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Micro 3010 > Unit 12 - Lower RTI > Flashcards

Unit 12 - Lower RTI Flashcards

1
Q

List some examples of Lower RTI’s

A
  • laryngitis and tracheitis
  • diphtheria
  • pertussis
  • bronchitis
  • pneumonia
  • tuberculosis
  • cystic fibrosis
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2
Q

Anatomy of Upper RT

A
  • epiglottis
  • larynx
  • nasal cavity
  • pharynx
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3
Q

Anatomy of Lower RT

A
  • trachea
  • bronchi
  • bronchioles
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4
Q

Laryngitis and Tracheitis:

Describe it

A

-Infection of larynx and trachea

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5
Q

Laryngitis and Tracheitis:

Adult symptoms?

A

hoarseness and burning pain

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6
Q

Laryngitis and Tracheitis:

Child symptoms?

A

narrow, easily obstructed

-causes hospitalization

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7
Q

Laryngitis and Tracheitis:

What are possible causes?

A 
parainfluenza virus
RSV
influenza
adenovirus
GAS (group A streptococci)
H. influenzae
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8
Q

Diphtheria:

What is it caused by?

A

Corynebacterium diphtheria

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9
Q

Diphtheria:

Common in ?

A

developing world

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10
Q

Diphtheria:

Complications?

A
  • Myocarditis (inflammation of heart tissue)

- Polyneuritis (paralysis of soft palate and regurgitation of liquids - can lead to choking)

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11
Q

Diphtheria:

Treatment?

A
  • Immediate, life-threatening

- Antitoxin (horse serum) + antibiotics

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12
Q

Diphtheria:

Vaccine?

A

Yes

Comes in combination with pertussis, tetanus, polio, and Haemophilus influenza B
TDap vaccine

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13
Q

Pertussis/Whooping Cough:

Cause?

A

Bordatella pertussis & parapertussis

B. Bronchiseptica

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14
Q

Pertussis/Whooping Cough:

Epidemiology

A

Highly transmissible; infants and young children

Attaches to and multiplies in ciliated respiratory mucosa

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15
Q

Pertussis/Whooping Cough:

Clinical manifestations & pathogenesis

A
  • Early phase: viral upper RT infection
  • Fever uncommon, paroxysms of coughing
  • Sum of several toxins
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16
Q

Pertussis/Whooping Cough:

Toxins involved

A

1) Pertussis toxin
2) Adenylate cyclase
3) Tracheal toxin

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17
Q

______ ________ kills tracheal cells

A

tracheal toxin

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18
Q

______ _____ - AB type, A subunit: ADP ribosyl transferase that catalyzes transfer of ADP-ribose from NAD to host cell proteins, affects signal transduction

A

pertussis toxin

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19
Q

____ ______ enters neutrophils, causes increased cAMP which inhibits their chemotaxis, phagocytosis and bactericidal killing ability

A

adenylate cyclase

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20
Q

Pertussis/Whooping Cough:

List 2 complications

A

1) Pneumonia (secondary infection) can cause alveolar rupture
2) CNS effects: seizures

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21
Q

Pertussis/Whooping Cough:

Describe the 3 stages

A

1) Catarrhal
- mild cold, runny nose, mild cough
- can last several weeks

2) Paroxysmal
- severe coughing begin
- 15-25 paroxysmal fits/24 hours
- vomiting and whopping

3) Convalescent
- slow decrease of symptoms
- 4 weeks after infection

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22
Q

Pertussis/Whooping Cough:

Is there a vaccine available? If yes, describe it.

A

Yes. (part of Tdap)

Acellular vaccine:
-Pertussis toxoid + bacterial components (filamentous haemagglutinin and fimbrae)

*cannot vaccine newborns/infants

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23
Q

Acute Bronchitis:

What is it?

A

inflammation of the tracheobronchial tree

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24
Q

Acute Bronchitis:

Is often _____

A

viral

-rhinovirus, coronavirus, influenza virus, adenovirus

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25
Q

Acute Bronchitis:

If it’s not viral, it can be bacterial. List some possible bacterial causes.

A

-Bordetella pertussis, B. parapertussis, Mycoplasma pneumoniae, chlamydophilia pneumoniae

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26
Q

Acute Bronchitis:

Epidemiology & Clinical Manifestations

A
  • peaks in winter

- cough, fever, variable amounts of sputum

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27
Q

Acute Bronchitis:

Pathogenesis?

A
  • usually follows upper respiratory tract infection

- spreads from damage of respiratory epithelial cells by same (usually viral) pathogens

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28
Q

Acute Bronchitis:

List 2 Complications

A

1) Secondary bacterial infections

2) Presentation varies

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29
Q

Acute Bronchitis:

Has ____ ____ consequences

A

long term

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30
Q

Acute Bronchitis:

Pneumonia is usually from community acquired pathogens such as?

