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metha 2010 chp 21
Infectious Diseases Affecting the Respiratory System
| Question | Answer |
|---|---|
| 1. Upper Respiratory System | a. Nose and throat (pharynx)- including the middle ear and auditory (Eustachian) tubes b. Defenses – Nasal hair- ciliary escalator – mucus produced by goblet cells of mucous membrane traps dust and microorganisms- and cilia assist in moving these to the |
| 2. Lower Respiratory System | a. Larynx (voice box)- trachea (windpipe)- bronchial tubes- and lungs |
| b. Lungs | 1) Alveoli – air sacs in lung tissue where oxygen and carbon dioxide are exchanged 2) Pleura – double-layered membrane around the lungs |
| c. Defenses | – Macrophages in the alveoli destroy many pathogens- and IgA in the mucous- saliva and tears help too. |
| B. Normal Microbiota Upper Respiratory System | – a number of potentially pathogenic microbes but competition keeps them in check |
| Normal Microbiota Lower Respiratory System | – nearly sterile b/c of the ciliary escalator |
| 1. Pharyngitis- | a sore throat |
| 2. Laryngitis- | an infected larynx |
| 3. Tonsillitis- | inflamed tonsils |
| 4. Sinusitis– | an infected sinus |
| 5. Epiglottitis – | an inflammation of a flap-like structure of cartilage that prevents material from entering the larynx- possibly life-threatening w/in hours; usually caused by Hib – incidence has decreased with vaccination |
| 6. Croup – | condition caused by the inflammation of the upper airway leading to a characteristic barking cough; most is viral croup (RSV); more common in children born prematurely or those with narrowed upper airways |
| 1. Bronchitis – | infection affecting the bronchi |
| 2. Pneumonia – | alveoli also become infected |
| Rhinitis: the Common Cold | 1. No cure but symptoms of nasal secretion and congestion can be reduced; laryngitis and otitis media are complications 2. Viral infections may lead to secondary bacterial infections 3. Rhinoviruses cause 50%- over 100 serotypes of this virus alone; p |
| B. Sinusitis | 1. Most commonly caused by allergies- but pathogens and anatomy can also play a role 2. Infections – viruses- bacteria- and even fungi in immunocompromised patients as fluid in the sinuses resulting from the inflammation process can provide an excellent |
| C. Otitis Media – | Infection of the middle earearache Caused by different bacteria (Streptococcus pneumoniae bacterium the case in about 35% of the cases – Prevnar vaccine introduced in 2000; Haemophilis influenzae type B – Hib vaccine) that form pus- which builds up pres |
| D. Pharyngitis – | Inflammation of the throat 1. Viral sore throats are usually mild; diagnosis by eliminating strep as a cause 2. Strep Throat 3. Diphtheria |
| Strep Throat a. Streptococcus pyogenes: | group A- -hemolytic streptococci b. Test – indirect agglutination using microscopic latex particles coated with antibodies; takes as little as 10 minutes; so sensitive can detect asymptomatic carriers c. Symptoms – local inflammation- fever- usually ton |
| Strep Throat e. Scarlet fever (aka scarlatina) – | if phage infected: erythrogenic toxin |
| Strep Throat f. Rheumatic Fever – | cross reaction b/t streptococcal M protein and heart muscle; usually 3 weeks after strep throat is resolved; can be prevented if antibiotics used early to treat strep throat |
| 3. Diphtheria – | Corynebacterium diphtheriae |
| Diphtheria – | a. DTaP b. Many adults lack immunity b/c not vaccinated as children; in the US- a tetanus shot is usually combined with diphtheria toxoid (Td vaccine) c. Early symptoms – sore throat- fever and chills; Infection begins in the throat but if toxin circula |
| a. DTaP vaccine – | D = diphtheria toxoid- an inactivated toxin that causes the body to produce antibodies against the diphtheria toxin; 2-4-6 months |
| A. Pertussis | or Whooping Cough |
| 1. Bordetella pertussis | bacteria destroy the ciliated cells in the trachea that prevents the movement of mucus by the ciliated escalator system causing the patient to desperately try to cough up mucus secretions resulting in a nonproductive cough |
