Group 8_Respiratory Bacterial Infections.pdf

RESPIRATORY BACTERIAL INFECTIONS Group 8 Top 3 Most Relevant Respiratory Bacterial Infections in the Philippines as of 2024: (Common Lung Conditions - De La Salle University Medical Center. (n.d.). Www....

RESPIRATORY BACTERIAL INFECTIONS Group 8 Top 3 Most Relevant Respiratory Bacterial Infections in the Philippines as of 2024: (Common Lung Conditions - De La Salle University Medical Center. (n.d.). Www.dlshsi.edu.ph. https://www.dlshsi.edu.ph/dlsumc/health-advisory/lungs) 1. Community Acquired Pneumonia (Streptococcus pneumoniae) (Shirley Paz B, B., Joel, S., & Adolf, L.-T. (2021). Prevalence, Demographic, Clinical Characteristics and Outcomes of Elderly Patients with Community Acquired Pneumonia Admitted in a Tertiary Medical Center: A Retrospective Cohort Study. Journal of Geriatric Medicine and Gerontology, 7(3). https://doi.org/10.23937/2469-5858/1510117) 2. Whooping Cough aka Pertussis (Bordetella pertussis) (On the rise: DOH records 1,112 pertussis cases. (2024). Manila Bulletin. https://mb.com.ph/2024/4/9/on-the-rise-doh-records-1-112-cases-pertussis-cases#google_vignette) 3. Bronchitis (Mycoplasma pneumoniae) (CDC. (2024, May 20). Clinical Overview of Haemophilus influenzae Disease. Haemophilus Influenzae Disease. https://www.cdc.gov/hi-disease/hcp/clinicians/index.html) COMMUNITY ACQUIRED PNEUMONIA Now, how do these minuscule bacteria, (STREPTOCOCCUS PNEUMONIAE) approximately 0.5 micrometers in diameter, affect us? I. Epidemiology 1. Pathogen Entry In the Philippines, the incidence of CAP per 100,000 discharges is 4205 patients. When CAP typically begins when put in percentage, it is 4.2% and when pathogens, such as bacteria (like plotted against age group, it was noted to Streptococcus pneumoniae) enter the lungs have a U-shaped curve, indicating impact of through inhalation or aspiration of burden on the youngest and oldest groups. contaminated secretions. (2. Infection) Moreover, many studies done in the These pathogens infect the alveoli (air sacs Philippines reported that community in the lungs), leading to inflammation and acquired pneumonia has higher prevalence immune response activation. (3. in male gender (usually aged 65-74) Inflammatory Response) The body's immune system responds by releasing II. Pathophysiology cytokines and inflammatory mediators. This response aims to eliminate the pathogen Worldwide, Streptococcus pneumoniae is a but also contributes to lung tissue damage bacteria that is most often responsible for and symptoms such as fever and cough. (4. CAP in adults. Some other common Consolidation) As the infection progresses, bacteria that cause CAP are: Haemophilus inflammatory cells, fluid, and debris influenzae and Mycoplasma pneumoniae. accumulate in the alveoli, causing consolidation which means there is solidification of lung tissue.  Reference: Mandell LA, Wunderink RG, (e.g., cough, fever) and may actually Anzueto A, et al. Infectious Diseases present with confusion and an altered Society of America/American mental status Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2 IV. Ddx There are a lot of differential diagnoses for Community Acquired Pneumonia but we only included the top three most common which is Acute Bronchitis, Congestive Heart Failure with Pulmonary Edema, and Tuberculosis. Acute Bronchitis is more likely because it presents with persistent cough and sputum production. It is less likely because high-grade fever is uncommon in (pwede din ito as pathophysio if need na shorter) acute bronchitis, significant dyspnea is not typical of acute bronchitis, marked or Traditionally, CAP is thought to be caused by persistent tachypnea is not common in inhalation or aspiration of a respiratory acute bronchitis, and Pleuritic chest pain pathogen into an otherwise sterile alveoli. The is not typical of acute bronchitis. local inflammatory response to the pathogen results in pulmonary signs and symptoms such Congestive heart failure with pulmonary as cough, sputum production, dyspnea, edema is more likely because it presents crackles, and hypoxemia. Release of cytokines with significant dyspnea, tachypnea is into the bloodstream leads to the systemic common in Congestive heart failure, and signs or symptoms of pneumonia, which often there