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MD3001 - Respiratory Disease/Pathology > Respiratory Tract Infections > Flashcards

Respiratory Tract Infections Flashcards

1
Q

What are the top 6 killers - infections responsible for the greatest number of deaths in the world?

A
  1. Acute respiratory tract infections
  2. HIV/AIDS
  3. Diarrheal diseases
  4. TB (chronic infection)
  5. malaria
  6. measles
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2
Q

What are common bacteria in the normal microbiota of the respiratory tract?

A
  • Bacteroides spp.
  • Candida albicans (causes thrush)
  • Oral Streptococci
  • Haemophilus influenzae (causes menigitis)
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3
Q

What are occasional organisms found in the normal microbiota of the respiratory tract of people?

A
  • Streptococcus pyogenes
  • Streptococcus pneumoniae
  • Neisseria meningitidis
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4
Q

What organisms are found in latent state in tissues?

A
  • Herpes simplex virus type I (HSV)
  • Epstein-Barr virus (EBV) - glandular fever
  • Cytomegalovirus (CMV)
  • Mycobacterium tuberculosis
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5
Q

What are the host defence mechanisms of the respiratory tract?

A
  • saliva
  • mucus
  • cilia (goblet cells)
  • nasal secretions
  • antimicrobiral peptides - defensins, lysozyme
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6
Q

What group of people experience the most cases of whopping cough?

A

90% of cases are children <5

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7
Q

What is the method of transmission of whopping cough?

A

air-born droplets

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8
Q

What is the incubation period of whopping cough?

A

1-3 weeks

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9
Q

What are the clinical features of whopping cough?

A
  • Catarrhal stage (week 1)
    • highly contagious
    • malaose (feeling unwell)
    • Mucoid rhinorrhoea (nasal cavity filled with mucus)
    • Conjunctivitis
  • Paroxysmal stage (1-4 weeks)
    • coughing eith classive inspiratory ‘whoop’
    • Lumen of respiratory tract is compromised by mucus secretion and mucosal oedema
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10
Q

How is whopping cough diagnosed?

A
  • Clinically characterised by ‘whoop’
  • Bacterial isolation from nasopharyngeal swabs
  • NAAT (nucleic acid amplification technique)
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11
Q

What is the treatment of whopping cough?

A
  • Catarrhal stage = erythromycin
  • paroxysmal stage = antibiotics have no effect
  • isolation
  • supportive care (hospitalisation for infants)
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12
Q

What is the prevention treatment of whopping cough?

A

vaccination

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13
Q

What is the causative pathogen of whopping cough? And what type of bacteria is this?

A

Bordetella pertussis

gram negtaive aerobic coccobacillus

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14
Q

What does Bordetella pertussis target and what are its toxic factors?

A
  • attached to and replicates in the ciliated respiratory epithelium - filamentous haemagglutinin (FHA)
  • Toxic factors:
    • Pertussis toxin (Ptx) - similar to diptheria
    • Adenylate cyclase toxin - affects neutrophil function (Increases cAMP)
    • Tracheal cytotoxin
    • Endotoxin
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15
Q

What is acute bronchitis?

A

inflammation of the tracheobronchial tree

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16
Q

What is acute bronchitis usually caused by?

A
  • rhinovirus
  • coronavirus
  • adenovirus
  • mycoplasma pneumoniae
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17
Q

What secondary infections can cause acute bronchitis?

A
  • streptococcis pnemoniae
  • haemophilus influenzae

**Causes more problems (bacterial and viral together)

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18
Q

What is chronic bronchitis characterised by?

A

cough and excessive mucus sewcretion in tracheobronchial tree

Not attributable to a specific disease

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19
Q

What are the anatomical disturbances to the respiratory system that cause acute bronchitis?

A
  • Immune deficit: SCID
  • Ciliary deficit: Kartegener Syndrome, smoking
  • Excessively thick mucus: cystic fibrosis
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20
Q

What are the main features of bronchiolitis?