| 2. DTaP vaccine – | aP a) sometimes seen in adults as the immunity decreases after 12 years; revaccination of young adults is under review by CDC as incidence has increased in the last 20 years b) a whole cell vaccine containing high levels of endotoxins suspected of causi |
| B. Respiratory Syncytial Virus (RSV) | 1. Most common viral respiratory disease in infants; 4500 infant deaths in the US each year; Most children have antibodies by age 3; life-threatening pneumonia in the elderly 2. Symptoms – croup-like symptoms: coughing and wheezing lasting more than a w |
| C. Influenza – | the Flu |
| Influenza 1. A- B- or C | with C causing only minor respiratory disease |
| Influenza 2. Has an envelope with 2 types of projections: | hemagglutinin (H) spikes and neuraminidase (N) spikes – antibodies directed mainly at these spikes- but variation in their composition allows the virus to evade established resistance |
| a. Antigenic drift – | changes in the glycoproteins of the envelope - minor variations in antigenic makeup |
| b. Antigenic shifts – | Recombination of the 8 RNA segments of the viral genome w/in the virus and between animal and human strains might be involved (only with influenza A) |
| Influenza 3. Annual vaccines with inactivated virus produced in | embryonated eggs developed to usually two influenza A and one influenza B types in circulation; FluMist – a nasal vaccine with an attenuated form |
| Influenza 4. Relenza or Tamiflu | taken within 48 hours for Influenza A or B will reduce symptoms; can be used as a preventative |
| A. Tuberculosis – | Mycobacterium tuberculosis; no toxin – symptoms from the bacteria itself; leading killer worldwide with one-third of the total population infected and leading killer of HIV patients in this country as well |
| B. Pneumonia – | caused by bacteria and viruses; fungal pneumonia is on the increase Viral pneumonia is usually a complication of influenza- measles or other viral diseases and is usually implicated if no other cause is determined and Mycoplasma pneumonia is eliminated |
| 1. Streptococcus pneumoniae – | pneumococcal pneumonia . Most common so called typical pneumonia |
| pneumonia b. Symptoms – | high fever- breathing difficulty- and chest pain (atypical pneumonias usually have a slower onset and less fever and chest pain); infection of the lobe of the lungs where fluid fills an entire lobe of the lung: lobar pneumonia |
| pneumonia c. Many carriers – | part of the normal flora in 5-50% of the normal population; virulence dependent on the host’s resistance |
| pneumonia d. Drug resistance common | so vaccine for those above 50 and now introduced into the vaccination schedule at 2 months of age |
| 2. Mycoplasma pneumoniae | a. Most common cause of PAP - primary atypical pneumonia; |
| b. Walking pneumonia; | inward swelling of the alveoli resulting in pneumonia w/o fluid in the lungs first symptom- an unproductive cough- not suggestive of pneumonia |
| Mycoplasma pneumoniae c. No cell wall- | does not respond to penicillin- etc.; DOC erythromycin or tetracycline for 2 to 3 weeks |
| Mycoplasma pneumoniae d. Transmission – | direct contact with aerosols- spread especially a problem in close living conditions |
| 3. Hantavirus Pulmonary Syndrome (HPS) | a. Hemorrhagic fever with renal syndrome in other parts of the world; fatal 33% of the time – lungs fill with fluids;b. Transmitted by inhalation of hantaviruses in dried urine from infected rodentsc. First cases in 1993; increase in occurrence especiall |
| 4. SARS – | Sudden Acute Respiratory Syndrome a. Caused by a previously unknown strain of a virus (coronavirus) b. Symptoms – fever >100.4 F- dry cough- troubled breathing; Spread – Person to person contact c. Occurrence – In the US- travelers or those in contact wi |
| 5. Histoplasmosis – | caused by Histoplasma capsulatum- a fungal pathogen that grows in moist soil especially high in nitrogen and littered with bird and bat droppings; widespread in Ohio and Mississippi river valleys; occasionally fatal |
| 6. Pneumocystis Pneumonia or PCP – | Pneumocystis (carinii) jiroveci |
| Pneumocystis Pneumonia | a. A fungus that is the most frequent opportunistic infection of AIDs patient b. Found in healthy lungs- but when it does cause disease- the microbes invade the lining of the alveoli and form cysts. Eventually rupture releases motile cells. Symptoms – co |
