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114 Cards in this Set

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what are some of the s n s of Bronchitis
-top 5 reasons for doctor visits
-inflammation of bronchial tubes
-viral, bacterial, fungal, parasitic, smoking, chemicals
-fever
-cough
-sputum production
-fatigue and muscle aches
-usually self limiting when acute
what is the main causative agent for bronchiloitis and pneumonia
Respiratory syncytial virus (RSV)
-usually occurs in infants
-can cause airway obstrcution
what are smoe of the characteristics of Respiratory syncytial virus (RSV)
-ss neg strand RNA
-virion have diff size and shape
-F-protein for fusion
-No HN, so haemglutination
what is the mode of transmission of Respiratory syncytial virus (RSV)
-inhalation of large droplets, aerosols
-unstable in the environment
-readily killed with drying, acid, soap/water and disinfectants
what are some of the reservoirs for Respiratory syncytial virus (RSV)
humans
how many subptue are there and what are there properties
2
Type B= asymptomatic
type a= causes severe clinical disease, and leads to the majority of the outbreaks
what is the epi involved with Respiratory syncytial virus (RSV)
-most common localized infection of the children
-most common acute/fatal respratory infection in the infants
-much sevre in kids
-mild in adults
what type of cells does RSV target
it targets the epithelial calls and macrophages and this will lead to sloughing off of the cells that usually get lodged in the airways
what is the pathogenesis of RSV
-stays localized in the airways
-causes atypical pneumonia
-nasopharyngits
what are the key features of the RSV bronciolitis
-sever respiratory illness that leads to small airway obstruction
-wheeze
-dyspnea
-rales=noise when breathing
-eventually will have LRT involvement
what are some of the sequelae associated with RSV bronchiolitis
usually asthma and pulmonary function deficits are two known conditions that will effect people who have RSV bronchiolitis
what is the key sign with RSV bronchiolitis
retracted chest during breathing
how does one proceed to LRT infection when infected with RSV
it involves the direct CPE of the virus on the endothelial cells but it also has to do with the inflammatory response that is mainly IL-10, LT, IL-6, rantes and MIP-1, and IL-8, these will cause the constriction of the airway and that would hinder nreathing
-this response i heightened in kids
what are some of the methods to diagnose RSV pneumovirus genus
-culture
-antigen detection
-detection of viral RNA
-increase in serum antiibodies
-
do the infants have any protection for the maternal anntibodies
-no, thats why they are at a high risk and that's why even as adults we don't have much protection form the virus
what is main treatment for RSV
for mild dosease steroids like albuterol can help
-severe disease req passive ((immunity via RSV IG)) ans ((aerosol ribavirin ))for infants
when is this virus mosy active s in causing most cases of infections
october-april
what is prevention and control against RSV
-no vaccines
-can cause re-infection
-prophylaxis RSV-IG or IM recommended for children
-
how is RSV-IG made
it is made from 90% human source and 10% rats, that is humanized, it is the anti-RSV sera, this is anti-F recombinant mAB
what are similarities between RSV and MUMPS
both cause syncytiia
what is the differnce b/t RSV and MUMPS
Mumps have haemadsorption but RSV doesn't
-it has eosinophilc filled inclusoin bodies
-there are no RBC involved with RSV
what are some of the common characteristics of paramyxovirus
negative strand RNA
-f protein for fusion
-envelope so they bud off in a pH independent manner
-there are three genera that differ from each other base on these structure
-they induce cell-cell syncytia
-cell mediated immunity causes many symptoms but it is necessary to control the infection
-transmitted in the respiratory tract and cause infection in the tract
w/c one of the paramyxovirus has the hemeaglutinin and neuraminidase activity
-parainfluenza and mumps
w/c one of the paramyxovirus lacksthe hemeaglutinin and neuraminidase activity
the G of RSV
how do paramyxovirus viruses fuse and exit
((they fuse via F protein in a pH independent or neutral pH)) and exit via budding off
how do they induce suncytia
"via F-protein" and cause the formation of multinucleated giant cells
