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Phase 1b - Cardiovascular & Respiratory Medicine > Respiratory Tract Infections & Immunity > Flashcards

Respiratory Tract Infections & Immunity Flashcards

1
Q

Outline the epidemiology of respiratory infections (Deaths / Age 3).

A

Deaths:
* Estimated 5 million deaths annually between 1990 - 2015
* About 3 million deaths annually from acute lower respiratory infections

Age:
* Age dramatically impacts mortality burden
* Over 70
* Under 5
* Pneumonia rates increase with age

Estimated that 1 in 4 people have latent TB, 1.4 million deaths from TB in 2019

Mortality burden definition:
* DALY – Disability-adjusted Life Year: A sum of Years of Life Lost (YLL) and Years Lost to Disability (YLP)

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2
Q

What are the risk factors of respiratory infections (pneumonia) divided into (5)?

A

Demographic and lifestyle factors:
* Age < 2 years or > 65 years
* Cigarette smoking
* Excess alcohol consumption

Social factors:
* Contact with children aged < 15 years
* Poverty
* Overcrowding

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

Medical history:
* COPD
* Asthma
* Heart disease
* Liver disease
* Diabetes mellitus
* HIV
* Malignancy
* Hyposplenism
* Complement or Ig deficiencies
* Risk factors for aspiration
* Previous pneumonia

Specific risk factors for certain pathogens:
* Geographical variations
* Animal contact
* Healthcare contacts

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3
Q

What are the demographic and lifestyle risk factors of respiratory infections (pneumonia) (3)?

A

Demographic and lifestyle factors:
* Age < 2 years or > 65 years
* Cigarette smoking
* Excess alcohol consumption

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4
Q

What are the social risk factors of respiratory infections (pneumonia) (3)?

A

Social factors:
* Contact with children aged < 15 years
* Poverty
* Overcrowding

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5
Q

What are the medication risk factors of respiratory infections (pneumonia) (3)?

A

Medications:
* Inhaled corticosteroids
* Immunosuppresants (e.g steroids)
* Proton pump inhibitors (PPIs)

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6
Q

What are the medical history risk factors of respiratory infections (pneumonia) (11 / know 5)?

A

Medical history:
* 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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7
Q

What are the specific risk factors for certain pathogens of respiratory infections (pneumonia) (3)?

A

Specific risk factors for certain pathogens:
* Geographical variations
* Animal contact
* Healthcare contacts

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8
Q

Outline the pathogenesis of respiratory infections (2).

A

Through (common) causative agents:

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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9
Q

What are the common bacterial causes of respiratory infections (4)?

A

Bacterial:
* Streptococcus pneumoniae
* Myxoplasma pneumoniae
* Haemophilus Influenzae
* Mycobacterium tuberculosis

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10
Q

What are the common vacterial causes of respiratory infections (5)?

A

Viral:
* Influenza A or B virus
* Respiratory Syncytial Virus
* Human metapneumovirus
* Human rhinovirus
* Coronaviruses

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11
Q

How would a patient with upper respiratory tract infection present (5)?

A
  • Cough
  • Sneezing
  • Runny or stuffy nose
  • Sore throat
  • Headache
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12
Q

How would a patient with lower respiratory tract infection present (6)?

A
  • A “productive” cough - phlegm
  • Muscle aches
  • Wheezing
  • Breathlessness
  • Fever
  • Fatigue
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13
Q

How would a patient with pneumonia present (4)?

Pneumonia is a medical condition that affects the lungs, characterized by inflammation of the air sacs in one or both lungs, which can be caused by a variety of infectious agents such as bacteria, viruses, or fungi.

A
  • Chest pain
  • Blue tinting of the lips
  • Severe fatigue
  • High fever
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14
Q

What are the 3 different types of pneumonia?

A
  • Community acquired pneumonia (CAP)
  • Hospital acquired pneumonia (HAP)
    • Ventilator associated pneumonia (VAP)
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15
Q

What are the main bacterial causes of community acquired pneumonia (CAP) (5)?

A
  • Streptococcus pneumoniae (40-50%)
  • Myxoplasma pneumoniae
  • Staphylococcus aureus
  • Chlamydia pneumoniae
  • Haemophilus Influenzae
Streptococcus pneumoniae: Gram-positive, extracellular, opportunistic pathogen
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16
Q

What are the main bacterial causes of hospital acquired pneumonia (HAP) (6)?

