Viral Pneumonia - Cross Flashcards by Drew Kropilak

Viruses cause (typical or atypical) pneumonia?

Atypical

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Viruses causes (lobar or diffuse) findings in lung?

Diffuse pictures in lungs, absence of physical findings of consolidation

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WBC count in viral pneumonia?

Only moderate elevation of WBC

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Alveolar walls infiltrated with what type of cells in viral pneumonia?

Mononuclear cells, as opposed to polymorphonuclear cells in bacterial pneumonia

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Nearly all viruses that cause pneumonia can cause what else?

URTIs (upper respiratory tract infections) aka “common colds”

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List some risk factors that predispose to extension of infection in viral pneumonia?

Extremes of age (very young, very old)

Malnutrition

Alcoholism

Underlying debilitating illnesses (does Marfan’s count?)

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List the 3 steps in the general mechanism of disease/ infection seen in viral pneumonia?

attachment to respiratory epithelium
viral replication causes cell death and inflammation
resulting damage and impairment of local defenses (mucociliary clearance) can predispose to bacterial superinfections

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Which virus is the most common cause of respiratory tract infections that result in physician visits each year?

Influenza

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Which virus causes the most number of deaths each year?

Influenza; 36,000 deaths each year. Mortality highest in elderly and children under 2 years old

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Influenza

viron shape?

envelope?

genetic material - single or double strand? sense?

helical, enveloped, single stranded, negative sense, linear RNA

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RSV

virion shape?

envelope?

type of genetic material - single or double strand? sense?

RSV

pleomorphic

enveloped

single stranded, negative sense, linear RNA

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Adenovirus

envelope?

type of genetic material? single or double strand?

Adenovirus

Nonenveloped

double stranded, linear DNA

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Parainfluenza virus

envelope?

type of genetic material? single or double stranded?

envelope

single stranded, linear, nonsegmented RNA

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Coronavirus - SARS

envelope?

type of genetic material? stranded? sense?

coronavirus - SARS

enveloped

single stranded positive sense RNA

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3 proteins involved with influenza?

hemagglutinin, neuraminidase, M2 ion channel

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Hemagglutinin function? How many subtypes?

binds to cell surface receptor and promotes viral entry.
3 subtypes (H1 - H3)

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2 Neuraminidase functions ? How many subtypes?

cleaves neuraminic acid to release progeny virus from infected cell
Also degrades protective layer of mucus in respiratory tract
2 Subtypes (N1, N2)

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M2 ion channel purpose?

Essential for viral infectivity

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Which type of influenza only infects humans? (A or B)

Influenza B

Influenza A can infect animals

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Which type of influenza is associated with epidemics and pandemics?

Influenza A

Influenza B causes sporadic outbreaks

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Which type of influenza is classified by subtypes? Importance of these subtypes?

Influenza A, Single subtypes predominate throughout the world at any given time.

Influenza B is not classified by any subtypes

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Widespread infection in 1 geographic community? Epidemic or pandemic

Epidemic.

Pandemic = widespread infection over multiple geographic locations

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Which causes pandemics? (drift or shift)

Antigenic shift.

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Reassortment with ANIMAL virus associated with shift or drift?

Reassortment with animals = shift.

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Spontaneous mutations associated with shift or drift?

Spontaneous mutations = drift

All individuals are susceptible in shift or drift?

Shift

Influenza transmission route?

airborne respiratory droplets

What causes myalgias seen in influenza virus?

Cytokines being released

4 ways to diagnose influenza? Which is most specific (can tell subtypes) ? Which not usually used

- RT-PCR (most specific/sensitive, can tell subtypes) - direct fluorescent antibody - Rapid viral antigen test - Viral culture (not usually used)

Treatment for influenza? Which one causes bronchospasm and is rarely used?

Oseltamivir or Zanamivir. Zanamivir can cause bronchospasms and is rarely used

Major complications of influenza (2)?

Secondary or viral pneumonia Reye's Syndrome

Reye's syndrome characterized by?

Encephalopathy and liver degeneration

What drug can cause Reye's Syndrome

Aspirin

2 Bacteria that most commonly cause post-viral seconadry pneumonia?

S. pneumo & S aureus

7 types of patients at risk of influenza complications. List as many

- Young children/elderly - Those with CHRONIC DISEASES - Immunosuppressed - Pregant or up to 2 weeks post partum - Morbidly obese - Nursing home peeps - Native Americans or Alaskan natives

Conjunctivitis "pink eye" (did you fart on my pillow) associated with what virus?

Adenovirus

Who should receive a influenza vaccine?

Everyone 6 months of age and older

What medication can be given prophylactically for influenza?

