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Respiratory Exam II > URT Bugs > Flashcards

URT Bugs Flashcards

1
Q

what bugs are part of the normal flora?

A
  • diphtheroids (gram + rods)
  • alpha/gamma strep
  • Neisseria spp.
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2
Q

what are 3 URT protective mechanisms?

A
  • nasal hairs
  • mucociliary elevator
  • sIgA
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3
Q

what URT infections are found in adults?

A
  • sinus infections
  • chronic sinusitis
  • pharyngitis
  • epiglottitis - rare
  • diphtheria - very rare
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4
Q

what URT infections are found in kids?

A
  • pharyngitis
  • acute otitis media
  • sinusitis
  • epiglottitis
  • diphtheria
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5
Q

what are the top 3 most common URT infections overall?

A
  • sinus infections and chronic sinusitis (adults)

- pharyngitis (kids)

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6
Q

predisposing factors for acute otitis media

A
  • daycare
  • sibling w/ otitis media
  • parents smoking
  • drinking from bottle on back
  • males
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7
Q

physical findings for otitis media?

A
  • otorrhea
  • bulging tympanic memb w/ cloudy or yellow fluid behind it
  • tympanic memb = red
  • local ear pain
  • FEVER
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8
Q

signs & symptoms for acute otitis media in a young child?

A
  • crying
  • irritability
  • anorexia
  • lethargy
  • hx of pulling at ear
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9
Q

what signs & symptoms would be seen w/ otitis media in an older child/adult?

A
  • earache w/ or w/o drainage
  • febrile
  • vertigo, tinnitus, decreased hearing
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10
Q

what are the 3 major bacterial pathogens for URT infections?

A
  1. Strep pneumo
  2. H. flu
  3. Moraxella catarrhalis
    - these are the same 3 that are involved in sinusitis
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11
Q

strep pneumo lab results?

A
  • gram (+) cocci (lancet-shaped)
  • alpha hemolytic
  • optochin sensitive
  • bile soluble
  • has polysaccharide capsule that cause B cell immune response
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12
Q

what is the virulence factor for strep pneumo?

A
  • capsule

- helps w/ attachement and prevents phagocytes from grabbing it

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13
Q

what are the available strep pneumo vaccines?

A
  • PPSV23 = polysaccharide vaccine

- conjugate vaccines = PCV7 & PCV13

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14
Q

PPSV23 vs. PCV13 vaccines

A 
PPSV23 = adults 65+, polysaccharide vaccine
PCV13 = pts 6 weeks-71 months, age 19+ w/ IC conditions, NOT recommended for healthy adults,  conjugate vaccine = incorporated protein
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15
Q

Haemophilus influenza lab results? what does it grow on? what factors does it need?

A
  • gram (-) coccobacillus
  • grows on chocolate agar
  • needs factors X and V
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16
Q

what is the H. flu virulence factor for the vaccine?

A
  • capsule

- only encapsulated forms are covered by the vaccine NOT the forms that cause AOM

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17
Q

what kind of H. flu causes AOM: capsulated or non-encapsulated? what other type of infections can this cause?

A
  • non-encapsulated H. flu causes AOM

- also can cause eye infections

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18
Q

H. flu causes unilateral or bilateral AOM in kids?

A

bilateral

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19
Q

symptoms of H. flu epiglottitis

A
  • acute, severe cellulitis of epiglottis
  • abrupt onset –> epiglottis swells
  • acute inflammation
  • edema with infiltration of PMNs
  • considered a true EMERGENCY
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20
Q

what is the presentation of H. flu epiglottitis in kids?

A
  • boys age 2-3
  • high fever, sits forward drooling
  • cherry red epiglottis
  • tachypnea
  • auscultation = inspiratory stridor, expiratory rhonchi
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21
Q

what are the other possible bugs that cause epiglottitis besides H. flu type b?

A
  • staph aureus
  • strep pneumo
  • strep pyogenes
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22
Q

what are the virulence factors for H. flu?

A
  • capsule = #1
  • IgA protease
  • endotoxin: associated w/ LPS; intrinsic part of gram (-) cell wall
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23
Q

characteristics of the H. flu capsule

A
  • polyribitol phosphate (polysaccharide)
  • type b was most common; now c, f are on the scene
  • vaccine is based on type b still
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24
Q

what would be in your ddx with epiglottitis?

A
  • croup
  • angioedema
  • foreign body aspiration
  • retropharyngeal or peritonsillar abscesses
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25
Q

what symptoms differentiate epiglottitis from croup?

A
  • abrupt onset
  • child appears toxic; very sick pt
  • drooling, dysphagia
  • no barking cough (croup)
  • check if pt has gotten Hib vaccine
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26
Q

how can you dx epiglottitis clinically?

A
  • neck xray –> enlarged edematous epiglottis w/ normal subglottic space
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27
Q

what is the main priority w/ epiglottitis pts? what is suggested for all peds pts?

