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respiratory infections Flashcards

1
Q

what causes respiratory infections how do we acquire them

A

animal resevoir
humans
environment

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2
Q

what pathogens can cause respiratory infections

A

viruses
bacteria
fungi
parasites

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3
Q

list pathogens in order of size smallest to largest

A

viruses, bacteria, protozoa, helminths

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4
Q

what makes up the upper respiratory system what features

A

nasal cavity
oral cavity
pharynx
larynx

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5
Q

what makes up lower respiratroy system

A

trachea
bronchi
bronchioles
lungs

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6
Q

what physical defences are within the respiratory tract

A

epithelial cells
mucus
cillia
cough reflex
anatomical barriers epiglottis
mucociliary escalator

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7
Q

what innate immunity defences do we have

A

alveolar macrophages
polymorphonuclear leucocytes
complement
dendritic cells
natural killer cells
antimicrobial peptides
pathogen pattern
recognition receptors PRRS

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8
Q

what pathogen causes 40-80% of pharyngitis cases

A

viruses
rhinovirus
adenovirus
coxsackie
ebv
cmv
orthomyxovirus

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9
Q

what pathogen causes 15-30% pharyngitis cases

A

group A streptococci
group c g and f streptococci
arcanobacterium
m pneumoniae
c pneumoniae
neisseria gonorrhoeae
fusobacterium necrophorum
c diptheria

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10
Q

what pathogen causes a small percentage of pharyngitis cases

A

fungi
candida albicans

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11
Q

what is the treatment for group a streptococci pharyngitis

A

mild to moderate: oral penicillin V, erythromycin
severe IV antibiotics +- steroids

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12
Q

what are the complications of GAS pharyngitis
group a streptococcocus pharyngitis

A

airway obstruction
epiglottitis
acute glomerulonephritis
peritonsillar abcess
toxic shock syndrome
scarlet fever

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13
Q

what is the difference between stridor and wheezing

A

stridor- in upper airways, trachea larynx

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14
Q

what is laryngotracheobronchitis croup

A

inflammation to bronchioles, trachea, and larynx leads to upper airway resistance

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15
Q

what is management of croup

A

oxygen
corticosteroids-dexamethasone and budesonide
nebulised adrenaline
supportive care-hydration
anti pyretics- reduce fever by inhibiting prostaglandin production through blocking cox enzymes

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16
Q

what are the different infections in an upper respiratory tract infection

A

sinusitis
pharyngitis
laryngitis
tonsilitis
nasopharyngitis

17
Q

what pathogens (named) cause sinusitis

A

s pneumoniae
h influenzae
m catarrhalis

18
Q

what pathogens (named) cause pharyngitis

A

streptococcus pyogenes
rhinovirus
coronavirus
adenovirus
influenza virus
parainfluenza virus
human metapneumovirus
respiratory syncitial virus
coxsackie virus
human bocavirus

19
Q

what pathogens (named) cause tonsilitis

A

streptococcus pyogenes
s pneumoniae
h influenzae
staphylococcous aureus

20
Q

what named pathogens cause nasopharyngitis

A

rhinovirus
coronavirus
adenovirus
influenza virus
parainfluenza virus

21
Q

what named pathogens cause laryngitis

A

parainfluenza virus
h influenzae
m catarrhalis
staphylococcus aureus
group a and group b streptococcus
c pneumoniae
m pneumoniae

22
Q

what is the definition of community acquired pneumonia

A

inflammation of lungs with consolidation or interstitial lung infiltrates

23
Q

what will you see on the chest x ray of someone with pneumonia

A

neutrophils infiltrating alveoli

24
Q

how does streptococcus pneumoniae cause disease

A

polysaccharide capsule>90 serotypes
major virulence determinant
allows adhesion to respiratory cells
capsule switching due to gene cassette
pneumococcal surface protein A
inhibits depostion of complement on bacterial surface
iga protease
cleaves anti capsular iga mucosal antibodies

25
what are the virulence determinants of streptococcus pneumoniae
capsular polysaccharide essential for colonisation, resistant to phagocytosis pneumococcal pilus-enable survival in lungs and adherence to epithelial cells induce tumour necrosis factor and inflammatory response hydrogen peroxide- damages cilliated epithelium and impairs mucocilliary escalator surface proteins- pneumolysin, adherence and virulence factors including techoic acid and lipoteichoic acid of the cell wall autolysin- lyses bacterial cells releasing toxins such as pneumolysin hyaluronidase- breaks down connective tissue
26
diagnosis and assessment of pneumonia
history examination imaging investigations
27
what acute consequences of pneumococcal disease
central nervous system-meningitis auditory-otitis media, hearing impairment cardiac-tachychardia, atrial fibrilation pulmonary-pleural effusion acute respiratory distress, renal-acute kidney injury, haemolytic uraemic syndrome, urinary tract infection vascular- septic shock, thromboembolism vascular
28
what are longer consequences of pneumococcal disease
cognitive impairment- frailty auditory- permanent hearing loss, learning and memory deficits cardiac- myocardial infarction, congestive heart failure arrythmia pulmonary- lung fibrosis exacerbation of copd renal- chronic kidney disease end stage renal disease vascular- cor pulmonale
29
how do you diagnose or assess of pneumonia
history examination imaging investigations
30
what are risk factors for pneumonia
age smoking underlying respiratory disease-chronic lung disease, cystic fibrosis, bronchiectasis immunodeficiency-congenital diabetes, chemotherapy, hiv impaired cough reflex- alcohol impaired conscious level ventilator associated pneumonia
31
what are symptoms of pneumonia
systemic- high fever, chills central- headaches, loss of apetite, mood swings, vascular low blood pressure heart-high heart rate gastric- nausea, vomiting joints-pain muscular- fatigue,aches lungs- cough with sputum phlegm shortness of breath pleuritic chest pain haemoptysis skin- clamminess, blueness
32
what examinations are done for pneumonia
temperature respiratory rate pulmonary rate blood pressure oxygen saturations cyanosis accessory muscle use focal chest signs decreased expansion dullness to percussion reduced air entry bronchial breath sounds crepitations effusion
33
what investigations are done for pneumonia
bloods full blood count urea and electrolytes c reactive protein liver function tests cultures- sputum, induced sputum, bronchio alveolar lavage. nasopharyngeal aspirate, blood sputum AFB smear and TB culture urine antigens, legionella, pneumococcus PCR- viruses some bacteria , PCP pneumocystis pneumonia serology mycoplasma fungal markers- serum beta d glucan and galactomannan histopathology aspergillus
34
what is the management of pneumonia
assess severity empirical antimicrobials oxygen positive and negative ventilatory support fluids ionotropes venous thromboembolysm prophylaxis physiotherapy mobilisation
35
what does curb 65 stand for
c confusion urea respiratory rate b-bp 65- age>65
36
what antibiotics are used in pneumonia
penicillin- inhibit pencillin binding proteins (pBPS) in the bacterial cell wall
37
what antibiotics are used in atypical (intracellular pathogens)
macrolides binds to 50s ribosomal rna Rrna floroquinolones-inhibit dna gyrase and topoisomerase
38
how do you prevent respiratory infections
vaccinations -s pneumoniae -influenza -covid-19 smoking cessation physiotherapy e.g cystic fibrosis

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