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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
What is sinusitis?
viral or bacterial bacterial - overgrowth of normal flora treatment not always necessary but consider clartihromycin
26
What are the clinical features of epiglottitis? How do you manage it?
rapid onset of fever, sore throat, dysphagia respiratory obstruction medical emergency: airway tracheostomy/intubation, antibiotics, prophylaxis, immunisation of contacts
27
What is whooping cough?
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
How do you diagnose and treat whooping cough?
pernasal swab, gram negative rod, grow, immediate inoculation erythromycin
29
What is diphtheria?
causes severe pharyngitis | due to a gram positive rod
30
What is the action of the diptheria toxin?
Diptheria toxin binds to EF-Tu (transfers tRNA to growing polypeptides) to form inactive diphthamide EF-Tu and stops protein synthesis
31
What is an adenovirus?
spread by droplets fomites, ingestion infect mucous membranes of eye, respiratory and GI tract, urinary tract involved local lymph nodes
32
What syndromes can adenovirus cause?
Epidemic kerato-conjunctivitis (shipyard eye) Pneumonia (and pneumonitis in children) Acute respiratory disease (ARD)
33
What is often the first symptom of an URTI?
Sore throat - pharyngitis
34
What is parainfluenza?
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
What are the clinical features of pharyngitis?
Tonsillar exudate quinsy scarlet fever sore throat, fever, ill
36
How to manage and prevent diphtheria?
isolate patient and give anti-toxin as well as penicillin monitor for resp obstruction trace, examine, treat and immunise contacts
37
What is influenza?
flu causes URTI clinical sings - cough, fever, myalgia, headache, sore throat
38
How do you prevent and treat influenza?
Prevention is best vaccinate staff in hospitals neuraminidase inhibitors
39
How do viruses infect a host cell?
- 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
What is the most common URTI?
nasopharyngitis - common cold
41
What are the symptoms of a nasopharyngitis?
runny nose, cough, sore throat, watery eyes, headache, low grade fever, earaches, sneezing, nausea, loss of appetite
42
What is rhinorrhea?
excess mucus filling in the nasal cavity
43
What is the pathophysiology of HRV (human rhinovirus) infection?
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
What is the pathophysiology of a RSV (respiratory syncytial virus) infection?
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
What is the pathophysiology for nasopharyngitis?
neutrophil inflammation -> increased vascular permeability -> mucus hypersecretion -> rhinorrhea and nasal obstruction
46
How do you prevent/manage nasopharyngitis?
infection control: disposable tissues, wash hands frequently and correctly, aboid touching eyes with contaminated hands, avoid touching nose
47
How to treat nasopharyngitis?
nasal irrigation- clear pollutants, thins mucus antibiotics - fights infection decongestants mucolytics nasal and systemic steroids - reduce swelling
48
In nasopharyngitis how does the virus impede immune recognition?
- 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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