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deanne's - MICROBIOLOGY & IMMUNOLOGY (RMIT) > W3 - pt2 respiratory infections 1 > Flashcards

W3 - pt2 respiratory infections 1 Flashcards

1
Q 
# 20.
What is H1N1?
A

SWINE FLU
a subtype of influenza A

(which is an “antigenic shift” mutation)

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2
Q

CDC.

what is antigenic “drift”?

A

antigenic drift changes are

- SMALL changes in the GENES of influenza viruses that happen CONTINUALLY OVER TIME as the virus replicates.

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3
Q

CDC.

antigenic drift produces viruses that are _ related on the _

A

PRETTY CLOSELY RELATED to one another, by their location close together on a PHYLOGENETIC TREE.

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4
Q

CDC.
antigenic drift
- what is cross protection?

A

VIRUSES that are CLOSELY RELATED to each other usually SHARE THE SAME ANTIGENIC PROPERTIES and an IMMUNE SYSTEM exposed to an similar virus will usually RECOGNISE it and RESPOND.
(This is sometimes called cross-protection.)

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5
Q

CDC.
antigenic DRIFT
- what happens when these small [antigenic DRIFT] changes accumulate over time?

A

result in viruses that are ANTIGENICALLY DIFFERENT (FURTHER AWAY on the PHYLOGENETIC TREE).

When this happens, the body’s immune system may NOT RECOGNIZE those viruses.

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6
Q

CDC.

does influenza B change by ‘drift’ or ‘shift’ or both

A

influenza type B viruses change

- only by the more gradual process of antigenic drift.

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7
Q

CDC.
pathophysiology
- PROCESS of antigenic drift

A

> a person infected with a particular flu virus
DEVELOPS ANTIBODIES against that virus.
As ANTIGENIC CHANGES ACCUMULATE,
the antibodies created against the older viruses NO LONGER RECOGNIZE the “newer” virus,
and the person can get sick again.

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8
Q

CDC.
why can people get the flu more than once even though they have antibodies?

incl
why the flu vaccine composition must be reviewed each year?

A

antigenic DRIFT-
GENETIC CHANGES that result in a virus with DIFFERENT ANTIGENIC PROPERTIES is the main reason why people can get the flu more than one time.

antigenic DRIFT is also why the FLU VACCINE composition must be REVIEWED EACH YEAR, and updated as needed to keep up with the EVOLVING VIRUS.

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9
Q

CDC.

what is antigenic “shift”?

A

is an ABRUPT, MAJOR CHANGE in the influenza A viruses, resulting in

  • new hemagglutinin and/or
  • new hemag/glutinin and neur/aminid/ase proteins in influenza viruses that infect humans.
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10
Q

CDC.

antigenic shift results in?

A

a NEW influenzaA SUBTYPE
(or a virus with a hemagglutinin) or
(a hemagglutinin and neuraminidase combination)
that has emerged FROM AN ANIMAL population

that is so different from the same subtype in humans that …
- MOST PEOPLE DON’T HAVE IMMUNITY
to the new “NOVEL VIRUS”.

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11
Q

CDC.

when did the last antienic SHIFT occur?

A

Such a “shift” occurred in the spring of 2009,

when an H1N1 virus with a NEW RECOMBINATION “reassortment” OF GENES emerged to infect people and quickly spread, causing a PANDEMIC.

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12
Q

CDC.

When shift happens, most people have _ or _ protection [against the new virus]

A

When shift happens, most people have LITTLE or NO protection [against the new virus]

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13
Q

CDC. how often does antigenic SHIFT happen compared to DRIFT?

A

While influenza viruses are changing by antigenic drift all the time, antigenic shift happens only occasionally.

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14
Q

CDC.
type A viruses undergo
type B viruses undergo

  • antigenic drift
  • antigenic shift
  • both
A

Type A viruses undergo
- BOTH kinds of changes (drift & shift)

type B viruses change ONLY BY the more gradual process of
- (drift)

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15
Q

21.
is the influenza virus
- naked or enveloped?

