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infectiuo Flashcards

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1
Q

effect of virus on the lung

A

cellular inflammation
local immune memory
loss of chemoreceptors
poor barrier to hygiene
promote bacterial growth as immune system fights virus cant fight bacteria
loss of cilia - less able to clear bacteria
mediator release

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2
Q

microbiomes

A

in lung and pharynx as dense as on skin

these bacteria cause pneumonia

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3
Q

common cold agents

A 
rhinovirus 
coronaviruses 
influenza viruses 
parainfluenza viruses 
resp syncytial virus 
adenovirus
enteroviruses
mycoplasma 
chlamydia 
exchange between hosts through air 
virus previously been GI - evolved because of ease of transmission
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4
Q

community acquired pneumonia

A

eading infectious cause of hospitalisation and deaths in US adults
exceeds $1obillion annually
cooperation between bacteria and virus in the disease - influenza A and B, and resp syncytial virus present

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5
Q

what causes hospital acquired pneumonia

A 
staphylococcus aureus 28% 
pseudomonas aeruginosa 21.8%
klebsiella species 9.8%
E coli 6.9%
Acinetobacter 6.8%
Enterobacter 6.3%
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6
Q

what causes CAP

A

strep pneumonia - classic presentation: cough, rusty sputum, cold sore
myxoplasma pneumonia - incidious atypical disease
staph aureus - people who are sick in other ways/immuneparetic
chlamidophilia pneumoniae - rare
haemophilus influenza - people with asthma, colo9nised with pneumonia after a viral infection

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7
Q

typical V atypical pathogens in CAP

A

typical - streptococcus pneumoniae, haemophilus influenzae, Moraxella catarrhalis
atypical pathogens - mycoplasma pneumoniae, chlamysia pneumonae, legionella pneuomophilia
atypical not covered by penicillins - need additional agents eg macrolides

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8
Q

pneumonia and age

A

after 70 the presenting rate of pneumonia increases
but younger eg 60, there is a higher fatality rate in the people who get the condition
age risk factor because of susceptibility to the virus

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9
Q

risk factor for pneumonia

A 
age <2, >65
smoking 
alcohol 
contact with children <15 
poverty and overcrowding - confound with passive smoking 
inhaled corticosteroids
immunosuppressants - steroids
proton pump inhibitors 
COPD 
asthma
heart disease
liver disease
DM 
HIV 
malignancy
hyposplenism 
complement or Ig deficiencies
risk factors for aspiration 
previous pneumonia 
geo variations 
animal
healthcare contacts
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10
Q

symptoms of pneumonia

A 
hypoxic
febrile - temp 38degrees
crepitations - crackle in lungs 
new respiratory symptoms orb signs 
pleuritic chest pain 
confused 
new X ray changes
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11
Q

what is pneumonia a disease of

A

interstitium

affect GE

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12
Q

investigations for CAP

A

chest xray - could be pneumponia even if normal
blood test - full count - see if responding should be neutrophils and WBC, check urea electrolytes liver func and C reactive protein - check for risk of combined disease part of the septic syndrome
arterial blood gases - how sevele lung desaturation is and look for lactic acidosis
microbiological investigations - sputum culture, blood culture, urine antigen tests for legionella pneumophilia and streptococcus pneumonia

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13
Q

guidelines for diagnosing pneumonia

A

acute lower resp tract syndrome
new focal chest sign and signs on X ray
>1 systemic feature eg fever, shiver ache, pain, temp> 38degrees
no other explanation

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14
Q

CRB 65 severity score

A 
1 point for every feature 
confusion 
resp rate >=30/min
SBP <90 or DBP <=60mmHg 
>=65years
0 = low severity - home and AB 
12 - moderate, consider hospital 
3-4 high severity - urgent hospital, empirical AB if life threatening, may need ventilation
consider social setting and home support
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15
Q

supportive therapy for pneumonia

A 
oxygen - for hypoxia 
fluids for dehydration 
analgia for pain 
nebulised saline - may help expectoration 
chest physiotherapy
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16
Q

AB therapy that is given for pneumonia

A

low severity - amoxicillin with doxycycline - effective and low side effect profile - especially with haemophilus
severe - benzylpenicillin IV or telcoplanin and clathiro PO
for 5-7 days
7-14 days for atypicals

