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Year 1 Week 15 - Airways and airways disease > Introduction to Respiratory Infections > Flashcards

Introduction to Respiratory Infections Flashcards

1
Q

most common site of infection

A

respiratory tract

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2
Q

how many rti in children per year

A

2-5

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3
Q

how many rti in adult per year

A

1-2

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4
Q

common reasons for medical consultations and time off work

A

inappropriate antibiotic prescription driving resistance
winter pressure on hospital beds
economic costs

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5
Q

tonsilitis

A

infection of tonsils

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6
Q

pharyngitis

A

“sore throat”
infection of pharynx

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7
Q

laryngitis

A

infection of larynx

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8
Q

tracheitis

A

infection of trachea

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9
Q

pleurisy

A

inflammation of pleura often caused by infection

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10
Q

bronchiolitis

A

infection of bronchioles (small airways)

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11
Q

bronchitis

A

infection of bronchi (large airways)

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12
Q

pneumonia

A

infection of alveoli and surrounding lung

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13
Q

protection - colonisation

A

commensal flora and colonisation resistance
normal swallowing reflex, epiglottis

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14
Q

protection - swallowing

A

neurological and anatomical factors

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15
Q

protection - lung anatomy

A

mucus and ciliated epithelium - mucociliary escalator
cough reflex

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16
Q

protection - immunity

A

innate and adaptive
soluble factors - IgA, defensins, collectin, lysozyme
alveolar macrophages
B and T cells

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17
Q

susceptibility to RTI

A

swallowing
colonisation of upper airway
altered lung physiology
immune dysfunction
co-morbidities

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18
Q

upper respiratory tract illness

A

viral - rhinovirus, influenza A, coronaviruses, adenoviruses, respiratory syncytial viruses, parainfluenza viruses
usually transient

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19
Q

complications of upper RTI

A

sinusitis, pharyngitis, otitis media, bronchitis, rarely pneumonia
may lead to bacterial super infection
influenza A causes systemic symptoms

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20
Q

rhinoviruses

A

common cold
bronchitis
sinusitis

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21
Q

coronaviruses

A

colds but occasionally severe resp illnesses

22
Q

adenoviruses

A

upper RTI
pharyngitis
bronchitis
occasional pneumonia

23
Q

resp syncytial viruses

A

bronchiolitis in small children
severe illness in care home residents
pneumonia in immunocompromised

24
Q

parainfluenza viruses

A

croup

25
Q

influenza A

A

flu

26
Q

sars-cov-2

A

covid 19
severe resp illness with resp failure
emerged as cause of major global pandemic in 2019
high mortality and major economic impact

27
Q

sars-cov

A

severe acute resp syndrome associated coronavirus
outbreak spread from china in 2002
severe resp illness with resp failure

28
Q

middle eastern resp syndrome novel coronavirus (mers-ncv)

A

individual cases spread from middle east in 2012
similar to sars but low person to person spread

29
Q

avian influenza

A

novel forms of influenza A
occasional human cases with severe illness
south-east asia
associated with exposure to poultry
low person to person spread

30
Q

aetiology of pharyngitis

A

β-hemolytic streptococci (10-30%)
viral (70-80%) - rhino/adenovirus etc
glandular fever - epstein barr virus
acute hiv infection

31
Q

aetiology of sinusitis

A

usually viral
bacterial - unilateral pain, purulent discharge, fever of >10 days/presenting acutely or with complications
microorganisms
streptococcus pneumoniae (40%)
haemophilus influenzae (30-35%)
other moraxella catarrhalis, streptococci
complications - brain abcess, sinus vein thrombosis, orbital cellulitis

32
Q

acute epiglottitis

A

formerly children 2-4, fever, dysphagia, drooling and stridor
haemophilus influenzae type B - now rare due to Hib vaccine
adults can also have - most severe from Hib, also from causes of pharyngitis, other bacterial airway infections, additional pathogens in immunocompromised - e.g. AIDS

