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RHS- Micro > Respiratory Infections 5 > Flashcards

Respiratory Infections 5 Flashcards

1
Q

Pneumonia classification: type of microbe

A
  • Typical = Gram Positive and Gram Negative Bacteria

* Atypical = Viruses, Atypical Bacteria, Fungi, Parasites

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2
Q

Pneumonia classification: exposure

A

Community acquired pneumonia
Nosocomial
- hospital acquired pneumonia: >48 hours post-admission
- ventilator associated pneumonia: >48 hours intubation
- Healthcare Associated Pneumonia HCAP <3 months post healthcare facility (hospital, long term care facility)

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3
Q

Pneumonia Classification: source of microbe

A

Aspiration Pneumonia: microbes originate from GI tract (vomiting, impaired gag reflex, intubation)

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4
Q

Broncho-pneumonia/Lobar

A

typical pneumonia with focal densities

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5
Q

Interstitial pneumonia

A

atypical pneumonia with diffuse, hazy infiltrates

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6
Q

Acute Exacerbated Chronic Bronchitis

A

reactivated inflammation in patient with chronic lung condition (CF, COPD)

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7
Q

Necrotizing/Cavitary Pneumonia

A

focal liquification, region of decreased opacity due to necrosis

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8
Q

Viral pneumonia

A
  • normal or increased lymphocytes
  • tachypnea and wheezing
  • no pleuritic Chest pain
  • no CNS features
  • hyperinflation with bilateral interstitial infiltrates
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9
Q

Bacterial pneumonia

A
  • high fever and chills
  • dyspnea and productive cough
  • pleuritic chest pain
  • anxiety and delirium
  • lobar consolidation +/- pleural effusion
  • increased granulocytes
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10
Q

Most common viral causes of atypical pneumonia

A

SARS-CoV2

Influenza

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11
Q

SARS-CoV2: Biology

A 
Family - Coronaviridae
SARS-CoV2
=Severe Acute Respiratory Syndrome Coronavirus 
• Enveloped ss(+)RNA virus
• Spike protein – vaccines
• RDRP–antivirals
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12
Q

How to diagnose SARS-CoV2

A
  • Rapid Antigen ELISA, lateral flow
    * Suggestive of active
  • NAAT (RT-PCR)
    * Confirmatory for active infection
  • Serology - EIA
  • IgM -> Suggestive of active infection
  • IgG -> Anti-nucleocapsid is indicative of past infection
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13
Q

Transmission of sars cov2

A

Aerosol droplet, Airborne

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14
Q

Who is high risk for sars cov2

A

• Unvaccinated ~97x risk of death
• Elderly,Hypertension,Obesity,Diabetes
Smokers, people with other respiratory illnesses

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15
Q

Prevention against sars cov2

A

Moderna,Pfizer
• mRNA subunit vaccines encoding Spike protein
• Require 2x doses to yield high efficacy
• Booster is recommended post-Omicron

Johnson-Johnson,AztraZeneca
• AdenovirusvectorswithsubunitDNASpikeprotein

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16
Q

Shift

A

Sudden phenotypic change of virus from gene rearrangement with co-infection with 2 strains

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17
Q

Drift

A

Gradual accumulation of random point mutations

18
Q

Alpha, Delta and Omicron BA.1 and Omicron BA.2 emerged from which process

A

Drift

19
Q

New strains of Omicron XE, XR, etc. emerged from

A

Shift gene recombination events with Omicron BA.1 and Omicron BA.2

20
Q

SARS-CoV2 Pathogenesis part 1

A

Spike Protein binds to ACE2 host receptor

21
Q

SARS-CoV2 Pathogenesis part 2

A
  1. Viral replication
    Virus initially downregulates Interferon-α
    Virus replicates in interstitial tissue, Syncytia formation
    Virions spread systemically, replicating in CD4+ T cells, cardiac, hepatic, renal tissue
22
Q

SARS-CoV2 Pathogenesis part 3

A
  • cytokine storm
  • bradykinin activation
  • Vascular damage accumulates on major organs
23
Q

What’s this showing

A

SARS-CoV2: Pathogenesis Syncytia Formation

24
Q

What is a syncytia

A

A single cell or cytoplasmic mass containing several nuclei, formed by fusion of cells or by division of nuclei

25
Q

Clinical Presentation: COVID-19

A
  • Onset~3-14days
  • Loss smell (anosmia)
  • Loss of taste (ageusia)
  • Interstitial pneumonia progressing to Acute Respiratory Distress Syndrome ARDS is most common cause of mortality
  • Viral replication in any tissue with ACE2R plus immune-mediated inflammation can cause multi-organ tissue damage
26
Q

What is seen on COVID-19 Imaging

A
  • Ground-glass opacities are most common.

