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Cardiorespiratory 2 > Respiratory Tract Infections and Immunity > Flashcards

Respiratory Tract Infections and Immunity Flashcards

1
Q

What are the signs and symptoms of an upper respiratory tract infection?

A 
A cough
Sneezing
A runny or stuffy nose
A sore throat
Headache
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2
Q

What are the signs and symptoms of a lower respiratory tract infection?

A 
A “productive” cough - phlegm
Muscle aches
Wheezing
Breathlessness
Fever
Fatigue
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3
Q

What are the signs and symptoms of pneumonia?

A

Chest pain
Blue tinting of the lips
Severe fatigue
High Fever

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4
Q

What are DALYs?

A

DALY – 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 demographic and lifestyle factors increase risk of pneumonia?

A

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

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6
Q

What social factors increase risk of pneumonia?

A

Contact with children aged <15 years
Poverty
Overcrowding

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7
Q

What medications increase risk of pneumonia?

A

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

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8
Q

What medical history increases risk of pneumonia?

A 
COPD, Asthma
Heart disease
Liver disease
Diabetes mellitus
HIV, Malignancy, Hyposplenism
Complement or Ig deficiencies
Risk factors for aspiration
Previous pneumonia
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9
Q

What specific risk factors for certain

pathogens are there?

A

Geographical variations
Animal contact
Healthcare contacts

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10
Q

What are causative Agents of respiratory infection?

A 
Bacterial 
Streptococcus pneumoniae
Myxoplasma pneumoniae
Haemophilus Influenzae
Mycobacterium tuberculosis
Viral
Influenza A or B virus
Respiratory Syncytial Virus
Human metapneumovirus
Human rhinovirus
Coronaviruses
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11
Q

Define bronchitis, bronchiolitis and pneumonia

A

Bronchitis - inflammation and swelling of the bronchi
Bronchiolitis - inflammation and swelling of the bronchioles
Pneumonia - Inflammation and swelling of the alveoli

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12
Q

What are the mechanisms of damage in acute bacterial pneumonia?

A

Lung injury results in arterial hypoxemia causing acute respiratory distress syndrome. Bacteremia causes organ infection resulting in organ injury or dysfunction which lung injury also contributes to. This leads to sepsis and deterioration. Pneumonia causes systemic inflammation and organ injury + dysfunction.
Deterioration refers to decrement in pulmonary, cardiovascular, neuromuscular, haematologic, cognitive, psychological and other functions.

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13
Q

How is potential bacterial pneumonia graded?

A 
CRB/CURB-65 scoring (1 point per item)
Confusion 
Respiratory rate – >30 breaths/min 
Blood pressure - < 90 systolic and/or 60 mmHg diastolic
65 -  65 years old or older
In hospital add
Urea -  7 mmol/L
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14
Q

What is the treatment plan based on CRB scoring?

A

If 0, low severity so antibiotics and home treatment
If 1-2, moderate severity so consider hospital referral
If 3-4, severe and urgent hospital admission + empirical antibitiotics

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15
Q

What are supportive treatments for bacterial pneumonia?

A 
Oxygen (for hypoxia)
Fluids (for dehydration)
Analgesia (for pain)
Nebulised saline (may help expectoration)
Chest physiotherapy?
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16
Q

What antibiotics are prescribed for bacterial pneumonia?

A

Penicillins e.g. amoxicillin – beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

Macrolides e.g. clarithromycin – bind to the bacterial ribosome to prevent protein synthesis

17
Q

Define opportunistic pathogen and pathobiont

A

Opportunistic Pathogen: A microbe that takes advantage of a change in conditions (often immuno-suppression).

Pathobiont: A microbe that is normally commensal, but if found in the wrong environment (e.g. anatomical site) can cause pathology.

18
Q

Why do viral infections result in disease?

A

Cause mediator release, cellular inflammation and epithelial damage. Epithelial damage results in loss of cilia, bacterial growth, poor barrier to antigen and loss of chemoreceptors.

19
Q

What factors cause severe disease?

A
  1. Highly pathogenic strains (zoonotic)
  2. Absence of prior immunity
    Innate immunodeficiency (e.g. IFITM3 gene variant)
    B cells (antibody- presumably local)
    T cells (correlate with peripheral levels?)
  3. Predisposing illness/conditions
    Frail elderly
    COPD/asthma
    Diabetes, obesity, pregnancy etc.
20
Q

Describe viral binding

A

Most respiratory viruses can infect cells throughout the respiratory tract, but tend to preferentially adapt to bind cells of the upper respiratory tract if they have existed in humans for a prolonged time

21
Q

What defence mechanisms does the respiratory epithelium have?

A

Tight junctions – prevents systemic infection
Mucous lining and cilial clearance – prevents attachment, clears particulates
Antimicrobials – recognise, neutralize and/or degrade microbes and their products
Pathogen recognition receptors – recognise pathogens either outside or inside a cell.
Interferon pathways – activated by viral infection. Promotes upregulation of anti-viral proteins and apoptosis.

22
Q

Contrast antibodies in oropharynx as compared to lower resp tract

A

Oropharynx has high frequency of IgA-plasma cells
ECs express poly IgA receptor, allowing export of IgA to the mucosal surface. Homodimer is extremely stable in protease rich environment.

LRT has thin-walled alveolar space which allow transfer of plasma IgGs into the alveolar space.

23
Q

What are symptoms of RSV bronchiolitis

A

Chest wall retractions, nasal flaring, hypoxemia and cyanosis, croupy cough, expiratory wheezing, tachypnoea with apnoeic episodes

24
Q

What are RSV risk factors

A

Premature birth

Congenital heart and lung disease

25
Q

What are antiviral treatments?

A

Remdesivir – broad spectrum antiviral – blocks RNA-dependent RNA polymerase activity
Paxlovid – antiviral protease inhibitor
Casirivimab and imdevimab - monoclonal neutralising antibodies for SARS-CoV-2

26
Q

What are therapeutic anti-inflammatories?

A

Dexamethasone (steroids)

Tocilizumab (Anti-IL6R) or Sarilumab (anti-IL6)

27
Q

How does viral infection interplay with chronic lung diseases?

A

Viral bronchiolitis is associated with the development of asthma
Rhinoviruses are the most common cause of asthma and COPD exacerbations
High likelihood of secondary bacterial pneumonia after viral infection

Cardiorespiratory 2 (13 decks)

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