A

s. pneumoniae

h. influenzae

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31
Q

Acute Bronchitis:

Getting bronchitis can make you more susceptible to getting _____.

A

asthma

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32
Q

What is the primary cause of bronchiolitis and pneumonia in infants under 2?

A

Respiratory Syncytial Virus (RSV)

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33
Q

Respiratory Syncytial Virus (RSV):

Describe the pathophys

A

bronchioles narrow which causes difficulty in breathing

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34
Q

Respiratory Syncytial Virus (RSV):

Transmission

A

droplets

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35
Q

Respiratory Syncytial Virus (RSV):

Inhaled and establishes infection in ________ and _________________________

A

nasopharynx

lower RT

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36
Q

Respiratory Syncytial Virus (RSV):

Causes _____ and _______

A

bronchiolitis

pneumonia

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37
Q

Respiratory Syncytial Virus (RSV):

Signs & symptoms

A
  • cough
  • fast respiratory rate
  • cyanosis
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38
Q

HPS

A

Hantavirus Pulmonary Syndrome

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39
Q

What is the new world hantavirus called?

A

Sin Nombre Virus (SNV)

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40
Q

Hantavirus Pulmonary Syndrome (HPS):

Recent outbreak in ??

A

deer mouse

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41
Q

Hantavirus Pulmonary Syndrome (HPS):

Transmission?

A

-Inhalation of SNV-infected rodent feces, saliva, or urine

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42
Q

Hantavirus Pulmonary Syndrome (HPS):

Signs & Symptoms

A
  • flu like symptoms
  • viral invasion of pulmonary capillary endothelium
  • fluid pours into lungs due to increased vascular permeability
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43
Q

Hantavirus Pulmonary Syndrome (HPS):

____% mortality rate

A

35%

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44
Q

What does old world hantavirus cause?

A

hemorrhagic fever and renal syndrome

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45
Q

Pneumonia is more common in _____ due to their decreased immune system

A

elders

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46
Q

List some ways a pathogen can get into the deepest possible layers of RT?

A

1- upper airway gets infected first and then the infection spreads to lower RT
2- direct aspiration of organisms (eating or drinking something large # of bacteria - something goes directly from your oral cavity to your lungs)
3-inhalation of airborne droplets
4-seeding of lung via blood from distant site

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47
Q

Describe Pneumonia

A

Inflammation of the lower RT

-lung invasion (alveolar spaces, interstitial, terminal bronchioles)

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48
Q

Pneumonia can be _____ or ______ acquired

A

community or nosocomial (hospital)

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49
Q

List the 4 routes for lung infection

A

1-upper airway colonization or infection that extends into lung
2-aspiration of organisms
3-inhalation of airborne droplets
4-seeding of lung via blood from distant site

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50
Q

Pneumonia can be a _____ ________ infection

A

secondary bacterial

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51
Q

List traits that contribute to pneumonia

A
  • alcoholics and vagrants
  • underlying respiratory tract disease
  • occupational exposure
  • travel exposure
  • exposure to animals
  • HIV positive
  • immunocomprimised
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52
Q

List the 4 types of pneumonia

A

1-Lobar pneumonia
2-Bronchopneumonia
3-Interstitial pneumonia
4-Lung abscess

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53
Q

_____ ______ - distinct region of the lung

A

lobar pneumonia

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54
Q

_________- diffuse patchy

A

bronchopneumonia

55
Q

______ ______ - invasion of the lung interstitial, viral

A

interstitial pneumonia

56
Q

_____ ______ - cavitation and destruction of the lung parenchyma

A

lung abscess

57
Q

Bacterial pneumonia:

Makes up what % of cases?

A

25-60% (down from 90%)

58
Q

Bacterial pneumonia:

Haemophilus influenza makes up ____% of cases

A

5-15%

59
Q

Bacterial pneumonia:

Is _____ pneumonia

A

atypical

60
Q

Bacterial pneumonia:

_____ sputum and ____ onset

A

minimal sputum

chronic onset

61
Q

Bacterial pneumonia:

List some causes

A

M. pneumoniae
Chlamydiophila psittaci
Coxiella burnetti
Legionella pneumophila

62
Q

Bacterial pneumonia:

What type of specimen do we use to diagnose?

A

sputum is specimen of choice (collected in the morning before breakfast)

63
Q

Bacterial pneumonia:

Other types of diagnostic tools?

A
  • gram stain

- serology

64
Q

Bacterial pneumonia:

Treatment?

A
  • antibiotics

- resistance issues

65
Q

Bacterial pneumonia:

vaccine available?

A 
Adults:
Pneumococcus capsular (23-valent) vaccine

Infants:
7-valent vaccine

66
Q

Viral pneumonia:

Causes?

