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CLS > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

Distinguish between URTI and LRTI

A

URTI: Common and relatively trivial - illnesses caused by an acute infection which involves the upper respiratory traccts including the nose, sinuses, pharynx or larynx.

LRTI: Potentially life-threatening, virus and bacteria - infection bellow level of larynx; Bronchiolitis, Bronchitis, Pneumonia

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2
Q

Some causes of common cold Coryza

A
  • Coronaviruses e.g.g SARS, MERS
  • Rhinoviruses
  • Adenoviruses
  • Parainfluenza virus 1-4
  • Enteroviruses - coxsackie
  • RSV (respiratory synctial virus

CRAPER

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3
Q

Common causes of Pharyngitits and Tonsilitis

A
  • Viruses (adenoviruses)
  • Bacteria - Strep Pyogens

Enlarges, white tonsils

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4
Q

Causes of epiglottitis

A
  • Bacterial, potentially life threatening
  • And rearely Haemophilus influenza type B
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5
Q

Causes and symptoms of Croup

A
  • In young children
  • Inspiratory stridor due to narrowed airways - noisy expiration
  • Viruses e.g. paraflu, RSV
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6
Q

Characteristics and causes of infectious mononucleosis

A

=Glandular fever

  • Syndrome, not aetiological diagnosis
  • Pharyngitis, lymphadenopathy, fever, malaise
  • Atypical mononuclear cells in peripheral
  • Caused by EBV, cytomegalovirus, tomxoplasmosis, HIV
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7
Q

Causes of LRTI

A
  • Influenza
  • Respiratory synctial virus

Rarely:

  • Varicella zoster
  • Measles
  • SARS, MERS
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8
Q

Clinical features of influenza virus infection

A
  • A,B,C only A has subtypes
  • Respiratory tract symptoms e.g. rhinits, cough, SOB
  • Systemic symptoms fever, headaches myalgia
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9
Q

Pathogenesis of influenza virus

A
  • Segmented single stranded RNA genome
    • 8 segments encoding 11 proteins e.g. segment 4=haemaglutinin which binds sialic acids on cells to intiate infection
    • 6= Neuroaminidase
  • Pneumotropic - infects cells lining respiratory tract down to alveoli
  • Lytic - strips off resp epithlium
  • Removes innate defence mechanisms - mucous secretion
  • Increased inhalation of bacteria
  • Interferon induced by virus circulates in blood
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10
Q

Complications of influenza virus

A
  • Pneumonia: primary viral -> mononuclear cell infiltration,
    • Secondary bacterial ->PMNL infiltrate
  • Caridovascular, potential myocarditis
  • CNS - encephalitis
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11
Q

Describe Antigenic drift in influenza

A
  • Occurs in inlfuenza A and B
  • random spontaneous mutations by RNA polymerase in viral genes encoding HA and NA; 1-2% AA sequence change
  • Mutations clustered in key HA and NA apitoptes, true darwinian evolution, selected by host immune response
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12
Q

Describe antigenic shift in influenza

A
  • Only in influenza A and
  • genetic reassortment
    • Between human and non-human(avian) viruses-> new subtypes
  • >20% AA differences -> new pandemic strain emerges with no existing immunity in population
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13
Q

Define epidemic

A

A widespread occurence of an influenza in a community ata particular time e.g. annual flu epidemic

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14
Q

Define pandemic

A

An infleunza pandemic is an epidemic of an influenza virus that spreads on a worldwide scale and infects a large proportion of the human population

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15
Q

Clinical features of RSV (Respiratory Synctial Virus)

A
  • LRTI in infants - bronchitis, pneumonia
  • High hospitalisation rates, low mortality
  • Re-infection occurs during life due to antigenic drift
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16
Q
A
17
Q

Main route of trnasmission for SARS, influenza and other respiratory viruses

A

Droplets

Usually under 1m spread

18
Q

Two main types of pneuomonia

A

Community acquired pneuomonia CAP

Hospital acquired pneumonia

19
Q

Demographics more prone to CAP

A

Males

Elderly

Alcoholics and smokers (poor neutrophils)

20
Q

Common bacteria that can cause CAP

A
  • S. pneumonia
    • Most common in those without COPD
    • Major virulence factor = the capsular polysaccharide
    • Relative resistant to penicillin
    • Can be vaccinated
  • H influenza
    • capsulated
      • Primary cause of CAP in children and immigrants without HIB vaccination
    • Non-capsulated
      • Important cause in COPD patients
21
Q

Atypical bacteria causing CAP

A
  • Mycoplasma pneumonia
  • Chlamydia pneumonia
  • Legionella pneumonia
  • S. auerues
22
Q

Mycoplasma pneumonia characteristics in CAP

A
  • Second most common cause of CAp
  • Characteristic extra-pulmonary features
    • Skin
  • Can occur seasonally and epidemic
  • Tetracycline
23
Q

Characteristics of legionella Pneumonia in CAP

A
  • Not as common as S.pneumonia, but severe as poorly treated with antibiotics
  • Sporadic cases occur in smokers and immunocompromised
  • Outbreak cases often water borne.
  • Treat legionellossis
    • High dose macrolide
    • Up to 4g erythromycin per day
    • Rifampicin
24
Q

Characteristics of S.aureus CAP

A
  • Common cause of CAP during influenza outbreak
  • Cause of necrotising haemorrhagic pneumonia
  • CXR: Not lobular/standard presentation, pulmonary abcesses
25
Q

Special circumstances in CF CAP

A
  • Chronically infected airways
    • S. aureus
    • P. aeruginosa
  • Symptoms are persistens, progressive, acute exacerbations
  • Parenteral treatment
26
Q

Symptoms requried for CAP diagnosis

A
  1. Cough, sputum, breathlessness, chest pain
  2. New pulmonary shadowing

By: Temp, full blood count, urea, electrolytes, LFT, CXR, Blood gases

27
Q

How is pneumonia severity assessed

A

CURB-65 criteria

Confusion

Urea

Respiratory rate

Blood pressure

65age

mild: amoxicillin & clarithromycin

3+ severe= amoxiclav & clarithromycin

28
Q

Treatment plan for CAP

A
  • Correct resp failure - O2
  • Correction of haemodynamic compromise - fluids
  • Specific Antimicrobial treatment
29
Q

Define hospital acquired pneumonia

A

Pneumonia that occurs:

  • More than 48 hours after hospital admin OR within 10 days of previous admission
30
Q

Likely organisms in HAP

A

More likely to be gram negative

  • E. coli
  • Klebs spp
  • Proteus spp
  • S. pneumonia
  • S. aureus
    • MSSA
    • MSRA
31
Q

M. tuberculosis characteristics

A
  • Human adapted form of M. bovis
  • Obligate aerobes e.g .lungs
  • Facultative intracellular pathogens
    • Usually infects mononuclear phagocytes
  • Slow-growing
  • Hydrophobic
32
Q

M. TB spread

A

Airborne droplets

Taken up by pulmonary macrophages, spread to hilar lymph nodes

Cell-mediated immunity

33
Q

Non-specific symptoms of TB

A

Fever, weight loss, Night sweats

34
Q

Respiratory symptoms in TB

A

Cough

SOB

Haemoptysis

Chest pain

35
Q

Typical tests in TB investigation

A
  • Sputum
  • Pus/tissue
  • Urine
  • Microscopy
  • Culture
  • Antibiotic sensitivity tests
  • Genomic tests
36
Q
A

CLS (20 decks)

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