Upper Respiratory & Lower Respiratory - L07 - 09/29

What are the parts of the upper respiratory tract?
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Streptococcus Pyogenes complication - Scarlet Fever 1. Cause 2. Characteristics1. Exotoxin 2. Sandpaper rash & strawberry tongueThe Sandpaper Rash is present everywhere on the body exceptPalms and solesStreptococcus Pyogenes complication - Rheumatic Fever 1. Cause 2. Complication1. Antibodies against M protein cross-react on protein on heart valve & joints 2. Endocarditis and polyarthritisPharyngitis - Candida Spp. 1. Symptoms 2. Treatment 3. High risk1. White patches in throat and cheeks, thrush, difficulty eating/ swallowing, painful 2. Clotrimazole, nystatin, fluconazole 3. Infants, elderly, immunocompromisedDiphtheria 1. Characteristics (Bacterial shape, Catalase, Gram stain) 2. Virulence factor 3. Transmission Types 4. Diagnoses 5. Vaccination1. Rod, C(+), G(+) 2. Exotoxin A 3. Respiratory and Contact 4. Modified Tinsdale Agar - cystine-tellurite & PCR 5. DTaPDescribe the Diphtheria cystine-tellurite agarTellurite: dark black/ blown colonies Cysteine: Brown HalosDiphtheria virulence factor 1. Causative Agent 2. Means of toxin transfer 3. Host receptor locations 4. MOA, same as?1. Corynebacterium diphtheriae 2. Phage 3. Heart and nerve cells 4. Exotoxin A = ADP ribosyl transferase. Transfers ADP ribose from NAD+ to EF2, inhibiting protein synthesis. Same as P aeruginosaRespiratory Diphtheria 1. Transmission 2. Location of replication 3. Symptoms 4. Characteristic features 5. Complications1. Respiratory Aerosols 2. Attaches and replicates in Pharynx 3. Malaise, sore throat, fever, exudative pharyngitis 4. Enlarged lymph nodes cause large neck & exudate is thick gray pseudo-membrane 5. Myocarditis and neurotoxicityCutaneous Diphtheria 1. Transmission 2. Symptom1. Gains entry to subcutaneous tissue through break in skin 2. Chronic non-healing ulcerEpiglottitis 1. Causative Agent 2. Characteristics (Bacterial shape, G Stain, virulence factors) 3. Symptoms 4. Prevention 5. Treatment 6. Diagnosis1. Haemophilus Influenza Type B 2. Rod, G(-), Capsule, Adhesins, & Endotoxin 3. Sever inflammation & edema, difficulty breathing, fever, drooling, sitting forward, otitis media, meningitis, pneumonia 4. Vaccine against capsule 5. Intubation, Antibiotic (Ceftriaxone) 6. Microscopy/ G Stain & fastidious cultureWhat agar and factors are required to culture Haemophilus Influenzae Type BChocolate agar w/ X (heme) and V (NAD) factorsPertussis 1. Causative Agent 2. Risk 3. Virulence Factors 4. Transmission 5. Clinical Manifestations (3 stages) 6. Diagnosis 7. Vaccines1. Bordetella pertussis 2. Unvaccinated children & vaccinated teens 3. Pertactin & hemagglutinin, Pertussis toxin & cytotoxin 4. Aerosol droplet 5. Catarrhal, Paroxysmal, & convalescence 6. Nasopharyngeal aspirate, Bordet-Gengou medium, Regan-Lowe Agar, PCR 7. DTAPDescribe the contagiousness of bordetella pertussis and a characteristic featureHighly contagious and results in uncontrolled violent coughingDescribe the two types of virulence factors in bordetella pertussis.Attachment: Pertactin and hemagglutinin bind to ciliated epithelial cells Tissue Damage: - Pertussis toxin ADP ribosylation activity of G proteins inc. cAMP and thus inc respiratory mucus - Tracheal cytotoxin has affinity for cilia causing ciliostasis which leads to characteristic whooping cough; also stimulates IL1 causing feverDescribe the pathogenesis of bordetella pertussisTransmission > attachment > proliferation > tissue damageDescribe the symptoms and infectivity of the Catarrhal stage of bordetella pertussisCold-like symptoms, runny nose, sneezing, malaise, low fever, loss of appetite Highly transmissible due to large # of bacteriaDescribe the symptoms of the paroxysmal stage of bordetella pertussisDamage ciliated cells, impair mucus clearance; prolonged coughing fits w/ inspiratory whoop, 40-50/ day, vomiting exhaustion, ruptured blood vessels in the eyesWhat is the convalescence stage of bordetella pertussis?RecoveryWhat are the best diagnostic methods for bordetella pertussis? What culture methods are there?Nasopharyngeal and PCR Old agar: Bordet-Gengou medium Current: Regan-Lowe AgarDescribe the bordetella vaccineInactivated pertussis toxin + filamentous hemagglutinin + pertactinWhat are the three parts of the lower respiratory tract?Trachea Primary Bronchi LungsDefine Pneumoniainflammation of the lungs accompanied by fluid-filled alveoli & bronchiolesHow does bacteria get into the LRT?