Viral Pneumonia (8/17)

Front 1

What findings of consolidation are seen in atypical pneumonia that is vaused by a virus?

Back 1

None

Front 2

Pathological findings in atypical viral pneumonia?

Back 2

Moderate elevation of WBC and alveolar walls infiltrated with mononuclear cells

Front 3

How many viruses that cause pneumonia result in common cold (URTI)? How many common colds can be linked to a specific virus?

Back 3

Nearly all and about 40-60%

Front 4

General mechanism of viral atypical pneumonias?

Back 4

-Viruses have tropisms allowing forattachment to respiratory epithelium

-Viral replication causes cell death and inflammation

-Resulting damage and impairment of mucociliary clearance predisposes to bacterial superinfection

Front 5

Most common cause of respiratory tract infection?

Back 5

Influenza

Front 6

Mortality from influenza is highest in which two age groups?

Back 6

Elderly and under 2 years old

Front 7

Physically describe the orthomyxovirus that is influenza

Back 7

Helical, enveloped single stranded negative-senselinear RNA virus consisting of 8 segments

Front 8

3 proteins and their functions in the envelope of influenza?

Back 8

-Hemagglutinin binds to cell surface receptor andpromotes viral entry. 3 major subtypes (H1-H3)

-Neuraminidase cleaves neuraminic acid to releaseprogeny virus from the infected cell. Also degradesprotective layer of mucus in respiratory tract. 2 majorsubtypes (N1, N2)

-M2 ion channel essential for virus infectivity

Front 9

Which influenza type is a major cause of epidemics and pandemics? It is also capable of infecting animals and is classified by subtype.

Back 9

Influenza A

Front 10

Which type of influenza causes sporadic outbreaks every year, that only affects humans and is not classified by subtype?

Back 10

Influenza B

Front 11

Define antigenic drift?

Back 11

Spontaneous mutations in the viral genome as it replicates that allow the new viral strain to elude anti influenza antibodies in the population from prior by changing the virus.

Front 12

Does antigenic drift or shift cause epidemics?

Back 12

Drift

Front 13

What is antigenic drift?

Back 13

When human hemagglutinin and neuraminidase genes are replaced through reassortment with animal influenza viruses to create an antigenically new virus

Front 14

What causes pandemics?

Back 14

Antigenic shift

Front 15

Who is susceptible to virus after antigenic shift?

Back 15

All individuals

Front 16

How is influenza transmitted?

Back 16

Airborne respiratory droplets

Front 17

Describe the infectious process of different cells by influenza.

Back 17

Neuraminidase degrades protective mucus layer and virus gains access to the cell, necrosis of superficial layers of the respiratory epithelium occurs, and then cytokines are released to cause myalgias

Front 18

Describe clinical manifestations during the incubation period (24-48 hours)

Back 18

Sudden onset of fever, myalgia, sore throat, dry cough, headache, and rarely vomiting/diarrhea.

Front 19

What is the diagnosis for influenza?

Back 19

Clinical, RT-PCR is most specific and sensitive and is rapid to differentiate between subtypes, direct fluorescent antibody, and rapid antigen test

Front 20

Treatment of influenza?

Back 20

Oseltamivir or Zanamivir

Front 21

What is Reye's syndrome?

Back 21

Encephalopathy and liver degeneration which is seen in children following viral infection with aspirin implicated as its cause

Front 22

Who should get the influenza vaccine? How long is protection? Describe the structure of the vaccine.

Back 22

Everyone older than 6 months and protection last 6 months. It is trivalent or quadrivalent.

Front 23

Prophylaxis for influenza is with which drug?

Back 23

Oseltamivir

Front 24

Describe the structure of the paramyxovirus RSV.

Back 24

Pleomorphic, enveloped, negative-sense single-stranded, linear RNA

Front 25

What is the most important cause of bronchiolitis and pneumonia in infants?

Back 25

RSV

Front 26

What causes respiratory epithelium to fuse with RSV and form syncytia?

Back 26

Fusion proteins (F) which cause respiratory epithelium cells to fuse forming multinucleated giant cells (syncytia)

Front 27

How is RSV transmitted?

Back 27

Respiratory droplets, direct contact of contaminated hands with nose or mouth, and community outbreaks every winter with hospital outbreaks too

Front 28

Infection of RSV in infants is more severe because it involves...?

