Acute Respiratory Infections(ARI) Flashcards by Iseoluwa Ojo

The respiratory tract is made up of a continuous mucosal surface and this ____________________________ , allows downward spread of infection along the tracheobronchial tree.

lack of restriction by anatomic boundaries

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The upper respiratory tract consists of the airways from the _________ to the _________ in the _________, including the _________ and the _________.

The lower respiratory tract covers the continuation of the airways from the _________ and _________ to the _________ and the _________.

nostrils ; vocal cords ; larynx

paranasal sinuses ; middle ear.

trachea ; bronchi ; bronchioles ; alveoli.

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Most of these ARI deaths are due to __________ and __________.

bronchiolitis and pneumonia

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Risk factors: Demographic factors

anatomy

protective immune

males

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Risk factors

Host factors

malnutrition ( ↓biological integrity of resp __________ - cellular __________, fibronectin)

mucosa; regeneration

pertussis, measles, pneumococcal, HIB

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Pathogenesis

ARIs occur from a pathogen activated failure or disruption of the normal anatomical barriers, protective reflex mechanisms and pathogen-specific immunological defence mechanisms of the respiratory tract.

Some of these include _________ activity, _________ reflex, sneezing, _________ production, _________ immunity( T-lymphocytes, natural killer cells, IF alpha and gamma), _________ immunity (IgA,IgG).

ciliary

cough ; mucus production

cell-mediated ; humoral immunity

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Pathogenesis of URTI

Organisms gain entry to the respiratory tract by __________ of droplets or direct contact with __________ hands or formites

Then they __________ the __________

______________ may ensue, along with redness, edema, hemorrhage and sometimes an __________

inhalation ;contaminated

Invade the mucosa

Epithelial destruction ;exudate

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Upper Respiratory Tract Infections

Include:

rhinitis (common cold)
Sinusitis
Ear infections

acute pharyngitis or tonsillopharyngitis(33%)

Laryngotracheitis or
laryngotracheobronchitis (croup)

epiglottitis and laryngitis

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___________ and ___________ cause the more severe complications (deafness and acute rheumatic fever/post streptococcal glomerulonephritis, respectively).

Ear infections and pharyngitis

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URI (Aetiology)

The vast majority of URIs have a ______ etiology.(eg ______,________,_________)

Bacterial causes include commonly _______________,________________, etc

viral; corona; RSV

GABHS (Group A beta haemolytic
streptococcuss)

Haemophilus influenza type B(HIB)

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Treatment of URTI

Symptomatic/supportive

Headaches, sorethroat, muscle aches
(_________).

Nasal congestion (___________ discouraged in children <______ years)

Antibiotics (Pharyngitis has bacterial cause in 15%)

________ (dehydration)

_______ rich foods

analgesics

decongestants

12; Fluids; Vit A

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Treatment of URTI

Specific treatments:

____________________ (sinusitis)

_______{(otitis externa)

Surgical antral washout

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Inflammation of the upper airway is classified as ________ or ______________ on the basis of the location, clinical manifestations, and pathogens of the infection.

epiglottitis

laryngotracheitis (croup)

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____________________ is the most common cause of epiglottitis, particularly in children age 2 to 5 years.

Haemophilus influenzae type b

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ACUTE EPIGLOTITTIS : Pathogenesis

A ________________________ may precede infection with H influenzae in episodes of epiglottitis.

However, once H influenzae type b infection starts, (slowly or rapidly?) progressive ———— and _________ of the epiglottis ensue, and bacteremia is usually present.

viral upper respiratory infection

rapidly

erythema ; swelling

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ACUTE EPIGLOTITTIS: clinical manifestations

The syndrome of epiglottitis begins with the acute onset of _______ , _______, hoarseness, _______, _______ and progresses within a few _______ to _______ and _______. The clinical course can be fulminant and fatal. The _______ may be inflamed, but the diagnostic finding is a “_______” epiglottis.

fever ; sore throat

drooling; dysphagia

hours ; severe respiratory distress

prostration ; pharynx

cherry-red

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EPIGLOTITTIS: clinical features

A
I
R

R
A
I
D

Airway closed
Increased pulse
Restlessness

Retractions
Anxiety increased
Inspiratory stridor
Drooling

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For EPIGLOTITTIS, DON’t???

Why?

Don’t examine the throat

Causes more anxiety

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ACUTE EPIGLOTITTIS: Diagnosis

__________ appearance of epiglottis on
__________

Lateral neck radiograph- __________ sign

Haemophilus influenzae type b is isolated from the blood or epiglottis in the majority of patients with epiglottis; therefore a __________ should always be performed.

