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Pulm > Viral Pneumonia > Flashcards

Viral Pneumonia Flashcards

1
Q

Characteristics of Viral pneumonia?

A
  • Patchy infiltrates, confined to alveolar septa and pulm. interstitium
  • NO consolidation
  • only slight elevation in white cell count
  • Path: alveolar walls infiltrated with mononuclear cells (Bacteria = poly)
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2
Q

Characteristics of the Influenza virus

A

Orthomyxovirus family

  1. Helical
  2. enveloped
  3. Linear ss negative-sense RNA virus
    - consists of 8 segments
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3
Q

What the the 3 proteins that are contained in the influenza virus’s envelope?

A
  1. Hemaglutinin - binds to cell surface and promotes entry
  2. Neuraminidase - cleaves neuraminic acid to release progeny into infected cell. Also degrades protective mucus layer in resp. tract.
  3. M2 ion channel
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4
Q

What is Antigenic drift? What does it cause?

A

A variance mechanism that involves the accumulation of mutations that prevent anti-influenza abs from recognizing.

  • causes epidemics
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5
Q

What is Antigenic Shift? What does it cause?

A

A variation mech where two or more viral strains, or two strains of different virus reassort to make antigenically new virus.

-causes pandemics

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6
Q

Transmission/pathology/pathogenesis of influenza virus

A
  1. Transmission via airborne resp. droplets
  2. once in haled, neuraminidase degrades protective mucus layer and enters cells.
  3. Necrosis of resp. epithelial cells
  4. Cytokines releases leading to myalgias
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7
Q

Clinical presentation of influenza virus

A

Sudden onset (24-48 hr incubation period)

  • Fevers (can be high) and chills
  • Myalgias
  • sore throat
  • Dry cough
  • headache
  • Vomiting/diarrhea rare (except in children)
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8
Q

Dx of influenza virus

A
  1. Clinical picture
  2. Reverse-transcriptase PCR - most sensitive and specific
  3. Direct fluorescent ab
  4. Rapid viral antigen test
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9
Q

Tx of influenza virus

A
  1. Oseltamivir

2. Zanamivir

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10
Q

Complications of influenza virus

A

Secondary viral or bacterial pneumonia

  • Reye’s syndrome also but rare
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11
Q

Those at risk of influenza virus complications

A
  1. Young children and elderly
  2. Pts w/ chronic disease
  3. Immunosuppressed
  4. pregnant or up to 2 wks post-partum
  5. morbidly obese
  6. Nursing home residents
  7. Native Americans
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12
Q

Who should get influenza vaccine?

A

Everyone 6 months of age and older

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13
Q

Characteristics of Respiratory Syncytial Virus (RSV)

A

Paramyxovirus family

  1. Pleomorphic
  2. Enveloped
  3. neg-sense ss linear RNA

RSV = most important cause of bronchioltis and pneumonia in INFANTS

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14
Q

What are syncytia and how does the RSV form them

A

Syncytia = multinucleated giant cells

Fusion proteins called Surface Spikes cause the resp. epithelial cell to fuse which forms the syncytia

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15
Q

How does RSV spread?

A
  1. Respiratory droplets

2. Direct contact of contaminated hands, nose, mouth, etc

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16
Q

Clinical manifestations of RSV

A
  1. Infants (more severe)
    - involves lower resp. tract pneumonia
    - persistant cough, wheezing, fever, tachypnea, hypoxemia
  2. Adults
    - typically upper resp. tract infection
    - lasts 4-5 days then resolves
17
Q

At risk for Respiratory Syncytial Virus (RSV)

A
  1. Immunocompromised (esp. bone marrow transplant)
  2. Institutionalized elderly
  3. Infants with chronic lung disease
  4. Infants born during RSV season (esp. if attend daycare)
  5. Infants born before 35 weeks
18
Q

Dx for Respiratory Syncytial Virus (RSV)

A

RT-PCR or Rapid antigen tests on nasal swab or washings

19
Q

Tx of Respiratory Syncytial Virus (RSV)

A
  1. Supportive care: Hydration, albuterol, and 02

2. Ribavirin (really only for stem cell transplant patients)

20
Q

Prevention Rx for Respiratory Syncytial Virus (RSV)? When is it used?

A

Palvizumab

  • monoclonal ab against the F protein
  • Prevents RSV pneumonia in premature infants
21
Q

Prognosis of Respiratory Syncytial Virus (RSV)? Sequelae?

A

Resolves without complications (healthy infants)

  • Apnea and resp. failure in infants w/ increased risk may occur

Sequelae - Asthma

22
Q

Characteristics of Adenovirus

A

Adenovirus family

  1. non-enveloped
  2. DS linear DNA virus
23
Q

Transmission of Adenovirus

A
  1. Respiratory droplet
  2. Fecal-oral
  3. Direct inoculation
  • often affects military recruits
24
Q

Diseases caused by Adenovirus

A
  1. Pneumonia (more severe in infants than older children)
  2. URTI
  3. Febrile pharyngitis
  4. Conjunctivitis (Pink Eye)
  5. Hemorrhagic cystitis
  6. Gastroenteritis (
25
Q

Dx, Tx, prevention, and sequelae of Adenovirus

A
  1. Dx - Clinical
  2. Tx Supportive
  3. Vaccine: Live enteric-coated - often used for military recruits
  4. Sequelae: Bronchiectasis
26
Q

Characteristics of Parainfluenza virus (PIV)

A

Paramyxoviridae family

  1. Enveloped
  2. ss linear non-segmented RNA virus
  3. Contains F (fusion) protein and HN (hemagglutinin/neuraminidase)
  4. Four distinct types
27
Q

Name the 4 types of PIVs and the diseases they cause

A
  • hPIV1 and hPIV2 => Croup
  • hPIV3 => Pneumonia and bronchiolitis
  • hPIV4 => mild resp. illness
28
Q

What is Croup? What virus causes it?

A

Laryngotracheobronchitis: A seal-like, barking cough

  • caused by inflammation around larynx, trachea, and bronchi
  • fever
  • rhinorrhea
  • sore throat
  • Stridor
  • Steeple sign (inflammation of larynx on neck x-ray)

*Usually caused by Parainfluenza virus

29
Q

Dx, Tx, and Px of Parainfluenza virus

A
  1. Dx: Clinical
  2. Tx: Supportive
  3. Px: Good; resolves on its own
30
Q

Characteristics of the Human Metapneumovirus

A

Paramyxoviridae family

  1. Discoved 2001
  2. Transmission: resp. Droplets
  3. Causes URTIs and Pneumonia
  4. Clinically indistinguishable from RSV and often mistaken for influenza
31
Q

Characteristics of Severe Acute Respiratory Syndrome (SARS)

A

Coronavirus Family

  1. Enveloped
  2. SS positive-sense RNA virus
32
Q

Regions affected by SARS

A

2002 - China, Vietnam, Singapore, Toronto

33
Q

Characteristics of Middle Eastern Respiratory Syndrome (MERS)

A

Coronavirus family

  1. discovered 2012
  2. clinical presentation: Severe illness with pneumonia, ARDS, Acute kidney injury

Pulm (14 decks)

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