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CardioRespiratory 2 > Respiratory tract infectons / immunity > Flashcards

Respiratory tract infectons / immunity Flashcards

1
Q

symptoms of upper resp infection? 5

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

symptoms of lower resp infection? 6

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

What are the symptoms of pneumonia?

A

Chest pain
Blue tinting of the lips
Severe fatigue
High Fever

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4
Q

How many deaths annually from acute L resp infection?

A

. About 3 million deaths

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5
Q

What is DALY?

A

Disability-adjusted Life Year

A sum of Years of Life Lost (YLL) and Years Lost to Disability (YLP)

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6
Q

Why do acute lung infections only rank 4th in global deaths but 1st in global DALYs?

A

..

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7
Q

What do pneumonia rates increase with?

A

age

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8
Q

infant mortality resp illness?

A

L resp more common

Pneumonia
Bronchiolitis

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9
Q

What are the demographic and lifestyle factors affecting pneumonia?

A

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

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10
Q

What are the social factors affecting penumonia?

A

Contact with children aged <15 years
Poverty
Overcrowding

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11
Q

What are the medication factors affecting penumonia?

A

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

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12
Q

What are the medical history factors affecting penumonia? 10

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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13
Q

common bacterial causative agents?

A

Streptococcus pneumoniae
Myxoplasma pneumoniae
Haemophilus Influenzae

Mycobacterium tuberculosis

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14
Q

common viral causative agents? 5

A 
Influenza A or B virus
Respiratory Syncytial Virus
Human metapneumovirus
Human rhinovirus
Coronaviruses
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15
Q

What are common community acquired pneuomia?

A 
Bacterial 
Streptococcus pneumoniae (40-50%)
Myxoplasma pneumoniae
Staphylococcus aureus
Chlamydia pneumoniae
Haemophilus Influenzae
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16
Q

What is Streptococcus pneumoniae?

A
  • Gram-positive,
  • extracellular,
  • opportunistic pathogen
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17
Q

What are examples of hospital acquired pneumonia agents?

A 
Staphylococcus aureus
Psuedomonas aeruginosa
Klebsiella species
E. Coli
Acinetobacter spp.
Enterobacter spp.
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18
Q

What are ventilator associated pneumonia agents?

A 
Psuedomonas aeruginosa (25%)
Staphylococcus aureus(20%)
Enterobacter
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19
Q

Examples of atypical Hosptial acquired penumonia agents?

A

Mycoplasma pneumoniae, Chlamydia pneumoniae,

Legionella pneumophilia

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20
Q

What is bronchitis?

A

Inflammation and swelling of bronchi

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21
Q

What is bronchiolitis?

A

Inflammation and swelling of bronchioles

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22
Q

What is penumonia?

A

Inflammation and swelling of the alveoli

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23
Q

How does pneuomonia lead to ARDS?

A

Lung injury –> arterial hypoxemia

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24
Q

How does pneumonia lead to sepsis?

A

bacteremia –>
organ infection –>
organ injury

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25
Q

How does pneuomonia lead to organ injury?

A

Through systemic inflammation
bacteremia
lung injury

which all leads to detoriation of pulomary, cardio,, neuromuscualr, haem, cognostive etx

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26
Q

How to grade potential bacterial pneumonia?

A

CRB /CURB-65

Confusion
Resp rate (30+)
Blood pressure <90/60
65. or older

  • in hospital add
    Urea - 7mmol/L
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27
Q

If CRB is 0?

A

suitable for home treatments

could give antibiotics

28
Q

If CRB is 1-2?

A

consider hospital refferal

29
Q

if CRB is 3-4?

A

urgernt hospital admission

empirical antibiotics if life threatening

30
Q

What supportive treatments are avaibalve for bacterial penuomona?

A 
Oxygen (for hypoxia)
Fluids (for dehydration)
Analgesia (for pain)
Nebulised saline (may help expectoration)
Chest physiotherap
31
Q

What antibiotics are given for bact pneuo?

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

32
Q

What is an opportunistic pathogen?

A

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

33
Q

What is a Pathobiont?

A

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

34
Q

WHat bacteria in your oropharync can cause penuomonia?

A 
Strep. viridans
Coagulase neg. staph
Veronella
Fusiforms
Treponena spp.
Beta-haem. strep
* Haemophilus spp.
* Staph. aureus
* Strep. pneumoniae
35
Q

What bacteria in your nose can cause pneumonia?

A 
Coagulase neg. staph
Haemophilus spp.
Staph. aureus
Strep. viridans
* Strep. pneumoniae
36
Q

How do viral infections cause disease?

