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CR2 > Upper Respiratory Tract Infections > Flashcards

Upper Respiratory Tract Infections Flashcards

1
Q

What does the upper respiratory tract include?

A

nasal cavity, mouth, pharynx, larynx

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2
Q

What colonises the upper respiratory tract?

A

Flora

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3
Q

What are some common infections of the upper respiratory tract? What causes them?

A 
Mostly caused by viruses:
Colds
Pharyngitis ("sore throat")
Tonsilitis
Sinusitis & Otitis Media
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4
Q

What are some examples of respiratory pathogens?

A 
Mostly viruses so:
ADENOVIRUS 
PARAINFLUENZA VIRUS 
RESPIRATORY SYNCYTIAL VIRUS 
RHINOVIRUS
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5
Q

What is the usual onset for URTI?

A

1-3 days

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6
Q

How long do URTI usually last?

A

7-10 days

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7
Q

What causes acute pharyngitis? What are the symptoms?

A

Bacteria - Strep group A (strep throat)

sore throat is first symptom, may not have runny nose/cough/sneezing

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8
Q

What types of viruses cause cold?

A

Rhinovirus, coronaviruses

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9
Q

What is coryza?

A

in a cold: watery to mucoid, sometimes purulent nasal discharge

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10
Q

What often accompanies a cold?

A

preceded by a sore throat, sometimes accompanied by fever and often followed by transient opportunist bacterial infection
Otitis media for children, sinusitis for adults

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11
Q

What is otitis media?

A

inflammatory disease of the middle ear

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12
Q

What virus family causes rhinoviruses?

A

Picorna virus

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13
Q

What viruses cause croup (acute laryngo-trachea bronchitis)?

A

RSV

Parainfluenza

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14
Q

What is rhinovirus?

A

Cause of 50% of common colds
headache, sore throat, fullness in nose, profuse watery discharge from nose which thickens, resolves in a week, followed by a short period of immunity to all other rhinoviruses

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15
Q

What is croup?

A 
children 3months - 3 years in age
hoarseness and cough, stridor
need to humidify inspired air
(acute laryngo-trachea-bronchitis)
caused by RSV and parainfluenza
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16
Q

What is RSV?

A

respiratory syncytial virus
fairly localised infection of the respiratory tract, and infants have no maternal passive protection.
single major pathogen in respiratory infections

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17
Q

What are the main viral URTIs?

A

Pharyngitis
Laryngitis
Otitis Media

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18
Q

What are the main bacterial UTRIs?

A 
Group A strep infection
(severe sore throat
peritonsillar abscess (quinsy)
rheumatic fever
glomerulonephritis)
epiglottis - haemophilus influenzae Type B
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19
Q

How do you diagnose pharyngitis?

A

throat swab for bacterial culture - gram positive cocci, beta haemolytic colonies
Serology - study of blood for rheumatic fever

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20
Q

How do you treat pharyngitis?

A

antibiotics

may get complications - rheumatic fever

21
Q

How do we prevent pharyngitis?

A

Isolate cases in hospital
ensure sufficient treatment is given
consider recognition of carriers

22
Q

What are the clinical features of Epstein Barr Virus?

A
  • causes infectious mononucleosis (glandular fever)
  • presents as sore throat but causes systemic disease
  • affects teenagers and young adults
  • exudates on tonsils and gross pharyngeal swelling
  • spleen and liver enlargement
23
Q

How do you diagnose and treat EBV?

A

White cell count
IgM antibody detection
rest & analgesia
hospital if threatened respiratory obstruction -> steroids
do not give penicillin/ampicillin = causes rash

24
Q

ottis media - cause and treatment

A

cause is virus - streptococcus pyogenes, chlamydia pneumoniae, streptococcus pneumoniae
treatment - children symptomatic antibiotics, less common in adults

25
Q

What is sinusitis?

A

viral or bacterial
bacterial - overgrowth of normal flora
treatment not always necessary but consider clartihromycin

26
Q

What are the clinical features of epiglottitis? How do you manage it?

A

rapid onset of fever, sore throat, dysphagia
respiratory obstruction
medical emergency: airway tracheostomy/intubation, antibiotics, prophylaxis, immunisation of contacts

27
Q

What is whooping cough?

