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Year 1 HLB Respiratory > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

What is included in the upper respiratory tract?

A
  • nose - pharynx - larynx
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2
Q

What is included in the lower respiratory tract?

A
  • trachea - bronchial tree - lungs
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3
Q

Are acute infections always dangerous?

A
  • no - but higher incidence of mortality in low socioeconomic countries
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4
Q

What are some of the most common respiratory infections that have the highest mortality worldwide?

A
  • HIV/AIDS
  • Tuberculosis
  • Measles
  • Whooping Cough
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5
Q

Certain patients have a decreased immune system, which groups of patients are at highest risk?

A
  • elderly - young children - malnourished
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6
Q

What has reduced the impact of microorganism infections worldwide?

A
  • vaccinations - antibiotics - 23% reduction since 1990
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7
Q

What are some risk factors, that could contribute to an increased risk of respiratory infection?

A
  • poverty - smoke/pollution - overcrowding - immunocompromised (HIV)
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8
Q

What is pathogenesis?

A
  • disease/condition caused by microorganisms
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9
Q

What are microorganisms?

A
  • bacteria - virus - fungi
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10
Q

What is the mucocillary escalator?

A
  • mucus and ciliary working together
  • remove microorganisms and debris
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11
Q

What are alveolar macrophages?

A
  • macrophages located in alveolar
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12
Q

What is the function of alveolar macrophages?

A
  • phagocytose pathogens/debris
  • secrete antimicrobials
  • recruit immune cells
  • antigen present to T helper cells
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13
Q

What are 2 of the key aspects of the innate immune system in the lower respiratory tract?

A
  • physical barrier = mucocillary escalator
  • immune cells = alveolar macrophages
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14
Q

What are the main adaptive cells and immunoglobulin secreted in the lower respiratory tract?

A
  • T cells
  • B cells
  • IgA antibodies
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15
Q

What happens at a microscopic level to lung tissue during an acute inflammatory response?

A
  • ⬇️ vasodilation
  • ⬆️ permeability (Extravasation - margination, rolling, adhesion)
  • ⬆️ inflammatory cell infiltration (neutrophils then macrophages)
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16
Q

If inflammation becomes chronic in the lungs, what could this lead to?

A
  • morphological changes - fibrosis
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17
Q

What are commensals?

A
  • microorganisms functioning in symbiotic relationship with the host
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18
Q

What are 2 important commensals located in the mouth?

A
  • staphylococcus aureus (grape like)
  • streptococcus pneumonia (chain of beads)
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19
Q

What are some of the important commensals located in the sinus/nasal passage?

A
  • streptococcus pneumonia
  • haemophilus influenze (most common cause of flu)
  • meticillin-resistant Staphylococcus aureus (MRSA)
  • rhinovirus (common cold)
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20
Q

What is one important commensals located in the throat?

A
  • meticillin-resistant Staphylococcus aureus (MRSA)
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21
Q

Bronchitis is common in the lower respiratory tract, what is it?

A
  • infection in large and medium airways
  • causes inflammation
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22
Q

Pneumonia is common in the lower respiratory tract, what is it?

A
  • infection of lung parenchyma
  • air sacs fill with fluid of pus (purulent)
  • ⬇️ perfusion
  • empysema can be a complication of pneumonia
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23
Q

Pulmonary Tuberculosis is common in the lower respiratory tract, what is it?

A
  • infection
  • caused by Mycobacterium tuberculosis
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24
Q

Empyema, also referred to as purulent pleuritis is a common in the lower respiratory tract, what is it?

A
  • infection causes pus to gather in pleural space
  • can follow from pneumonia
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25
Q

What is the viral infection influenza, also commonly known as?

A
  • common flu
  • viral infection
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26
Q

What is the viral infection rhinovirus, also commonly known as?

A
  • common cold
  • most common viral infectious agent
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27
Q

What is the Respiratory Syncytial Virus (RSV)?

A
  • common viral infection affecting the lungs
  • mainly affects children <2 years of age
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28
Q

What is the most common symptoms of the Rhinovirus?

A
  • runny discharge (snotty nose)
  • common cold
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29
Q

What is Tonsilitis?

A
  • tonsils become enlarged and inflammed
  • can be due to bacterial or viral infection
  • Streptococcus is Group A is the most common cause
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30
Q

Does the lower respiratory tract generally contain commensals?

