Introduction to Respiratory Infections

Question 1

most common site of infection

Answer 1

respiratory tract

Question 2

how many rti in children per year

Answer 2

2-5

Question 3

how many rti in adult per year

Answer 3

1-2

Question 4

common reasons for medical consultations and time off work

Answer 4

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

Question 5

tonsilitis

Answer 5

infection of tonsils

Question 6

pharyngitis

Answer 6

“sore throat”
infection of pharynx

Question 7

laryngitis

Answer 7

infection of larynx

Question 8

tracheitis

Answer 8

infection of trachea

Question 9

pleurisy

Answer 9

inflammation of pleura often caused by infection

Question 10

bronchiolitis

Answer 10

infection of bronchioles (small airways)

Question 11

bronchitis

Answer 11

infection of bronchi (large airways)

Question 12

pneumonia

Answer 12

infection of alveoli and surrounding lung

Question 13

protection - colonisation

Answer 13

commensal flora and colonisation resistance
normal swallowing reflex, epiglottis

Question 14

protection - swallowing

Answer 14

neurological and anatomical factors

Question 15

protection - lung anatomy

Answer 15

mucus and ciliated epithelium - mucociliary escalator
cough reflex

Question 16

protection - immunity

Answer 16

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

Question 17

susceptibility to RTI

Answer 17

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

Question 18

upper respiratory tract illness

Answer 18

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

Question 19

complications of upper RTI

Answer 19

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

Question 20

rhinoviruses

Answer 20

common cold
bronchitis
sinusitis

Question 21

coronaviruses

Answer 21

colds but occasionally severe resp illnesses

Question 22

adenoviruses

Answer 22

upper RTI
pharyngitis
bronchitis
occasional pneumonia

Question 23

resp syncytial viruses

Answer 23

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

Question 24

parainfluenza viruses

Answer 24

croup

Question 25

influenza A

Answer 25

flu

Question 26

sars-cov-2

Answer 26

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

Question 27

sars-cov

Answer 27

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

Question 28

middle eastern resp syndrome novel coronavirus (mers-ncv)

Answer 28

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

Question 29

avian influenza

Answer 29

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

Question 30

aetiology of pharyngitis

Answer 30

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

Question 31

aetiology of sinusitis

Answer 31

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

Question 32

acute epiglottitis

Answer 32

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

Question 33

bordatella pertussis

Answer 33

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

Question 34

croup

Answer 34

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

Question 35

bronchiolitis infection and inflammation

Answer 35

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

Question 36

bronchitis clinical features

Answer 36

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

Question 37

bronchitis investigations

Answer 37

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

Question 38

bronchitis treatment

Answer 38

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

Question 39

bronchiectasis

Answer 39

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

Question 40

bronchiectasis aetiology

Answer 40

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

Question 41

bronchiectasis symptoms

Answer 41

chronic cough coius sputum recurrent pneumonia weight loss

Question 42

pneumonia aetiology

Answer 42

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%)

Question 43

people at risk of pneumonia

Answer 43

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

Question 44

community acquired pneumonia (CAP)

Answer 44

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

Question 45

key decisions

Answer 45

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

Question 46

pneumonia in immunocompromised

Answer 46

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

Question 47

pneumonia treatment

Answer 47

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

Question 48

tuberculosis

Answer 48

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

Question 49

TB clinical features

Answer 49

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

Question 50

TB radiological appearances

Answer 50

upper lobe disease with cavities pleural disease multiple tiny nodules lymphadenopathy