What is the dividing line between the upper and lower respiratory tract?
The glottis
Respiratory invaders posses one or more of which properties?
Ligand to bind receptor on cell surface
Interfere with ciliary movement
Resist phagocytosis, major defense in alveoli
Cause local damage (to resp. tract)
Which bacteria are secondary to flu infections?
S. aureus
S. pneumonia
H. influenzae
What bacteria are secondary to cystic fibrosis?
S. aureus
Pseudomonas aeruginosa
Which infections are secondary to depressed immune system in AIDS or cancer with chemotherapy?
Pneumocystis jirovecii
CMV
M. tuberculosis
What are the infection patterns of bacteria?
They tend to localize
What are disseminating viral infections?
CMV, EBV, Mumps
What virus is most commonly associated with rhinitis (common cold)?
Picornaviridae (ssRNA)
What kills picornaviridae?
Acid (because its naked)
What is pharyngitis?
A sore throat
What causes pharyngitis?
Adenoviruses EBV CMV HSV S. pyogenes
What causes hand, foot and mouth disease?
Coxsadievirus
Do you give antibiotics to every patient with a sore throat?
No, it is only bacterial infection in 1-20%
What does CMV cause?
Infectious mononucleosis
What can intrauterine infection of CMV cause?
Congenital deafness and mental retardation
What can CMV cause in AIDS?
Retinitis and blindness as well as pneumonitis and colitis
What do you treat CMV with?
Ganciclovir
What is used to detect CMV infection especially of intrauterine infections?
Detection of anti-CMV IgM (not IgG because IgG may come from the mother and not indicate intrauterine infection)
What does the EBV infect?
B cells through the C3d receptor (a second signal in B activation)
What does EBV cause?
Polyclonal activation of B cells producing heterophil antibodies and autoantibodies (infectious mononucleosis in youth)
How do T cells react to EBV?
They become atypical lymphocytes
How do you test for EBV?
Monospot test
Autoantibodies (cold agglutinin)
What is the monospot test?
Heterophil antibodies against horse or sheep erythrocytes
Why do you not transplant an organ from a donor with EBV?
Because the virus will be carried with it and may cause lymphomas
What happens in East Africa with EBV infections?
Burkitt’s lymphoma when EBV works with plasmodium (malaria)
What causes scarlet fever?
Erythrogenic toxin from Streptococcus pyogenes
What causes rheumatic fever?
Cross-reacting Ab attacking the skin, joint, heart and neurons after S. pyogenes infection
What does increase ASO (antistreptolysin O) mean?
There was a recent infection of S. pyogenes
What do rapid strep tests test for?
Against bacterial antigens
What is acute otitis media and what can it cause?
Infection of the middle ear
Meningitis
What can cause acute epiglottitis?
Haemophilus influenza type B (Hib)
What is the vaccine for Hib?
Purified capsule
Conjugate polysaccharide
What type of virus is mumps?
Paramyxovirus (ssRNA, enveloped)
What is the primary target for mumps?
Parotid gland
What can mumps cause in adults?
Orchitis (leads to infertility; inflammation of testis :))
What type of vaccine is used for mumps prevention?
Attenuated MMR vaccine
What does the diphtheria cytotoxin do?
Destroys epithelium and neutrophils
What do patients with diphtheria present with?
Ulcers covered with dead tissue false-membrane
How does diphtheria toxin work?
Inhibits EF-2 in protein synthesis
What can diphtheria toxin cause in the heart?
Myocarditis
What vaccine is the diphtheria toxoid found in?
DTP (diphtheria, tetanus, pertussis)
What type of bacteria is Bordetella pertussis?
Gram-negative
What does pertussis cause?
Laryngotracheobrochitis
What does the pertussis toxin mediate?
Attachment and tissue injuries
What is the pertussis vaccine?
Inactivated vaccine in DTP
What do the cellular and acellular component of the DTP vaccine for pertussis contain respectively?
Cellular: endotoxin causing side effects
Acellular: toxoids
What is RSV?
Respiratory synctytial virus
Traditional antibiotic for pertussis?