A

Many viruses capable of causing pneumonia:

  • influenza A or B
  • parainfluenza (types 1-4)
  • measles
  • RSV
  • adenovirus
  • cytomegalovirus
  • VZV
67
Q

Viral pneumonia:

Clinical condition associated with:
Influenza A or B

A

primary viral pneumonia or pneumonia associated with secondary bacterial infection

68
Q

Viral pneumonia:

Clinical condition associated with:
Parainfluenza (types 1-4)

A

Croup, pneumonia in children <5 years of age; upper respiratory illness (often subclinical) in older children in adults

69
Q

Viral pneumonia:

Clinical condition associated with:
Measles

A

Secondary bacterial pneumonia common; primary viral (giant cell) pneumonia in those with immunodeficiency

70
Q

Viral pneumonia:

Clinical condition associated with:
RSV

A

bronchiolitis - infants

common cold syndrome - adults

71
Q

Viral pneumonia:

Clinical condition associated with:
Adenovirus

A

Pharyngoconjunctival fever, pharyngitis, atypical pneumonia (military recruits)

72
Q

Viral pneumonia:

Clinical condition associated with:
CMV

A

interstitial pneumonitis

73
Q

Viral pneumonia:

Clinical condition associated with:
VZV

A

pneumonia in young adults suffering primary infection

74
Q

Influenza Virus:

A

A

epidemics and pandemics animal reservoirs (birds)

75
Q

Influenza Virus:

B

A

epidemics, no animal involvement

76
Q

Influenza Virus:

C

A

no epidemics (does not jump continents), mild respiratory illness

77
Q

Influenza Virus:

Describe the basic structure

A

H and N antigens
-Characterization of different strains

Full nomenclature
-Ex. A/Philippines/82/H3N2

  • eight segments of single-stranded RNA
  • RNA viruses mutate faster which leads to resistance, proof reading for RNA viruses is not very good which causes these mutations
78
Q

Describe antigenic drift

A

1) influenza virus 1 enters host cell
2) mutations in antigen genes occur during replication within host cell
3) influenza virus 1’ differs slightly from virus 1

79
Q

Describe antigenic shift

A

1) influenza viruses 1 and 2 enter host cell
2) genes and antigens from both viral types are incorporated into new visions
3) influenza virus 3 very different from viruses 1 and 2

80
Q

What is the “Missing Vessel Hypothesis”?

A
  • new influenza strains emerge because influenza virus type A infects pigs, horses and other mammals
  • avian H5N1 & H3N2 + human H1N1 or H3N2
81
Q

Influenza Virus:

Outbreaks of southern hemisphere

A

May-Oct

82
Q

Influenza Virus:

Outbreaks of northern hemisphere

A

Nov-Apr

83
Q

Influenza Virus:

Transmission of Avian flu

A

movement of poultry and products

84
Q

Influenza Virus:

Entry

A

in droplets, attaches to sialic acid receptor on epithelial cell surface via H-spikes

85
Q

Influenza Virus:

Cytokines cause ??

A

fever and chills, muscle aches, runny nose and cough

86
Q

Influenza Virus:

If it lasts longer than 7-10 days, may lead to _____ or _________________________

A

bronchitis

interstitial pneumonia

87
Q

Influenza Virus:

can have a ____ _____ infection

A

secondary bacterial

88
Q

Influenza Virus:

higher risk pts

A

> 60 yrs

pregnant

89
Q

Influenza Virus:

Vaccines available?

A

1) egg-grown virus - purified - formalin inactivated (dead, but antigenic structure still intact) - ether extracted
2) purified H and N Ags, ‘split’ vaccine
* exact virus strains reviewed annually

90
Q

Influenza Virus:

vaccines provide ____% protection

A

70%

91
Q

Influenza Virus:

Antiviral agents available for treatment

A
  • neuraminidase inhibitors

- zanamivir and osteltamivir

92
Q

Influenza Virus:

Diagnosis?

A

PCR

93
Q

SARS-CoV

A

Severe acute respiratory syndrome associated coronavirus

94
Q

SARS-CoV is ____-______ _____

A

single-stranded RNA

95
Q

SARS-CoV:

___% are cold-like infections

A

15%

(fever >38, cough, shortness of breath/difficulty breathing, chest X-ray - pneumonia

96
Q

SARS-CoV:

___% fatality

A

10%

97
Q

SARS-CoV:

Causes ??

A

changes in viral reservoir and human eating habits

98
Q

SARS-CoV:

You can get it from consumption of ??

A

exotic animals (ex. bats, civet cats)

99
Q

SARS-CoV:

What type of animals is SARS-CoV-like virus detected in?