is sputum production. Less likely include fever, fatigue, tachycardia, and because fever is typically absent in leukocytosis. Congestive heart failure with pulmonary edema, while cough is common, it is III. Clinical Manifestations typically dry or associated with frothy sputum, and Pleuritic chest pain is not Patients with CAP usually present with fever and a brief history of respiratory problems common in Congestive heart failure. such as cough, dyspnea, tachypnea, Elderly patients may be less likely to Pulmonary Tuberculosis is also more present with standard symptoms of CAP likely because it presents fever, cough,  sputum production, and pleuritic chest pain. Less likely because dyspnea is V. Diagnostic workup usually not a prominent early symptom in PTB and tachypnea is not commonly Diagnostic workups for CAP includes imaging associated with early or uncomplicated such as X-ray, to identify infiltrates or effusions, PTB. and CT scan for further evaluation, such as identifying lung abscesses or bilateral pneumonia. We can also test for Complete Blood Count (CBC) More Likely Less Likely with Differential, Serum Electrolytes, Renal, and Acute Cough Fever Liver Function Tests, and Respiratory Virus Testing. Bronchitis (persistent) (high-grade) We also have Severity Assessment Tools such as Sputum Tachypnea CURB-65 and Pneumonia Severity Index (PSI). For Production (persistent) microbiological testing we have Blood and Sputum Dyspnea Cultures, Urine Antigen Testing, and Serum Pleuritic Procalcitonin. Chest Pain Imaging: More Likely Less Likely Chest X-ray: Essential to identify Congestive Dyspnea Fever infiltrates or effusions, which improve Heart Failure Tachypnea Cough diagnostic accuracy. with Sputum Pleuritic CT Scan: May be used for further Pulmonary Production Chest Pain evaluation, such as identifying lung abscesses or bilateral pneumonia. Edema Blood Work: More Likely Less Likely Pulmonary Fever Dyspnea Complete Blood Count (CBC) with Tuberculosis Cough Tachypnea Sputum Differential: Helps confirm inflammation Production Pleuritic and assess severity. Chest Pain Serum Electrolytes, Renal, and Liver Function Tests: Evaluates overall health and organ function. More Likely Less Likely Respiratory Virus Testing: Consider Community Fever Acquired Cough molecular testing on nasopharyngeal Pneumonia Dyspnea Tachypnea swabs if available. Pleuritic Chest Pain Sputum Production  For suspected aspiration, ampicillin-sulbactam or Severity Assessment Tools: ertapenem is preferred. If Pseudomonas is a concern, antipseudomonal agents should be CURB-65: Assesses confusion, urea used, and if MRSA is suspected, vancomycin or levels, respiratory rate, and blood linezolid should be added. pressure to help determine treatment setting (outpatient vs. inpatient). Pneumonia Severity Index (PSI): The typical duration of therapy is 5-7 days, but Another tool to assess severity, but can be extended for complicated cases or clinical judgment is crucial for specific pathogens. For influenza-related decision-making. pneumonia, oseltamivir is recommended if started within 48 hours of symptom onset or for any hospitalized patient regardless of timing. Microbiological Testing: Intravenous glucocorticoids may be considered for critically ill patients without contraindications, Blood and Sputum Cultures: Should be as they may reduce mortality and ICU days. collected before starting antibiotics, if possible, but treatment should not be delayed. Urine Antigen Testing: Consider testing WHOOPING COUGH AKA PERTUSSIS for Legionella and pneumococcal (BORDETELLA PERTUSSIS) antigens if cultures are negative. Serum Procalcitonin: Useful in patients with comorbidities like congestive heart VII. Epidemiology failure to guide antimicrobial therapy. The epidemiology of pertussis, or whooping cough, in the Philippines reflects a significant public health challenge, particularly due to fluctuating vaccination VI. Principles of treatment & other info rates and periodic outbreaks. For outpatient treatment of community-acquired General Trends: pneumonia (CAP), monotherapy with a macrolide (erythromycin, azithromycin, or clarithromycin) or Incidence Rates: The incidence of doxycycline is recommended. If there are pertussis in the Philippines, like in many comorbidities, the