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17
Q

time frame of delivery of AB for pneumonia

A

crucial
in severe AB delivered as soon as possible
for every hour dekay in septic shock - chance of survival reduced by 7.9%
duration 1wk

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18
Q

Influenza pandemic

A

helitrope hue
could detect bacteria - haemophilus influenza
show association with bacterial colonisation and pneumonia

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19
Q

treatment for flu

A

Tamiflu and IV clarithromycin early

otherwise need prol0ngued ventilation

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20
Q

signs of flu

A 
fever 
cough 
aches 
breathless at rest 
nausea 
increased SOB at rest
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21
Q

what causes severe disease

A

RNA sequence
viral load
DNA
environment
cause epithelial damage and storm of mediators
secondary bacteria infection
from host and virus - host genetics - variation in IFITN3

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22
Q

what causes sever flu

A 
highly pathogenic strains - zoonotic 
ijnnate immune deficiency - IFITN3 
local absence of B cells 
absence of T cells 
frail elderly 
COPD 
asthma 
DM 
obesity 
pregnancy 
V young
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23
Q

global changes in RSV and flu prevalence per month

A

swing between N and S hemispheres

RSV slightly predates flu

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24
Q

influenza

A 
no reinfection by the same strain 
imperfect vaccines 
homotypic immunity 
vaccine induced immunity fades
annual vaccine required 
perfect virus - runs away from immune system by evolving
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25
RSV
``` infectious form is filamentus recurrent reinfection with similar strains controls the immune system no vaccine poor immunogenity vaccine enhanced disease researched field relatively stable but does evolve - now have niche strains ```
26
RSV broncholitis
caused by RSV affects babies commonest cause of admission in infancy in developed countries 1/3 beds in winter airways full of inflammatory cells - blocked - stop airflow
27
RSV broncholitis clinical features
``` chest wall retractions tachypnea with apneic episodes expiratory wheezing prolonged expiration rates and rhonchi croupy cough hypoxemia and cyanosis nasal flaring ```
28
Age and RSV
children - infantile bronchitis - causally related to wheeze, older siblings spreaders transmitted from children to older people when they get admitted already had it for 3wks when tested for it its already gone old people - major cause of progressive lung disease and deaths adults - colds, transmitters but not severe
29
RSV vaccine
nasal spray not immunogenic enough novavex - injected nanoparticle into pregnant women, effective against severe disease but not common - overnight drop in stock market
30
symptoms and viral load for RSV and flu
RSV more delayed disease | communication between virus and the mucosa
31
bacterial loads in COPD patients infected with rhinovirus
bacteria level climb with virus level
32
relationship between bacteria and virus
lung not sterile - contain organisms that are likely to casue pneumonia bacterial infection likely to be caused by viral pathogen
33
location of airway diseases
allergic rhinitis - upper airways bronchi - asthma allergic alveolitis - alveoli
34
immunological hypersensitivity
IgE mediated - atopic diseases, hayfever, eczema and asthma | non IgE mediated - allergic diseases - farmers lung
35
non-immunological hypersensitivity
intolerance enzyme deficiency - lactase DH pharmacological - aspirin hypersensitivity
36
allergic rhinitis
``` hayfever 25% prevalence in UK 40% world wide seasonal allergy 12-15% children effect on exams - reduced QoL polysensitised because of travel sleep deprivation reduced productivity runny nose, sneeze, congestion, red and watery eyes ```
37
allergy
exaggerated immunological response to allergen - inhaled, injected, swallowed, in contact with skin/eye mechanism in some diseases some of the time, others all the time
38
mechanism of allergy
biophysical response early hypersensitive response - 5-30mins eg sneeze, mast cells late hypersensitivity response - 8-12hrs - nasal congestion, eosinophils make IL 5 - recruit T cells
39
T helper type 1
``` for virus, bacteria, fungi, protozoa Th17 cells NK cells cytotoxic t cells IgM IgA IgG ```
40
T helper type 2
``` for helminths and ectoparasites (ticks) IgE IgG1 innate lymphoid cells eosinophils mast cells basophils activated macrophages ```
