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Flashcards in this deck (40)

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  • COVID-19 is an infection caused by SARS‑CoV‑2, which is a positive-sense RNA coronavirus and causes respiratory and systemic disease ranging from asymptomatic to critical illness.

    covid virology pathogenesis

  • Key steps in COVID-19 pathogenesis: - Virus binds ACE2 receptor via the spike protein and enters respiratory epithelium - Replication triggers immune response - Severe disease: cytokine storm causing ARDS, multiorgan injury and coagulopathy

    pathogenesis covid

  • ARDS in COVID-19 is hypoxaemic respiratory failure from a "cytokine storm" within 1 week of COVID, often with bilateral opacities on CXR.

    complications ards covid

  • Symptoms of COVID-19 by severity: - Mild: fever, cough, fatigue, anosmia, myalgia, sore throat - Moderate: SOB and O2 sat 90–94% - Severe: hypoxia <90%, ARDS, multi-organ failure

    presentation symptoms covid

  • Extra-respiratory manifestations of COVID-19 include GI (diarrhoea/nausea), neuro (headache, confusion, anosmia), cardiac (myocarditis), and skin (rashes/COVID toes).

    manifestations covid systems

  • Major risk factors for severe COVID-19 include age >65, male sex, comorbidities (DM, CKD, COPD, CVD, obesity), immunosuppression, third trimester pregnancy, and unvaccinated status.

    riskfactors covid

  • Investigations commonly show lymphopenia, raised CRP and D-dimer, possible mild thrombocytopenia, raised ferritin/LDH, and troponin in severe disease; diagnostic test: RT-PCR nasopharyngeal swab.

    investigations covid labs

  • Oxygen therapy target for most COVID-19 patients is SpO2 92–96%, with stepwise escalation: nasal cannula → face mask → high-flow nasal O2 → CPAP → mechanical ventilation.

    management oxygen covid

  • First-line treatments: dexamethasone for those needing oxygen; IV remdesivir for hospitalised patients on O2 if symptom onset is <7 days. Second-line: tocilizumab for systemic inflammation and prophylactic LMWH/UFH in hospitalised patients. Prevention: vaccine.

    warning triangle

    treatment covid pharmacology

  • Influenza is an acute viral respiratory infection caused by influenza A or influenza B viruses.

    infectiousdisease influenza overview

  • Key steps in influenza pathogenesis: - Virus binds respiratory epithelial cells via Hemagglutinin (HA) - Viral replication → cell death and airway inflammation - Host immune response causes systemic symptoms

    pathogenesis influenza virology

  • Common systemic symptoms of influenza include fever, chills, myalgia, headache and malaise.

    symptoms influenza clinical

  • Respiratory and less common GI symptoms of influenza: - Respiratory: cough, sore throat, nasal congestion - GI (less common): nausea, vomiting, diarrhea

    symptoms influenza clinical

  • Major complications of influenza include viral or secondary pneumonia, COPD/asthma exacerbation, myocarditis, encephalitis and multi organ failure.

    complications influenza clinical

  • Key risk groups for severe influenza are people over 65 years, pregnant, with chronic heart, lung, liver, or renal disease, immunocompromised and residents of long-term care facilities.

    riskfactors influenza publichealth

  • Investigations for suspected influenza: clinical diagnosis in mild cases; for confirmation use RT-PCR from nasopharyngeal swab. In severe cases consider FBC, CRP and CXR if pneumonia is suspected.

    investigations diagnosis influenza

  • Treatment and prevention: First-line is supportive care and paracetamol for fever. If severe/hospitalised or immunocompromised, aim within 48 hours to give oseltamivir (oral) or zanamivir (inhaled). Prevention: annual influenza vaccine (live attenuated in children, inactivated in adults).

    treatment prevention influenza

  • Influenza classification includes Types, Subtypes/Lineages, Clades and Sub-clades. The provided diagram illustrates these groupings: Human seasonal influenza classification Which hierarchical groups are shown in the diagram? Types, Subtypes/Lineages, Clades, Sub-clades

    classification influenza virology

  • Upper respiratory tract infections (URTIs) are acute infections affecting structures above the vocal cords: nose, pharynx, larynx or sinuses.

    ent urti

  • Common clinical types of URTIs include: - Common cold - Pharyngitis/Tonsillitis - Laryngitis - Sinusitis/rhinosinusitis - Otitis media/eustachian tube dysfunction - Epiglottitis

    types urti

  • Typical URTI symptoms include: nasal congestion, rhinorrhoea, sore throat, cough and sometimes low-grade fever.

    symptoms urti

  • Red-flag URTI signs requiring urgent attention: stridor, drooling, severe pain, high fever, neck stiffness, immunosuppression. red flag symbol

    redflag safety

  • URTI risk factors include being young, immunosuppressed, having asthma/COPD, seasonal peaks (winter viruses), smoking and close contact.

    risk epidemiology

  • Investigations for mild URTI are clinical; if severe/atypical consider throat swab (strep culture/rapid antigen) and nasopharyngeal swab (viral PCR for COVID/influenza).