A
  • no
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31
Q

What are 2 common organisms that can cause bronchitis?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • both are bacterial infections
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32
Q

In infants (<2 years of age) what is the main organism that causes of Bronchiolitis?

A
  • Respiratory syncytial Virus (RSV)
  • bronchitis = primary bronchi (1 bronchi)
  • bronchiolitis = lower down bronchi (>1 bronchi)
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33
Q

What are the most common organisms causing pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Legionella pneumophila
  • Mycoplasma pneumoniae
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34
Q

What is the most common viral infection that causes the common cold?

A
  • rhinovirus (30-50%)
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35
Q

What other virus accounts for 10-15% of common colds?

A
  • coronavirus
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36
Q

What is bradykinin?

A
  • a peptide that promotes inflammation
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37
Q

How is bradykinin released?

A
  • mast cells secrete it
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38
Q

In a common cold what do mast cells secrete that causes the common symptoms such as sore throat and nasal congestion?

A
  • bradykinin
  • ⬆️ vasodilation
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39
Q

In a common cold a component is released from mast and basophils that causes sneezing, what is this?

A
  • histamine, one of main components of allergies
  • induces nasal itch and sneezing
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40
Q

In a common cold a component is nasal discharge, what is the most common enzyme released from neutrophils that contributes to this?

A
  • myeloperoxidase - greeny/yellow in appearance
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41
Q

What are the most common symptoms of a cold?

A
  • appears gradually - nose and throat mainly affected - may feel unwell - should be fine to work
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42
Q

What are the most common symptoms of the flu caused by influenza?

A
  • appears quickly
  • systemic effects
  • fever and myalgia (muscle pain)
  • unable to work
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43
Q

What are the most common types of influenza that infect humans?

A
  • Type A and B
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44
Q

Haemagglutinin is a protein on the surface of influenza that can vary slightly in structure. This is called the H protein. How do variations in H proteins help influenza infect humans?

A
  • bind to sialic acid (sugars) receptors on cells
  • once bound they can enter the cell and infect
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45
Q

What are sialic acid receptors on cells?

A
  • sugars with a carbon backbone
46
Q

Neuraminidase are N proteins located on the surface of influenza. How do variations in N proteins help influenza infect humans?

A
  • cleaves sialic acid molecules from cell surfaces
  • the virus can freely move and infect other cells
  • helps evade host immunity
47
Q

Why is influenza able to infect people consistently?

A
  • changes in H and N proteins randomly during replication
  • able to evolve over time for survival
  • able to do this in or outside of host cells
  • called genetic drift - IMPORTANT
  • called drift as its a slow process
48
Q

Does B type influenza contain as many H and N protein variations?

A
  • no - still able to infect just not as often
  • doesnt adapt as well as influenze type A
49
Q

Which groups of patients are most at risk from influenza?

A
  • immunocompromised - co-morbidities - <2 and >65 years old - BMI >40
50
Q

Influenza is generally not life threatening, but in patients who are at high risk there can be some complications. What are the most common complications that can occur in higher risk patients?

A
  • primary viral pneumonia
  • secondary bacterial pneumonia
  • CNS disease
  • death
51
Q

More than one influenza virus can infect the same cell. This is called antigenic shift. What can this do the influenze virus?

A
  • influenze virus has a segmental genome
  • segmental genomes can therefore mix, similiar to miosis
  • creates mixed and unqiue genome with new H and N proteins
52
Q

Why is antigenic shift important?

A
  • non human viruses are mixed with human virus
  • creates unique H and N containing influenza
  • this is why vaccinations need to be changed each year
53
Q

What are simple day to day activities that can reduce infection and transmission of influenza?

A
  • hand hygiene - PPE
54
Q

What do annual vaccinations aim to do against influenza?

A
  • reduce risk of infection
  • vaccination created against common H and N proteins
  • most common is H1N1
55
Q

What is Tamiflu, commonly known as oseltamivir?

A
  • antiviral medication to treat influenza types A and B
56
Q

How does Tamiflu, commonly known as oseltamivir work?

A
  • inhibits neuraminidase (N protein)
  • virus is unable to spread and replicate
57
Q

What are the common symptoms associated with bacteria pneumonia?

A
  • fever (rigors = cold feelings)
  • breathlessness (dysponea)
  • cough with sputum production
  • pleuritic chest pain
58
Q

What happens to respiratory rate in bacteria pneumonia?

