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Study notes - Respiratory > *Microbiology 2 (Lecture 2) > Flashcards

*Microbiology 2 (Lecture 2) Flashcards

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1
Q

What are the causes of the classical flu?

A

Influenza A virus

Influenza B virus

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2
Q

What is the cause of a flu like illness?

A

Parainfluenza viruses but many other causes

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3
Q

Does haemophilus influenzae cause flu?

A

Not a primary cause (it is a bacterium) but may be a secondary invader

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4
Q

Complications of flu?

A 
Primary influenzal pneumonia
Secondary bacterial pneumonia
Bronchitis
Otitis media
Influenza during pregnancy may also be associated with perinatal mortality, prematurity, smaller neonatal size and lower birth weight
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5
Q

How is flu treated?

A

Symptomatic (bed rest, fluids, paracetamol)

Antivirals (only if patient is at risk of complications and when flu is circulating and early in disease)

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6
Q

What antivirals are used to treat flu?

A

Oseltamivir

Zanamivir

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7
Q

What are epidemics of flu associated with?

A

Winter

Minor mutations in the surface proteins of the virus (antigenic drift)

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8
Q

What is the difference between epidemic and pandemic?

A

An epidemic occurs when a disease affects a greater number people than is usual for the locality or one that spreads to areas not usually associated with the disease. A pandemic is an epidemic of world-wide proportions.

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9
Q

What type of flu can cause pandemics?

A

Influenza A only

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10
Q

What subtype of influenza A is avian flu?

A

H5N1

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11
Q

How is influenza confirmed in the lab?

A

Direct detection of virus:
PCR (nasopharyngeal swab, throat swab or other respiratory samples)
Other labs/ hospitals may used immunofluorescence, antigen detection (near patient)

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12
Q

Prevention of flu?

A 
Killed vaccine (given to adult/ child (aged 6 months to 2 years) patients at high risk and healthy care workers)
Live attenuated vaccine (more effective than killed vaccine in children aged 2-17, given to ALL children aged 2-5 and all primary school children administer intra-nasally)
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13
Q

When are antivirals used as a prophylaxis against flu?

A

After a contact with flu

Very rarely

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14
Q

What are 3 examples of atypical pneumonia?

How are these treated?

A

Mycoplasma pneumoniae
Coxiella and Chlamydohila psittaci
Tetracycline and macrocodes e.g. clarithromycin

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15
Q

Mortality of atypical pneumonias?

A

Varies with pathogen by generally lower than classical bacterial pneumonia

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16
Q

How are the atypical pneumonias (mycoplasma, coxiella, psittaci) diagnosed?

A 
By serology (send acute and convalescent bloods to lab)
Virus detection (PCR on respiratory swabs/ secretions)
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17
Q

Who tends to get mycoplasma pneumoniae?

A

Children and young adults

Person to person spread

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18
Q

What diseases does coxiella burnetti cause?

A

Pneumonia

Q-fever

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19
Q

what is infection with coxiella burnetti associated with?

A

Sheep and goats

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20
Q

Complications of infection wit coxiella burnetti?

A

Culture negative endocarditis

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21
Q

What illness does infection with chlamoydophila psittaci cause?
How does this usually present?

A

Psittacosis (parrot fever)

Pneumonia

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22
Q

What age do patients present with bronchiolitis?

Symptoms

A 
1st or 2nd year of life
Fever
Coryza
Cough
Wheeze
Severe cases can cause grunting, decreased PaO2, intercostal/ sternal indrawing
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23
Q

Complications of bronchiolitis?

A

Respiratory and cardiac failure

especially if premature or pre-existing conditions

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24
Q

What is usually the cause of Bronchiolitis?

How is this confirmed?

