Respiratory Tract Infections Flashcards
Otitis Externa Etiologies
Psuedomonas aeruginosa and Staphylococcus aureus
Pseudomonas aeruginosa description
Gram-negative encapsulated bacilli. Produces fluorescent blue/green pigments pyocyanin (virulence factor, produces ROS) and pyoverdin. Infectious isolates have pili.
Staphylococcus aureus description
Gram-positive encapsulated cocci in clusters.
Staphylococcus aureus Culture
Coagulase positive (gold standard) and Beta-hemolytic
AOM and Sinusitis Etiologies
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
Streptococcus pneumoniae Description
Gram-positive, lancet-shaped, encapsulated diplococci.
Streptococcus pneumoniae Culture
Alpha hemolysis with optochin sensitivity.
Moraxella catarhalis Description
Gram-negative diplococci
Moraxella catarhalis Culture
Oxidase positive. Beta-lactamase producer.
Diphtheria Etiology
Corynebacterium
Corynebacterium Description
Gram-positive pleomorphic bacilli. Palisades (V or chinese letters appearance). Metachromatic volutin granules. Green organism with dark stained granules.
Diptheria toxin
A-B exotoxin. Stimulated by low iron concentrations. Binds the heparin-binding EGF and is endocytosed. The vesicle becomes acidified and releases the A subunit. The A subunit inactivates EF-2 via ADP- ribosylation and halts protein synthesis.
Cutaneous Diphtheria Presentation
Chronic ulcers usually due to non-toxigenic strains.
Respiratory Diphtheria presentation
Sudden onset of malaise, exudative pharyngitis, low-grade fever and LAD (“bull neck”). Forms a pseudomembrane in the pharynx made of fibrin, bacteria, WBC and necrotic epithelial cells. Systemic toxicity can lead to myocarditis and demyelination.
Corynebacterium culture
Loeffler’s medium (enhances formation of the volutin granules) and cysteine-tellurite agar (definitive test).
Diphtheria Diagnosis
Gram stain (positive with volutin granules), culture, Elek test (immunodiffusion assay of the toxin), PCR, ELISA, immunochromatographic strip assay.
Pertussis Etiology
Bordetella pertussis
Bordetella pertussis Description
Small, gram-negative coccobacilli
Bordetella pertussis virulence factors
endotoxin, adhesins, exotoxins
Bordetella pertussis adhesins
Mediate the attachment to integrins to colonize the ciliated respiratory epithelium. Filamentous hemagglutinin, pertactin and agglutinogens.
Bordetella pertussis A-B exotoxin
Dysregulates cAMP and inhibits phagocytes. Causes lymphocytosis.
Bordetella pertussis adenylate cyclase toxin
Decreases chemotaxis
Bordetella pertussis Dermonecrotic toxin
Causes vasoconstriction that can lead to necrosis
Bordetella pertussis tracheal cytotoxin
Kills ciliated respiratory cells. Allows infection of the lower respiratory tract.
Pertussis disease stages
Catarrhal: inflammaiton of the mucous membranes with nonspecific URI symptoms but is highly contagious. Paroxysmal: attacks/spasms, paroxysmal coughing often followed by vomiting, characteristic “whoop” can last for weeks.
Convalescent: Gradual recovery
Pertussis Complications
pneumonia, encephalopathy, seizures and death
Pertussis epidemiology
Usually occurs in children less than 1 yo.
Bordetella pertussis Culture
Grows on enriched selective medias. Bordet-Gengou agar (definitive) and Regan-Lowe (Gray/silver colonies).
Pertussis Diagnosis
Serology for the toxin or adhesins, culture, PCR for the toxin gene.
Acute Respiratory Disease Etiologies
Rhinovirus, coronaviruses, Adenoviruses
Rhinovirus Epidemiology
Hyperendemic during the winter. Usually occurs in children and you adults. Transmission occurs with direct contact and through aerosols. Immunity is transient.
Rhinovirus Treatment
Zinc gluconate (cold eeze) and picovir (inhibits viral binding).
Influenza Serotypes
Type A > Type B > Type C. Subtypes are based on envelope proteins, H=hemagglutinin (attachment) and N=neuraminidase (penetration and release).
Influenza Presentation
Abrupt onset of fever, aches, chills and cough, that usually lasts a week.
Influenza complications
Primary influenza pneumonia, Secondary/bacterial pneumonia (S. pneumoniae, S. aureus, Hib), Reyes syndrome and Guillain-Barre syndrome.
Reyes syndrome
Acute, catastrophic systemic disorder. Edematous encephalitis and fatty alteration of liver tissue. Usually seen in kids 6 mo-15 yo. Associated with influenza and the chicken pox that is treated with aspirin.
Guillain-Barre Syndrome
Demyelination that can be induced by the vaccination but there is a ten fold higher risk from the natural infection.
Influenza Diagnosis
Direct isolation from throat/nasopharyngeal swabs or rapid antigen detecting kits (can give false negatives).
Amantadine/rimantadine
Treats influenza type A. Stops uncoating and penetration. Some resistance has emerged.
Ostemivir (tamiflu)/ zanamivir (relenza)
Treats influenza type A and type B. Neuraminidase inhibitors that stop the release and spreading. Resistance has emerged.
Influenza vaccine
Trivalent contains two type A and one type B virus that is predicted to be most likely. Children less than 9 yo require two administrations for their first time. Can result in mild flu-like symptoms.
Influenza vaccine target groups
Adults over 65, long term care facilities, pulmonary/cardiac chronic conditions, asthma, immunosuppressed, DM, renal dysfunction, hemoglobinemias, pediatric patients on aspirin therapy, healthcare workers.
Antigenic Drift
Point mutation in the H or N genes that causes minor genetic variation.
Antigenic Shift
Exchange of genomic segments. Causes major genetic variation. Occurs more in type A due to it’s segmented genome and wide range of hosts.
Influenza Nomenclature
type/location of discovery/year of isolation/isolation number/antigenic type