preferred treatment is a other countries, has seen periodic spikes respiratory fluoroquinolone or a combination of a due to lapses in vaccination coverage. beta-lactam and a macrolide. These spikes are often associated with outbreaks in regions where immunization Inpatient care is advised for those with a programs are not fully implemented or have CURB-65 score of 2 or higher, using either a been disrupted. respiratory fluoroquinolone monotherapy or Age Distribution: Pertussis primarily beta-lactam plus macrolide therapy. ICU affects infants and young children, admission should be considered for patients particularly those who are too young to be fully vaccinated. However, older children, showing significant signs of deterioration (e.g., adolescents, and adults can also contract high respiratory rate, multilobar infiltrates), where the disease, often serving as reservoirs for combination therapy with a beta-lactam and transmission to younger, more vulnerable either a macrolide or fluoroquinolone is populations. recommended. Regional Distribution: VIII. Pathophysiology Recent Outbreaks: Recent outbreaks in 2024 have been reported in various parts of the country, including Iloilo City, parts of Luzon, and the Visayas. These outbreaks are typically linked to areas with lower vaccination rates. Urban vs. Rural: Urban areas with better healthcare access tend to have lower incidence rates due to more robust vaccination programs, while rural and underserved areas, where healthcare access is more limited, are more prone to outbreaks. Vaccination Coverage: Declining Immunization Rates: There has been a concerning decline in routine immunization rates in recent years, partly due to vaccine hesitancy, logistical challenges, and the impact of the COVID-19 pandemic on healthcare services. Impact on Epidemics: The decline in vaccination has led to the loss of herd immunity in certain regions, making these areas more susceptible to pertussis outbreaks. Morbidity and Mortality: High-Risk Groups: Infants and young children are at the highest risk of severe disease and complications from pertussis, including pneumonia, seizures, and death. The disease's impact is particularly severe in regions where healthcare access is limited. Mortality Rates: While the overall mortality IX. Clinical Manifestations rate from pertussis is relatively low, it remains a significant cause of death among Early Stage (Catarrhal Stage): unvaccinated infants in outbreak settings. Runny Nose (Coryza): A common cold-like symptom. Mild Cough: Initially mild, but gradually worsens.  Low-Grade Fever: Usually mild and may X. Ddx be absent. Sneezing: Common in this early phase. Pertussis can initially resemble other respiratory General Malaise: Feeling of being unwell. infections like viral upper respiratory infections, bronchiolitis, pneumonia, and Paroxysmal Stage: even pulmonary tuberculosis. However, key differentiating factors include its typical Severe Coughing Fits (Paroxysms): progression through three phases and a These are the hallmark of pertussis, with persistent cough without fever. multiple rapid coughs followed by a sudden inhalation that produces the characteristic In infants and young children, we consider "whooping" sound. bronchiolitis, often caused by RSV (respiratory Post-Tussive Vomiting: Vomiting after intense coughing fits. syncytial virus), which can mimic early pertussis Cyanosis: A bluish discoloration of the skin with coughing fits and respiratory distress. due to lack of oxygen, particularly during Asthma exacerbation is another possibility, coughing fits. where paroxysmal coughing might resemble Exhaustion: Extreme tiredness after pertussis, though asthma usually includes coughing episodes. wheezing and responds to bronchodilators. Inspiratory Whoop: The "whooping" sound is more common in children than in infants Acute bronchitis should also be considered; it or adults. causes persistent coughing, but typically lacks Apnea: Brief periods where breathing the characteristic “whoop” of pertussis and may stops, more common in infants. involve productive cough with sputum. Pneumonia presents with cough, fever, and Convalescent Stage: respiratory distress, but usually with productive cough in bacterial cases, unlike the dry cough of Gradual