from all the paramyxovirus w/c cause viremia
""measesl and mumps""
from all the paramyxovirus w/c cause respiratory infections
RSV and parainfluenza
what is the broad division of Myxoviruses
paramyxovirus= parainfluenza, measels, mumps, RSV
orthomyxovius= influenza
what are some of the properties of paprmyxoviruses
non-segmented
-(-ve)sense ss RNA
-hemeagglutinin ""except RSV""
-cell to cell spread, suncytia via F protein in neutral pH
-replicate in cytoplasm
what are some of the properties of orthomyxoviruses
segmented
-(-ve) sense ss RNA
-""hemagglutinin""
-HA mediated fusion at acid pH
-""needs a nucleus so not just in cytoplasm""
what is the most common type of orthomyxovirus
-influenza
what does influenza cause
flu and atypical pneumonia,
what is the difference b/t typical and atypical pneumonia
typical is caused by bacteria
atypical is viral and by atypical bacteria
what are some of the characteristics of parainfluenza virus
ss -ve RNa
-linear
-3 types A,B,C
-segmented genome
-enveloped
-spikes HA, NA, helical w/nucleocapisd
what are some of the reservoirs for influenza viruses
it is mainly species specific and resrvoirs are human, pigs and birds
parainfluenza virus has HA and neuroamanidase, what is the function of each
HA= binds receptors that are made of sialic acid and are located on the epithelial cells of the respiratory where tehe infection is localized
NA= cleaves the sialic acid bonds and allows the virus to excape
what is the pathogenesis of parainfluenza virus and the clinical disease
usually doesn't involve the lungs
-aches
-headaches
-myalgia
-short incubation and that's why is capable of epidemics
what is the main charateristic that seperates influenza from common cold (coryza)
a fever exceeding 101.5, and any of the following
-cough
-sore throat
-headache
-nuscleache
what are some of the complications involved with influenza
mainly seen in individuals with prior cardio pulmonary disease and they consist of pneumonia caused by
-parainfluenza
-other ganets like staph aureus,strep pneumoniae, and haemophillus influenzae
-other viral infections like adenoviruses
what was the spanich flu
it was a pandemic of influenza viruses
-killed millions of people
what is the transmission of influenza
aerosol droplets, fomites, respiratiry transmission, and direct transmission
what are some of the currently circulationg
theres is subtype of H1N2
what is the most emerging threat involved with influenza
avian flu in hong kong 1997
-Type A= undergoes antigenic shifts(pandemics)
and antigenic drifts (epidemics) in NA and HA
what are some of the currently circulating strain of the influenza
they would be H1N1, H3N5
-mainly H1N2
what is recently emerging strain of influenza
H5N1, avian flu
w/c type of influenza undergoes shifts and drifts
Type A
what id the difference between shift and drift
-shift= pandemic, it is the change in either H or N, so H1N1 going to H1N2 would be a shift
-drift= epidemcs, this not in a change in the structure of the virus but there may be an AA change
what must happen for antigenic shift to take place
two different strains of virion must get in to one host and re assembly will take place and the n we will have a new virus w/c will be different and will not have any treatment
what is the main diagnosis of influenza virus
-isolation= mainly from respiratory secretions, nasal swabs, gargele, aspirate
-nasal swabs for rapid antigen testing
-rapid examination of cells immunoflouoresence
-inocultion of cell cultures or eggs for confirmation or subtyping
-serology= seerum Ab by HAI, CFT and EIa
when and how do we do a rapid antigen test
for treatment strategies it takes 30 minutes
or elisa =2-3 hours high sensitivity and specificity
what are the treatment options with influenza
adamantanes= only inhibit type A
neuraminidase inhibitors= inhibit type A and B
what are adamanatanes
they are amantadine and rimantadine,
-only inhibits type A
-many strains resistant
-interferes w/M2 channel,
-""interfers with viral uncoating and assembly""
-lowers the release of the type influenza particles and lowers the shedding
what are neruaminidase inhibitors
ostelamvir and zanamvir
=early treatment of the influenza A and B
-begins w/in 48 hours and ends by the 5th day
-""block site of neuraminidase""
-lowers the shedding and amount of type A and B particles