    investigations diagnosis

  • First-line supportive URTI treatment: rest, hydration, saline nasal spray or steam inhalation plus analgesics/antipyretics (paracetamol, ibuprofen).

    treatment management

  • Recommended antibiotics for specific bacterial URTIs: Phenoxymethylpenicillin for strep throat (Group A), Amoxicillin for bacterial sinusitis and Amoxicillin for otitis media.

    antibiotics treatment

  • Antiviral guidance: Oseltamivir is indicated for influenza in high-risk patients.

    antivirals treatment

  • Lower respiratory tract infections (LRTIs) are infections below the larynx involving: - trachea - bronchi/bronchioles - lung parenchyma (alveoli)

    lrti definition respiratory

  • Common types of LRTIs include: - Acute bronchitis - Bronchiolitis - Community-acquired pneumonia (CAP) - Healthcare-associated pneumonia (HAP) - Ventilator-associated pneumonia (VAP) - Exacerbation of COPD - COVID-19 / Influenza pneumonia

    types lrti

  • Typical viral causes listed for acute bronchitis and bronchiolitis include: influenza A/B, RSV, COVID, adenovirus, parainfluenza

    etiology viral bronchitis

  • Common bacterial pathogens causing community-acquired pneumonia (CAP) are Streptococcus pneumoniae and Haemophilus influenzae.

    etiology bacterial cap

  • Key symptoms of LRTIs include: - Cough - Fever / chills - Dyspnoea - Wheeze - Pleuritic chest pain - Fatigue / malaise

    symptoms presentation

  • Risk factors for LRTIs include: Smoking, age <5 or >65, chronic lung disease (COPD & Asthma), bronchiectasis, diabetes mellitus, immunosuppression, and recent hospital stay.

    risk epidemiology

  • Investigations for suspected LRTI include blood tests: FBC, CRP, U&E, LFT, plus sputum culture and blood culture if severe and viral PCR for influenza/COVID, and CXR for imaging.

    investigations diagnosis

  • A chest X-ray showing consolidation suggests pneumonia.

    investigations cxr

  • First-line antibiotic for uncomplicated acute bronchitis given here is Amoxicillin.

    treatment bronchitis antibiotics

  • Empirical treatment for CAP in moderate disease is co-amoxiclav + doxycycline/clarithromycin and for severe CAP is benzylpenicillin + clarithromycin.

    treatment cap antibiotics

  • HAP treatment: early (<5 days) options include co-amoxiclav OR doxycycline; late-onset or high-risk HAP uses piperacillin-tazobactam (Tazocin).

    treatment hap

  • VAP recommended empirical therapy is piperacillin-tazobactam (Tazocin), adding vancomycin if there is MRSA risk.

    treatment vap antibiotics

  • For COPD exacerbation, antibiotics are recommended only if there is increased sputum purulence, sputum volume and dyspnoea; first-line is doxycycline and second-line amoxicillin.

    treatment copd antibiotics
Notes de cours

COVID-19 — key points

  • Definition: Infection caused by SARS‑CoV‑2, a positive‑sense RNA coronavirus causing respiratory and systemic disease from asymptomatic to critical illness.

Pathogenesis

  • Entry: Virus binds ACE2 receptor via spike protein and infects respiratory epithelium.
  • Course: Local replication → innate/adaptive immune response; severe cases show hyperinflammation ("cytokine storm").
  • Severe effects: ARDS, multiorgan injury and coagulopathy.

Clinical features

  • Mild: Fever, cough, fatigue, anosmia, myalgia, sore throat.
  • Moderate: Shortness of breath, SpO2 \(90\%\)–\(94\%\).
  • Severe: Hypoxia SpO2 \(<90\%\), ARDS, multi‑organ failure, ICU requirement.
  • Extra‑respiratory: GI (diarrhoea, nausea), neuro (headache, confusion, anosmia), cardiac (myocarditis), skin (rashes, "COVID toes").
  • ARDS definition: Hypoxaemic respiratory failure from hyperinflammation within ~1 week of illness with bilateral opacities on chest imaging.

Risk factors for severe disease

  • Age >65, male sex, comorbidities (DM, CKD, COPD, CVD, obesity), immunosuppression, pregnancy (third trimester), unvaccinated.

Investigations

  • Microbiology: RT‑PCR from nasopharyngeal swab = gold standard; lateral flow for screening.
  • Bloods: Lymphopenia, elevated CRP, raised D‑dimer, mild thrombocytopenia, high ferritin/LDH; troponin if cardiac involvement.
  • Other: ABG for hypoxia, CXR (bilateral infiltrates), CT chest (ground‑glass, consolidation), ECG/echo if cardiac signs.

Management overview

  • Oxygen targets: maintain SpO2 \(92\%\)–\(96\%\).
  • Escalation (stepwise): 1) nasal cannula, 2) face mask, 3) high‑flow nasal oxygen, 4) CPAP, 5) invasive mechanical ventilation.
  • First‑line drug therapies: Dexamethasone for patients requiring supplemental oxygen; remdesivir IV for hospitalized patients on oxygen with symptom onset <7 days.
  • Second‑line / adjuncts: Tocilizumab for severe systemic inflammation (IL‑6 inhibition); prophylactic LMWH/UFH for hospitalized patients to reduce thrombotic risk.
  • Prevention: Vaccination.