Recovery: The coughing fits pertussis. slowly decrease in frequency and severity. Lingering Cough: A mild cough may XI. Diagnostic workup persist for weeks to months. Specimens: The preferred method of Complications (especially in infants and acquiring specimens is to use a young children): nasopharyngeal swab or aspirate with saline. Pneumonia: A common complication that can lead to more severe outcomes. Direct Fluorescent Antibody Test: The Seizures: Can occur due to hypoxia during fluorescent antibody (FA) reagent can be severe coughing episodes. Encephalopathy: Rare but serious, can used to examine nasopharyngeal swab result from prolonged lack of oxygen to the specimens. However, keep in mind that its brain. sensitivity is only about 50%, so there’s a Rib Fractures: From severe coughing in chance of false positives or negatives. It's older children and adults. most useful after a culture has been done on solid media. These symptoms can vary in intensity, particularly in vaccinated individuals or those who have some Culture: we also culture NP aspirates or immunity from a previous infection​ swabs on solid media. The media contain  antibiotics to inhibit other respiratory microbiota, allowing B. pertussis to grow. INFECTION CONTROL MEASURES The organisms are then identified using Infection control is a key component of immunofluorescence staining or slide managing pertussis, particularly in agglutination with specific antiserum. hospital settings. Hospitalized patients with pertussis should Polymerase Chain Reaction: This is the be placed in respiratory isolation, with the most sensitive method for diagnosing use of precautions appropriate for pertussis. pathogens spread by large respiratory droplets. Isolation should continue for 5 Serology: This detects antibodies like days after initiation of macrolide therapy IgA, IgG, and IgM using enzyme or, in untreated patients, for 3 weeks (i.e., immunoassays. However, serologic tests until nasopharyngeal cultures are aren't very helpful early on, as antibodies consistently negative). don’t rise until the third week of illness. They’re more useful between 2 to 4 weeks Other information of illness or in cases where the cough has persisted for more than 4 weeks. PREVENTION XII. Principles of treatment & other info The best way to prevent pertussis is through immunization. Infants should receive the primary diphtheria-tetanus-pertussis (DTP3) series, administered as a combination vaccine known as DTaP, which includes doses at 2, 4, 6, and 15–18 months, followed by a booster at 4–6 years of age. ANTIBIOTICS To further protect against pertussis, Antibiotics aim to clear the bacteria from adolescents and adults are advised to the nasopharynx. Macrolides receive a single booster dose of tetanus, (azithromycin, clarithromycin, diphtheria, and acellular pertussis (Tdap). erythromycin) are the preferred choice. Additionally, to protect infants under 6 For those allergic to macrolides, months of age, pregnant women are trimethoprim-sulfamethoxazole is an encouraged to receive the Tdap vaccine alternative. Early treatment during the during pregnancy. catarrhal phase is most effective. BRONCHITIS (MYCOPLASMA PNEUMONIAE) SUPPORTIVE CARE Hospitalization is recommended for XIII. Epidemiology young infants and severe cases. Bacterial bronchitis is a common respiratory condition in A quiet environment helps reduce the Philippines, which may be due to Mycoplasma pneumoniae. It’s global, with upper respiratory infections coughing fits. from this pathogen being up to 20 times more common Use of beta-adrenergic agonists and/or than pneumonia. Clinical disease occurs in about 80% of glucocorticoids has been advocated by cases, with high intrafamilial attack rates (up to 84% in some authorities but has not been proven children, 41% in adults) with frequent institutional to be effective. Cough suppressants are outbreaks. not effective and play no role in the In the Philippines, M. pneumoniae significantly management of pertussis. influences bacterial bronchitis, a common respiratory condition. A 2020 study by De La host’s immune system, Salle University Medical Center ranked bacterial establishing colonization in bronchitis as one of the most prevalent lung the respiratory tract. conditions in the country. The