- Inhalation of aerosols - Aspiration of normal flora from URT or GI - Hematogenous spread from another site of infectionWhere is pneumonia acquired?- Community acquired (CAP) - Hospital acquired (HAP)What is a typical pneumonia?Sign and symptoms are similar to pneumococcal pneumonia - Fever, chills, congestion shortness of breath, chest pain, & productive coughWhat are some examples of typical pneumoniaStreptococcus pneumoniae Klebsiella pneumoniae Haemophilus Influenzae Moraxella Catarrhalis Staphylococcus aureusStreptococcus Pneumoniae 1. Characteristics (type of pneumonia, G stain, grouping, hemolysis) 2. Virulence Factors 3. Seasons 4. CAP or HAP 5. Vaccine 6. Typical/ Atypical1. Lobar pneumonia, G(+), pairs/ chains, alpha hemolytic 2. Capsule, Adhesin, IgA protease, Pneumolysin 3. Fall & Winter 4. CAP 5. PPSV23 (pneumovax): 23 most common capsule serotypes; given to adults. PCV13 (Pneumococcal conjugate vaccine) for children under 5 6. TypicalWhat is the function of streptococcus pneumoniae pneumolysin?Lyses ciliated epithelial cellsDescribe the diagnostic methods used for streptococcus pneumoniaeSputum sample: - Rust colored sputum: blood - Microscopy: G(+) & numerous PMNs - Antigen agglutination: secreted in urine too Hemolysis Optochin sensitiveWhat are some predisposing factors of streptococcus pneumoniaePrevious viral infection Alcoholism Children Elderly SplenectomyWhat is an atypical pneumonia? (organism microscopy and symptoms)Organism not seen w/ gram stain (except legionella) Symptoms: headache, malaise, nausea, diarrhea, nonproductive cough (dry hacking cough)What are some examples of atypical pnuemonia?Mycoplasma Pneumoniae Chlamydophila spp. Legionella Pneumophila Coxiella burnetiMycoplasma Pneumoniae 1. Typical or Atypical 2. CAP/ HAP 3. Characteristic symptoms 4. Seasonality 5. Population at Risk 6. Cell Wall/ No Cell Wall 7. Virulence Factors 8. Transmission 9. Diagnostics 10. Treatment1. Atypical 2. CAP 3. Excessive sweating & nonproductive cough 4. None 5. Late Teens and Twenties 6. No Cell Wall 7. Capsule & Adhesins 8. Inhalation of aerosols 9. Can't see on microscope. Large # of PMNs. Grows slowly in culture. PCR 10. Macrolide: Azithromycin & erythromycin. DoxycyclineChlamydophila Pneumonia 1. Characteristics (G stain, Intra/ Extra cellular) 2. CAP/ HAP 3. Diagnostics 4. Stages 5. Transmission 6. Symptoms 7. Treatment 8. Other chlamydia spp.1. G(+), Intracellular 2. CAP 3. Nun on microscope, Large # of PMNs, and ELISA 4. Elementary Body & Reticulate Body 5. Respiratory droplets 6. Mild fever, sore throat, malaise, persistent nonproductive cough 7. Macrolide: Azithromycin & Eryhtromycin. Doxycycline. 8. Chlamydia Psittaaci (Parrot fever): transmitted from birdsLegionella Pneumophila 1. Characteristics (G stain, transmission via, intra/ extra + types) 2. Transmission 3. Symptoms 4. Complications 5. Diagnosis1. G(-) but not well; vents/ AC, intracellular in amoebas in the environment and in the macrophages of human alveolar cells 2. Inhalation of Aerosol droplets 3. Abrupt onset of fever, headache, pleurisy, chills, myalgia, dry cough 4. Gi Tract, CNS, Liver & kidneys 5. Fastidious culture via buffered charcoal yeast & fluorescent antibody staining of urineWhat are the common causes of nosocomial pneumonia?Pseudomonas aeruginosa, S. Aureus, H. Influenza, Enterics (Enterobacter, Klebsiella, E. Coli, Serratia Marcescens)Pseudomonas Aeruginosa 1. Characteristics - G Stain + shape - Temperature Preference - Ana/Aerobic - Biofilm? - Motility - Oxidase - Opportunistics