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Pathology MD3001 > Respiratory Tract Infections 2 > Flashcards

Respiratory Tract Infections 2 Flashcards

1
Q

What is pneumonia and how is it confirmed?

A

It is inflammation of the substance of the lungs. Confirmed using chest radiograph

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2
Q

Describe the difference in pneumonia in children and adults?

A
  • Children - Mainly viral, neonates can develop it from chlamydia trachomatis from mother during birth.
  • Adults - Mainly bacterial, the aetiology varies with age, underlying disease, occupational and geographic risk factors.
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3
Q

What are the common causes of viral pneumonia?

A
  • Influenza virus,
  • Measles,
  • Coronavirus,
  • Parainfluenza virus,
  • Respiratory syncytial virus,
  • Cytomegalovirus,
  • Adenovirus
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4
Q

What are some bacterial causes of pneumonia?

A
  • Streptococcus pneumoniae,
  • Mycobacterium tuberculosis,
  • Haemophilus influenza,
  • Pseudomonas aeruginosa,
  • Staphylococcus aureus
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5
Q

What are some of the atypical cause of pneumonia?

A

These are a failure to respond to treatment with penicillin, caused by;

  • Mycoplasma pneumoniae,
  • Legionella pneumophilia,
  • Chlamydia psittaci/pneumoniae,
  • Coxiella burnetii.
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6
Q

Describe the anatomical classification of pneumonia

A
  • Lobar pneumonia,
  • Bronchopneumonia,
  • Interstitial pneumonia,
  • Necrotising pneumonia (lung abscesses and destruction of parenchyma)
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7
Q

What are the clinical features of streptococcus pneumoniae infection?

A

Initially - Abrupt onset, rigors, fever, malaise, tachycardia, dry cough.

Followed by productive cough with rusty sputum, spiky temperature and lobular consolidation

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8
Q

What are the clinical features of mycoplasma pneumoniae?

A

Fever, dry cough, dyspnoea and lymphadenopathy.

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9
Q

What are the clinical features of haemophilus influenza infection?

A

Mainly occurs in children, it results in consolidation or patchy bronchopneumonia with persistent purulent sputum and malaise.

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10
Q

What are the clinical features of legionella pneumophila infections?

A
  • It causes legionnaire’s disease
  • Results in tachypnoea, purulent sputum and chest x-ray shows consolidation.
  • Gram negative bacillus which secretes protease causing lung damage.
  • Transmitted by aerosol, not person to person
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11
Q

How do you diagnose legionnaire’s disease?

A

Gram staining of sputum.

Recognition with serotype specific fluorescent antibody.

  • Detection of antigen in urine
  • 4-fold rise in antibodies.
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12
Q

Describe clinical features of measles?

A

Fever, runny nose, Koplik’s spots (only occur in measles) and a characteristic rash. It may cause neurological complications.

  • May cause Hecht’s pneumonia
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13
Q

What is the prevention, diagnosis and treatment of measles?

A

Prevention - Immunisation with MMR vaccine.

Diagnosis - Serology for measles-specific IgM, viral isolation or viral RNA detection.

Treatment - If severe ribavirin or antibiotics for secondary bacterial infections.

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14
Q

What are some of the risk factors for pneumonia?

A
  • Bird contact, Travel/air conditioning, cystic fibrosis, immigration, farming (sheep) and recent influenza.
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15
Q

What are the symptoms of pneumonia?

A

Cough, breathlessness, weakness and malaise, chest pain (pleural inflammation) and purulent sputum

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16
Q

What are the signs of pneumonia?

A
  • Raised temperature
  • Purulent sputum
  • Rapid respiration
  • Signs of lung consolidation
  • Shock
  • Cyanosis
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17
Q

How do you diagnose pneumonia?

A
  • History,
  • Examination,
  • Radiology,
  • Sputum,
  • Serology,
  • Histopathology.
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18
Q

Describe the CURB scores for pneumonia

A
  • Confusion of new onset.
  • Blood Urea nitrogen greater that 7mmol/l
  • Respiratory rate over 30
  • Blood pressure with systolic less than 90 or diastolic less than 60
  • Age 65 or older.
19
Q

Define endemic, epidemic and pandemic disease

A

endemic - Present in community at all times but at low levels.

Epidemic - Sudden severe outbreak within a region or group.

Pandemic - Occurs when epidemic becomes widespread and affects whole region/continent or world

20
Q

What are the three types of influenza?

