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66 Cards in this Set

  • Front
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Types of Respiratory Syndromes
URTIs
Colds
Sinusitis/Otitis
Pharyngitis
Diphtheria
Laryngitis
Tracheitis
Types of Respiratory Syndromes
LRTIs
Pertussis
Bronchitis
Bronchiolitis
Pneumonia
Viral Groups Associated With Respiratory Disease
Rhinoviruses
Coronaviruses
Adenoviruses
Paramyxoviruses
Enteroviruses
Influenza viruses
Herpesviruses
Others
Bacteria Associated With Respiratory Disease
Streptococcus pneumoniae
Group A Strep (S. pyogenes)
Haemophilus influenzae
Moraxella catarrhalis
Corynebacterium diphtheriae
Neiserria gonorrhoeae
Bordetella pertussis
Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Mycobacterium tuberculosis
Staphylococcus aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Enteric gram-negative rods
Anaerobes
Fungi Associated With Respiratory Disease
Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum
Aspergillus sp.
Pneumocystis jiroveci
Common Colds most common cause
Rhinovirus
Rhinovirus receptor is ubiquitous molecule _____
ICAM-1
Why is rhinovirus only working in the nose?
temperature
Common cold symptoms
Sore throat, nasal congestion, watery nasal discharge changing to purulent discharge
+/- cough
Fever more common in children
Complications of Common Colds
Otitis media
Sinusitis
Apnea in neonates
Bronchospasm and asthma exacerbation
Rhinovirus is what type of virus?
Picornaviridae; RNA viruses
Second most frequent cause of common colds
Coronaviruses
cause of SARS
Novel Coronavirus
Enterovirus Disease Associations (Picornaviridae)
Respiratory
Common colds
Skin/Mucous Membrane
Herpangina, hand, foot and mouth disease, summer rash
Eye infections
Acute hemorrhagic conjunctivitis
Muscle
Pleurodynia, myocarditis, pericarditis
Nervous System
Meningitis, encephalitis, polio
Hepatitis
HAV
predisposing factor causing children to get otitis media
Short and horizontal Eustachian tube
Supine position while bottle feeding allows reflux of pharyngeal contents into Eustachian tube
Viral and bacterial causes of otitis media
Most are viral in etiology
Rhinovirus
RSV
Others
Bacterial causes:
Streptococcus pneumoniae
Non-typeable Haemophilus influenzae
Moraxella catarrhalis
major virulence factor Pneumococcal Infections
Capsule
cytotoxin secreted by Streptococcus pneumoniae. Kills cells ie, phagocytes, ciliated epithelial cells
Pneumolysin
Most of tissue damage in setting of S. pneumonia infection is caused by ____
host inflammatory response
Disease associations of S. pneumonia
otitis media, sinusitis, pneumonia, sepsis, meningitis
agar used to culture Strep pneumo
blood agar
Test to help differentiate Sterp pneumo from others
optocin- disk - inhibs growth

Bile solubility test-isolated colony dissolves when exposed to drop of bile-
DOC for Strep pneumo
susceptible strains: penicillin group (penicillin, amoxicillin, ampicillin)

DOC for high-level DRSP (MIC>2ug/ml) is vancomycin
Vaccine for strep pneumo
Conjugate vaccine for children

Polysaccharide vaccine for adults:
Haemophilus influenzae gm stain and shape
Gram-negative, pleomorphic rods
Haemophilus influenzae causes what problems?
Causes epiglottitis, meningitis, pneumonia, otitis media, sinusitis, bacteremia, cellulitis
Major virulence factor for Type B H. influenzae is
anti-phagocytic capsule containing polyribitol phosphate
agar for diagnostic culture of Haemophilus influenzae
chocolate agar
Forms satellite colonies around what bacteria on blood agar?
S. aureus


why? b/c aureua lyses RBCs
Haemophilus influenzae treatment
Treatment
Amoxicillin/clavulanate
2nd generation cephalosporin
prevention of Haemophilus influenzae
Prevention
Vaccine 4 doses given @2, 4, 6 and 12-15 mo. age
Moraxella catarrhalis
breathing, gm-stain, shape, oxidase or not?
Aerobic, oxidase-positive, gram-negative diplococci
Moraxella catarrhalis Disease associations
Disease associations: otitis media, sinusitis, bronchitis, pneumonia
Is Moraxella catarrhalis hemolytic on blood agar?
Non-hemolytic on blood agar
Treat Moraxella catarrhalis with penicillin?
Most isolates produce b-lactamases, resistant to penicillins
Moraxella catarrhalis DOC
DOC is amoxicillin-clavulanate; alternatively cephalosporins or fluoroquinolones
Treatment plan of otitis media
"wait to treat approach" except in < 6mo.