A

Bordetella pertussis - releases toxin causing disease
week 1 - cough increases
weeks 3-4 paroxysmal, severe spells of coughing, may turn blue/vomit, nose haemorrhages
typical whoop: vigorous inspiration through glottis at end of paroxysm

28
Q

How do you diagnose and treat whooping cough?

A

pernasal swab, gram negative rod, grow, immediate inoculation
erythromycin

29
Q

What is diphtheria?

A

causes severe pharyngitis

due to a gram positive rod

30
Q

What is the action of the diptheria toxin?

A

Diptheria toxin binds to EF-Tu (transfers tRNA to growing polypeptides) to form inactive diphthamide EF-Tu and stops protein synthesis

31
Q

What is an adenovirus?

A

spread by droplets fomites, ingestion
infect mucous membranes of eye, respiratory and GI tract, urinary tract
involved local lymph nodes

32
Q

What syndromes can adenovirus cause?

A

Epidemic kerato-conjunctivitis (shipyard eye)
Pneumonia (and pneumonitis in children)
Acute respiratory disease (ARD)

33
Q

What is often the first symptom of an URTI?

A

Sore throat - pharyngitis

34
Q

What is parainfluenza?

A

Causes minor infections in children and adults
Different types - 1,2,3,4
1,2,3 associated with more severe LRTI’s in children

35
Q

What are the clinical features of pharyngitis?

A

Tonsillar exudate
quinsy
scarlet fever
sore throat, fever, ill

36
Q

How to manage and prevent diphtheria?

A

isolate patient and give anti-toxin as well as penicillin
monitor for resp obstruction
trace, examine, treat and immunise contacts

37
Q

What is influenza?

A

flu
causes URTI
clinical sings - cough, fever, myalgia, headache, sore throat

38
Q

How do you prevent and treat influenza?

A

Prevention is best
vaccinate staff in hospitals
neuraminidase inhibitors

39
Q

How do viruses infect a host cell?

A
  • binds to outside of cell in URT
  • releases genetic material into host cell
  • copies of genetic material are made and coat proteins are manufactured
  • genetic material and coat proteins assembled into viruses
  • newly formed viruses exit cell ready to infect more of cells
40
Q

What is the most common URTI?

A

nasopharyngitis - common cold

41
Q

What are the symptoms of a nasopharyngitis?

A

runny nose, cough, sore throat, watery eyes, headache, low grade fever, earaches, sneezing, nausea, loss of appetite

42
Q

What is rhinorrhea?

A

excess mucus filling in the nasal cavity

43
Q

What is the pathophysiology of HRV (human rhinovirus) infection?

A

infection of airway epithelial cells ->TLRs and retinoic acid inducible gene 1 like receptors detect and recognise -> epithelial cells release pro-inflammatory mediators (TNFalpha, IFN0-> recruit and activate inflammatory and immuno-effector cells (neutrophils)

44
Q

What is the pathophysiology of a RSV (respiratory syncytial virus) infection?

A

viral replication targeting epithelial cells -> TLRs and retinoic acid inducible gene 1 like receptors recognise and detect -> cellular infection triggers pro-inflammatory mediators (TNFalpha & IFN) -> triggers and activates innate and adaptive response

45
Q

What is the pathophysiology for nasopharyngitis?

A

neutrophil inflammation -> increased vascular permeability -> mucus hypersecretion -> rhinorrhea and nasal obstruction

46
Q

How do you prevent/manage nasopharyngitis?

A

infection control: disposable tissues, wash hands frequently and correctly, aboid touching eyes with contaminated hands, avoid touching nose

47
Q

How to treat nasopharyngitis?

A

nasal irrigation- clear pollutants, thins mucus
antibiotics - fights infection
decongestants
mucolytics
nasal and systemic steroids - reduce swelling

48
Q

In nasopharyngitis how does the virus impede immune recognition?

A
  • high glycosylation and structural variability of surface G protein impedes recognition
    release of soluble g protein binds viruse specific antibodies so you get less virus specific antibody concentrations available for virus neutralisation

CR2 (35 decks)

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