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Pulmonary > Respiratory Viral infections Dr. Roane > Flashcards

Respiratory Viral infections Dr. Roane Flashcards

1
Q

What typically causes the common cold and bronchiolitis?

A

-rhinovirus typically causes the common
cold

-respiratory syncytial virus (RSV) causes bronchiolitis

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2
Q

Characteristics of the common cold

A

-acute, usually afebrile (no fever), self-limited

-upper respiratory symptoms: rhinorrhea, cough, and sore throat

-Treatment is supportive

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3
Q

Viruses causing the common cold

A

50% of all common cold cases are caused by the >100 serotypes of rhinoviruses

-Coronaviruses
-Influenza
-parainfluenza viruses
-enteroviruses
-adenoviruses
-respiratory syncytial viruses (RSV)
-metapneumovirus

-> may manifest as the common cold

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4
Q

Bronchiolitis

A

-acute viral infection of the lower respiratory tract (bronchioles - smallest branch)
-affecting infants <24 months
-respiratory distress (fluid leak into the lungs), wheezing, and/or crackles
-tolerated well, but can be dangerous

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5
Q

What causes Bronchiolitis?

A

-respiratory syncytial virus (RSV), can be identified with a rapid assay (diagnosis is often suspected during an outbreak)

-treated supportive with oxygen and hydration

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6
Q

What causes Croup?

A

-caused by parainfluenza virus type 1 infection

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7
Q

Characteristics of Croup

A

-acute inflammation of the upper and lower respiratory tracts

-Brassy, barking cough and inspiratory stridor (noisy breathing)

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8
Q

Treatment of Croup

A

antipyretics (reverse fever mediated increased body temperature)
-hydration
-nebulized racemic epinephrine
-corticosteroids

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9
Q

How is Pneumonia diagnosed?

A

X-ray
Clinical findings (patient presentation)

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10
Q

What are the factors determining the type of Pneumonia?

A

-bacterial, mycobacterial, viral, fungal, or parasitic

-where acquired? community (CAP), hospital (HAP), ventilation (VAP)

-is the patient immunocompromised?

-differ in Causes, symptoms, treatment, preventive measures, and prognosis

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11
Q

What is the leading infectious cause of death?

A

-Pneumonia with Influenza
-9th leading cause of death
-leading in infectious cause of death
-most fatal hospital-acquired infection

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12
Q

What is the most common pathogen that causes Pneumonia?

A

Streptococcus pneumoniae

(pathogens of every sort, from viruses to parasites, can cause pneumonia)

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13
Q

Community-acquired pathogens (CAP)

A

-Bacterial: Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis

-atypical bacteria: (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species)

-viruses: Coronavirus, RSV, Influenza, Adenovirus, metapneumovirus, parainfluenza

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14
Q

What are the most common hospital-acquired pathogens?

A

-gram-negative bacilli and Staphylococcus aureus

-considered hospital-acquired when developed at least 48 hours after hospital admission

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15
Q

What are the most common ventilator-acquired pathogens?

A

-gram-negative bacilli and Staphylococcus aureus
-MRSA, MSSA, Pseudomonas

-considered VAP after being intubated for more than 48 hours

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16
Q

What are the different types (species) of Influenza?

A

-Influenza A-D
-Influenza A is the common flu

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17
Q

How are the subtypes of Influenza A identified?

A

-Hemaglutinin (Hx) and Neuraminidase (Nx) on the surface of the virus

18
Q

What is the Antigenic Shift seen in Influenza A?

A

-2 strains (f.e. pig and bird) of influenza A can mix their genome to create a new virus with different surface proteins
-> the new virus can now infect different species

19
Q

How is Influenza categorized based on Pathogenicity?

A

Highly Pathogenicity
Low Pathogenicity

20
Q

Zoonotic Influenza

A

Influenza viruses are transmitted from animals to humans

21
Q

What is the Influenza strain with the highest Pathogenicity so far?

A

Highly Pathogenic Avian Influenza - HPAI
-H5N1 from China 1996 -> Bird flu 2004

22
Q

Which strain is responsible for the Spanish flu?