A

Type A - Epidemics and pandemics, animal reservoir.

Type B - Epidemics but no animal hosts

Type C - Minor respiratory illness

21
Q

What are some of the type-specific antigens on the surface of influenza?

A

Haemagglutinin (H) and Neuraminidase (N)

22
Q

What genetic changes does influenza virus undergo?

A

Antigenic drift - Small point mutations in the H and N antigens occurs constantly.

Antigenic shift - Sudden major change based on recombination between two different virus stains when they infect the same cell. (produces a virus with novel surface glycoproteins)

23
Q

What makes a pandemic?

A

Antigenic shift, lack of immunity, attack rate is high and so it mortality

24
Q

Describe features of swine flu

A

Influenza A virus H1N1. Since it was a H1N1 virus there was a high attack rate but low mortality due to a degree of immunity.

25
Q

How do you diagnose influenza?

A

Nasopharyngeal aspirate - Direct immunofluoresence, culture and NAAT detection. Serology.

26
Q

How do you treat influenza?

A

Amatadine, zanamavir and oseltamivir (very little effect)

27
Q

What is the management of influenza?

A

Rest, warmth, hydration and analgesia. If given antiviral treatment in first 48 hours then it has some effect on fever duration. Antibiotics not given unless there is a secondary bacterial infection.

28
Q

Describe features of the influenza vaccine

A

Antigenic variation means need for new one each year. It is based on the predicted strains. New recombination methods speed up the process of developing a vaccine

29
Q

What are the symptoms of SARS

A

High fever, cough, shortness of breath and chest X-rays consistent with pneumonia

30
Q

How is the SARS-associated coronavirus identified and what are its identifying features?

A
  • Virus isolation in cell culture,
  • Electron microscopy,
  • Molecular techniques.

It is an enveloped RNA virus with a ‘halo’

31
Q

What is the treatment for SARS?

A

Non specific anti-viral treatment available but can use ribavirin, corticosteroids, interferons and anti-retroviral therapies.
However inactivated virus vaccine developed.

32
Q

What is tuberculosis associated with?

A
  • AIDS,
  • Increased use of immunosuppressive drugs,
  • Decreased socio-economic conditions,
  • Increased immigration from areas of high endemicity,
  • Multiple drug resistance,
  • Overcrowding and poor nutrition.
33
Q

What are the clinical features of primary TB?

A

Usually symptomless but may be associated with a cough and wheeze. Small transient pleural effusions may occur.

34
Q

What are the clinical features of miliary TB?

A

Results from acute diffuse dissemination of bacillus and can be fatal without treatment

35
Q

What are the clinical features of post-primary TB?

A

Onset over weeks/months and symptoms are;

  • Malaise,
  • Fever,
  • Weight loss,
  • Mucoid, purulent or blood stained sputum,
  • Pleural effusion
36
Q

What are some of the symptoms for tuberculosis?

A

Poor apatite, night sweats, weakness, fever, dry cough, weight loss and GI symptoms

37
Q

Describe features of mycobacterium tuberculosis

A
  • Neither gram neg or positive.
  • Acid-fast bacilli
  • Spread by inhalation of organisms from dust/aerosols.
  • Obligate aerobe (found in well aerated upper lobes of the lungs)
38
Q

How can you detect latent TB infection?

A

Mantoux text - tuberculin is injected intradermally, there will be an immune response if an individual has previously been exposed to bacterium.

39
Q

What is the importance of bacterial load on diagnostics?

A

Symptoms differ at different bacterial loads and diagnostic tests become more positive at different bacterial loads so reducing the bacterial load can delay the diagnosis

40
Q

How can you detect M.tuberculosis?

A

Visualising acid-fast bacilli in sputum smears

41
Q

What is the treatment for tuberculosis?

A

Combination therapy - (isoniazid, rifampicin etc) however multi-drug resistant TB is becoming a big issue.

Prolonged therapy of a minimum of 6 months to eradicate slow-growing organisms

42
Q

How do you prevent TB?

A

Childhood immunisation, live attenuated BCG vaccine or prophylaxis with isoniazid for a year.

43
Q

What are some pathogens that cause fungle infections?

A

Aspergillus fumigatus and pneumocystis jiroveci.

44
Q

What are some pathogens that cause parasitic infections?

A
  • Ascaris,
  • Stringyloides
  • Schistosoma

Pathology MD3001 (20 decks)

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