A

enveloped

via budding from the host’s own respiratory cells

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16
Q
  1. name the protein spikes on influenza
    1.
    2.
A
  1. hemag/glutin/in (H spike)

2. neur/amin/id/ase (N spike)

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17
Q 
# 21.
inside the influenza virus is ..
A

ssRNA genome

# composes of
- 8 fragments (ea carrying diff genes)

~~8 arnott’s assortments biscuits

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18
Q

27.
antigenic drift
- antigens exhibit minor variations over to years

A

2 to 3 years

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19
Q 
# 27.
antigenic drift is due to?
A

genetic mutations that change

  • ONE or MORE AMINO ACIDS
  • in N or H antigens
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20
Q

30.
SWINE INFLUENZA OUTBREAK 2009
case study
kidney transplant pt w flu

a) should the patient be Rx?
b) what other patient groups would Rx be advised?

C) pt completed Rx with tamiflu but RELAPSED
- what are 3 possible causes?

A

a) yes with antiviral “TAMIFLU”
(other treatment “RELENZA” #normally admin via INTRANASAL SPRAY ***can also be via IV)
- bec immunocompromises bec in transplant given Rx of immunosupressor to prev organ rejection

b)
1. pregnant
2. obese

C)
1. RESISTANCE (bec he is immunocomp. his more resistant forms [mutants] were able to grow into large numbers again
> when Rx pt we do rely on some immunity to help, the drug can get rid of alot of it
> but when you have an infection most are suseptable to the drug but some will have mutated bec they multiply so quick so there is always some mutants
> so what we hope is that the immune system gets these extra mutants
> but this persons immunocomp.
» so his mutants able to grow into large numbers and relaps into flu again
(to stonger mutations after tamiflu Rx)
**pt then given IV RELENZA Rx
**pt lungs cleared but then pt DIED of COMPLICATION of infection = intraperitoneal infection (bacterial secondary infection or cross infection in hospital)

  1. bacterial SECONDARY INFECTION (strep pneum)
  2. CROSS INFECTION bec in hospital (with another virus)
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21
Q

41 -45.
Streptococcal pyogenes
(streptococcal pharyngitis) strep throat

complications?
and
explain pathophys process?

A
  1. rhuematic fever
  2. glomerularnephritis

high risk population
- indigenous communities
>they get sore throat
> dev antibodies
> soar throat goes away
> antibodies stay and start to turn on body
» rheumatic fever (heart- cardiac tissue)
» or glomerularnephritis (kidneys- renal tissue)

  1. scarlet fever
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22
Q 
# 38.
case study
- pus on the tonsils

most likely bacterial or viral?

A

pus = bacterial

  • **however
  • some viruses cause so much DAMAGE TO THE EPITHELIUM that the POLYMORPHS and MACROPHAGES come to clean up all the dead tissue
  • **and just bec there is NO PUS doesn’t mean its VIRAL why?
    bec. streptoccoci KILLS CELLS, so any polymorph that have come can KILLED BY THE TOXIN produced by strep pyogenes (no polymorphs no pus)
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23
Q

40.

extreme tonsilitis can cause?

A

Quinsy

1/2 cup of pus can come out one tonsil EWW!!

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24
Q

DDX
toxic shock syndrome TSS (staphlococcal TS)
vs
septic shock

A

Septic shock and toxic shock syndrome (TSS) in children are
BOTH RELATED TO BACTERIAL INFECTIONS

Whereas
septic shock
- OVERWHELMING IMMUNE RESPONSE TO INFECTION

TSS
- result of ENDOTOXINS of the bacteria themselves.

