Pod: Lrt Infection

Front 1

List some pulmonary host defenses in each of the following areas:
1. nasopharynx
2. oropharynx
3. trachea/bronchi
4. terminal airway/alveoli

Back 1

1. IgA, mucocilliary apparatus
2. saliva, pH, complement, sloughing of epithelial cells, complement production
3. mucocilliary apparatus, cough, Ig production
4. surfactant, Igs, complement, iron-binding proteins, cytokines, PMNs, macrophages

Front 2

Describe bordetella pertussis:
1. gram stain morphology
2. intra or extracellular
3. aerobe or anaerobe

Back 2

1. GNC
2. extracellular noninvasive
3. aerobe

Fastidious growth requirements: special transport medium, special agar media(Bordet-Gengou),5-7 days.

Front 3

Which toxin is responsible for the typical whooping cough caused by pertussis?

Back 3

Tracheal toxin:
1. interfere with DNA synthesis in host cells.
2. cause ciliastasis and ultimately the death of ciliated epithelial cells.
3. stimulate IL1, cause fever.

Front 4

What toxins are produced by bordatella pertussis?

Back 4

1. pertussis toxin: AB toxin,inhibit phagocyte killing and monocyte migration, cause lymphocytosis
2. Adenylate cyclase toxin: AB toxin, inhibits lymphocyte migration and killing, damage ciliated cells, increase mucus production.
3. dermonecrotic toxin: local ischemic damage.
4. tracheal toxin: cause the typical whooping cough.

Front 5

How does bordelleta pertussis bind to ciliated epithelial cells?

Back 5

FHA:filamentous hemagglutinin

Front 6

List the phases of pertussis infection.

Back 6

1. incubation
2. catarral phase: most infectious
3. paroxymal phase: whooping cough.
4. convalescent phase

Front 7

A patient presents with cough for 2 weeks.
1. What does he have?
2. How to treat him>

Back 7

1. Bordetella pertussis
2. supportive or erythromycin

Front 8

Why do doctors recommend vaccinate adolescence and adults for pertussis?

Back 8

waning protectivity

Front 9

What agents can cause acute bronchitis?

Back 9

1. pertussis
2. mycoplasma pneumonina
3. chlamydia pneumonia
4. common cold virus
5. secondary infection: strep pneumo, H. influenza, moraxella catarrhalis.

Front 10

What causes acute bronchiolitis?

Back 10

virus
1. RSV
2. parainfluenza virus
3. human metapneumonvious virus

Front 11

Describe RSV:
1. genome
2. enveloped or not?
3. family

Back 11

1. (-)ssRNA
2. enveloped
3. paramyxovirus

Front 12

Name the molecule that aid in adherence and fusion(syncycia)llowing virus:
1. RSV
2. parainfluenza virus

Back 12

RSV
a) adherence: G protein
b) fusion:F protein

Parainfluenza:
a) adherence: HN protein
b) fusion: F protein

Front 13

which of the following virus is enveloped?
A. RSV
B. parainfluenza virus
C. measles
D. mumps
E. all the above

Back 13

E. All are paramyxovirus.

Front 14

What is the leading cause of laryngotracheitis (croup)?

Back 14

parainfluenza virus

laryngotracheitis: erythema and swelling of the lateral walls of the trachea, just below the vocal cords.

Front 15

How to treat croup?

Back 15

supportive: corticosteroids to suppress the inflammation.

Front 16

What are some comoon hospital acquired infections?

Back 16

aerobic GNB
1. E.coli
2. Serratia
3. enterobacter
4. klebsiella
5. pseudomonas aeruginosa

facultative anaerobe GPC
6. Staph aureus

Front 17

Describe strep pneumonia:
1. gram stain morphology
2. catalase activity
3. capsulated or not?

Back 17

1. GPC, lancet shaped in pairs, halo area around.
2. catalase -
3. capsulted

Front 18

What factors facilitates the adherence of strep pneumoniae?