A
  • restricted to children <2 years old
  • bronchioles have such a fine bore
  • Infection may lead to epithelial cell necrosis
  • Mainly caused by Respiratory Syncytial Virus (RSV)
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21
Q

What is pneumonia?

A

inflammation of the substance of the lungs

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22
Q

How is pneumonia confirmed?

A

on a chest radiograph

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23
Q

How does pneumonia get into the lung?

A

acess to lower respiratory tract by inhalatiom of aerosolised microbes or by aspiration of normal flora of the upper respiratory tract

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24
Q

What is an important determinant of the type of pneumonia?

A

AGE

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25
Q

Describe pneumonia in children?

A
  • Mainly viral
  • Neonates may develop pneumonia caused by streptococcus B, E.coli, Chlamydia trachomatis (aquired from mother during birth)
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26
Q

Describe pneumonia in adults

A
  • mainly bacterial
  • aetiology varies with age, underlying disease, occupation and geohraphical risk factors
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27
Q

Aetiological causes of viral pneumonia

A
  • Influenza virus
  • Measles
  • Coronavirus
  • Parainfluenza virus
  • Respiratory syncytial virus (RSV)
  • Cytomegalovirus (CMV)
  • Adenovirus
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28
Q

Aetiological causes of bacterial pneumonia

A
  • Streptococcus pneumoniae
  • Mycobacterium tuberculosis
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
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29
Q

What is atypical pneumonia and what is it caused by?

A
  • Failure to respond to treatment with penicillin
  • Mycoplasma pneumoniae
  • Legionella pneumophilia
  • Chlamydia psittaci
  • Chlamydia pneumoniae
  • Coxiella burnetii
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30
Q

What are the anatomical classifications of pneumonia?

A
  • Lobar pneumonia - distinct region of lung e.g. lobe
  • Bronchopneumonia
    • Diffuse, patchy consolidation
    • Assocaited with bronchi and bronchioles
  • Intersitital pneumonia
    • invasion of lung interstitum
    • Usually characteristic of viral infection
  • Necrotising pneumonia
    • lung abscesses and destruction of parenchyma
31
Q

What are the initial clinical features of Streptococcus pneumoniae?

A
  • abrupt onset
  • rigors
  • fever
  • malaise
  • tachycardia
  • dry cough
32
Q

What are the initital clinical features of Streptococcus pneumoniae followed by?

A
  • productive cough and rusty sputum
  • spiky temperature
  • lobular consolidation
33
Q

What are the clinical features of Mycoplasma pneumoniae

A
  • fever
  • dry cough
  • dyspnoea
  • lymphadenopathy
34
Q

What are the clinical features of Haemophilus influenzae

A
  • mainly occurs in children
  • consolidation or patchy bronchopneumonia
  • persistent purulent sputum and malaise
35
Q

What is legionella pneumophila caused by?

A

legionnaire’s disease

36
Q

What is legionella pneumophila?

A

severe systemic infection with pneumonia

37
Q

What are the clinical features of legionella pneumophila?

A
  • tachypnoea
  • purulent sputum
  • chest x-ray shows consolidation
38
Q

What is legionella pneumophila?

A

gram negative bacillus

39
Q

How is legionella pneumophila transmitted?

A

aerosol, but not person-person

40
Q

How does legionella pneumophila usually occur?

A

in outbreaks

41
Q

What is the laboratory diagnosis of Legionnaire’s Disease

A
  • gram staining of sputum
  • recognition with serotype-specific floursecent antibody
  • Culture of Legionella on cystine yeast extract agar
  • Detection of antigen in urine
  • 4-fold rise in antibody
42
Q

What are the clinical features of measles?

A
  • fever
  • runny nose
  • Kolpik’s spots
  • characteristic rash
43
Q

What can measles result in?

A

neurological complications

44
Q

What can measles cause?

A

Can cause “giant cell” (Hecht’s) pneumonia in the immunocompromised – usually fatal

45
Q

What type of virus is measles?

A

paramyxovirus

46
Q

How is the measles virus spread?

A

aerosol

47
Q

Where does the measles virus replicate?