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25
DDX rheumatic fever vs infective endocarditis rheumatic fever (caused by streptococcus pyogenes) is similar to?
endocarditis although endocarditis is caused by mostly other types of bacteria - Staphylococcus aureus Bacterial. - Staphylococcus aureus followed by - - Streptococci of the viridans group - and coagulase negative Staphylococci (are the three most common organisms responsible for infective endocarditis.) ***Other Streptococci and Enterococci are also a frequent cause of infective endocarditis.
26
scarlet fever is caused by?
bacteria - streptococcal pyogenes - some strains of s. pyogenes carry EXOTOXINS that cause scarlet fever (RED RASH and RED THROAT) red tongue, sore throat chills/fever, HA causes shedding of the skin after 2 DAY incubation period (exotoxin goes OUTSIDE of the cell, vs endotoxin inside the cell wall and causes damage only when bacteria killed by immune or antibiotics or cooking)
27
``` # 46. pathogenesis (path generates) ``` S. pyogenes
``` produce #- STREPTOLYSINS (hemolytic exotoxin that lyse cells surrounding bact) ``` lyse #- RBC ("beta haemolysis") - white bld cells - tissue cells
28
46. | strep pyogenes outer wall contains
M-proteins m proteins are a MAJOR IMMUNOGEN there are over 130 diff types of M proteins (meaning - would have to be infected by every type before have all the antibodies to each and are immune to strep) (immunogen = a molecule capable of eliciting and immune response, an immunogen is an antigen, but and antigen doesn't have to be an immunogen)
29
48. | Rx for streptococcal pyogenes infection
antibiotics 1. penicillin G (narrow spectrum for gram positives) 2. erythromycin important to Dx and Rx CHILDREN to PREVENT RHEUMATIC FEVER
30
strep pyogenes - gram pos or neg? - chain or cluster?
strep pyogenes = - gram positive - chain
31
48. | strep pyogenes can cause conditions of? *3
- flesh eating disease - skin impertigo - strep sore throat however strep pyogenes has never become resistant to penicillin
32
48. | how many people have allergy to penicillin?
1 in 10 people keep pt for 20 min to make sure they don't go into anaphylaxis
33
48. | alternative to penicillin (if allergic)?
"rulide" (erythromycin) - causes nausea (penicillin doesn't) - narrow spectrum
34
48. | narrow spectrum is good because?
causes less damage to pt's bowel flora
35
49. what organism causes epiglottitis? - season? - pathophys?
HAEMOPHILUS INFLUENZAE - gram neg / cocci bacillus (hard to see against pink polymorphs) - common in winter - a bacteria that loves viruses > get viral cold/flu > haemophilus influenzae grows into large numbers
36
50. | another strain of haemophilus influenzae?
haemophilus influenzae B - has a capsule (polysaccharide) - HIB vaccination available
37
``` # 50. vaccine for Haemophilus influenzae B? ```
HIB vaccine - also prevents haemophilus influenzae MENINGITIS * **not all of them, a few new strains out now - with this vaccine epiglottitis is far less prevelant now than several years ago
38
50. gram neg cocci hard or easy to see against polymorphs?
hard - both pink (no stain) - against pink background
39
50. gram pos cocci (eg. strep pneumoniae) hard or easy to see?
easy - purple cocci against a pink background
40
51. DIPHTHERIA causes #just need to know the name though
diphteria bacteria produce a POWERFUL EXOTOXIN that causes - "false membrane" (looks sticky glu in throat- stop breath) - local edema
41
51. | immunisation of diphtheria is via a?
TOXOID means - taken the toxin - cooked it until its white - no complication with this vaccine - simple one component vaccine
42
52. | PERTUSSIS (whooping cough)
- every winter
43
52. why is PERTUSSIS (whooping cough) such a problem?
it's got to do with immunity - WC doesn't invade (grows on surface resp airway) - tf its only the TOXIN that causes children to COUGH - coughing spreads bacteria - bec it doesn't invade we don't need to make IgG (bld Abs) for it - our body fights it instead with IgA (secretory Abs) - IgA is not long lasting (approx 5 yrs) so when kids start school they often get WC again - but more of a problem is that its really dangerous to children under 1yr (bec they don't make IgA in the 1st year of life)!! >babies coughing non stop, can't sleep >need 24 hr care, great risk of suffocation ***tf need booster shots to bring up IgA levels, to strenghten immunity
44
``` 52. if PERTUSSIS (whooping cough) doesn't invade do we make IgG (blood antibody)? ```
no - IgA (the secretory antibody) needs to come out and go to the surface - IgA goes into all the secretion - IgA not as long lasting as IgG (IgA last ~5yrs, so when kids start school they often get whooping cough again) - WC mild in children, parents get much worse
