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BRS YR2 > Respiratory Tract Infection and Immunity > Flashcards

Respiratory Tract Infection and Immunity Flashcards

1
Q

What are the symptoms of upper respiratory tract infection?

A
  • cough
  • sneezing
  • runny or stuffy nose
  • sore throat
  • headache
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2
Q

What are the symptoms of lower respiratory tract infection?

A
  • a productive cough : phlegm
  • muscle aches
  • wheezing
  • breathlessness
  • fever
  • fatigue
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3
Q

What are the symptoms of pneumonia?

A
  • chest pain
  • blue tinting of lips
  • severe fatigue
  • high fever
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4
Q

What is Disability-adjusted Life Year?

A

sum of Years of Life Lost (YLL) and Years Lost to Disability (YLP)

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5
Q

What is the impact of age on mortality?

A

dramatically increases mortality once age is greater than 70 years

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6
Q

What is the leading cause of death in those younger of 5?

A

malaria, then lower respiratory infections (pneumonia and bronchitis)

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7
Q

What are the different forms of pneumonia?

A
  • community acquired pneumonia
  • hospital acquired pneumonia
  • ventilator associated pneumonia
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8
Q

What are the main causes of community acquired pneumonia?

A
  • streptococcus pneumoniae (40-50%)
  • myxoplasma pneumoniae
  • staphlococcus aureus
  • chlamydia pneumoniae
  • haemophilus influenzae
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9
Q

What are the main causes of hospital acquired pneumonia?

A
  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Klebsiella species
  • E. Coli
  • Acinetobacter spp.
  • Enterobacter spp.
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10
Q

What are the main causes of ventilator associated pneumonia?

A
  • pseudomonas aeruginosa (20%)
  • staphylococcus aureus (20%)
  • enterobacter
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11
Q

What strains present as ‘walking’ (atypical) pneumonias?

A
  • mycoplasma pneumoniae
  • chlamydia pneumoniae
  • legionella pneumophilia
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12
Q

What are the mechanisms of damage of pneumonia?

A
  • bronchitis (bronchi inflammation)
  • bronchiolitis (bronchiole inflammation)
  • pneumonia (alveoli inflammation)
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13
Q

How do you grade potential bacterial pneumonia?

A
  • using the CRB/CURB-65 scoring system
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14
Q

What does CRB/CURB-65 mean?

A
  • Confusion
  • Respiratory rate (>30 breaths/min)
  • Blood pressure (<90 systolic and/or 60mmHg diastolic)
  • 65 (>65 years or older)
    In hospital, add:
  • Urea (7mmol/L)
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15
Q

What is the difference between CRB and CURB-65?

A

CURB-65 is used in hospital, add Urea (7mmol/L)

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16
Q

What are the different classifications for CRB and CURB-65?

A

0 - low severity (home treatment, anitbiotics)
1-2 - moderate severity (hospital referral)
3-4 - high severity (urgent admission, empirical antibiotics)

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17
Q

What are the treatments for bacterial pneumonia?

A
  • supportive therapies
  • antibiotics
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18
Q

What are the different supportive therapies are used to treat pneumonia?

A
  • oxygen (for hypoxia)
  • fluids (for dehydration)
  • analgesia (for pain)
  • nebulised saline (for expectoration)
  • chest physiotherapy
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19
Q

What is the impact of the time of administration on survival rate?

A

the earlier the better (<8hours) after admission

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20
Q

Is bacterial pneumonia infectious/contagious?

A
  • Not commonly contagious
  • Most of the bacteria is present in the microbiome of oropharynx, nose, oral cavity, they’re commensal bacteria
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21
Q

What is an opportunistic pathogen?

A

a microbe that takes advantage of a change in conditions (often immunosuppression)

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22
Q

What is a pathobiont?

A

a microbe that is normally commensal, but found in the wrong environment can cause pathology

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23
Q

What does cloudiness on the x-ray indicate?

A

fluid in the lungs

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24
Q

Why do viral infections result in disease?

A

causes:

  • cellular inflammation (mediator release)
  • damage to epithelium (cilia loss, poor barrier, chemoreceptor loss, bacterial growth)
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25
Q

What are the factors that cause severe disease?

A
  • highly pathogenic strains
  • absence of prior immunity
  • predisposing illness/conditions
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26
Q

What does zoonotic mean?

A

highly pathogenic strains

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27
Q

What is viral tropism?

A

the ability of a virus to infect a particular cell

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28
Q

What are the features of the respiratory epithelium?

A
  • tight junctions (prevents systemic infection)
  • mucous lining and cilial clearance (prevents attachment)
  • antimicrobials (recognise and neutralise)
  • pathogen recognition receptors
  • interferon pathways (activated by infection, promotes upregulation of anti-viral proteins and apoptosis)
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29
Q

What are the most common causes of the common cold?

A
  • rhinovirus
  • coronaviruses
  • influenza
30
Q

What are serotypes?

A

pathogens that cannot be recognised by serum (antibodies) that recognise another pathogen

31
Q

What is antibody mediated immunity?

A

humoral immunity

  • adaptive, dependent on prior exposure
  • B cells differentiate into antibody secreting plasma cells
  • different antibody classes have different biochemical properties and functions
32
Q

What are the characteristics of RSV?