A
  • ⬆️ respiratory rate - tachypnoea
59
Q

What happens to chest expansions and breathe sounds in bacteria pneumonia?

A
  • ⬇️ chest expansion - ⬇️ breathe sounds - bronchial breathing
60
Q

What happens to tremor vocal resonance in patients with bacteria pneumonia?

A
  • ⬆️ vocal resonance
  • indicates increased density
  • if hyperinflation, this would be reduced
61
Q

In patients with bacterial pneumonia they are at risk of a type 1 respiratory failure, what can this cause?

A
  • ⬇️ PaO2 (60mmHg) - hypoxia
62
Q

Do elderly patients present with the same symptoms as younger patients with bacterial penumonia?

A
  • not always - absence of typical symptoms - confused - generally unwell - ⬇️ appetite - dehydrated
63
Q

What are the 3 main classifications (of how pneumonia can be contracted) of pneumonia that we need to know about?

A
  • community acquired pneumonia (CAP) (MAIN one)
  • hospital acquire pneumonia (HAP)
  • ventilator acquired pneumonia (VAP)
64
Q

What is community acquired pneumonia (CAP)?

A
  • pneumonia acquired in the general community - away from healthcare setting
65
Q

What % of patients admitted to hospital with community acquired pneumonia (CAP) require admission to the intensive care unit (ICU)?

A
  • 1.2-10% - 30% of whom die
66
Q

What are some of the clinical signs that medics can look for in younger patients?

A
  • cough
  • ⬆️ temperature
  • tachypnoea (respiratory rate >20b/min)
  • tachycardia (pulse >100bpm)
  • consolidation (can include crackles)
67
Q

What is consolidation in the lungs?

A
  • air in lungs is replaced with something else
  • generally replaced with liquid or pus
  • appears as a white area on imaging
68
Q

As with any other lung disease/condition, what is one of the first tests that must be done?

A
  • chest X-ray
  • shadows present called infiltrates (as in image)
  • consolidation
69
Q

What is a lobar pneumonia?

A
  • infection of one lobe
70
Q

What are the 2 most common bacteria that can cause community acquired pneumonia?

A
  • Streptococcus pneumonia
  • Haemophilus influenza
71
Q

What is streptococcus pneumonia?

A
  • pneumonia infection caused by streptococcus
  • Gram - cocci
  • most common bacteria in community acquired pneumonia (CAP)
72
Q

Which groups of patients may be more susceptible to streptococcus pneumonia?

A
  • alcoholics - current lung disease - smokers - heart disease - HIV patients
73
Q

How is streptococcus pneumonia initially acquired and does it cause symptoms in everyone?

A
  • acquired in nasopharynx
  • no patients can be asymptomatic carriers
74
Q

What human fluid can antigen from streptococcus pneumonia be measured in clinically?

A
  • urine
75
Q

in addition to hand cleaning and PPE, what is another method for reducing transmission and infection of streptococcus pneumonia?

A
  • vaccinations
76
Q

If a patient has streptococcus pneumonia, what is the most common antibiotic treatment, which is 2 of the core drugs we need to know?

A
  • amoxicillin or clarithromycin antibiotics
77
Q

What is the mechanism of action of amoxicillin, which is a Beta Lactam?

A
  • binds and blocks transpeptidase
  • cell wall breaks and bacteria is destroyed
78
Q

What is the mechanism of action of clarithromycin?

A
  • binds to RNA and inhibits reading of tRNA
  • protein synthesis is reduced or stopped
79
Q

What is Haemophilus Influenza pneumonia?

A
  • pneumonia infection caused by Haemophilus Influenza - Gram -anaerobe
80
Q

Which groups of patients may be more susceptible to Haemophilus Influenza pneumonia?

A
  • those with co-morbidities - common complications in patients with empyema (pus collection in pleural space)
81
Q

Does Haemophilus Influenza pneumonia generally cause symptoms in everyone?

A
  • no - can be asymptomatic carrier
82
Q

What are the mortality rates for Haemophilus Influenza pneumonia?

A
  • 12-29%
83
Q

What is the common treatment for Haemophilus Influenza pneumonia?

A
  • Tetracycline (doxycycline)
84
Q

What is the mechanism of action of Tetracycline?

A
  • inhibit binding of tRNA to RNA
  • ⬇️ protein synthesis
85
Q

What is Mycoplasma pneumonia?