A

lower respiratory tract

48
Q

What is the incubation period of measles?

A

10-14 days

49
Q

How do you diagnose the measles virus?

A
  • serology for measles
  • virus isolation
  • viral detection
50
Q

What is the treatment of measles virus?

A

ribavirin treatment (anti-viral)

antibiotics for secondary bacterial infections

51
Q

methods of the prevention of the measles virus

A

immunisation with highly effective, live, attenuated MMR vaccine

52
Q

What is an endemic

A

present in a community at all times; at a relatively low to medium frequency but at a steady state

53
Q

What is an epidemic?

A

sudden severe outbreak within a region or group

54
Q

what is a pandemic?

A

occurs when an epidemic becomes widespread and affects a whole region, a continent or the entire world

55
Q

What type of virus is influenza?

A

orthomyxovirus

56
Q

What are the three tpes of influenza?

A
  • Type A = epidemics and pandemics, animal resovoir
  • Type B = epidemics, no animak hosts
  • Type C = minor respiratory illness
57
Q

Dsecribe the influenza virus?

A
  • type-specific antigens on cell surface (spikes)
    • Haemagglutinin (H)
    • Neuraminidase (N)
  • Single-standed RNA
    • Segmented genome
    • Resassortment gives ruse ti novel combinations of H and N genes
58
Q

What mild changes does influenza undergo during spread through the host species?

A

Antigenic drift

  • small point mutations in the H and N antigens occurs constantly
  • Allows the virus to multiply in individuals with immunity to preceding strains
  • new subtype can reinfect community
  • occurs with all influenza types
59
Q

What major changes does influenza undergo during spread through the host species?

A

Antigenic shift

  • sudden major change based on recombination between two different strains when they infect the same cell
  • produces a virus with novel surface glycoproteins
  • new strain can spread through previously immune populations - new pandemic
60
Q

What makes a pandemic?

A
  • antigenic shift
  • most people have no immunity
  • attach rate is high - it spreads rapidly
  • mortaltity can be high
61
Q

What type of virus is swine flu? And who did it mostly affect?

A

H1N1 virus

People inder the age of 40. Attack rate was high but mortality was low

62
Q

How is influenza diagnosed?

A
  • Nasopharyngeal aspirate
    • Direct immunofluorescent
    • culture
    • NAAT detection
63
Q

What is the treatment used for influenza?

A
  • Amantadine
  • Zanamavir
  • Oseltamivir (Tamiflu)
64
Q

What is the management for influenza?

A
  • rest, warmth, hydration, analgesia
  • Anti-viral treatment within 48hrs has some effect on the duration of fever
  • Antibiotics not given unless secondary bacterial infection is suspected
65
Q

What is the prevention for influenza?

A

killed vaccine (~70% efficacy)

66
Q

What is SARS?

A

Severe Acute Respiratory Syndrome

67
Q

What are the symptoms of SARS?

A
  • High fever
  • cough
  • Shortness of breath
  • CXRs consistent with pneumonia
68
Q

What is the incubation period of SARS?

A

2-7 days (max 10 days)

69
Q

How is SARS transmitted?

A

via droplets, faeces, infected animals (many modes)

70
Q

How is SARS identified?

A
  • virus isolation in cell culture
  • electron microscopy
  • molecular techniques
71
Q

What type of virus is SARS?

A
  • coronavirus
  • enveloped RNA virus
  • Characterisitic “halo”
  • receotir for spike protein is ACE2
72
Q

What is the treatment for SARS?

A

No specific treatment avaliable

  • Ribavirin
  • Corticosteroids
  • Interferons
  • Anti-retroviral therapies (protease inhibitors)
73
Q

Common fungal infections of RT

A
  • Aspergillus fumigatus
  • Pneumocystis jiroveci (previously P. carinii)
    • AIDS defining condition
74
Q

Common parasitic infections of RT

A
  • Ascaris
  • Strongyloides
  • Schistosoma
  • Echinococcus granulosus

MD3001 - Respiratory Disease/Pathology (7 decks)

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