A
  • Staphylococcus aureus
  • Psuedomonas aeruginosa
  • Klebsiella species
  • Escherichia coli (E. coli)
  • Acinetobacter spp.
  • Enterobacter spp.
17
Q

What are the main bacterial causes of ventilator acquired pneumonia (VAP) (3)?

A
  • Psuedomonas aeruginosa (25%)
  • Staphylococcus aureus (20%)
  • Enterobacter
18
Q

What are the most typical causes of pneumonia (3)?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
Streptococcus pneumoniae: Gram-positive, extracellular, opportunistic pathogen
19
Q

What are the most atypical causes of pneumonia (3)?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumophilia
20
Q

Outline the pathophysiology of acute bacterial pneuonia.

A
21
Q

What is CURB-65 scoring?

A
  • A grading potential bacterial pneumonia
22
Q

Describe the CURB-65 scoring system.

A
  • Confusion
  • (In hospital add) Urea
    • > 7 mmol/L
  • Respiratory rate
    • > 30 breaths/min
  • Blood pressure
    • < 90 systolic and / or 60 mmHg diastolic
  • 65 years old or older

1 point per item

23
Q

What is the management of bacterial pneumonia divided into (2)?

A
  • Supportive therapy
  • Treatments
24
Q

What is the supportive therapy recommended for the management of bacterial pneumonia (5)?

A
  • Oxygen (for hypoxia)
  • Fluids (for dehydration)
  • Analgesia (for pain)
  • Nebulised saline (may help expectoration)
  • Chest physiotherapy
25
Q

What is the treatment for the management of bacterial community accquired pneumonia (CAP) with CURB-65 score of 0 (1)?

A

Penicillins
* Amoxicillin (or clarithromycin/ doxycycline if pen. allergic)

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

26
Q

What is the treatment for the management of bacterial hospital accquired pneumonia (HAP) with CURB-65 score of 0 (1)?

A

Penicillins
* NOT SEVERE: doxycycline PO

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

27
Q

What is the treatment for the management of bacterial community accquired pneumonia (CAP) with CURB-65 score of 1-2 (2)?

A

Penicillins + Macrolides
* Amoxicillin + clarithromycin (or clarithro./doxy.)

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

28
Q

What is the treatment for the management of bacterial community accquired pneumonia (CAP) with CURB-65 score of 3-4 (2)?

A

Penicillins + Macrolides
* Benzyl-penicillin IV + clarithro. PO (or teicoplanin + clarithro.)

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

29
Q

What is the treatment for the management of bacterial hospital accquired pneumonia (HAP) with CURB-65 score of 3-4 (2)?

A

Penicillins + Macrolides
* SEVERE: tazocin (piperacillin-tazobactam) IV +/- gentamicin IV

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

30
Q

Outline the pathogenesis of viral respiratory infection.

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.
31
Q

How is the respiratory epithelium designed to resist infections (5)?

A
  • Tight junctions: prevents systemic infection
  • Mucous lining and cilial clearance: prevents attachment, clears particulates
  • Antimicrobials: recognise, neutralise 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.
32
Q

What is antibody mediated immunity (humoral immunity) (2)?

A
  • Adaptive, so dependent on prior exposure
  • B cells activated to differentiate into antibody secreting plasma cells
    • Different antibody classes provide different biochemical properties and functions
33
Q

How is the nasal cavity and bronchi designed to resist infections (2)?

A
34
Q

Outline the pathophysiology of viral respiratory infections.

A
35
Q

What is the supportive therapy recommended for the management of viral respiratory infections (5)?

A
  • Oxygen (for hypoxia)
  • Fluids (for dehydration)
  • Analgesia (for pain)
  • Nebulised saline (may help expectoration)
  • Chest physiotherapy
36
Q

What is the preventative / prophylactic therapy recommended for the management of viral respiratory infections (1)?

A
  • Vaccines
    • Major surface antigen – spike protein
    • Viral vector (e.g. adenovirus vaccine e.g. Oxford/AZ)
    • mRNA vaccines (e.g. BioNtech/Pfizer)
37
Q

What is the treatment recommended for the management of viral respiratory infections (2)?

A

Anti-inflammatory
* Dexamethasone (steroids)
* Tocilizumab (anti-IL-6R) or Sarilumab (anti-IL-6)

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

38
Q

What anti-inflammatory medication is recommended for the management of viral respiratory infections (3)?

A
  • Dexamethasone (steroids)
  • Tocilizumab (anti-IL-6R)
  • Sarilumab (anti-IL-6)
39
Q

What anti-viral medication is recommended for the management of viral respiratory infections (3)?

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

Phase 1b - Cardiovascular & Respiratory Medicine (21 decks)

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