41
pathophysiology of allergic rhinitis
sensitisation then subsequent exposure nasal epi already damaged allergen seep in DC capture allergen migrate to lymph node stimulate ILC2 cells - produce IL5 and IL13 help T cell prime and mature to T follicular helper cell TfH prime B cell for proliferation and differentiation into plasma cells make IgE sensitise mast and basophils in target by cross linking them subsequent exposure = degranulation
42
Type 2 immune response
IL4 Il5 - survival factor for eosinophils IL13 cytokines
43
atopy
hereditary predisposition to produce IgE Ab agaiunst common env allergens atopic disease: allergic rhinitis, asthma, atopic eczema characterised by Th2 cells and eosinophils can be atopic but not allergic - don't express symptoms
44
allergic march
through age - asthma increase gradually | hayfever - exposed to 3 seasons before prevalent
45
causes of allergic rhinitis and asthma
``` house dust mite cats dogs Alternaria cockroach horses ```
46
asthma
effects 8-12% population eosinophil/neutrophil L5 inflamed lung from allergen and infiltration of cells
47
phenotypes of asthma
based on control and severity: intermnittent, mild, allergy freq important presistant, manageable allergy often important chronic, severe, uncontrolled based on endotype or endo-phenotype: allergic, atopic, eosinophilic neutrophilic
48
endotype
subtype of condition | defined by distinct pathophysiological mech
49
extrinsic allergic alveolitis
``` 0.1% pop exposure to allergens allergen captured by Ab complement, chemotactic factors, neutrophils, macrophages, fibroblasts hypersensitivity response cause inf response ```
50
examples of extrinsic allergic alveolitis
farmers lung - mouldy hay bird fanciers lung - bird dropping air conditioners lung - air conditioner mould mushroom workers lung - mushroom compost coffee workers lung - unroasted coffee beans millers lung- infested flour hot tub lung - bacterial contamination
51
treatment of allergic disease
allergen avoidance anti-allergic med - antihistamine(80%pop)/nasal steroids immunotherapy - desensitisation/hyposensitisation
52
prevalence of allergic rhinitis
ww 40% uk 23% Belgium and france highest
53
what does treatment of allergic rhinitis depend on
type of condition mild intermittent - start H1 blocker, allergen avoidance mod/severe int - start intranasal and immunotherapy mild persistent mod/severe persistent
54
noon and freeman
mash up pollen treat hayfever by immunisation patients did better
55
investigating immunotherapy
RCT practicality - incremental dose over 12 wks maintenance over 3yrs only can demonstrate if good pollen season
56
types of allergen immunotherapy
tablet - for 3yrs daily - compliance issue | subcutaneous - have to monitored for a day, exposed to allergen - not risk free
57
allergen immunotherapy +ve
effective | long lasting
58
allergen IT -ve
occasional severe rn time consuming standardisation problems
59
mechanism of IT
alter DC make IL 10 and IL 27 - shift to type 1 response - immune deviation interferon gamma produced Treg cells produced - suppress proallergic response and casue production og IgG - capture antigen IgG compete with IgE - stop IgE fascilitating cross link between basophils and eosinophil remove IgG - remove response add it back - response returns
60
studies for IT
suppression of TH2 for yr 1 and 2, symptoms and TH2 appear again in 3rd yr measure IL5 - type 2, Inf gamma - type 1 - evaluate immune deviation measure IL 10 - measure Trg response take 12 moths for immune deviation 3month for Treg biopsy of allergic area - see T cell in mucosa correlation between symptom, cell and cytokine to see if there is a correlation 2 months ago
61
IL 35
member of IL12 superfamily bind to P35, Ebi3 receptor - IL12Rbeta2, gp130 STAT4 and STAT1 suppress type 2 response supress T cekll response - so late allwergic response suppress B cell response making IgE - stop basophil and mast cell bind - stop early phase make IL10 - suppress cytokines, monocytes making TNF-a, Th2, Th1 diff, Tr1 induction, IgE. induce IgG and Foxp3+ Treg cells
62
antibodies
immunological marker in term sof exposure produced by Breg measure func of Ab IgG compete with OgE biomarker of compliance and clinical response have IT = more IgG
63
how to B cells and T cells communicate
FceRII (CD23) on B cell bind to allergen and IgE complex internalised present as MHC class 2 to T cell not when IgG compete

Respiratory system (23 decks)

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