A
  • nasal flaring
  • chest wall retractions
  • hypoxemia and cyanosis
  • croupy cough
  • expiratory wheezing, prolonged expiration
  • tachypnea
33
Q

What is the impact of RSV and its paediatric burden?

A
  • leading cause of infant hospitalisations
  • recurrent re-infection
  • no vaccine
  • 1% develop severe bronchitis
  • all children infected by age 3
34
Q

What are the treatment options for viral respiratory infections?

A
  • supportive therapy
  • preventative/prophylactic
  • therapeutic
35
Q

What are the different types of vaccines?

A
  • major surface antigen (spike protein)
  • viral vector
  • mRNA vaccine
36
Q

What are the different therapeutic options for viral respiratory infections?

A 
Anti-inflammatory 
- Dexamethasone (steroids)
- Tocilizumab (anti-IL6R)
- Sarilumab (anti-IL6)
Anti-virals
- Remdesivir (broad spectrum)
- Paxlovid (anti-viral protease inhibitor)
- Casirivimab and Imdevimab (monoclonal neutralising)
37
Q

What are the different supportive therapies available for viral respiratory tract infections?

A
  • oxygen (hypoxia)
  • fluids (dehydration)
  • analgesia (pain)
  • nebulised saline
  • chest physiotherapy
38
Q

What is the interplay between viral and bacterial infections?

A

high likelihood of simultaneous viral and bacterial infections

39
Q

What are the common bacterial causes of respiratory infection?

A
  • Streptococcus pneumoniae
  • Myxoplasma pneumonia
  • Haemophilus influenzae
  • Mycobacterium tuberculosis
40
Q

What are the common viral causes of respiratory infection?

A
  • Influenza A or B virus
  • Respiratory Syncytial Virus
  • Human metapneumovirus
  • Human rhinovirus
  • Coronaviruses
41
Q

What is commensal bacteria?

A

microbes that live in a symbiotic relationship with their host

42
Q

What are the risk factors of developing RSV bronchiolitis in infants?

A
  • premature birth
  • congenital heart and lung disease
43
Q

What respiratory infection causes the highest annual mortality in the average year?

A

Mycobacterium tuberulosis

44
Q

At what age do humans experience the most frequent respiratory infections?

A

0-10 years old

45
Q

What is the frequency and severity of an upper respiratory tract infection?

A

Low severity, high frequency

46
Q

What is the frequency and severity of a lower respiratory tract infection?

A

Moderate severity and frequency

47
Q

What is the frequency and severity of pneumonia

A

High severity, low frequency

48
Q

How do respiratory tract infections rank in global causes of death and DALYs?

A
  • 4th highest cause of death
  • 1st in global DALYs
49
Q

What are the demographic and lifestyle risk factors for pneumonia?

A

Age <2 years or >65 years
Cigarette smoking
Excess alcohol consumption

50
Q

What are the social risk factors for pneumonia?

A

Contact with children aged <15 years
Poverty
Overcrowding

51
Q

Which medications are risk factors for pneumonia?

A

Inhaled corticosteroids
Immunosuppresants (e.g steroids)
Proton pump inhibitors

52
Q

What risk factors for pneumonia are found in a patient’s medical history?

A

COPD, Asthma
Heart disease
Liver disease
Diabetes mellitus
HIV, Malignancy, Hyposplenism
Complement or Ig deficiencies
Risk factors for aspiration
Previous pneumonia

53
Q

Which risk factors for pneumonia are specific to certain pathogens?

A

Geographical variations
Animal contact
Healthcare contacts

54
Q

Which causative agent is most likely to cause a pandemic?

A

Influenza A

55
Q

What are the key characteristics of streptococcus pneumoniae?

A

Gram-positive, extracellular, opportunistic pathogen

56
Q

What are the typical pneumonias?

A
  • Streptococcus pneumoniae
    -Haemophilus influenzae
  • Moraxella catarrhalis
  • most common
57
Q

What does pneumonia lead to in lungs?

A
  • lung injury
  • arterial hypxemia
  • ARDS
58
Q

How does pneumonia lead to sepsis?

A
  • bacteraemia and systemic inflammation cause organ infection and injury/dysfunction
  • treatment can also cause this
59
Q

Which antibiotics are used to treat bacterial pneumonia?

A
  • penicillins e.g amoxixillin
  • macrolides e.g. clarithromycin
  • broad spectrum antibiotics
60
Q

How do penicillins work?

A

beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

61
Q

How do macrolides work?

A

bind to the bacterial ribosome to prevent protein synthesis

62
Q

What can cause absence of prior immunity?

A
  • innate immunodeficiency
  • insufficient B cell and T cell response
63
Q

Which predisposing conditions can lead to severe disease?

A

Frail elderly
COPD/asthma
Diabetes
obesity
pregnancy

64
Q

Where do viruses which have existed in humans for a long time prefer to bind?

A

Cells of the upper respiratory tract

65
Q

What does influenza A bind?

A

Haemogglutinin binds to sialic acid

66
Q

What does SARS-CoV-2 bind?

A

Spike protein binds to ACE2

67
Q

Which immunoglobulin is the upper respiratory tract enriched for?

A

IgA

68
Q

Which immunoglobulin are the lungs enriched for?

A

IgG

69
Q

What is viral bronchiolitis associated with?

A

Development of asthma

70
Q

Which virus is the most common cause of asthma and COPD exacerbations?

A

Rhinovirus

BRS YR2 (67 decks)

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