A

cellular inflammation

  • mediator release
  • local immune memory
DAMAGE TO EPITHELIUM: 
- loss of chemoreceptors
- bacterial growth
loss of cilia
- poor barrier to antigen
37
Q

What causes severe disease?

A

highly pathogenic strains

absence of prior immunity

predismposing illness/conditions

38
Q

What may cause absence of prior immunity?

A 
Innate immunodeficiency (e.g. IFITM3 gene variant)
	B cells (antibody- presumably local)
	T cells (correlate with peripheral levels?)
39
Q

What may be examples of predisposing conditions?

A

Frail elderly
COPD/asthma
Diabetes, obesity, pregnancy etc.

40
Q

differential diagnosis?

A

look at slide 28

41
Q

Where does H1N1 influenza A bind?

A

Haemogglutinin binds 𝛂2,6 sialic acids

42
Q

Where does H5N1 avian Flu bind?

A

Haemogglutinin binds 𝛂2,3 sialic acids

43
Q

Where do viruses tend to bind in the resp system?

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

44
Q

Where does SARS coV-2 bind?

A

Spike (S) protein binds Angiotensin converting enzyme 2 (ACE2)

45
Q

Where are ACE2 in the lungs?

A

Nasal epithelium
AND
Pneumocytes

  • levels increase in smokers
46
Q

What defences are within the epithelial cells? (5)

A
  • tight junctions
  • mucous cilia lining
  • antimicrobial
  • pathogen recognition receptors
  • interferon pathways *activated by viruses, promotes upregulation of anti-viral proteins and apoptosis
47
Q

What is the upper resp?

A

nasal cavity

paharynx

48
Q

What is lower resp?

A

larynx
trachea
bronchi

49
Q

What are serotypes?

A

viruses which cannot be recognized by serum (really antibodies) that recognize another virus – implications for protective immunity

50
Q

What is antibodiy mediated immunity?

A

Humoral immunity

adaptive to previous exposure

B cell activated to differentiate into antibody secreting plasma cells

different antibody classes privide different biochemical proeprties and functions

51
Q

What is the nasal cavity enriched with?

A

Enriched for IgA
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

52
Q

What is the bronchi enriched with?

A

Enriched for IgGs

Thin-walled alveolar space allows transfer of plasma IgGs into the alveolar space

53
Q

What is RSV?

A

Respiratory syncytial virus

54
Q

compare the vaccines for

influenza

RSV

SARS cov 2

A

Influenza : Vaccine-induced immunity rapidly wanes
Mainly homotypic immunity
Annual vaccination required

RSV :
No vaccine
Poor immunogenicity
Vaccine-enhanced disease
active research field
Covid:
Newly licenced vaccine
Waning immunity 
Potential for re-infection
Unclear what vaccination regime
55
Q

Describe the epideiology of RSV bronchiolitis in infants?

A
  • Leading cause of infant hospitalization in the developed world
  • 50% of children infected in year 1 of life, all children by year 3.
  • 1% develop severe bronchiolitis.
    Can repeatedly infect children.
56
Q

Risk factors for infant RSV bronchiolitis?

A

Premature birth
Congenital heart and lung disease

usully spready by older siblings

57
Q

Symptoms of infant RSV bronchiolitis?

A
  • nasal flaring
  • chest wall retractions
  • hypoxemia
  • croupy cough
  • expiratory wheezing,
  • prolonged
  • expiration
  • Rales and rhonchi
  • Tachypnea with apneic episodes
58
Q

is it bad if the old and infirm get RSV?

A

Major cause of progressive lung disease and winter deaths

59
Q

if a caring adult gets RSV how will it present?

A

Repeated colds.
Transmitters.
Very rarely severe

60
Q

What antivirals are avaible?

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

61
Q

What therapuetic treatment is given for antivrials?

A

Anti inflammatory
Dexamethasone (steroids)
Tocilizumab (Anti-IL6R) or Sarilumab (anti-IL6)

62
Q

What is analgesia given for

A

pain

63
Q

WHat is nebulised saline for?

A

Nebulised saline (may help expectoration)

64
Q

What other disease is viral bronchiolitis associated with the development of?

A

Asthma

65
Q

What virus are the most common cause of asthma and COPD?

A

Rhinovirus

66
Q

What increases the liklihood of secondary bacterial pneumonia?

A

viral infections

*55% of rhinovirus-infected COPD patients also have bacterial infections

CardioRespiratory 2 (12 decks)

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