Cherry red ; laryngoscopy

thumb sign

blood culture

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ACUTE EPIGLOTITTIS: Treatment and Prevention

It is a ____________ , especially in
children.
Observe carefully, keep calm, DO NOT ____________

____________/ ____________ (skilled personnel)

Antibacterial therapy should be directed at ____________

For prevention, ____________

Medical emergency ; AGITATE

intubation , tracheostomy

H influenzae.

Haemophilus influenzae type b conjugated vaccine.

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Laryngotracheitis(Croup)

Most cases of laryngotracheitis are due to __________ .

__________ viruses are most common but RSV, adenoviruses, influenza viruses, enteroviruses and Mycoplasma pneumoniae have been implicated.

More serious bacterial infections have been associated with __________ , __________ and __________.

viruses; Parainfluenza

H influenzae type b

group A beta-hemolytic streptococcus

C diphtheriae.

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CROUP: Pathogenesis

Viral infection of laryngotracheitis commonly begins in the _________ and eventually moves into the _________ and _________.

Inflammation and edema involve the epithelium, mucosa and submucosa of the _________ which can lead to _________

nasopharynx ; larynx ; trachea.

subglottis ; airway obstruction.

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CROUP(Clinical manifestation)

history of preceding _______-like symptoms is typical of laryngotracheitis, with _______, _______, _______ and a _______ cough.

Tachypnea, a ___________ cough and inspiratory _______ eventually develops.

Children with bacterial tracheitis appear (more or less?) ill than adults and are at (lesser or greater?) risk of developing airway obstruction.

rhinorrhea ; fever

sore throat ;mild

deep barking cough

stridor

more ; greater

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When the duration of symptoms of infections of the tracheobronchial tree is less than _____________, they are referred to as acute respiratory infections

28 days

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Croup (diagnosis) _________ cultures or cultures from ______________. Serologic studies- antibody titers to various viruses.(retrospective diagnosis) Xray of Neck- _________ of _________ (_________ sign).

Sputum ; pharyngeal swabs. narrowing ; subglottis steeple sign

Acute respiratory Infections (ARI) may be defined as a heterogeneous and complex group of (infectious) clinical entities in which the possible anatomic site(s) affected extend from the __________ to the _________ .

pharynx alveoli.

Acute respiratory infections (ARIs) are classified as ________ respiratory tract infections (URIs) or _______ respiratory tract infections(LRIs).

upper lower

The upper respiratory tract consists of the airways from the _________ to the _________ in the _________, including the _________ and the _________ ear.

The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear.

CROUP(diagnosis) Newer, rapid diagnostic techniques- detect virus in _________,____________ swabs, or ______ washings.

sputum pharyngeal swabs nasal washings.

Croup (treatment) Usually supportive _______ ________ or __________ air _________(↓severity & duration/need for ET intubation). IM ___________ __________ PO 2mg/kg/d for 3days Nebulized budesonide 2mg stat. racemic epinephrine(nebulized).

Fluid Moist or humidified Steroids; dexamethasone; Prednisolone

_______ sign is to epiglottis as _______ sign is to CROUP

Thumb Steeple

Acute lower respiratory tract infection(ALRI) is defined as any infection that affects the airways below the _______ and includes: ???

larynx Tracheitis Bronchitis Bronchiolitis Lung infections such as pneumonia and empyema

Pathogenesis LRTI Organisms enter the (proximal or distal ?) airway by ________,_________ or by __________ seeding. The pathogen multiplies in or on the __________, causing inflammation, increased _____________ , and impaired ___________ function; other lung functions may also be affected.

distal inhalation ; aspiration ; haematogenous epithelium; mucus secretion muco-ciliary

Bronchiolitis(Clinical manifestation) _________ and cough ______ A _________ cough, increased RR, and _________ follow _________ of the chest wall, nasal _________, and _________ are prominent findings. Wheezing or an actual lack of breath sounds. Respiratory failure and death.

Coryza ; Fever deepening ; restlessness Retractions ; flaring grunting

Bronchiolitis (diagnosis) Aspirations of ___________ secretions or swabs for viral culture. Serologic tests demonstrating a rise in antibody titer to specific viruses can also be performed- RDT (fluorescent-antibody staining), ELISA or DNA probe procedures

nasopharyngeal

Bronchiolitis(Treatment) Supportive measures. (O2, fluids, nebulised saline) Respiratory syncytial virus infections in infants may be treated with ________. __________ and ____________ are available for chemoprophylaxis or treatment of influenza type A viruses.

ribavirin Amantadine and rimantadine

Bronchiolitis(Treatment) Two neuraminidase inhibitors (_________ [oral] and _________ [inhaled]) are active against influenza A and B. Immunization(__________)- those at high risk of complications- chronic underlying disease, HIV. Routine for infants and children in some developed countries.

oseltamivir zanamivir Influenza

Pneumonia is ___________ of the _____________.

an inflammation lung parenchyma.