Macrolides such as erythromycin
What is the number 1 reason for hospitalization for infants under 2 years?
RSV
Symptoms of RSV?
Cough, dyspnea, cyanosis
What causes the symptoms in RSV?
Immunity-mediated
What are the treatments for RSV?
Ribavirin aerosol for severe cases
What is the prevention treatment for RSV?
Palivizumab, monoclonal Ab against F protein
What causes pneumonia in children?
Mostly viral
What causes pneumonia in neonates?
Chlamydia trachomatis
E. coli
What causes pneumonia in healthy adults?
S. pneumoniae Chlamydophilia pneumoniae Mycoplasma pneumoniae (no cell wall) L. pneumophila Influenza viruses
What causes pneumonia in alcoholics and vagrants?
S. pneumonia
K. pneumoniae (gram -)
M. tuberculosis
What causes pneumonia with underlying respiratory disease?
S. aureus H. influenzae P. aeruginosa S. pneumoniae M. catarrhalis
What causes pneumonia in AIDS patients?
Pneumocystis jirovecii
Mycobacterium species
CMV
Streptococcus pneumoniae gram stain:
Gram positive
What give streptococcus pneumoniae its pathogenicity?
Its capsule
Is streptococcus pneumoniae alpha or beta hemolytic?
Alpha-hemolytic
What type of sputum does pneumococcus produce?
Rusty sputum
What type of sputum does Klebsiella produce?
Thick, bloody, mucoid sputum (red jelly)
What type of sputum does Pseudomonas aeruginosa produce?
Green sputum
Pneumococcal vaccine for children under 5?
Conjugate vaccine Prevnar 13
Pneumococcal vaccine for adults?
Unconjugated Pneumovax 23
How are conjugated vaccines made?
Conjugated to a protein for T-dependent Ig production
What do polysaccharides do?
Illicit T-independent response producing IgM and IgG2 (non opsonizing)
What is orthomyxoviridae?
Influenza virus family
What is the genome of orthomyxoviridae?
8 segments of ssRNA
What does orthomyxoviridae use for attachment to epithelial cells?
Haemagglutinin
What does orthomyxoviridae use to destroy cellular receptor for release from cell?
Neuraminidase
What are the three capsid protein serotypes on influenza viruses?
Type A: recombines with animal flue viruses to cause epidemics and pandemics
Type B: not in animals but causes epidemics
Type C: causes minor disease and no epidemics
What causes drift and change in flu viruses?
An accumulation of mutations because RNA polymerase
What is shift?
Reassortment of human and animal viruses
Timing difference between shift and drift:
Shift is sudden
Drift is slow and continuous
What does re-assortment of RNA segments in flu virus lead to?
New H and N combinations
What is H and N refer to in nomenclature?
Haemagglutinin
Neuraminidase
How are Inactivated influenza vaccines administered?
Shots (transdermal)
How are live attenuated influenza vaccines administered?
Nasal sprays
Which drugs block uncoating of flu viruses?
Rimantadine
Amantadine
Which drugs inhibit neuramidase and viral release?
Zanamivir
Oseltamivir (Tamiflu)
Peramivir
What causes cystic fibrosis?
Autosomal recessive defect in Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein
What does a defect in CFTR protein result in?
Defective Cl- channel necessary for secretion and impaired mucociliary escalation system
What bacteria infects CF patients?
Pseudomonas aeruginosae (oxidase-positive, Gram negative)
What does pseudomonas aeruginosae produce?
A mucoid slime layer for adherence and protection
What fungus can affect the lungs in immunocompromised patients?
Aspergillus fumigatus
What can aspergillus fumigatus cause in patients with CF or asthma?
Allergic bronchopulmonary aspergillosis (can leave lungs via blood)
What is a aspergilloma?
Hyphae ball in a pre-existing cavity or chronic pulmonary disorders
What fungus can be found in SW USA and Latin American countries?
Coccidioides immitis
What is diagnostic for coccidioides immitis?
Biopsy for spherules
What is used to treat coccidioides immitis?
Azoles and amphotericin B