A
  • pneumonia infection caused by Mycoplasma
86
Q

Which patients are most commonly affected by Mycoplasma pneumonia?

A
  • young patients
  • experience vague general upset for weeks
87
Q

Why is penicillin not used to treat mycoplasma pneumonia?

A
  • resistant to penicillin - lack of cell wall
88
Q

What is the common treatment for mycoplasma pneumonia?

A
  • macrolides (clarithromycin)
  • tetracyclines (doxycycline)
  • both target protein synthesis
89
Q

How can mycoplasma pneumonia be diagnosed?

A
  • qPCR of throat swab
  • amplify bacterial sequence
90
Q

What is Legionella pneumonia?

A
  • bacterial infection, normally contained water
  • gram -
91
Q

Is Legionella pneumonia common and dangerous?

A
  • uncommon (350 cases/year) - can causes severe life threatening infections
92
Q

What are the 2 most common risk factors for Legionella pneumonia?

A
  • current lung disease
  • smoking
93
Q

How can Legionella pneumonia be diagnosed?

A
  • urinary antigen
  • difficult to grow in culture
94
Q

What is the common treatment for Legionella pneumonia?

A
  • macrolides (clarithromycin) target ribosome and protein synthesis
  • quinolones (ciprofloxacin) target DNA replication
95
Q

What is the mechanism of action of quinolones?

A
  • inhibits DNA winding and structure
96
Q

In patients with community acquired pneumonia (CAP) the CURB score is used to determine the severity of the patients, what does CURB stand for??

A
  • test to assess severity of CAP
  • C in CURD can be CAP to remember
  • C = confusion - U = urea - R = respiratory rate - B = blood pressure
97
Q

What is hospital acquired pneumonia (HAP)?

A
  • someone who did not have pneumonia upon admission - pneumonia develops 48 hours after admission
98
Q

Hospital acquired pneumonia (HAP) is generally caused by highly virulent organisms, what are the 4 most common?

A

1 - Pseudomonas aeruginosa

2 - Klebsiella pneumoniae

3 - Escherichia coli

4 - Methicillin Resistant Staphylococcus Aureus (MRSA)

99
Q

What % of hospital infections are caused by Hospital acquired pneumonia (HAP)?

A
  • 1.5%
100
Q

Why is hospital acquired pneumonia (HAP) more dangerous than community acquired pneumonia?

A
  • ⬆️ virulence in organisms - ⬆️ antibiotic resistance
101
Q

In patients with hospital acquired pneumonia (HAP), 50% who are intubated and ventilated then go on to develop ventilator associated pneumonia (VAP). Is this dangerous?

A
  • yes
  • same organisms as HAP, but ⬆️ antibiotic resistance
  • ⬆️ morbidity and mortality
102
Q

What is the incidence and mortality of empyema?

A
  • 80,000/year - 20% mortality
103
Q

Diagnosis of empyema?

A
  • pus collects in pleural space, commonly following pneumonia
  • imaging (chest X-ray, thoracic ultrasound, CT thorax)
  • pleural aspiration/sampling
104
Q

How do we treat empyema?

A
  • chest drains
  • surgery
  • antifibrotic drugs
  • long course of antibiotics
105
Q

What is one of the most common risk factors for opportunistic infections?

A
  • HIV
  • always do a HIV test
106
Q

What is pneumocystis carinii (PCP)? (also known as pneumocystis jirovecii).

A
  • pneumocystis is a genera of fungi
  • pneumocystis carinii (jirovecii is a strain)
  • causes pneumonia
107
Q

What are the common symptoms of a patient with a pneumocystis carinii (PCP) (jirovecii) infection?

A
  • cough - severe breathlessness - hypoxia
108
Q

How is pneumocystis carinii (PCP) (jirovecii) infection treated?

A
  • sulfonamides called co-trimoxazole
  • inhibit nucleic acid generation
109
Q

Streptococcus pneumonia is a common bacteria located in the sinus/nasal passage. What can this bacteria cause?

A
  • can infect the ears through the sinuses
  • infect sinuses
  • pneumonia
110
Q

Haemophilus influenza is a common bacteria located in the sinus/nasal passage. What is the most common illness this bacteria can cause?

A
  • flu - most common cause of the flu
111
Q

Rhinovirus is a common virus located in the sinus/nasal passage. What is the most common illness this virus can cause?

A
  • common cold

Year 1 HLB Respiratory (25 decks)

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