A
  • concerned mainly w/ keeping the airway patent

- suggest peds pts be intubated

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28
Q

what are the types of Hib vaccine

A
  • all are conjugated
  • PRP-HbOC conjugated w/ nontoxic diphtheria toxin
  • PRP-OMC conj w/ outer memb protein of N. meningitides
  • PRP-T conj w/ tetanus toxoid
  • PRP-D conj w/ diphtheria toxoid
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29
Q

at what age is it suggested to get Hib vaccine?

A

2, 4, and 6 months of age

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30
Q

what is different about the PRP-D?

A
  • not recommended for kids <12 months
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31
Q

why do you want a conjugate vaccine? what immune response does it activate?

A
  • you use the conjugate b/c the previous polysaccharide vaccine was not providing effective protection
  • activates a T cell immune response
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32
Q

what is caused by Haemophilus aegypticus?

A
  • conjunctivitis aka pink eye
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33
Q

lab results for Moraxella catarrhalis? where is it found?

A
  • gram (-) diplococcic

- found in normal flora

34
Q

what does M. coatarrhalis produce? implication of this?

A
  • produces beta lactamase

- means you can’t use beta lactams to tx it i.e. no penicillins

35
Q

characteristics of acute LOCALIZED otitis externa

A
  • similar to skin, follicular infections
  • intense pain and tenderness
  • canal has local erythema, heat, and tenderness over the tragus
  • could be preauricular lymphadenopathy
36
Q

characteristics of acute DIFFUSE otitis externa

A
  • aka swimmers ear
  • hot humid climates; hot tub baths
  • pain and itching in canal
  • canal is erythematous, edematous; sometimes hemorrhagic
37
Q

MALIGNANT otitis externa

A
  • aka invasive otitis externa
  • severe necrotizing infection
  • invasion into surrounding tissues including blood vessels, cartilage and bone
  • IC pts; elderly, diabetics at risk
  • dx by culture
38
Q

what but most often causes malignant otitis externa?

A
  • Pseudomonas aeruginosa
39
Q

P. aeruginosa lab results

A
  • gram (-) rod
  • oxidase +
  • grows on blood, chocolate, MacConkey agars
  • lactose non-fermenter
  • blue-green pigmentation from pyanocyanin and pyanoveridin
  • grape-like odor
40
Q

what type of infection do you most often get w/ a new piercing?

A
  • P. aeruginosa
  • causes destruction of the pinna and you may have to remove some cartilage
  • can also cause a keloid to form
41
Q

abx selection for Pseudomonas

A
  • Pseudomonas is very resistant
  • resistance mechs = mutation of porin proteins & production of beta-lactamase
  • typically use a combo therapy to tx
42
Q

causative agents of pharyngitis

A
  • viral = #1 cause
  • bacteria
  • yeast (Candida)
43
Q

what are all the bacteria that can cause pharyngitis?

A
  • strep pyogenes, GABHS are top causes
  • non-group A strep
  • corynebacterium diphtheria
  • N. gonorrhoeae
  • arcanobacterium hemolyticum = teenagers
  • anaerobic bacterial spp. = very smelly
44
Q

what makes streptococcal pharyngitis different from viral pharyngitis?

A
  • winter, early spring
  • peak in ages 5-11
  • abrupt onset
  • FEVER
45
Q

lab results for strep pyogenes?

A
  • gram (+) cocci
  • beta hemolytic
  • catalase (-)
46
Q

virulence factors for strep pyogenes?

A
  • M protein

- pyrogenic exotoxins = Spe’s and superantigens

47
Q

other virulence factors for strep pyogenes?

A
  • hemolysins: lyse RBCs; streptolysin O = ASO titer is good for dx; streptolysin S
  • hyaluronic acid capsule
  • enzymes: hyaluronidase = can break down their own capsule; streptokinase = useful for clot busting
48
Q

what is weird about the M protein strains and the protective antibodies?

A
  • your body will only make antibodies for the one type of M strain it was exposed to
  • you will not be protected from any other M strains
49
Q

recall the JONES criteria for dx rheumatic fever

A 
J = joints
O = heart (carditis)
N = nodules
E = erythema marginatum
S = syndenham chorea
50
Q

nephrogenic strains of strep pyogenes

A
  • can be skin or pharyngitis
  • kids age 6-10
  • immune complexes deposited in kidney
  • onset of acute post-streptococcal glomerulonephritis (APSGN) 10d after pharyngitis and 3wks after cellulitis
  • type III HS rxn
51
Q

symptoms of nephritic syndrome

A
  • hematuria = “cola-colored”
  • mild proteinuria
  • edema = periorbital, abdomen, feet, ankles, hands
  • HTN
52
Q

virulence factors for strep pyogenes

A
  • major mech = in situ immune complex formation d/t deposition of streptococcal nephritogenic antigens w/in glomerulus
53
Q

what antigens are virulence factors for strep pyogenes?

A
  • NOT M protein
  • NAPlr = nephritis-associated plasmin receptor
  • SPE B = associated w/ a lot of the pathologic manifestations
  • possible that separate antigens are responsible in different people
54
Q

tx for strep pyogenes?