33
Q

bordatella pertussis

A

acellular vaccine may not give lifelong immunity and vaccination may have reduced boosting from natural infections
adults - chronic cough, paroxyms of coughing and 50% post-ptussive vomitting
complications - pneumonia, encephalopathy, subconjunctival haemorrhage

34
Q

croup

A

acute laryngo-tracheobronchitis
disease of children up to 6 (mostly 3mo-3yo)
mainly due to parainfluenza (also RSV, IAV and other resp viruses)

35
Q

bronchiolitis infection and inflammation

A

infection due to resp syncytial virus (RSV) (80%) - rarely other viruses
inflammation of bronchioles and mucus production cause airway obstruction

36
Q

bronchitis clinical features

A

cough may be productive or non-productive
SOB and often wheeze
may be fever by not systemic features of infection
wheeze but no signs of focal consolidation

37
Q

bronchitis investigations

A

ABG/oximetry for those with chronic lung disease - determines need for hospitalisation
CXR shows no features of pneumonia - usually normal

38
Q

bronchitis treatment

A

usually none especially if viral - sometimes antimicrobials
manage exacerbation of COPD/asthma with steroids and increased inhalers

39
Q

bronchiectasis

A

abnormal dilation of airways and suppurative infection
chronic scarring of lung with excessive sputum production - bronchoohoea

40
Q

bronchiectasis aetiology

A

congenital - CF, ciliary dysfunction, hypogammaglubulinemia
post-infectious - TB, suppurative pneumonia measles, whooping cough
other - foreign body

41
Q

bronchiectasis symptoms

A

chronic cough
coius sputum
recurrent pneumonia
weight loss

42
Q

pneumonia aetiology

A

mainly streptococcus pneumoniae (40%)
mycoplasma pneumoniae (~10%)
chlamydophila pneumoniae (~10%)
legionella pneumoniae and other spp. (<5%)
haemophilus influenzae (<5%)
klebsiella pneumoniae (rare, homeless and in hospital)
staphylococcus aureus (low % in community but increased after influenza and in hospital)
viruses (>10%)

43
Q

people at risk of pneumonia

A

infants and elderly
copd and other chronic lung diseases
immunocompromised
nursing home
impaired swallow
diabetes
congestive heart disease
alcoholics and drug users

44
Q

community acquired pneumonia (CAP)

A

incidence 5-11 per 1000
20-50% hospitalised, 5-10% require ITU
mortality 1% community, 10% hospital, 30% ITU
hospitalisation 6-8 days
significant short and long term mortality from other causes after pneumonia

45
Q

key decisions

A

does the patient need antimicrobials
how sick? hospital?
alternative diagnosis? - heart failure, PE, cancer, TB, interstitial lung disease

46
Q

pneumonia in immunocompromised

A

bacterial - all common causes but may be atypical presentation
fungal - pneumocystis pneumoniae (PCP), moulds
viruses - cytomegalovirus (CMV), adenovirus, RSV

47
Q

pneumonia treatment

A

prompt but appropriate initiation of antimicrobials
use narrowest spectrum to stop spread of resistance
mild severity in community - oral antimicrobial, e.g. amoxicillin for short duration
severe - IV combination - e.g. co-amoxiclav and oral clarithromycin. duration 7d mild-moderate, 7-10d severe

48
Q

tuberculosis

A

chronic resp tract infection - can be extrapulmonary - usually due to reactivation of latent infection
at risk - exposed, born in country of high incidence, homeless, alcoholic HIV infection

49
Q

TB clinical features

A

cough
haemoptysis
SOB
weight loss
fever
night sweats
swollen lymph nodes/other extrapulmonary features

50
Q

TB radiological appearances

A

upper lobe disease with cavities
pleural disease
multiple tiny nodules
lymphadenopathy

Year 1 Week 15 - Airways and airways disease (5 decks)

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