| 1. Upper Respiratory System | a. Nose and throat (pharynx)- including the middle ear and auditory (Eustachian) tubes b. Defenses – Nasal hair- ciliary escalator – mucus produced by goblet cells of mucous membrane traps dust and microorganisms- and cilia assist in moving these to the |
| 2. Lower Respiratory System | a. Larynx (voice box)- trachea (windpipe)- bronchial tubes- and lungs |
| b. Lungs | 1) Alveoli – air sacs in lung tissue where oxygen and carbon dioxide are exchanged 2) Pleura – double-layered membrane around the lungs |
| c. Defenses | – Macrophages in the alveoli destroy many pathogens- and IgA in the mucous- saliva and tears help too. |
| B. Normal Microbiota Upper Respiratory System | – a number of potentially pathogenic microbes but competition keeps them in check |
| Normal Microbiota Lower Respiratory System | – nearly sterile b/c of the ciliary escalator |
| 1. Pharyngitis- | a sore throat |
| 2. Laryngitis- | an infected larynx |
| 3. Tonsillitis- | inflamed tonsils |
| 4. Sinusitis– | an infected sinus |
| 5. Epiglottitis – | an inflammation of a flap-like structure of cartilage that prevents material from entering the larynx- possibly life-threatening w/in hours; usually caused by Hib – incidence has decreased with vaccination |
| 6. Croup – | condition caused by the inflammation of the upper airway leading to a characteristic barking cough; most is viral croup (RSV); more common in children born prematurely or those with narrowed upper airways |
| 1. Bronchitis – | infection affecting the bronchi |
| 2. Pneumonia – | alveoli also become infected |
| Rhinitis: the Common Cold | 1. No cure but symptoms of nasal secretion and congestion can be reduced; laryngitis and otitis media are complications 2. Viral infections may lead to secondary bacterial infections 3. Rhinoviruses cause 50%- over 100 serotypes of this virus alone; p |
| B. Sinusitis | 1. Most commonly caused by allergies- but pathogens and anatomy can also play a role 2. Infections – viruses- bacteria- and even fungi in immunocompromised patients as fluid in the sinuses resulting from the inflammation process can provide an excellent |
| C. Otitis Media – | Infection of the middle earearache Caused by different bacteria (Streptococcus pneumoniae bacterium the case in about 35% of the cases – Prevnar vaccine introduced in 2000; Haemophilis influenzae type B – Hib vaccine) that form pus- which builds up pres |
| D. Pharyngitis – | Inflammation of the throat 1. Viral sore throats are usually mild; diagnosis by eliminating strep as a cause 2. Strep Throat 3. Diphtheria |
| Strep Throat a. Streptococcus pyogenes: | group A- -hemolytic streptococci b. Test – indirect agglutination using microscopic latex particles coated with antibodies; takes as little as 10 minutes; so sensitive can detect asymptomatic carriers c. Symptoms – local inflammation- fever- usually ton |
| Strep Throat e. Scarlet fever (aka scarlatina) – | if phage infected: erythrogenic toxin |
| Strep Throat f. Rheumatic Fever – | cross reaction b/t streptococcal M protein and heart muscle; usually 3 weeks after strep throat is resolved; can be prevented if antibiotics used early to treat strep throat |
| 3. Diphtheria – | Corynebacterium diphtheriae |
| Diphtheria – | a. DTaP b. Many adults lack immunity b/c not vaccinated as children; in the US- a tetanus shot is usually combined with diphtheria toxoid (Td vaccine) c. Early symptoms – sore throat- fever and chills; Infection begins in the throat but if toxin circula |
| a. DTaP vaccine – | D = diphtheria toxoid- an inactivated toxin that causes the body to produce antibodies against the diphtheria toxin; 2-4-6 months |
| A. Pertussis | or Whooping Cough |
| 1. Bordetella pertussis | bacteria destroy the ciliated cells in the trachea that prevents the movement of mucus by the ciliated escalator system causing the patient to desperately try to cough up mucus secretions resulting in a nonproductive cough |
| 2. DTaP vaccine – | aP a) sometimes seen in adults as the immunity decreases after 12 years; revaccination of young adults is under review by CDC as incidence has increased in the last 20 years b) a whole cell vaccine containing high levels of endotoxins suspected of causi |
