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Pulmonary - Micro > Viral Pneumonia > Flashcards

Viral Pneumonia Flashcards

1
Q

Tom is admitted to the ED at 2:00 pm for dyspnea and now at 2:00 am is experiencing flu-like symptoms.

  • Is it likely that he contracted influenza while in the hospital?
  • How would you most likely treat him?
  • MOA of treatment options?
  • Tom lives with his 96 year old grandma with SCID. What should you do for her?
A

NO - flu take 24-48 to incubate

Treatment: Oseltamivir or Zanamivir - both are neurominidase inhibitors

Grandma: Give Oseltamivir prophylactically

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2
Q

In 2002-2003 there was a pandemic in some asian countries of a disease causing fever, dyspnea, and hypoxemia. Patients were also more susceptible to bleeding during this infection.

  • what were some potential reserviors of this disease?
  • Why were patients susceptible to bleeding?
A

Reserviors:
• Masked palm civet
• Horseshoe Bat

Blood:
• Patients infected with SARS CoV (enveloped, single stranded, positive sense RNA virus) are THROMBOCYTOPENIC and LEUKOPENIC
• leukopenia should be noticable since you would expect WBCs to be increased

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3
Q

Jane is a 95 year old alcoholic that has been living at home by herself and presents with a pneumonia characterized by mononuclear infiltrates in the alveolar interstitium. The week prior she had suffered from an URTI.
• what risk factors did she have for the onset of this pneumonia?
• Other risk factors for this type of pneumonia?

A

Pneumonia - most likely is viral given histological findings

Risk Factors:
• Old Age
• Alcoholism
• Malnutrition - possible b/c she is living by herself

Other risks not seen here:
• Underlying debilitating illness = risk factor

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4
Q

How is Respiratory Syncytial Virus (RSV) transmitted?

A
  • Respiratory Droplets
  • Direct contact of contaminated hands with nose or mouth
  • Community outbreaks every winter
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5
Q

What single stranded linear nonsegmented RNA virus is responsible for viral pneumonia?
• What are 3 virulence factors of this virus?
• How is this virus transmitted?

A

Parainfluenza Virus - enveloped single stranded nonsegmented RNA virus

3 Virulence determinants:
• Contain F (fusion protein)
• Contains H/N (hemogluttinin and neuraminidase)

Transmission:
• respiratory droplets

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6
Q

A child developes a seal-like, barking cough along with sore throat, and fever. What finding may be present on CXR?
• What is/are the etiologic agents?
• what causes this cough?
• What other respiratory sounds may be present?

A

Etiologic agents: hPIV1, 2, or 3 (remember only 2-3% of infections will progress this far)

Croup: associated with this cough, CXR is likely to show the steeple sign that results from inflammation around the larynx, trachea, and bronchi

Stridor: may be heard because it is caused by inflammation and obstruction of the larynx

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7
Q

Someone presents with atypical pneumonia following a flu infection. Onset of infection occured 24 to 48 hours after exposure to an infected friend. Onset was characterized by Fevers, Chills, and myalgia.
• explain how this virus was transmitted?
• What is the pathogensis of influenza?
• what causes the characteristic myalgias?

A

Transmission:
• airborne respiratory droplets

Pathogenesis:
• Inhalation => Neuraminadase degrades mucous layer gaining access to cells, Hemagluttinin attaches virus to cells => necrosis of respiratory epithelium

Myalgia:
• Myalgia of flu is caused by CYTOKINE release

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8
Q

In 2002-2003 there was a pandemic in some asian countries of a disease causing fever, dyspnea, and hypoxemia. Patients were also more susceptible to bleeding during this infection.
• what virus caused this outbreak?
• Why do you think it was pandemic?
• What is the structure of this bug and its genome?

A

Virus:
• SARS CoV (corona virus) is genetically distinct from other CoVs so caused more widespread disease.
• SARS CoV - is a single stranded positive-sense RNA virus

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9
Q

MERS
• what are some clinical presentation of MERS infection?

A
  • Pneumonia
  • ARDS
  • Hemoptysis
  • Myalgia
  • Nausea/Vomitting/Diarrhea

(high mortality rate)

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10
Q

Differentiate what you would see in CBC and in pathological specimen in viral pneumonia and bacterial pneumonia.

A

Bacterial CBC/Pathology:
• Overall WBC very elevated
• Lots of PMNs
• PMN infiltrate would be seen

Viral CBC/Pathology:
• Overall WBC not insanely elevated
• Lots of Lymphocytes
• Mononuclear infiltrate

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11
Q

Who should get the flu vaccine and how long does it last?

A
  • Anyone over 6 months of age should get the flu vaccine.
  • Protection lasts 6 months
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12
Q

Dave is 3 months old when he is infected with a virus that causes pneumonia. He experiences lethargy, diarrhea, and vomitting. The infective virus is believed to be a non-enveloped double-stranded DNA virus.
• what virus is this?
• what are some problems that Dave may have down the road?