or Equilibrium - CAP/ HAP - Antibiotic Resistance - Color/ Odor 2. Risk Factors 3. Treatment1. G(-) Rod - 4-42ºC - Anaerobic - Alginate capsule biofilm - Flagella and Pili - Oxidase (+) - Opportunistic - HAP - Antibiotic resistant - Green & sweet 2. CF - Infected w/ S. Aureus first - Colnoized w/ p.a. by 5yrs - Chronic microbial colonization Hospitalized on ventilation: VAP 3. Difficult to treatWhat is Cystic fibrosis?Autosomal recessive disease that causes defective CFTR which results in a build up of mucusAnaerobic Bacteria 1. Transmission 2. Risk Factors 3. Mixture of bacteroides and fusobacterium causes 4. Sputum Odor 5. Treatment1. Aspiration of respiratory or GI 2. Dental work or loss of consciousness 3. necrosis & lung abscesses 4. Foul 5. MetronidazoleExamples of Bioterrorism agentsAnthrax, Plague, Q fever, Tularemia, BrucellosisAnthrax 1. Causative Agent 2. Characteristics - G stain & shape - Anae/ Aerobic - Motile? - Spores? - Found where? 3. Types1. Bacillus Anthracis 2. - G(+) rod - Aerobic - Non-motile - endospores - Ubiquitous 3. Inhalation, Cutaneous, and Gastro intestinalInhalation Anthrax 1. Virulence Factors 2. Transmission 3. Symptoms 4. Diagnosis 5. Treatment 6. Vaccination availability 7. Mortality rate1. Capsule and Anthrax toxin 2. Inhalation of endospores 3. Initially like cold, then severe coughing, nausea, vomiting, lethargy, confusion, shock, death 4. Microscopy/ G stain of sputum 5. Penicillin, doxycycline, ciprofloxacin 6. Military and Researchers 7. HighDescribe the Anthrax Toxin. What codes it? Type? Components?Plasmid codes A/B Toxin with three components Protective antigen (PA- binding), Edema Factor (EF) and lethal factor (LF)What are Covid-19 surface proteins and what host cell receptor do they bind to?S proteins bind to host cell ACE2Tuberculosis 1. Causative Agent 2. Characteristics - Anae/ Aerobic - Stain? Shape? - Cell Wall - Extra/ Intracellular 3. Transmission 4. Virulence 5. Symptoms 6. Risk Factors 7. Types 8. Diagnostics 9. Treatment 10. Vaccine1. Mycobacterium Tuberculosis 2. Aerobic - Acid Fast, Rod - Mycolic acid cell wall -Intracellular 3. Inhalation 4. Cord Factor (characteristic serpentine arrangement) 5. Productive cough, ~ bloody sputum, weight loss, sweating 6. Poor nutrition, drug users, alcoholics, crowded living conditions, immunocompromised, endemic areas (Asia, Africa, Europe) 7. Primary, Secondary, and Disseminated 8. - TB Skin, Mantoux, or PPD. Intradermal injection of purified protein derivative. Check site in 48-72 hrs. Positive indicates exposure not activity. - Chest X-Ray: Tubercles - Sputum Microscopy: Acid Fast & fluorescent auramine stain - Culture: Lowenstein Jensen Agar (very slow) 9. - Combination therapy, - rifampin, isoniazid, pyrazinamide, ethambutol (RIPE) - Potential exposure: Isoniazid only 10. BCG VaccineWhat is purpose does the mycolic acid cell wall of tuberculosis serve?- Resistance to detergents and common antibiotics - Protected from desiccationHow does tuberculosis affect the tissue?Immune response causes tissue necrosisDescribe the three types of tuberculosisPrimary: Initial case of TB results in caseous lesion and Ghon Complex Secondary: reactivated; cavity formation Disseminated: Multiple systems (miliary tb), cavitiesDescribe the pathogenesis of TBInhaled respiratory droplet makes its way into alveolus where it replicates in the macrophage and forms a tubercle. Builds a collagen shell and caseous necrosis initiates in center. Tubercle ruptures and mycobacterium move to next alveolusWhat are tubercles? Types?Caseous lesion: Cheese-like consistency Ghon complex: Calcified caseous lesion shown in X-Ray Tuberculosis cavities: Tubercle that has liquefied and formed an air-filled cavity from which bacteria can spread (Secondary and miliary stages)Describe Tuberculosis resistanceMDR-TB (Multidrug Resistant): - Isoniazid and Rifampin XDR-TB (extensive drug resistant): - Isoniazid, rifampin, and at least one other DOTS (Directly Observed Treatment Short course): Recommended by WHO and CDC