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CARDIORESPIRATORY 2 > RESPIRATORY TRACT INFECTIONS AND IMMUNITY > Flashcards

RESPIRATORY TRACT INFECTIONS AND IMMUNITY Flashcards

1
Q

What symptoms are indicative of an upper respiratory tract infection?

A 
Cough
Sneezing
Runny or stuffy nose
Sore throat
Headache
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2
Q

What symptoms are indicative of a lower respiratory tract infection?

A 
Phlegm from a cough
Muscle aches
Wheezing
Breathlessness
Fever
Fatigue
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3
Q

What symptoms are indicative of pneumonia?

A

Chest pain
Blue tinting of lips
Severe fatigue
High fever

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4
Q

What is the epidemiology for respiratory infections?

A

One of the leading causes of death in the world causing increased mortality in elderly

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5
Q

What are some demographic and lifestyle risk factors for pneumonia?

A

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

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6
Q

What are some social risk factors for pneumonia?

A

Contact with children aged <15
Poverty
Overcrowding

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7
Q

What are some medications that increase risk of pneumonia?

A

Inhaled corticosteroids
Immunosuppresants e.g. steroids
PPIs

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8
Q

What are some previous diseases which could increase risk of pneumonia?

A 
COPD, asthma
Heart disease
Liver disease
Diabetes mellitus
HIV
Malignancy
Hyposplenism
Previous pneumonia
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9
Q

What are the 4 most common bacterial species that cause respiratory infections?

A

Streptococcus pneumoniae
Myxoplasma pneumoniae
Haemophilus influenzae
Mycobacterium tuberculosis

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10
Q

What are the most common viruses that cause respiratory infections?

A 
Influenza A/B
Respiratory syncytial virus
Human metapneumovirus
Human rhinovirus
Corona viruses
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11
Q

How often do respiratory viral pandemics occur?

A

Almost one pandemic every decade

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12
Q

What are some bacteria that are responsible for community acquired pneumonia?

A 
Streptococcus pneumoniae (40-50%)
Myxoplasma pneumoniae
Staphylococcus aureus
Chlamydia pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
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13
Q

What are some bacteria that are responsible for hospital acquired pneumonia?

A 
Staphylococcus aureus
Pseudomonas aeruginosa
Klebsiella species
E. coli
Acinetobacter spp.
Enterobacter spp.
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14
Q

What are some bacteria that are responsible for ventilator associated pneumonia?

A 
Pseudomonas aeruginosa (25%)
Staphylococcus aureus (20%)
Enterobacter
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15
Q

What are some atypical bacterium causes of pneumonia?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophilia

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16
Q

What is pneumonia?

A

Inflammation and swelling of alveoli

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17
Q

How do you grade bacterial pneumonia?

A

CRB65 scoring (1 point per criteria)

  • Confusion
  • Respiratory rate > 30 breaths/min
  • Blood pressure < 90 systolic/ 60 mmHg diastolic

In hospital:
- Urea > 7 mmol/L

0 = home treatment
1-2 = consider hospital referral
3-4 = urgent hospital admission, empirical antibiotics if life-threatening
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18
Q

What are the treatments for bacterial pneumonia

A

Oxygen
Fluids
Analgesia
Antibiotics

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19
Q

What are the 2 types of antibiotics you can give patients with bacterial pneumonia?

A

Penicillins e.g. amoxicillin

Macrolides e.g. clarithromycin

20
Q

How do penicillins work?

A

Beta-lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

Typical CAPs may respond to these

21
Q

How do macrolides work and give an example?

A

Antibiotics which bind to bacterial ribosome to prevent protein synthesis
E.g. clarithromycin

Atypical CAPs may respond these

22
Q

Why can you catch pneumonia from yourself?

A

Many of the bacteria which can cause it are abundant in your microbiota

23
Q

What are some bacteria that are present in your oropharynx microbiota and can cause pneumonia?

A

Haemophilus spp
Staph. aureus
Strep. pneumoniae

Haemophilus spp and staph. aureus also seen in nose but more commonly

24
Q

What are some bacteria that are present in your nose microbiota and can cause pneumonia?

A

Strep. pneumoniae

25
Q

What is a pathobiont?

A

A microbe which is normally commensal but if found in wrong environment (anatomical site) can cause pathology

26
Q

What is an opportunistic pathogen?

A

A microbe that takes advantage of a change in conditions e.g. immunosuppression

27
Q

What 3 things cause severe viral disease?

A

Highly pathogenic strains
Absence of prior immunity
Predisposing illness/conditions

28
Q

What is viral tropism?

A

Depending on what the virus binds to, will decide where in the respiratory tract the virus tends to affect

29
Q

Where does H1N1 influenza A tend to affect in the respiratory tract and why?

A

H1N1 influenza A haemogglutinin binds to alpha 2,6 sialic acids which are presented more in upper respiratory tract rather than lower

30
Q

Where does H5N1 avian flu tend to affect in the respiratory tract and why?

A

H5N1 avian flu haemogglutinin binds to alpha 2,3 sialic acids which are presented more in lower respiratory tract rather than upper

31
Q

Why do most viruses which have existed in humans for a prolonged time tend to infect cells of the upper respiratory tract?

A

Upper respiratory tract infections are easier to spread but cause less pathology/damage than lower respiratory tract infections

32
Q

In what ways does the respiratory epithelium defend against infections?

A

Tight junctions (preventing systemic infection)
Mucous lining + cilial clearance
Antimicrobials
Pathogen recognition receptors
Interferon pathways (induces anti-viral state in cells)

33
Q

Why do rhinoviruses account for 60% of all colds?

A

Over 100+ different serotypes

34
Q

Which antibody is in greater numbers in the nasal cavity?

A

IgA as these bind to viruses and disable them

Lots of disulphide bridges so strong against protease rich extracellular environment

35
Q

Which antibody is in greater numbers in the bronchi?

A

IgGs as the thin walled alveolar space allows transfer of plasma IgGs into alveolar space.
Good at killing intracellular pathogens

36
Q

How many serotypes does influenza have?

A

Lots of serotypes so vaccine-induced immunity rapidly wanes, annual vaccination required

37
Q

How many serotypes does respiratory syncytial virus (RSV) have ?

A

Only 2 so causes recurrent re-infection with similar strains

38
Q

Why does RSV currently not have a vaccine?

A

Poor immunogenicity of vaccine

Vaccine-enhanced disease

39
Q

What is the leading cause of infant hospitalisation in the developed world?

A

RSV

40
Q

Why is RSV notable in infants and what can it lead to?

A

50% of children infected in year 1 of life, all children by year 3
1% develop severe bronchiolitis
Can repeatedly infect children

41
Q

What are some symptoms of RSV in infants?

A 
Nasal flaring
Hypoxemia and cyanosis
Expiratory wheezing, prolonged expiration
Chest wall retractions
Tachypnea with apneic episodes
Croupy cough
42
Q

What are the risk factors for RSV broncholitis in infants?

A

Premature birth

Congenital heart and lung disease

43
Q

What are the treatment options for viral respiratory tract infections?

A 
Oxygen
Fluids
Analgesia
Vaccines
Anti-inflammatory e.g. steroids
Anti-virals e.g. remdesivir
44
Q

What is the most common cause of developing asthma and COPD exacerbations?

A

Rhinoviruses

45
Q

What does a viral respiratory tract infection increase the risk of?

A

Secondary bacterial pneumonia

46
Q

What is viral bronchiolitis associated with?

A

Development of asthma

CARDIORESPIRATORY 2 (8 decks)

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