Department of Health reported over 340,000 cases of acute 2. Epithelial Damage respiratory infections in early 2022, highlighting - Once attached, it releases its widespread impact. toxins, including hydrogen peroxide and an The incidence of bacterial bronchitis ADP-ribosylating and peaks during the wet season from June to vacuolating cytotoxin similar November due to high humidity and to pertussis toxin. crowded conditions, which facilitate its - These toxins damage the transmission. Key risk factors include air respiratory epithelial cells. pollution, smoking, pre-existing asthma, - The damage impairs the and the tropical climate. mucociliary clearance mechanism, which normally XIV. Pathophysiology helps to clear pathogens and debris from the M. pneumoniae is an atypical bacterium airways. lacking a cell wall, making it resistant to antibiotics like penicillins. It is a major 3. Immune Response Activation cause of respiratory infections, including - The injury to epithelial cells acute bronchitis. triggers an immune response. Its Infection Mechanism involves the - Inflammatory cells, following steps: including macrophages and neutrophils, are recruited to the site of infection. - Inflammatory mediators such as cytokines and chemokines are released, leading to increased mucus production and further inflammation. - Additionally, lipoproteins from the mycoplasmal cell 1. Attachment and Colonization membrane appear to have - It uses specialized proteins inflammatory properties, called adhesins to attach to probably acting through ciliated respiratory epithelial Toll-like receptors (primarily cells. TLR2) on macrophages and - This attachment is mediated other cells. by a terminal organelle at - Lung biopsy specimens the tip of the bacterium. from patients with bronchitis - The adhesins allow the may reveal a monocytic bacterium to evade the infiltrate that coincides with  a luminal exudate of polymorphonuclear leukocytes 4. Clinical Manifestations - The inflammation narrows the airways, resulting in symptoms such as a persistent cough, wheezing, and shortness of breath. - The excessive mucus production contributes to airway obstruction and exacerbates respiratory symptoms. 5. Impact of Environmental Factors - Factors such as air pollution and high humidity can worsen the infection. - These environmental conditions can exacerbate bronchial inflammation and prolong the recovery period. 6. Resolution and Recovery - The infection is generally self-limiting. - With appropriate immune response, symptoms usually resolve within few weeks. - Following severe infections, the immunity tends to be more protective and longer-lasting. - However, genuine second infections are rare. XV. Clinical Manifestations  doesn't always indicate a need for antibiotics. - Individuals with asthma or COPD may experience worsened symptoms, necessitating more intensive treatment. XVI. Ddx Allow me to give you some differentials in diagnosing patients that experience symptoms such as a dry cough which later becomes productive, along with fever, sore throat, fatigue, and chest discomfort. Aside from Acute bronchitis, These symptoms may present in other conditions like pneumonia, COPD, asthma, bronchiectasis, and influenza. Other symptoms and diagnostic results will help differentiate acute bronchitis from these other conditions: Pneumonia often presents with a productive cough, pleuritic chest pain, and localized lung findings like crackles, This is confirmed by a chest X-ray showing infiltrates, unlike acute bronchitis, which primarily involves inflamed Bacterial bronchitis caused by airways. Mycoplasma pneumoniae typically COPD is characterized by airflow obstruction presents with the following symptoms: that makes breathing difficult, often leading to - It typically begins with upper a use of accessory muscles. This condition is respiratory symptoms like a runny accompanied by a chronic history of cough nose, sore throat, and watery eyes and sputum production. Airflow obstruction - followed by a persistent, often dry observed on spirometry distinguishes COPD cough, the most common from acute bronchitis. presenting symptom that may later produce clear or yellowish sputum. Asthma is marked by recurrent wheezing - Patients commonly experience that frequently occurs upon exposure to mild fever, fatigue, headache, triggers, Nocturnal symptoms like coughing, chills, and malaise. shortness of breath that worsens at night or - Wheezing and shortness of breath early in the morning. These patterns differ are common, especially in those from those seen in acute bronchitis. with asthma, due to airway Bronchiectasis involves a chronic, productive inflammation. cough with large amounts of sputum or - Chest discomfort may occur from sometimes hemoptysis, often identified prolonged coughing. Though thick, through CT imaging showing bronchial purulent sputum can appear, it dilation.  