A

himalayan palm civet cats
chinese ferret badgers
horseshoe bats

100
Q

SARS-CoV:

How long is it stable for?

A

stable at RT for 2 days on surfaces and 4 days in feces

101
Q

MERS

A

middle east respiratory syndrome

102
Q

MERS-CoV

A

middle east respiratory syndrome coronavirus

103
Q

MERS-CoV:

__________ transmission is rare

A

human to human is rare so that is why its mostly confined to one country, it jumps from human to camels. The receptors for MERS-CoV are found in LRTI so it is less likely to spread human to human.

104
Q

Tuberculosis:

A disease of ____

A

poverty

105
Q

Tuberculosis:

Cause?

A

Mycobacterium tuberculosis

106
Q

Tuberculosis:

_______ documented communicable disease

A

oldest

107
Q

Tuberculosis:

Infects ___ of the world population

A

1/3

108
Q

Tuberculosis:

Kills _______ per year

A

3 million

109
Q

Tuberculosis:

Infects _______ per year

A

9 million

110
Q

Tuberculosis:

______ resistant

A

disinfectant

111
Q

Tuberculosis:

_____-fast

A

acid-fast

112
Q

Tuberculosis:

Describe the pathology

A
  • primary infection in lung (asymptomatic)
  • causes hypersensitivity rxn to mycobacterium Ag
  • granuloma
  • dissemination through bloodstream (military TB)
113
Q

Tuberculosis:

Describe the diagnostic process

A

-diagnose based on signs & symptoms
-culture ?
(Tb culture can be done but can take up to 6 weeks for visible colonies to form, so probably would initiate treatment before determining results)
-Tb test

114
Q

Tuberculosis:

Describe the Tb test

A
  • standardized amount of PPD (purified protein derivative) is injected subdermally (upper layers of skin)
  • If there is an immune response, this means the person has Ab against Tb and therefore has been exposed to Tb
  • This does not tell you if they have active Tb cells right now, someone who has been vaccinated against Tb will likely text positive so it is important to ask if they have been vaccinated.
115
Q

Tuberculosis:

Describe the Tb test for immunocompetent individuals

A

“induration” > 10 mm - positive

116
Q

Tuberculosis:

Describe the Tb test for immunosuppressed individuals

A

“induration” > 5 mm - positive

*they will have a weaker immune response so that’s why the size is smaller

117
Q

Tuberculosis:

Which antibiotics treat it?

A
  • Rifampin (RNA synthesis inhibitor)
  • Isoniazid (cell wall synthesis inhibitor)
  • Ethambutol (cell wall synthesis inhibitor)
  • Pyrazinamide (cell wall synthesis inhibitor)
118
Q

Tuberculosis:

Describe treatment

A

at least 3 of the antibiotics previously listed

119
Q

Tuberculosis:

Length of treatment

A

6-9 months

*non-compliance is an issue

120
Q

Tuberculosis:

What is MDR-TB?

A

Resistant to at least isoniazid and rifampin

121
Q

Tuberculosis:

What is XDR-TB?

A

MDR-TB + fluoroquinolone, and at least one of the three injectable second-line drugs (capreomycin, kanamycin, and amikacin)

122
Q

What is cystic fibrosis?

A

Inherited disease of secretory glands

  • cystic fibrosis transmembrane conductance regulator 9CFTR gene)
  • The transport protein is not expressed properly and it results in a fluid imbalance across the membrane
123
Q

Cystic fibrosis:

Most common lethal inherited disorder in ______

A

caucasians

1/2500 births

124
Q

Cystic fibrosis:

What does it cause?

A
  • pancreatic insufficiency
  • abnormal sweat electrolyte concentrations (salt concentration in their sweat is 5x that of a normal person)
  • production of very viscid bronchial secretions
125
Q

Cystic fibrosis:

Describe the microbes that colonize in the lung

A
  • P. aeruginosa (almost all patients 15-20 yrs)
  • S. aureus (younger pts)
  • B. cepacia
126
Q

Cystic fibrosis:

If the infection is drug resistant, what is the only option available?

A

lung transplant

127
Q

Cystic fibrosis:

Most damage is from?

A

our own immune cells

  • P. aueruginosa produces virulent factors that cause the immune system to start attacking the lungs
  • see slide 39 for diagram
128
Q

Summary:

LRT infections spread through _____ route

A

airborne

129
Q

Summary:

____ if not treated properly

A

fatal

130
Q

Summary:

Pneumonia is caused by a variety of _____

A

pathogens

131
Q

Summary:

Predisposing factors for pneumonia?

A
  • age
  • underlying disease
  • occupational/geographical factors
132
Q

Summary:

Tb complicated with ____

A

AIDS

133
Q

Summary:

Cystic fibrosis is an _____ disease

A

inherited

Micro 3010 (20 decks)

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