hoe does one determine that a particular year is an epidemic year
via epidemic threshold, it the # of reported cases increae above the threshold then it is a epidemic year
what was the epidemic year for influenza
2003
what are some of the steps take in prevention of the influenza virus
vaccination
the method of vaccine production for influenza entails
it entails taking strain A and B and interchanging there properties based on the analysis of recently isolated virus and epidemiological data and serologic studies in human
what are the different types of vaccines we have against flu
we have 2 types
live=attenuated, flumist and LAV
dead or inactivated= fluvirin, fluarix and fluazone
where are both types of influenza virus grown
egg
how are these vaccines made
basicaaly we take 2 viruses, one is attenuated master strain and the other is new virulent starin and we combine them in a way so that we get the virulence of the attenuated and dividing capability of the virulent strain, basically we take the glcyoproteins of the virulent but the genome of master attenuated strain and therefor e virulence of the attenuated strain
what are the CDC recommendation as far as the distribution of the vaccine for influenza is concerned
tier system
what are the months that the influenza virus is most active
october and nov
what are the priority groups for the vaccines
-kids 6-23 months
-adults>50
-ppl with underlying medical condition
-pregnant women
-healthcare professionals
who should get the inactivated influenza virus TIV
ppl with chronic illnesses
-asthma
-HIV, immunosuppressed
-heart disease
-renal
-hemoglobinopathy
who should get the live attenuated virus LAIV
5-49 years ppl that are healthy
-healthcare workers
what is a preservative that exists in fluzone that's no longer used in US and why
thimerzol, it causes autism
if there was going to be a pandemic of influenza virus, where would it most likely be
it would most likely be with avian flu
-strain H5N1
-it is already confirmed in indonesia due to sick poultry
what is the key thing about the avian flu H5N1 that can become a pandemic
H5 prefers SA a23gal, w/c is a bird receptor rather than 2,6 w/c is human
why would H5 be particularly dangerous
b/c it has ploymerase that will allow to replicate quickly
what virus causes SARS
Coronavirus-SARS-Cov
what is SARS
severe acute respiratory distress syndrome
it is pneumonia like
-discovered in 2003
-it spread w/in 6wks worldwide
what are some of the symptoms of SARS
-fever >100.4 or 38 c
-difficluty breathing
-cough
-discomfort
-10-20% of the cases ppl require ventillators to help them breathe
What group causes the common cold
Group 1 and 2
What kind of receptors do group 1 and 2 attach to
They attach to the termibal sialic acid residues
What does SARS attach to
SARS attaches to ACE2, and it has a group on its own
how are infection w/SARS mediated
They are mediated by ACE 2 receptor on the host cell
what is the treatment option under production
Mainly anti ACE2 antibodies will disrupt the interaction b/t the virus and the host
What is considered to be the suspect case of SARS 1
Presenting with a fever exceeding 38 C after November 2002, and cough or difficulty breathing, AND either coning in contact with SARS infected person, or traveling to the ares where SARS is common, or living in an area where SARS transmission occurred
What is considered to be the suspect case of SARS 2
Also a person who had died with an acute respiratory illness after November 2002, AND has all the same problems as SARS 1
What is considered to be the probable case of SARS
a suspect case with radiographic evidence that this person has the infection via x-rays OR a suspect case of RDS that is positive for corona virus shown by lab diagnostic assay OR a suspect with autopsy findings of RDS
What is considered exclusion criteria for SARS
Any other clinical finding that or alternative diagnosis can fully explain their illness
What are some of the lab diagnostic methods SARS
Confirmed positive test via PCR, take sample from different sources like sputum or stool, if that can’t be done then take 2 samples from nasopharynx at different times, or 2 different assays or do PCR again
What are some of the serological tests that can be done with SARS
Negative AB test on the acute serum or positive AB test on the convalescent serum or four fold increase in the antibody titer b/t acute and convalescent phase