Influenza typically causes sudden onset of individuals with neurocognitive impairment. In High grade fever, severe body aches and such instances, a more extensive workup headache. These systemic symptoms are should be considered part of the evaluation more prominent in influenza and help process. differentiate it from acute bronchitis. Chest x-ray (CXR) findings in cases of acute Evaluating these symptoms carefully and bronchitis are generally nonspecific and often using appropriate diagnostic tests is essential appear normal. The CXR findings may to accurately identify the underlying condition occasionally reveal increased interstitial and distinguish it from acute bronchitis. markings indicative of bronchial wall thickening. The purpose of this test is to XVII. Diagnostic workup exclude pneumonia. Laboratory testing, including a complete blood Let's walk through the step by step process to count and chemistry panel, may be conducted diagnose this condition. as part of the diagnostic workup for fever. The white blood count might show a mild elevation Step 1 is a COMPREHENSIVE in some cases of acute bronchitis. ASSESSMENT of the Medical History of the patient. Make sure to Inquire about symptoms C-Reactive Protein (CRP) Testing of persistent cough, sputum production, chest Differentiates between viral and bacterial discomfort, and fatigue, also note any infections. Viral infections usually have lower presence of fever and duration of symptoms. CRP levels. Pearls: Assess Exclusion to rule out Sputum Culture (Optional) will identify any respiratory conditions like pneumonia, bacterial pathogens if symptoms are severe or asthma, COPD based on patients history and persistent. symptoms. Spirometry (if indicated): will help to rule out Step 2 proceed with your PHYSICAL asthma or COPD. Acute bronchitis usually EXAMINATION to check for the vital signs shows normal spirometry results. such as Pulse rate to monitor for tachy or bradycardia, Temp. to look for fever as an indicator of inflammation, and Respiratory rate Additional testing (if necessary) includes to check for tachypnea that suggests Procalcitonin testing and Influenza testing respiratory distress. After that, proceed for to rule out influenza. Pulmonary examination by auscultation to listen for wheezing or rhonchi. An absence of To confirm a diagnosis of acute bronchitis, crackles or abnormal lung sounds can ensure that the clinical presentation aligns differentiate from pneumonia. Additionally, with typical symptoms such as a persistent percuss to assess for any dullness which cough, sputum production, and chest could indicate lung consolidation rather than discomfort, while ruling out other conditions acute bronchitis. through a comprehensive evaluation. Acute bronchitis is primarily diagnosed based on Pearls: In cases where vital signs fall within history and physical examination. Supporting normal ranges and no physical examination Evidence such as CXR, CRP, and sputum findings suggest pneumonia, further culture can aid in ruling out other conditions, diagnostic investigations are generally they are generally not required if the clinical unnecessary. However, an exception to this picture is clear. rule applies to older patients (>75 years) or XVIII. Principles of treatment & other info 2. Which bacteria is most often responsible In Acute Bronchitis, The symptoms often for causing Community-Acquired Pneumonia resolve on their own and lung functions go back to (CAP) in adults? normal , however, Supportive care such as hydration, proper rest and healthy diet will help boost your A) Streptococcus agalactiae immune system additionally, Symptoms can be B) Streptococcus