Influenza — essentials

  • Definition: Acute respiratory infection caused by influenza A or B viruses.

Pathogenesis

  • Virus attaches via hemagglutinin to respiratory epithelial cells → replication, cell death and airway inflammation → systemic symptoms from host response.

Clinical features

  • Systemic: Fever, chills, myalgia, headache, malaise, fatigue.
  • Respiratory: Cough, sore throat, nasal congestion.
  • GI: Nausea/vomiting/diarrhoea (less common).

Complications

  • Primary viral or secondary bacterial pneumonia, COPD/asthma exacerbation, myocarditis, encephalitis, multi‑organ failure.

Risk factors

  • Age >65, pregnancy, chronic cardiorespiratory/hepatic/renal disease, immunocompromise, long‑term care residents.

Investigations

  • Clinical diagnosis usually adequate for mild illness; confirm with RT‑PCR on nasopharyngeal swab when important for management.
  • FBC/CRP if severe; CXR if suspected pneumonia.

Treatment

  • Supportive care: Antipyretics (paracetamol), fluids, rest.
  • Antivirals: Oseltamivir (oral) or zanamivir (inhaled) ideally within 48 hours for uncomplicated disease at high risk; give to severe, hospitalized or immunocompromised patients even if beyond 48 hours per clinical judgement.
  • Prevention: Annual influenza vaccination (live attenuated for some children, inactivated for adults).

Seasonal influenza types and clades diagram

Upper respiratory tract infections (URTIs)

  • Definition: Acute infections of the nose, pharynx, larynx or sinuses (above the vocal cords).

Common types

  • Common cold, pharyngitis/tonsillitis, laryngitis, sinusitis/rhinosinusitis, otitis media, epiglottitis.

Symptoms

  • Nasal congestion/rhinorrhoea, sneezing, sore throat, cough, hoarseness; fever usually low unless bacterial.
  • Red flags: Stridor, drooling, severe neck pain/stiffness, high fever, severe pain, signs of airway compromise or immunosuppression — urgent assessment required.

Investigations

  • Usually clinical; throat swab for Group A strep (rapid antigen or culture) if bacterial pharyngitis suspected. Nasopharyngeal PCR if testing for influenza/COVID is needed.

Treatment

  • Supportive: Rest, fluids, analgesics (paracetamol, ibuprofen), saline nasal spray.
  • Antibiotics (when indicated):
  • Strep throat (Group A): phenoxymethylpenicillin.
  • Bacterial sinusitis or otitis media: amoxicillin.
  • Antivirals: Oseltamivir for influenza in high‑risk patients.

Lower respiratory tract infections (LRTIs)

  • Definition: Infections below the larynx: trachea, bronchi, bronchioles and lung parenchyma.

Types & common pathogens

  • Acute bronchitis / bronchiolitis: usually viral (influenza A/B, RSV, SARS‑CoV‑2, adenovirus, parainfluenza).
  • Community‑acquired pneumonia (CAP): Streptococcus pneumoniae, Haemophilus influenzae.
  • Healthcare‑associated / hospital‑acquired pneumonia (HAP): Gram‑negative organisms, water‑associated resistant bugs.
  • Ventilator‑associated pneumonia (VAP): often multi‑drug resistant organisms.

Symptoms

  • Cough, fever, dyspnoea, wheeze, pleuritic chest pain, malaise.

Risk factors

  • Smoking, age (<5 or >65), chronic lung disease (COPD, bronchiectasis), diabetes, immunosuppression, recent hospitalization.

Investigations

  • Bloods: FBC, CRP, U&E, LFTs; blood cultures and sputum culture if moderate–severe.
  • Microbiology: Viral PCR for influenza/COVID when indicated.
  • Imaging: CXR to detect consolidation consistent with pneumonia.

Empiric treatment summary

  • Acute bronchitis (bacterial suspicion): amoxicillin.
  • CAP:
  • Mild: amoxicillin.
  • Moderate: co‑amoxiclav + doxycycline or clarithromycin.
  • Severe: benzylpenicillin + clarithromycin.
  • HAP: early onset (<5 days) — co‑amoxiclav or doxycycline; late onset/high‑risk — piperacillin‑tazobactam.
  • VAP: piperacillin‑tazobactam; add vancomycin if MRSA risk.
  • COPD exacerbation: give antibiotics only if increased sputum purulence/volume and worsened dyspnoea; 1st line doxycycline, 2nd line amoxicillin.

Practical tips for clinical exams

  • Triage by oxygen requirement and red flags (airway compromise, sepsis, severe hypoxia).
  • Use SpO2 targets and stepwise oxygen escalation to guide immediate management.
  • Distinguish URTI vs LRTI by presence of focal consolidation, systemic features and imaging.
  • Consider risk factors to decide on antivirals, antibiotics and inpatient care.