A

Virus: Adenovirus

Sequelae:
• Bronchiectasis
• Bronchiololitis obliterans- a rare andlife threateningNON-reversibleobstructive lung disease characterized byFIBROSISand scar tissue that causescollapse of broncioles

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13
Q

Someone is infected with viral pneumonia. The etiologic agent has a segmental genome consisting of 8 segemnts of helical negative sense RNA that is enveloped. One of the virulence factors for this bug is Neuraminidase.
• what is the function of neuraminidase?
• what are 2 other virulence factors for this pathogen?
• What causes the endemic nature of this virus?
• What causes the pandemic nature of this virus?

A

Infleunza virus (could be A or B)

Neuraminidase: cleaves neuraminic acid to release viral progeny. ALSO, it degrades the protective mucous layer in the respiratory tract. (2 major subtype N1 and N2)

2 other:

  • *Hemagglutinin**: allows the virus to grab onto to cell surface recptors and infect human cells
  • *M2 ion channel:** essential for infectivity of flu virus

Endemic nature:
• Less severe - caused by mutations that make it different enough to evade immune response

Pandemic nature:
• More severe - caused by reassortment human genes and animal genes. The virus becomes antigenically new.

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14
Q

What the structural and genomic characteristics of adenovirus?
• How is it transmitted?

A

• Non-enveloped, double-stranded, linear DNA virus

• Transmitted via aerosol droplet, fecal-oral, or direct inoculation

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15
Q

Beisides Upper Respiratory Tract infection and pneumonia. What other diseases are caused by Adenovirus?

A

Adenovirus Diseases:
• Febrile Pharyngitis
• Conjunctivitis
• Hemorrhagic Cystitis
• Gastroenteritis (less than 2 years old)
• Disseminated infection in immunocompromised

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16
Q

Jack is a 34 week old infant who is suffering from a presumed viral pneumonia. He is experiencing persistent cough, wheezing, fever, tachypnea, and is turning blue. Labs indicate that it is likely RSV.
• what put this kid at a high risk of RSV infection?
• How could you treat him?
• What should have been given to this kid to prevent this disease?
• MOA of preventative measure?

A

High Risk:
• Infants get pneumonia from RSV, especially those born under 35 weeks of gestation

Treatment:
• ONLY treatment option is supportive care with hydration, albuterol, and O2.
• Ribavirin - reserved for adults (particularly stem cell transplant pts)

Prevention:
• Kid should have been given Palvizumab a monoclonal antibody against F-protein - PREVENTS VIRUS INFECTIVITY

17
Q

What pathogen is clinically indistinguishable from RSV? what other virus is also often mistaken for?
• How is this virus transmitted?
• Diseases caused?

A

• Human Metapneumovirus - member of the same Paramyxoviridae family, its also sometime mistaken for Influenza.

Route of Transmission:
• Respiratory Droplets

Diseases:
• causes upper respiratory tract infections and pneumonia.

18
Q

What is the most common cause of respiratory tract infections that results in physician and hospital visits in the U.S?
• what groups of people are most likely to die from these infection?

A
  • Influenza Virus
  • Children under 2 and the Elderly are the most likely to Die as a result of infections.
  • ~36,000 death/year from flu
19
Q

In 2002-2003 there was a pandemic in some asian countries of a disease causing fever, dyspnea, and hypoxemia. Patients were also more susceptible to bleeding during this infection.

• what are you likely to see on CXR of these patients?

A
  • Range from normal to diffuse interstitial infiltrates
  • Bilateral peripheral infiltrates common usually in middle or lower lung lobes
20
Q

An infant succombs to a pneumonia characterized by diffuse interstitial infiltrates on CXR. Mononuclear infiltrates are seen on lung biopsy along with mutlinucleated giant cells.

  • what are key characteristics to determine the etiologic agent as given here?
  • Describe the reason we see these characteristics?
A

Key Characteristics:
• Viral b/c of interstitial infiltrates with MONONUCLEAR cells, since it was an infant start thinking RSV

• GIANT CELLS - SYNCYTIA - key - caused by surface spikes on RSV that are fusion proteins that cause fusion of respiratory epithelium.

21
Q

What type of pneumonia is caused by viruses?

• what characterizes this type of pneumonia on CXR?

A

Atypical Pneumonia - characterized by patchy inflammatory changes in the lungs, largely confined to the alveolar septa pulmonary interstitium (aka NO CONSOLIDATION)

22
Q

Differentiate the progression of a case of RSV in infants and adults?
• what are some risk factors of getting RSV?
• How would you diagnose this disease?

A

Infants:
• Persistent cough, wheezing, fever, tachypnea, hypoxemia
• Often involes the lower respiratory tract and turns into pneumonia

Adults:
• Typical Upper repiratory tract infection
• Lasts 4-5 days then resolves

Diagnosis:
• RT-PCR on nasal swab or washings
• Rapid antigen test on nasal swab or washings

23
Q

How do we keep military recruits from getting Adenovirus?

A

Vaccine:
• LIVE oral enteric-coated vaccines directed aginst adenovirus serotypes 4 and 7.

24
Q

How do you treat a child with a parainfluenza virus infection?
• What do you do to diagnose?
• what is the prognosis?
• What are the chances that the same kid will be back in your office with a seal-like cough in the future?