Treat symptomatically. If no improvement in 2-4 days, then treat with antibiotics
Amoxicillin in most cases
Amoxicillin plus clavulanate for b-lactamase producing H. influenzae or M. catarrhalis
Most common etiology of acute sinusitis
URT viruses
Treatment of Acute sinusitis
Antibiotics are not immediately prescribed
Treat symptomatically for 7-10 days
If symptoms persist or worsen or fever >102 treat with antibiotics to cover H. influenzae, S. pneumoniae and M. catarrhalis
Amoxicillin, TMP/SMX
Common Viral Causes of Pharyngitis
Adenoviruses
Coxsackieviruses
Parainfluenza viruses
Rhinoviruses
Coronaviruses
Influenza
EBV
HSV-1
Common Bacterial Causes of Pharyngitis
Group A Streptococci (Streptococcus pyogenes)
- 5-10% adults
- 15-30% children
Group C and G Streptococci
Neisseria gonorhoeae
Corynebacterium diphtheriae
Hemophilus influenzae
Borrelia vincenti
If symptoms of GAS paryngitis:

Give quick strep test --> if negative, then what?
culture the child/adolescent

treat adult symptomatically
Over 70% of acute pharyngitis is caused by ____ (all age groups)
viruses

so don't think antibiotics first
Can fever, exudate on tonsils, cervical lymphadenopathy occur in both viral and bacterial pharyngitis ?
yes
What (in culture) distinguishes GAS from other strep?
Disk= bacitracin;
Treatment of GAS pharyngitis
Penicillins
Oral penicillin V for adults
Ampicillin for children;
Amoxicillin-clavulanate for frequent infections
Serious complications of GAS pharyngitis
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Signs of Scarlet fever
Diffuse erythematous rash 1-2 days after onset of pharyngitis
“Strawberry tongue”
Desquamation 7 days following onset of rash
Pastia’s lines- red
coloration under arms
and groin
Major manifestations of ARF
Polyarthritis (75%)
Carditis (40-50%)
Chorea (15%)
Subcutaneous nodules
Erythema marginatum
What's the problem?

Hematuria, proteinuria following strep pharyngitis or skin infection
Due to Type III hypersensitivity reaction
Associated with certain strain of S. pyogenes (nephritogenic strains: 12, 4, 1, 3, 25, 49)
Strains differentiated on by M protein differences –what is the function of M proteins?
Post-streptococcal glomerulonephritis
Viral causes of acute pharyngitis
Adenoviruses (Acute pharyngitis)
Rhinoviruses, Coronaviruses (Common cold)
Parainfluenza (Colds)
Influenza (Fever,malaise, myalgia, arthralgia)
Neisseria gonorrhoeae diagnostic agar
Thayer Martin Agar
viral cause of pharyngeal conjunctival fever
adenovirus
Respiratory Syndromes Caused by Adenoviruses
Acute febrile pharyngitis
Pharyngeal-conjunctival fever
Flu-like illness
Pneumonia
Common cold
Outbreaks of adenovirus associated with _____
under-chlorinated swimming pools
What is heterophil antibody assoc with?
infectious mononucleosis (IM)
Does negative heterophil antibody test rule out EBV cuase of IM?
no
Causes of heterophil-negative mononucleosis
EBV
CMV
HIV
Toxoplasma
Corynebacterium diphtheriae
Epidemiology:
asymptomatic carriage by immune individuals
Spread by respiratory droplets
Corynebacterium diphtheriae:

Toxin-induced cell damage induces thick exudate called _________ tightly adhered to underlying submucosa.
“pseudomembrane”
diagnostic characteristic of
Corynebacterium diphtheriae
Dislodging membrane causes bleeding


Diagnosis: culture taken from nasopharynx and throat; cultured on cysteine-tellurite agar or serum tellurite agar
Corynebacterium diphtheriae:

Toxin in blood stream can cause damage to cardiac myocytes -->_______
Organisms can also cause skin ulcers
myocarditis
Clinical Manifestations of Corynebacterium diphtheriae
Sudden onset pf exudative pharyngitis,
Low grade fever, malaise
Development of pseudomembrane
In severe cases, breathing obstruction
Skin ulcers can occur especially with poor hygiene; primarily tropical areas
Treatment of Corynebacterium diphtheriae:
diphtheria antitoxin; erythromycin or penicillin
Control of Diphtheria
vaccine (toxoid)
What's the problem?

Primarily affects children 2-4 yr age
Most often due to spread of H. influenzae b from nasopharynx to epiglottis
Induces intense inflammation
Epiglottis swells and can obstruct airflow
Medical emergency!
Acute Epiglottitis