Oseltamivir

Bacterial antibiotics preventing post viral secondary pneumonia Antibiotic against gram (+) ? Antibiotics against gram (-) ?

Vancomycin for gram (+) Piperacillin/Tazobactam (Zosyn) for gram (-) = best choice. others available too

Most important cause of bronchiolitis and pneumonia in infants?

RSV

Military associated virus?

Adenovirus

Fusion proteins associated with what virus? What is their function?

RSV cause respiratory epithelium cells to FUSE forming multinucleated giant cells

Gastroenteritis

Adenovirus

Transmission route of RSV?

- Respiratory droplets - Direct contact of contaminated hands with nose or mouth - Community outbreaks every winter; hospital outbreaks also occur

Clinical manifestations of RSV

Persistent cough, wheezing, fever, tachypnea, hypoxemia

2 ways to diagnose RSV

RT-PCR, Rapid antigen test on nasal swab and washings

Only type of DNA virus (for these slides)

Adenovirus

Only nonsegmented virus

Parainfluenza virus

Only positive sense virus

Coronavirus - SARS

Febrile pharyngitis associated with what virus?

Adenovirus

Healthy adult has URT infection lasting 4-5 days then resolves, associated with what virus?

RSV

(5) groups at risk for RSV pneumonia

- Immunocompromised (bone marrow transplant) - Institutionalized elderly - Infants with chronic lung disease - Infants born during RSV season who are less than 6 months of age, particularly who attend daycare - Infants born before 35 weeks gestation

Bronchiectasis or bronchiolitis obliterans can be as a consequence of what virus?

Adenovirus

Reinfection common in what virus

Parainfluenza virus

Ribavirin used to treat what virus? Not recommended for who? Recommended for what subset of patients

RSV not recommended for children, efficacy unproven Recommended for stem cell transplant patients

Prophylatic treatment for RSV? MOA of drug

Palvizumab Monoclonal antibody against F protein. Prevents pneumonia caused by RSV in premature infants by neutralizing virus infectivity

Palvizumab must be given via what route?

IM, cant give orally. its a monoclonal antibody

Asthma can result from what virus?

RSV

What subset (4) of patients can be severly affected by RSV?

- Preemies - less than 12 weeks of age - underlying cardiopulmonary disease - immunodeficient patients

Which virus can be transmitted via aerosal droplet, fecal-oral route, or direct inoculation?

Adenovirus

Mortality rate of RSV?

2%, most healthy infants survive

Palvizumab monoclonal antibody detail (Whitt stressed it)

its a chimerized humanized monoclonal antibody.

Hemorrhagic cystitis associated with what virus?

Adenovirus

70% mortality rate occurs in what subset of patients infected with adenovirus?

Occurs if immunocomprimsed patient has disseminated infection

Military recruits receive a vaccine for what virus? What serotypes of this virus?

Adenovirus, serotypes 4 and 7

Croup associated with what virus? What specific subtypes?

Parainfluenza virus hPIV 1,2,3 only 2-3% of infection progress to croup

Asian associated virus? What year did it occur

Coronavirus - SARS, 2002

What virus(es) cause leukopenia? Which causes thrombocytopenia? What 2 syndromes are this associated with?

Coronavirus can cause leukopenia seen in SARS & MERS SARS also associated with thrombocytopenia

Year associated with MERS?

2012

Route of transmission of human metapneumovirus?

Respiratory droplets

What year was human metapneumovirus discovered?

2001. If question stem has a year before 2001, you can rule this virus out

Metapneumovirus is clinically indistinguishable from what other viruses?

RSV influenza human parainfluenza virus - 3

CXR shows bilateraly peripheral infiltrates in MIDDLE and LOWER lungs. Which virus?

SARS coronavirus

Stridor seen in which virus?

Parinfluenza virus

Besides croup, hPI3 can cause what other infections?

Pneumonia and bronchiolitis

Common cold caused by what subtype of which virus?

hPIV4

Mucous membranes of the throat are infected in early or late stage parinfluenza virus? What other clinical symptoms are seen and in which stage?

Initially, mucous membranes of throat are affected Extensive infections will involve larynx and upper trachea

Helical, enveloped, single-stranded negative sense linear RNA virus

Influenza

Pleomorphic, enveloped, negative-sense single stranded linear RNA virus

RSV

Non-enveloped, double stranded, linear DNA virus

Adenovirus

Enveloped, single stranded linear nonsegmented RNA virus

Parainfluenza virus

enveloped, single stranded positive sense RNA virus

Coronovirus family - SARS, MERS

Viral Pneumonia - Cross Flashcards

(82 cards)