A

-H1N1 (swine)
(Hong-Kong flu -> H3N2)

23
Q

How does Transmission of Zoonotic Influenza occur?

A

Direct contact with animals (slaughterhouse, raising)

24
Q

What are the symptoms of Zoonotic Influenza?

A

-Fever, headache, chills, dry cough
-fatigue, muscle or joint pain, chills, runny nose

25
Q

MOA of Amantadine and Rimantadine

A

-Blocking the M2 protein, a proton pore protein (viroporin)
-Viroporin is needed to release the viral proteins and genome from the virion

26
Q

MOA of Oseltamivir (Tamiflu) oral, Zanamivir (Relenza) inhaled and Peramivir (Rapivab) I.V.?

A

-Neuraminidase inhibitor
-neuraminidase is required for the newly formed
Virus to be released from the host cell -> detachment from sialic acid on the host cell

-the virus is stuck and gets degraded

27
Q

MOA of Baloxavir

A

-The virus doesn’t have a starting sequence for its translation
-it uses an endonuclease to cut one from the host mRNA -> cap-snatching

-Baloxavir blocks the Endonuclease

28
Q

MOA of Nirmatrelvir

A

-the mRNA of the virus is translated in one big protein
-the big protein needs to be cleaved into small pieces -> replication/transcription complex
-cleavage of the big protein is conducted by the viral protease

-Nirmaltrevir blocks the viral protease!

29
Q

Which drug is used to treat SARS-Cov-19?

A

Paxlovid
-Ritonavir and Nirmaltrevir
-Ritonavir acts as a booster by deactivating CYP3A4
-Ritonavir is not active against SARS-COVID-2

30
Q

MOA of Remdesavir

A

-IV administered nucleotide analog (prodrug) of adenosine triphosphate

-incorporated into the growing RNA chain by the viral RNA-dependent RNA polymerase

-chain termination

31
Q

MOA of Molnupiravir

A

-Orally administered nucleotide analog (prodrug) of cytosine triphosphate

-incorporated by the RNA polymerase of SARS-COV-2

-genome error -> the cytosine analog is read as cytosine or uridine -> mutations

32
Q

Study results of Molnupiravir

A

-did not lower hospitalization or death
-But patients recover faster

33
Q

Respiratory Syncytial Virus (RSV)

A

-Ubiquitous -> Most children have had it by age 4
-severity is reduced due to previous exposure and antibodies

-No drug treatment
-Ribavirin has been used, but ribavirin is dangerous in healthcare providers

34
Q

Why is Ribavirin dangerous for health care providers?

A

-Known teratogen
-Has caused testicular abnormalities

-Has 2 black boxes: hemolytic anemia, birth defects

35
Q

Adenovirus

A

-can be asymptomatic or
-mild infections of respiratory infections, keratoconjunctivitis, gastroenteritis, cystitis, and primary pneumonia

36
Q

Symptoms of Adenovirus

A

-mostly in children
-fever and upper respiratory symptoms:
pharyngitis, otitis media, cough, and exudative tonsillitis with cervical adenopathy

-rare in infants: severe bronchiolitis and pneumonia

37
Q

Treatment of Adenovirus

A

Ribavirin and Cidofovir

38
Q

MOA of Cidofovir and treatment

A

-used to treat Cytomegalovirus
-MOA: gets incorporated as cidofovir diphosphate into the growing chain -> viral DNA synthesis reduction

39
Q

Which drugs work by inhibiting Neuramidase?

A

-Oseltamivir (Tamiflu) oral,
-Zanamivir (Relenza) inhaled and
-Peramivir (Rapivab) I.V.

40
Q

Which drugs treat SARS-Cov-2?

A

-Paxlovid (Ritonavir and Nirmatrelvir)
-Remdesavir (adenosine analog) IV
-Molnupiravir (cytosine analog) oral

41
Q

Which drugs work by incorporating nucleotide analogs?

A

-Remdesavir (adenosine analog)
-Molnupiravir (cytosine analog)
-Cidofovir (acyclic, incorporated as cidofovir diphosphate)

Pulmonary (13 decks)

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