?

A

Influenza A
Influenza B

101
Q

What are some common aetiologies of flu-like illnesses?

A

Parainfluenza
Coronavirus
Cold viruses

102
Q

What are the 2 types of protein that most viruses express?

A

Hemagglutinin
Neuraminidase

103
Q

How is a virus named?

A

Virus type/Georgraphic origin/Strain number/year of isolation (Heagglutinin Neuraminidase)

104
Q

What is an example of a virus name e.g. influenza A strain?

A

A/Fujian/411/2002 (H3N2)

105
Q

What are some complications of influenza or influenza like illnesses?

A

Primary influenza pneumonia
Secondary bacterial pneumonia

106
Q

Describe the epidemiology of influenza

A

Influenza follows a pattern of winter epidemics, possibly because people spend more time indoors, with others over winter, as well as there being a possible vitamin D correlation

107
Q

What is the usual cause of pandemics?

A

A very large antigenic shift, usually caused by an animal reservoir or mixing vessel, meaning a person with the flu also gets infected with an animal born virus, which mix and mutate together and then spreads

Respiratory (23 decks)

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