A
  • no specific tx

- relieve symptoms: blood pressure meds; diuretics

55
Q

strep pyogenes lab results

A
  • gram (+) cocci; beta hemolytic

- streptozyme test = gives you everything

56
Q

pyrogenic exotoxins = Spe

A
  • formerly “erythrogenic toxins”; now pyrogenic
  • four distinct toxins = SPE A, B, C, & F
  • lysogenized strains make A, C = superantigens; manifest as scarlet fever
57
Q

lab results for strep pyogenes

A
  • gram (+) cocci; beta hemolytic on BLOOD agar
  • bacitracin sensitive
  • PYR positive
58
Q

what is the other organism that is PYR positive?

A

Enterococcus

  • but they don’t cause sore throat or skin infections
  • more commonly they cause UG or GI infections
59
Q

what is the causative agent for diphtheria?

A

C. diphtheriae

60
Q

lab results for C. diphtheriae; lysogenized strains make ?? spread through ??

A
  • gram (+) rod w/ club-like swellings on ends
  • lysogenized strains produce exotoxin
  • spreads through resp droplets
61
Q

toxigenic strain of C. diphtheriae

A
  • beta-prophage carrying tox gene
  • DTxR = diphtheria toxin repressor; iron regulated i.e. low iron –> high toxin production
  • induces necrosis = formation of pseudomembrane
  • 10-20% develop myocarditis
62
Q

clinical signs & symptoms of diphtheria

A
  • low grade fever, sore throat, malaise
  • pseudomembrane: initially white and smooth; later becomes gray w/ patches of green and black necrosis; bleeds upon removal = DANGER b/c toxin gets into the blood
  • cervical adenopathy and swelling; “bull neck” = BUZZ
63
Q

what about giving vaccines to kids w/ diphtheria?

A
  • don’t give vaccines while they are sick

- you want to vaccinate once they are healthy again

64
Q

epidemiology of diphtheria

A
  • droplet spread
  • uncommon in developed countries
  • suspect in unimmunized pts w/ rapidly spreading tonsillar exudate
65
Q

clinical dx of diphtheria

A
  • presence of pseudomemb that bleeds on removal
  • deficits in CN IX & X
  • EKG changes
66
Q

lab dx for diphtheria

A
  • loeffler’s or tellurite selective media
  • modified ELEK test
  • PCR for tox gene, ELISA for toxin, immunochromatography for toxin
67
Q

tx for diphtheria

A
  • abx = penicillin and erythromycin

- give antitoxin

68
Q

prevention of diphtheria

A
  • vaccination = toxoid
  • DTaP –> kids get 5 doses
  • Tdap –> adulescents, adults single dose; anyone going to be around babies has to get it to prevent spread of pertussis
  • DT –> no pertussis part
  • Td –> 10 yr booster for adolescents/adults
69
Q

gram stain and shape of Bordetella pertussis

A
  • Gram (-) coccobacillus
70
Q

virulence factors for pertussis

A
  • filamentous hemagglutinin
  • pertactin
  • pertussis toxin
  • adenylate cyclase toxin
  • other toxins = tracheal cytotoxin –> cough/fever
71
Q

filamentous hemagglutinin

A

allows binding to ciliated cells of trachea

72
Q

pertussis toxin

A
  • ADP ribosylation of Gi

- causes fluid/mucus buildup

73
Q

adenylate toxin

A
  • increases conversion of ATP to cAMP

- causes fluid/mucus buildup

74
Q

pertactin

A
  • binds to ciliated cells in trachea
75
Q

tracheal cytotoxin

A
  • causes cough

- stimulates IL-1 which causes fever

76
Q

prevention of pertussis

A
  • whole-cell inactivated vaccine: can cause neurological s/e especially
  • acellular vaccine = less s/e; currently recommended; has pertussis toxin + FH, fimbriae, pertactin –> the organism won’t be able to bind OR produce toxin
77
Q

what vaccines are available for pertussis?

A
  • DTP
  • DTaP
  • Tdap –> now given to prego women in 3rd trimester, family members and caregivers; the mom passes antibodies to the baby until they are old enough to get the vaccine
78
Q

dx of pertussis

A
  • nasopharyngeal aspirate best
  • Regan Lowe charcoal medium –> inoculate at bedside
  • DFA (direct fluorescent antibody) staining
  • PCR = best if available
79
Q

tx of pertussis

A
  • ID contacts –> erythromycin; immunize
  • hospitalize w/ supportive care
  • DOC = erythromycin x 14d
80
Q

what are other Bordetella bugs that cause infections?

A
  • B. parapertussis = milder whooping cough; no pertussis toxin produced
  • B. bronchiseptica = usually animal pathogen (kennel cough, rabbit snuffles, atrophic rhinitis in pigs); rare human infections –> assoc w/ animals, some underlying diseases

Respiratory Exam II (7 decks)

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