Back 28

Lower respiratory tract

Front 29

In healthy adults, infection is a typical URTinfection. How long does it last before resolving?

Back 29

4-5 days

Front 30

What is the diagnosis of RSV based on?

Back 30

RT-PCR on nasal swab or rapid antigen test on nasal swab

Front 31

Treatment for RSV?

Back 31

Supportive care with hydration, albuterol and oxygen. Inhaled ribavirin is not recommended for children.

Front 32

What do you use for prevention of RSV?

Back 32

Palvizumab is a monoclonal antibody against F protein and it prevents against pneumonia caused by RSV in premature infants

Front 33

Mortality rate for RSV?

Back 33

Low, at 2%

Front 34

Describe the structure of the adenovirus?

Back 34

Non enveloped, double stranded and linear DNA virus

Front 35

Diseases caused by adenovirus?

Back 35

-Pneumonia: typically more severe in infantsthan older children and can be accompaniedby lethargy, diarrhea and vomiting

-URTI

– Febrile pharyngitis

– Conjunctivitis (“pink eye”)

– Hemorrhagic cystitis

– Gastroenteritis <2 years old

– Disseminated infection

Front 36

Diagnosis of adenovirus?

Back 36

Only clinical

Front 37

Treatment of adenovirus?

Back 37

Only supportive

Front 38

Prevention of adenovirus?

Back 38

-Live oral enteric-coated vaccines directed against adenovirus serotypes 4 and 7 have been used for years in military recruits.

Front 39

Sequelae of adenovirus pneumonia?

Back 39

Bronchiectasis or bronchiolitis obliterans

Front 40

Describe the structure of the parainfluenza virus. What family is it in?

Back 40

-Enveloped single stranded linear nonsegmented RNA virus

-Paramyxoviridae family

Front 41

Which proteins does parainfluenza virus contain?

Back 41

F (fusion) and HN (hemagglutinin/neuraminidase) proteins

Front 42

Transmission of parainfluenza virus?

Back 42

Respiratory droplets?

Front 43

4 Distinct parainfluenza viruses?

Back 43

-Croup: Caused by hPIV1, 2, 3 (only 2-3% of infectionprogress to croup)

-hPIV3: Pneumonia and bronchiolitis

-hPIV4: mild respiratory illness (common cold)

Front 44

Mode of infection of PIV?

Back 44

PIVs infect mucous membrane of the throat; moreextensive infections will involve larynx and upper trachea

Front 45

What is croup (laryngotracheobronchitis)?

Back 45

Seal-like, barking coughcaused by inflammation around the larynx, trachea, and bronchi resulting in fever, rhinorrhea, sore throat, and sometimes stridor. Think steeple sign on xray.

Front 46

Diagnosis, treatment, and prognosis of PIV?

Back 46

Clinical, supportive, good with high risk of reinfection

Front 47

Clinically describe the paramyxovirus human metapneumovirus.

Back 47

-Clinically indistinguishable from RSV and also often mistaken for influenza

-Causes both URTIs and pneumonia

Front 48

What family is SARS in?

Back 48

Coronavirus

Front 49

Describe the structure of corona virus.

Back 49

Envelopedsingle stranded positive-sense RNA virus

Front 50

Clinical presentation of SARS? CXR?

Back 50

-Fever, chills, rigors, headache, malaise, nonproductive cough, dyspnea, hypoxemia, leukopenia, thrombocytopenia

-Range from normal to diffuse interstitial infiltrates with bilateral peripheral infiltrates common to middle of lower lung zones

Front 51

What is MERS? Clinical presentation?

Back 51

-Novel coronavirus reported in Saudi Arabia after male presented with sever pneumonia, ARDS, and AKI in 2012 with over 830 cases since reported

-Clinical pres: severe illness with PNA and ARDS, some withAKI. Fever, chills/rigors, cough, SOB, hemoptysis, sorethroat, myalgias, n/v/d, abdominal pain

Front 52

Which virus is common in military?

Back 52

Adenovirus

Front 53

What race/state gets pneumonia as a complication of influenza

Back 53

Native americans and Alaskans

Front 54

Spike (S) proteins are on the surface of which virus?

Back 54

Corona virus like SARS

Front 55

Is there a rapid urine antigen test for influenza?

Back 55

No

Front 56

If it looks like RSV or influenza but its definitely not early winter or spring then what is it?

Back 56

Human metapneumovirus (HMPV)