A

Dx:
• Clinical

Tx:
• Supportive

Prognosis:
• good - most children recover after a few days but reinfection is common

25
Q

Is vomitting and diarrhea a typical characteristic of a flu infection?

A

NO - we really on see these symptoms in children

26
Q

Do you suspect RSV of being capable of causing the same type of pandemics that are seen in flu infection?

Why or why not?

A

NO - it is single stranded negative sense linear RNA where influenza is segemented negative sense linear RNA

27
Q

Differentiate the 2 types of influenza.

A

Influenza A:
• Major cause of epidemics and pandemics capable of infecting animals

• Single subtypes predominate throughout the world at any given time

Influenza B:
• Sporatic outbreaks each year that can be serous
• ONLY infects humans
• no subtypes

28
Q

Differentiate between the 3 diseases caused by the 4 different type of parainfluenza virus (enveloped single stranded, linear nonsegmented RNA virus).
• where does intitial infection most often take place?

A

3 disease caused by parainfluenza:
• Croup: caused by hPIV 1, 2, 3, (only 2-3% of infections progress this far)
• Pneumonia and Bronchiolitis: caused by hPIV3
• Mild respiratory illness (common cold): hPIV4

Initial Infection:
• PIVs infect mucous membranes of the throat with more extensive infections involving the Larynx and upper trachea

29
Q

What are some unusual groups that are at risk of getting flu?

A

At Risk:
• Morbidly Obese - Indians (native ams) and Inuits (alaskan natives) - living in Nursing homes - who just had a baby (less than two weeks ago.

Typical Shit:
• Young children and elderly, immunosuppressed, and those with chronic diseases

30
Q

Differentiate the structures of Respiratory Syncytial Virus (RSV) and influenza. name their viral families.

A

RSV: paramyxovirus family
• pleomorphic, enveloped, negative-sense, single-stranded, linear RNA

Influenza: orthomyxovirus family
• helical, enveloped, negative sense linear RNA virus consisting of 8 segements

31
Q

Describe the structure of Influenza.
• what family is it in?
• Key Envelope proteins?

A

Orthomyxovirus family

Structure:
• Helical, enveloped single stranded negative-sense linear RNA virus consisting of 8 segements

Envelope 3 main proteins:
• Hemagglutinin - binds to cell surface receptor and promotes viral entry
• Neuraminidase- cleaves neuraminic acid torelease progeny viruses from the infected cell
• M2 ION CHANNEL - essential for virus infectivity

32
Q

Describe the general mechanism of how viral pneumonia progresses.
• what other disease does this infection predispose people to?

A
  1. Viruses have tropisms that allow them to attach to the respiratory epithelium
  2. Viruses replicate and cause cell death and inflammation
  3. Resulting damage and impairment of local defenses such as mucociliary clearance
  4. all damage increases risk of superimposed bacterial infection
33
Q

Jack is a 34 week old infant who is suffering from a presumed viral pneumonia. He is experiencing persistent cough, wheezing, fever, tachypnea, and is turning blue. Labs indicate that it is likely RSV.

  • what disease is jack likely to develop later in life?
  • Should his parents be concerned about him surviving? Why or why not?
A
  • Jack more likely to develop ASTHMA as a result of his RSV infection
  • NO mortality rate is only 2% in infants who were previously healthy - severly affected patients are typically less than 12 weeks of age, have underlying cardiopulmonary disease, or immunodeficiency
34
Q

Dave is 3 months old when he is infected with a virus that causes pneumonia. He experiences lethargy, diarrhea, and vomitting.

  • Most likely virus?
  • How to make the diagnosis?
  • How to treat?
A

Virus:
• Adenovirus most likely due to diarrhea and vomitting that accompany the pneumonia

Dx:
• CLINICAL dx.

Tx:
• Supportive

35
Q

Dave is 3 months old when he is infected with a virus that causes pneumonia. He experiences lethargy, diarrhea, and vomitting.
• what are the envelope and genome characteristics of the infective agent?
• What are some risk factors for getting this disease?

A

Adenovirus most likely due to Diarrhea and Vomitting that accompary the pneumonia.

Adenovirus - Non-enveloped, Double-Stranded, Linear DNA virus

Other people who get this:
• Army people get Adenovirus

36
Q

Who (outside of the usual suspects) is susceptible to RSV pneumonia?

A
  • Institutionalized elderly
  • Infants with chronic lung disease
  • Infants born in RSV season less than 6 months, especially those who attend daycare

• Infants born before 35 weeks gestation

37
Q

T or F: almost all viruses that cause pneumonia can cause URTIs.

A

True - also only 40-60% of colds can be linked to specific viruses

38
Q

A child is experiencing high fever, dry cough, and myalgia. To lower the fever the parents give the kid asprin. Why have the parents fucked up (unless the kid has kawasaki’s)?
• what are possible complications that could be caused?

A

Reye’s Syndrome happens in children experiencing viral infections who are administered Asprin. These kids might get encephalopathy and liver degeneration.

**Kid may turn jaundice or something**

Pulmonary - Micro (7 decks)

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