pneumoniae relieved by taking OTC cough suppressants C) Staphylococcus aureus (antitussive drugs) like dextromethorphan for non D) Mycobacterium tuberculosis productive coughs and expectorants help loosen mucus to make it easier to expel or corticosteroids to 3. Which of the following is NOT typically reduce inflammation. Pain relievers such as acetaminophen or ibuprofen can help manage any included in the diagnostic workup for associated fever or discomfort. Community-Acquired Pneumonia (CAP)? Important to note is that antibiotic use should A) Chest X-ray to identify infiltrates or effusions be avoided in uncomplicated cases of acute B) Complete Blood Count (CBC) with Differential bronchitis, considering factors such as the cost of C) Urine Antigen Testing for bacterial pathogens antibiotics, the increasing global concern of antibiotic D) Echocardiogram to assess heart function resistance, and the potential side effects associated with antibiotic usage. 4.Which of the following is a common differential diagnosis for Community-Acquired Pneumonia (CAP)? A) Acute Bronchitis B) Pulmonary Embolism C) Chronic Obstructive Pulmonary Disease TEST BANK (COPD) D) Tuberculosis Questions 1-5: Community Acquired 5. Which of the following pulmonary signs Pneumonia (Streptococcus pneumoniae) and symptoms is commonly associated with the local inflammatory response in 1. Which of the following best describes the Community-Acquired Pneumonia (CAP)? progression of Community-Acquired Pneumonia (CAP)? A) Chest pain and bradycardia B) Cough, sputum production, and crackles A) Pathogens infect the bronchi, causing C) Abdominal pain and vomiting inflammation and immune suppression. D) Hypertension and peripheral edema B) Pathogens enter the lungs, triggering inflammation that leads to fluid and debris accumulation in the alveoli. Questions 6-10: Whooping Cough aka C) The immune system fails to respond, allowing Pertussis (Bordetella pertussis) pathogens to freely spread throughout the body. D) Pathogens primarily affect the bloodstream, 6. Pertussis, also known as whooping causing systemic infection without lung cough, is a highly contagious respiratory involvement. disease caused by the bacterium _______. a. Bordetella pertussis  b. Bordatella pertusis Questions 11-15: Bronchitis (Mycoplasma c. Mycobacterium tuberculosis pneumoniae) d. Staphylococcus aureus 11. The incidence of acute bronchitis usually peaks during what season in the Philippines? 7. What were the 3 stages of the said disease? A. Dry a. Early, Paroxysmal, and Catarrhal Stage B. Wet b. Hot, cold, and warm stage C. Not seasonal c. Catarrhal, Paroxysmal, and D. Both seasons Convalescent Stage d. Stage 1, 2, and 3 12. Mycoplasma pneumoniae is an atypical bacterium lacking a________, making it resistant 8. Which antibiotic is commonly used as the to antibiotics like penicillins. first-line treatment for pertussis? A. Nucleus A. Penicillin B. Cell membrane B. Azithromycin C. Cell Wall C. Ciprofloxacin D. Cytosol D. Doxycycline Answer: B. Azithromycin 13. What is the most common manifestation of acute bronchitis? 9. What is the recommended preventive A. High fever measure for pertussis in infants? B. Sore throat A. Annual influenza vaccination C. Persistent night sweats B. Diptheria-tetanus-pertussis (DTaP) series D. Cough C. High-dose vitamin C D. Prophylactic antibiotics 14.Which of the following clinical findings is more indicative of pneumonia rather than acute bronchitis? Answer: B) Diptheria-tetanus-pertussis (DTaP) series A. Dry cough that later becomes productive B. Wheezing and episodic breathlessness 10. Which diagnostic method is the most C. Focal lung crackles and infiltrates on chest sensitive for detecting pertussis? X-ray A. Direct Fluorescent Antibody Test D. Sore throat and fatigue B. Culture on solid media C. Polymerase Chain Reaction (PCR) 15.Which of the following is the primary treatment D. Serology approach for a patient diagnosed with acute bronchitis? Answer: C) Polymerase Chain Reaction (PCR) A) Immediate antibiotic therapy B) Supportive care and symptomatic relief C) High-dose corticosteroids D) Sputum culture to guide treatment REFERENCES: Measles and pertussis outbreaks a wake-up call for thPhilippines. 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