A

Respiratory Syncytial Virus

By PCR on throat or perusal swab

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25
Therapy for bronchiolitis?
Supportive
26
What is metapneumovirus?
A respiratory viral pathogen that causes acute respiratory tract infection in children Most children have antibody by age 5
27
What diseases does metapneumovirus cause?
Second only to RSV in bronchiolitis 2% of cases pf influenza-like illness Ranges in severity from mild to requiring ventilation
28
How is metapneumovirus confirmed in the lab?
PCR
29
what is a cause of infantile pneumonia related to an STI? | How is it diagnosed?
Chlamydia trachomatis | PCR on urine of mother or perusal/ throat swabs of child
30
What does chlamoydophila pneumonias cause?
Mostly mild respiratory infeciton | Person to person spread
31
What is the upper respiratory tract colonised with?
``` Gram positives: Alpha-haemolytic streptococci inc. strep pneumoniae B-haemolytic streptococci inc. strep pyogenes Staph aureus Gram negatives: Haemophilus influenzae Moraxella catharalis Many others ```
32
What are the 5 types of upper respiratory tract infections
``` Sinusitis Rhinitis Pharyngitis (includes pharynx, tonsils and uvula) Epiglottitis Laryngitis ```
33
What usually causes epiglottitis/
Haemophilus influenzae type B
34
Clinical picture of epiglottitis?
``` Children (2-7): Acute onset (hours) Sore throat Drooling sevre croup/ stridor High temp Adult onset is days ```
35
How do we test for epiglottitis?
Blood culture
36
Why do we not test for epiglottis using a throat swab?
It can irritate the epiglottis further causing it to swell up further
37
Treatment for epiglottis?
Usually admitted to ICU and treated with Ceftriaxone
38
Are the conducting airways (trachea and bronchi) usually colonised?
No
39
When do patients tends to get infection in their conducting airways (trachea and bronchi)?
Changes to airway e.g. trauma/ intubation Airway abnormalities Virulent pathogen
40
What are the pathogenic causes of acute COPD exacerbation?
``` Can be environmental Haemophilus influenzae Moraxella catarrhalis Streptococcus pneumoniae Gram negatives Virus ```
41
Why do patients with CF tend to get frequent infections?
Inefficient clearance and build-up of mucus
42
What types of bacteria are often seen in CF patients?
Staph aureus. haemophilus influenzae, strep pneumoniae, pseudomonas aeruginosa, Burkholderia cepacia and MANY others
43
What is whooping cough (pertussis)?
Acute tracheobronchitis
44
What are the clinical features of whopping cough (pertussis)
Cold like symptoms for 2 weeks Paroxysmal coughing Repeated voilent exhalations with severe inspiratory whoop, vomiting common Residual cough for month or more
45
What bacteria causes whooping cough?
Bordetella pertussis (gram negative coccobacillus)
46
How is pertussis diagnosed?
Bacterial culture (pernasal swab) PCR (pernasal swab) Serology
47
Treatment of pertussis?
Antibiotics if had cough for less than 21 days - clarithromycin (erythromycin if pregnant)
48
Clinical features of CAP?
``` Cough Increased sputum Chest pain Dyspnoea Fever CXR with infiltrates Acquired in the community ```
49
Is legionella gram negative or gram positive?
Gram negative
50
Clinical features of legionella pneumonia?
Flu like illness which may progress to severe pneumonia, with mental confusion, acute renal failure and GI symptoms
51
How is legionella pneumonia spread?
No person to person spread Inhalation of contaminated water droplets Therefore associated with shower heads, cooling towers, air conditioning
52
Diagnosis of legionella pneumonia?
Legionella urinary antigen (detects serogroup 1 only) | PCR available direct from sputum
53
Treatment of legionella pneumonia?
Clarythromycin, erythromycin, levofloxacin
54
What is the greatest risk for developing hospital acquired pneumonia?
Endotracheal intubation with mechanical ventilation (also risks with sedation, micro aspirations, aspirations of GI contents, immunosuppression)
55
Microbiology of HAP?
60% = gram negative including E. coli, Klebsiella spp, pseudomonas app, CAP organisms, S aureus and anaerobes
56
Treatment of a severe HAP?
IV amoxicillin, metronidazole and gentamicin | Step down to PO co-trimoxazole + metronidazole
57
Treatment of non-severe HAP?
PO amoxicillin + metronidazole
58
What is the full name of PCP?
Pneumocystis jirovecii pneumonia
59
What type of patients get this?
One of the most frequent and severe opportunistic infection in people with weakened immune systems e.g. aIDS, immunosuppression (people with a normal immune system can be asymptomatic with it either carrying it or eradication it)
60
What type of organism is pneumocystitis jirovecii?
Fungus
61
Does mycoplasma pneumonia cause a dry or wet cough?
Dry
62
Symptoms of PCP?
``` Fever Dry cough SOB Fatigue HIV patients = sub-acute, low grade fever, severe pneumonia Non-HIV = more acute high fever ```
63
Diagnosis of PCP?
Microscopy (immunofluorescence of gargle) | PCR
64
Treatment of PCP?
Co-trimoxazole or pentamdine
65
What are a list of causes of CAP?
``` Streptococcus pneumonia (Common) Haemophilus pneumoniae (common) Moraxella catarrhalis (common) Mycoplasma pneumonie (common, atypical) Chlamydias (pneumoniae (atypical), psiticci (atypical), trachomatis) PCP Legionella pneumoniae (atypical) Staphylococcus aureus Coxiella burnetti (atypical) Viruses ```
66
Aside from PCP, what is another fungal chest infection?
Apergillus
67
What causes aspergilus chest infection?
Usually aspergillum fumigates (common environmental fungus)
68
What type of patients get aspergillus chest infection?
Immunocompromised/ supressed patients | causes severe pneumonia and invasive disease
69
What type of infection do immunocompetent patients infected by aspergillus get?
Localised pulmonary infection | Aspergilloma (fungus ball) in pre-existing chest caivties
70
How is aspergillus diagnosed?
Bronchoalveolar lavage ideally (fungal culture, PCR) | Tissue (histopathology)
71
Treatment of aspergillus?
Amphotericin B Voriconazole Surgery
72
Causes of TB? | Appearance of TB?
Mycobacterium tuberculosis | Acid alcohol fast bacilli with a thick waxy coat
73
Pathogensis of TB?
Mycobacterium tuberculosis are engulfed by alveolar macrophages in alveoli but resist killing and multiply leading to a focus
74
Types of TB?
90% asymptomatic and develop latent TB (alterations in immune function leads to reactivation and active TB) 10% develop immediate active TB
75
Clinical symptoms of TB?
``` Long term cough Chest pain Sputum =?- haemoptysis Weakness or fatigue Fever and chills Night sweats ```
76
Diagnosis of TB?
Microscopy of sputum/ tissue Culture on selective media PCR Immune reaction
77
How is microscopy of mycobacterium tuberculosis prepared?
Ziehl-Neelsen (ZN) stain is used - red dye which is added to smear and heated to allow dye to penetrate waxy coat, acid/alcohol added Waxy coat of mycobacterium retains the dye even after exposure to acid and alcohol

Study notes - Respiratory (29 decks)

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