What are some of the isolation tests that can be done to diagnose SARS
Isolation in cell culture of SARS-CoV from any specimen, plus PCR confirmation using a validated method
How many different type of pneumonia are there
Mainly 2 type: community acquired and nosocomial infections
What are species of pathogens cause pneumonia that is community acquired by ppl with no predisposing factors
Strep. Pneumonia,m. pneumonia and C. pneumonia
Out of the three that cause community acquired, non risk factor pneumonia, w/c is typical
s.pneumonia
Out of the three that cause community acquired, non risk factor pneumonia, w/c is atypical
C and M. pneumonia
What are causes of pneumonia that fall under both community and nosocomial
Mainly ppl with immune probs like HIV patients
What type of pathogens cause problems in HIV patients and lead to pneumonia
Mainly atypical pathogens like CMV, fungi, and M.tuberculosis
What is the difference b/t typical and atypical pneumonia
Pneumonia causes by typical bacteria vs. pneumonia caused by atypical bacteria, viruses, fungi, and parasites
What are the cardinal symptoms of strp. Pneumonia
Otitis media, sinusitis, and pneumonia
What is most common symptom of strp. Pneumonia
It is the most common cause of community acquired, typical pneumonia, it causes 2/3 of bacteremic and lethal pneumonia
What is the most common pathogen
Influenza
What is the second most common pathogen
strp. Pneumonia
What are some of the characteristics of S.pneumonia
G+, encapsulated, oval or lancet shaped cocci, seasonal change upto 50% incidencs, “it has no group specific carbs” so it is not lancefield typed
What are some of the virulence factors of strp. Pneumonia
Polysachiride caps, neuramindse (thins out the mucous), IgA protesase, pneumolysin (alpha-hemolysis), and po4choline (important in spread)
What kind of hemolysis I observed with strp. Pneumonia
Alpha hemolysis, this is a misnomer b/c it only partially hemolysises the blood cells
What is the main function of pneumolysin associated with strp. Pneumonia
Pneumolsysin is cholesterol binding toxin, it’s released as a monomeric protein but assembles into oligomeric pore on target cell membrane
What is the main way of spread of strp. Pneumonia
5-75% is via respiratory droplet
What are some of the s n s of pneumococcal pneumonia
Prodromal symptoms of URI, productive sputum tinges with blood, rust or cherry colored, severe shaking, fever, aspiration into lower lobes leading to lobar pneumonia, leakage of RBC and immune cells, rapid recoverry with antibacterial
What is usually seen in x-rays with pneumococcal pneumonia
Inflammatory exudates filling alveolar spaces
What kind of pneumonia is pneumococcal pneumonia and what are it’s forms
It Lobar pneumonia and it be red hepatiation (RBC estravasate) and grey hepatization (fibrin, inflammatory)
What is the main diagnosis of pneumococcal pneumonia (i.e. strp. Pneumonia)
Microscopily confirm by Gram stain neufeld rxn with quellung (swollen) capsule due to coating by the Antibody
Hew is strp. Pneumonia identified
Bile solubility (soluble), optochin susceptibility, catalase –ve
Why do we test strp. Pneumonia with optochin
This helps us differentiate from strep. Viridians w/c is resistant to optichin but strep. Pneumonia is not resistant
Can strep pneumonina be lancfield typed
No, because it doesn’t have specific carbs
What are some of the methods of control and prevention of penumococcal bacteria
Poly valent anti pneumococcal capsular Polysaccharide vaccine, this protects the high risk population over 2yrs and are over 65, also heptavalent pneumococcal conjugated vaccine, like HIB
None
What are some of the pathogens that cause nosocomialpneumonia
Aeuroginosa, kelbsiella, e-coli, influenza
What pathogens are considered early pathogens for nosocomial pneumonia and why
s.pneumoniae, influenza, catarhalis and these cause problems with in 5 days after admission
What is the criteria for a nosocomial pneumonia infection
It you get after one week of hospitalization, if it happens less than 5 days, early pathogen
Is the nosocomial pneumonia more serious
Yes, b/c ppl infected already have a low immune response and the strains are usually very virulent then community
Who is at risk of getting nosocomial pneumomnia
Alcoholics, older, immunosuppressed, from medications, or disease, recent illness and risk of aspiration