* Consolidation can be observed, esp. with superinfection

27
Q

COVID-19 Complications

A
  • Interstitial Pneumonia -> ARDS -> Death
  • Secondary Bacterial Pneumonia Superinfections
  • Sepsis, Coagulopathy
  • Multi-System Inflammatory System in Children (MIS-C)
  • Long COVID aka Post-Acute Sequalae SARS-CoV2 Infection (PASC)
28
Q

Influenza: Biology

A
  • Family–Orthomyxoviridae
  • Enveloped
  • Segmented ss(-)RNA
  • Haemagglutinin (HA) glycoprotein
    * Viral Attachment Protein
  • Neuraminidase (NA) surface enzyme
    * Release of new virions by sialic acid cleavage
  • Based on Matrix (M-protein) and nucleoproteins
  • Rapid Antigen test can determine Type A/B
29
Q

Influenza replication

A
  • Hemagluttanin does attachment: binds sialic acid
  • virus enters by endocytosis
  • M2 - uncoating
  • segmented ss(-)rna is replicated by RNA dependent RNA polymerase
  • neuraminidase cuts sialic acid releasing the virus
30
Q

Type A Influenza

A

Zoonotic!
• More pathogenic than Type B or C.
• Reservoir: humans, birds, swine, horses, seals.
• Antigenic Shift cause pandemics (ex. Swine flu H1N1 in 2009)
• Antigen Drift cause localized annual epidemics

31
Q

Type B and Type C influenza are human-restricted cause milder symptoms and undergo __________ only

A

Antigenic drift only

32
Q

How is Influenza transmitted

A

Aerosol droplet: human-to-human, animal-to-human (Bird & Pig)

33
Q

Influenza type A H1N1 has tropism for

A

humans, pigs, horses and ducks

34
Q

What caused the global swine Flu Pandemic

A

Genetic reassortment shift events

  • A host animal was co-infected with more than 1 strain and the new virions are packaged with a new combination of genome segments.
  • Introduction of new HA type (H1) on human-adapted virus to immunologically-susceptible population = pandemic
35
Q

Influenza Virus Prevention

A

Annual drift necessitates yearly booster

Live, attenuated nasal spray
• Induces strong IgA response
• Recommended for > 2 years, < 50 years

Killed, Inactivated shot
• Induces IgG response
• Recommended for health care workers, age extremes, immunocompromised

36
Q

Influenza Virus Pathogenesis

A
  • Influenza HA targets sialic acid on mucus secreting, ciliated cells and replicates in respiratory tract
  • Infection in lower respiratory tract leads to cytokine storm and desquamation (shedding) of bronchial epithelium cells
  • Virus infection facilitates primary viral pneumonia and onset of secondary bacterial infections (most common cause of Flu-associated death)
37
Q

Clinical presentation of the flu

A
  • Preceded by or with a cold
  • Dry sputum cough
  • Dyspnea
  • High fever
  • Intense muscle pain
  • GI symptoms are more common in children
38
Q

Influenza Complications

A

Secondary Bacterial Superinfections including sinusitis, otitis media (children), typical bacterial pneumonia (elderly) = MOST COMMON CAUSE of “Flu-associated” deaths

39
Q

COVID-19 and Flu prognosis

A

▪ Can be range from mild to life-threatening, especially hypoxia
▪ Approximately 1/3 COVID-19 patients experience symptoms for months
▪ Antivirals for Influenza will shorten the course if administered <24 hours after onset

40
Q

Is it COVID, Common Cold or Flu?

A

RHS- Micro (8 decks)

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