From an anatomical point of view, lobar pneumonia denotes an _________ process involving ___________ of the lung while bronchopneumonia describes an _________ process occurring in a distribution that is ________ without ________________

alveolar an entire lobe of the lung while alveolar patchy ; filling an entire lobe.

classification of pneumonia Pneumonias occurring in usually healthy persons not confined to an institution are classified as __________________ pneumonias. Infections arising while a patient is hospitalized or living in an institution such as a nursing home are called ___________ or ____________ pneumonias.

community-acquired pneumonias. hospital- acquired nosocomial pneumonias.

Common Bacterial causes of Community-acquired pneumonias List 4

Streptococcus pneumoniae, Haemophilus influenzae type B , Staphylococcus aureus , Mycobacterium tuberculosis

CLASSIFICATION OF SEVERITY OF PNEUMONIA Pneumonia (non-severe) _______ chest in-drawing: (i.e. ______ chest wall goes in when the child breathes in) chest auscultation signs: ________ breath sounds, _________ breath sounds, ________ or ________.

Mild ; lower decreased ; bronchial crackles ; crepitations.

CLASSIFICATION OF SEVERITY OF PNEUMONIA Severe pneumonia These children will have, in addition to the features of non-severe pneumonia, at least one or more of the following: ____________ , or oxygen saturation _____% or less on pulse oximetry in room air Severe _______________ (e.g. _________ , chest _________ )

Central cyanosis ; 90% respiratory distress grunting ; chest indrawin

Common viral causes of Community-acquired pneumonias ??

Respiratory syncytial virus (RSV)

Severe pneumonia Chest auscultatory signs: _______/_______ breath sounds or vocal resonance as in _______,_________ Signs of pneumonia with a general danger sign: Inability to ________ or drink, lethargy or __________, _________ Presence of complications or co-morbidities: e.g. congestive heart failure, severe malnutrition and sickle cell disease

decreased/absent pleural effusion ; pleural rub breastfeed; unconscious convulsions.

Pneumonia: Diagnosis (Investigations) Microbiology: _________ ________ or _______ (if present) culture Viruses- PCR, serologic tests (detect antibodies) ____________ (gold standard)- hardly done, invasive,expensive

Sputum M/c/s Blood or pleural fluid Lung aspirate culture

Pneumonia: Diagnosis (Investigations) Radiology ________ ________/_____

Chest X-ray CT/MRI

Treatment of pneumonia Depends on severity Non- severe: _________ and ____________ (out patient) Severe- •_________ •Fluids(restrict in ___________ ) •______ antibiotics( broad spectrum then change as cultures become available).

antipyretics and oral antibiotics oxygen; heart failure IV

Pneumonia Antibiotics therapy for a child that is less that 2months old??

Admit and treat as neonatal sepsis

Pneumonia Antibiotics therapy for a child that is more than 2months old?? Out patient first line Our patient alternative In patient first line In patient alternative

Oral Amoxicillin ; oral amoxicillin-clavulinic acid IV amoxicillin; IV ceftriaxone

Common fungal causes of Community-acquired pneumonias List 2

Candida species, Pneumocystis jirovecii

Clinical features of pneumonia List 5

Fever (high grade) ± chills Cough Fast breathing Difficult breathing Chest pain Inability to feed

Prevention and control of ARI _______________ (measles, diphteria, pertussis,HIB, pneumococcus, influenza) Early diagnosis and treatment Improvement in nutrition (________________, adequate complementary feeds, Vit A) Safer environments and practices (ventilation, overcrowding, indoor pollution, daycare, handwashing).

Immunization exclusive breastfeeding,

Complications of ARI Disease Complications Common-cold 1 Otitis media 2 pharyngitis 3

sinusitis Menningitis ; Hearing loss Retopharyngeal abscess; Rheumatic heart disease ; Post-streptococcal glomerulonephritis, AKI

Complications of ARI Disease Complications bronchiolitis

Respiratory failure pneomothorax

Complications of ARI Disease Complications pneumonia

Congestive cardiac failure Pneumothorax, subcutaneous emphysma Septicaemia Pleural effusion

Bronchiolitis is a _______ respiratory disease of infants and is caused primarily by ________________ Other viruses, including parainfluenza viruses, influenza viruses and adenoviruses (as well as occasionally M pneumoniae) are also known to cause bronchiolitis.

viral respiratory syncytial virus.

Acute Respiratory Infections(ARI) Flashcards

(61 cards)