45
``` 52. can infants (< 6 wks or 2 months ) get the PERTUSSIS (whooping cough) vaccination (DTap)? ```
no - vaccine boost IgA antibodies in bod (babies don't make their own IgA until 6 weeks/2 months so vax not indicated - babies get high levels of IgA from breast milk - not being able to be vax means greatest risk in these first 2 months - mother gets vaccine at 28 wks to pass immunity to baby before birth
46
52. Rx PERTUSSIS (whooping cough)?
antibiotic - ERYTHROMYCIN (for 2 wks) help prev infect siblings, from 5 days after Rx start steroids - SALBUTAMOL (red the severity of paroxysms: sudden attack or outburst of activity)
47
53. causes SINUSITIS? 4
1. viral infection (cold then get the complication) 2. allergic reactions 3. anatomical defects (make some more prone) > pyogenic bacterial fill space > block drainage) 4. indwelling nasal tubes - chronic sinusitis often needs OPERATION
48
54. DDX OTITIS media vs externa
media - endogenous eg. sinusitis > STREP PNEUMO goes into middle ear >> middle ear infect (buldging of ear drum, children repeated infections the perferation can cause scarring and deafness) ``` externa - exogenous PSEUDOMONAS AERUINOSA (green slimy organism, loves water & plastic) ```
49
explain | otisis externa from swimming?
``` > pseudomona aeruinosa, green slimy, loves water & plastic > swimming water stuck in ear > pseud in water > gets in ear, warm, moist, multiplies >> causing inflamation - otitis externa ```
50
``` # 29. we IDENTIFY the flu virus by? ```
variation in the - H - N antigens
51
``` # 24. rapid REASSORTMENT by recombination of genes of more than one strain =? ```
antigenic SHIFT REASSORTMENT of different strains put together
52
``` # 24. antigenic SHIFT: (def on lecture slide) ``` ~~packet of arnott's assortment biscuits
antigenic SHIFT: - modification in PROTEIN COAT of a virus due to REASSORTMENT ***ie. if our N or H changes your body can no longer recognise a virus
53
``` # 26. hemagglutinin for? ```
- recognition | - attachment
54
``` # 26. neuraminidase for? ```
- release of virus from the infected cell
55
``` # 26. immunity to a influenza virus is dependant on? ```
PRODUCTION of antibodies | to HEMAGGLUTININ & NEURAMINIDASE antigens
56
strains of similar antigenic type cannot cause
epidemic
57
``` # 27. due to genetic mutations the change in ONE OR MORE AMINO ACIDS in N or H antigens results in? ```
antigenic DRIFT
58
``` # 27. how does antigenic DRIFT occur? ```
due to genetic mutations the change in ONE OR MORE AMINO ACIDS in N or H antigens
59
``` # 24 & 27. antigenic SHIFT vs DRIFT ```
shift modifications in the PROTEIN COAT of a virus due to REASSORTMENT (of two diff strains coming together in one virion) drift due to genetic mutations the change in ONE OR MORE AMINO ACIDS in N or H antigens
60
29. | antigenic _ is responsible for reccurence of MINOR epidemics ever 2-3 yrs
drift
61
epidemic vs pandemic
epidemic occurs when a disease affects a GREATER NUMBER people THAN IS USUAL for the locality or one that SPREADS TO AREAS NOT USUALLY ASSOCIATED with the disease. pandemic is an EPIDEMIC of WORLD-WIDE proportions.
62
29. antigenic drift - vaccines must be derived from?
the strain causing the epidemic #but vaccines not available until NEW STRAINS APPEAR
63
49. | if you suspect epiglottitis in child with sore throat DO NOT...
open the childs mouth! - medical emergency >opening the mouth could close airway (bec the epiglottis is so swollen that the action of opening the mouth can completely obstruct the airways) >>then may need intubation emergent procedure
64
``` # 32. CROUP (Laryngo/tracheo/bronchitis) ``` infectious organism? causes airway sound? population?
PARAINFLUENZA virus ***(other causes 1 in 10 babies # RSV - respiratory syncytial virus) STRIDOR (hoarse sound, d. impeded air flow sub-glottic area - like blocked straw sucked in on self) children 3mth to 3yr
65
33. bronch/io/li/tis 1. infectious organism? 2. population? 3. histologically causes? 4. why is hospitalisation indicated for severly infected?
1. mostly RSV (respiratiory syncytial virus) 2. children 1/10 or 11/100 in first year of life 3. - lots of EXUDATE in respiratory epithelium (making very hard to breath) - necrosis of respiratory epithelium 4. - bec they will most likely need breathing help - can have NEBULISED ANTIVIRALS to help
66
bronchiolitis got it's name bec?
it joins cells together (all nuclei of once separate cells, and the virus make all the cell s join together so it can be a -giant virus factory

deanne's - MICROBIOLOGY & IMMUNOLOGY (RMIT) (4 decks)

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