Back 18

1. choline binding proteins
2. aspiration/post viral infection
3. pneumolysin damages ciliated cells
4. bing to IgA to trap organism in the mucus layer
5. activate pneumocyte to express PAF that futher stimulate adhesive receptors.

Front 19

How does strep pneumonia avoid phagocytosis?

Back 19

1. capsule
2. pneumolysin: reduce oxidative bursts and effectiveness of PMNs.
3. DNAses: lyse PMN nets.

Front 20

How does strep pneumoniae invade?

Back 20

Initiate intense inflammation:
1. teichoic acid released by autolysin, activate complement and recruits PMNs(C5a).
2. pneumolysin binds fc region of antibodies and activates complement

Front 21

Could strep pneumoniae cause systemic infection?

Back 21

Yes. May enter blood trough damaged endothelium.

1. meningitis
2. otitis media
3. empyema(extension to pleura).

Front 22

Spleen is key to removal of encapsulated organisms. List some encapsulated organisms.

Back 22

1. strep pyogenes
2. strep pneumoniae
3. H. influenza
4. N. meningitidis

Front 23

A 60 yrs patient has a abrupt onset of fever, shaking chills, chest pain, purulent and bloody cough.
1. What does he have?
2. What does a X-ray show?
3. How to diagnose?
4. How to treat?

Back 23

1. Strep pneumoniae
2. lobar infiltrate
3. sputum culture with optochin: α-hemolytic, mucoid(capsule).
4. Vancomycin, or quinolones, or 3rd generation cephalosporins, or linezolid.

Front 24

How does strep pneumoniae acquire penicillin resistance?

Back 24

DNA transformation with viridians in the oral cavity, result in alterations in PBP binding proteins.

Front 25

Why is strep pneumoniae vaccine different between adults and infants?

Back 25

polysaccharide capsule: infants don'f have the immunity to capsulated organisms, need protein conjugates.ex. Prevnar.

Front 26

Which type of H. influenza is capsulated?

Back 26

Type B: PRP

Front 27

A patient presents with fever, cough, otidis media, and pink eye.
1. What does he have? be specific.
2. What other organism is also likely?

Back 27

1. H. influenza noncapsulated.
2. Moraxella catarrhalis.

Front 28

A pateint presents with pneumonia, epiglottitis, and signs of CNS problems.
1. What is the cause? be specific.
2. How could this be prevented?
3. How to treat?

Back 28

1. H. influenza, capsulated(typeb).
2. Hib vaccine.
3. 3rd generation cephaloporin combined with β-lactamase inhibitors.

Front 29

Describe klebsiella pneumoniae:
1. gram stain morphology
2. casulated or not?
3. family

Back 29

1. GNB
2. capsulated
3. enterobacteriaceae

Front 30

Describe pseudomonas aeruginosa:
1. gram stain morphology
2. capsulated or not?

Back 30

1. GN, motile, fimbriae
2. capsulated (produce slime)

oxidase +
pigment producer (pyocyanin): blue-green

Front 31

What are the virulence factors of pseudomonas aeruginosa?

Back 31

1. fimbriae
2. slime
3. pyocyanin: toxic radicals->tissue damage
4. proteases, elastases, hemolysins: tissue damage.
5. exotoxin A: ADP-ribosylation
6. endotoxin: shock or sepsis

Front 32

Burn patients, patient on ventilators, patients with CF, and people lacking neutrophils are susceptible to this infection.

Hint: blue-green pigmented

Back 32

pseudomonas aeruginosa

Front 33

Treatment of pseudomonas aeruginosa.

Back 33

Extended spectrum penicillins: piperacillin, 3rd gen sephalosporin

aminoglucoside

Front 34

These organisms that cause pneumonia grows slow, need sterols in membranes, don't respond to β-lactams, and cause less inflammation(no pus). What are they?

Back 34

Atypical pneumonia: mycoplasma pneumonia, chlamydophila pneumonia, and legionella pneumophilla.