| B. Respiratory Syncytial Virus (RSV) | 1. Most common viral respiratory disease in infants; 4500 infant deaths in the US each year; Most children have antibodies by age 3; life-threatening pneumonia in the elderly 2. Symptoms – croup-like symptoms: coughing and wheezing lasting more than a w |
| C. Influenza – | the Flu |
| Influenza 1. A- B- or C | with C causing only minor respiratory disease |
| Influenza 2. Has an envelope with 2 types of projections: | hemagglutinin (H) spikes and neuraminidase (N) spikes – antibodies directed mainly at these spikes- but variation in their composition allows the virus to evade established resistance |
| a. Antigenic drift – | changes in the glycoproteins of the envelope - minor variations in antigenic makeup |
| b. Antigenic shifts – | Recombination of the 8 RNA segments of the viral genome w/in the virus and between animal and human strains might be involved (only with influenza A) |
| Influenza 3. Annual vaccines with inactivated virus produced in | embryonated eggs developed to usually two influenza A and one influenza B types in circulation; FluMist – a nasal vaccine with an attenuated form |
| Influenza 4. Relenza or Tamiflu | taken within 48 hours for Influenza A or B will reduce symptoms; can be used as a preventative |
| A. Tuberculosis – | Mycobacterium tuberculosis; no toxin – symptoms from the bacteria itself; leading killer worldwide with one-third of the total population infected and leading killer of HIV patients in this country as well |
| B. Pneumonia – | caused by bacteria and viruses; fungal pneumonia is on the increase Viral pneumonia is usually a complication of influenza- measles or other viral diseases and is usually implicated if no other cause is determined and Mycoplasma pneumonia is eliminated |
| 1. Streptococcus pneumoniae – | pneumococcal pneumonia . Most common so called typical pneumonia |
| pneumonia b. Symptoms – | high fever- breathing difficulty- and chest pain (atypical pneumonias usually have a slower onset and less fever and chest pain); infection of the lobe of the lungs where fluid fills an entire lobe of the lung: lobar pneumonia |
| pneumonia c. Many carriers – | part of the normal flora in 5-50% of the normal population; virulence dependent on the host’s resistance |
| pneumonia d. Drug resistance common | so vaccine for those above 50 and now introduced into the vaccination schedule at 2 months of age |
| 2. Mycoplasma pneumoniae | a. Most common cause of PAP - primary atypical pneumonia; |
| b. Walking pneumonia; | inward swelling of the alveoli resulting in pneumonia w/o fluid in the lungs first symptom- an unproductive cough- not suggestive of pneumonia |
| Mycoplasma pneumoniae c. No cell wall- | does not respond to penicillin- etc.; DOC erythromycin or tetracycline for 2 to 3 weeks |
| Mycoplasma pneumoniae d. Transmission – | direct contact with aerosols- spread especially a problem in close living conditions |
| 3. Hantavirus Pulmonary Syndrome (HPS) | a. Hemorrhagic fever with renal syndrome in other parts of the world; fatal 33% of the time – lungs fill with fluids;b. Transmitted by inhalation of hantaviruses in dried urine from infected rodentsc. First cases in 1993; increase in occurrence especiall |
| 4. SARS – | Sudden Acute Respiratory Syndrome a. Caused by a previously unknown strain of a virus (coronavirus) b. Symptoms – fever >100.4 F- dry cough- troubled breathing; Spread – Person to person contact c. Occurrence – In the US- travelers or those in contact wi |
| 5. Histoplasmosis – | caused by Histoplasma capsulatum- a fungal pathogen that grows in moist soil especially high in nitrogen and littered with bird and bat droppings; widespread in Ohio and Mississippi river valleys; occasionally fatal |
| 6. Pneumocystis Pneumonia or PCP – | Pneumocystis (carinii) jiroveci |
| Pneumocystis Pneumonia | a. A fungus that is the most frequent opportunistic infection of AIDs patient b. Found in healthy lungs- but when it does cause disease- the microbes invade the lining of the alveoli and form cysts. Eventually rupture releases motile cells. Symptoms – co |
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