Podcast
Questions and Answers
In the context of respiratory tract infections, what is the most critical role of alveolar macrophages?
In the context of respiratory tract infections, what is the most critical role of alveolar macrophages?
- Secreting mucus to trap pathogens
- Phagocytosis of pathogens (correct)
- Initiating the cough reflex
- Producing IgA antibodies
A patient presents with a chronic cough, fever, and night sweats. Which diagnostic approach would be most effective in determining if Streptococcus pyogenes is the causative agent?
A patient presents with a chronic cough, fever, and night sweats. Which diagnostic approach would be most effective in determining if Streptococcus pyogenes is the causative agent?
- Chest X-ray
- Sputum culture (correct)
- Blood culture
- Rapid Strep Test
How does normal microbiota in the upper respiratory tract protect against potentially harmful pathogens?
How does normal microbiota in the upper respiratory tract protect against potentially harmful pathogens?
- By stimulating excessive inflammation.
- By directly attacking and destroying pathogens through phagocytosis.
- By creating a physical barrier that prevents pathogen attachment.
- By competing for resources and producing antimicrobial substances. (correct)
Why is treatment with macrolides not always the first-line choice for Streptococcus pyogenes infections?
Why is treatment with macrolides not always the first-line choice for Streptococcus pyogenes infections?
A young child presents with a barking cough, stridor, and hoarseness. What is the most likely etiological agent causing these symptoms?
A young child presents with a barking cough, stridor, and hoarseness. What is the most likely etiological agent causing these symptoms?
An elderly patient with diabetes presents with severe otitis externa. Cranial nerve palsy is noted during examination. What complication is most suspected?
An elderly patient with diabetes presents with severe otitis externa. Cranial nerve palsy is noted during examination. What complication is most suspected?
Why is dacron a preferred material for swabs used in microbiological investigations of respiratory infections?
Why is dacron a preferred material for swabs used in microbiological investigations of respiratory infections?
What is the rationale behind using a combination of clindamycin/vancomycin plus cefotaxime/ceftriaxone in treating epiglottitis?
What is the rationale behind using a combination of clindamycin/vancomycin plus cefotaxime/ceftriaxone in treating epiglottitis?
Under what circumstances would a microbiological investigation NOT be recommended for acute rhinosinusitis?
Under what circumstances would a microbiological investigation NOT be recommended for acute rhinosinusitis?
Why are viral respiratory infections the deadliest infectious diseases?
Why are viral respiratory infections the deadliest infectious diseases?
What is the key distinction between viral and bacterial pharyngitis?
What is the key distinction between viral and bacterial pharyngitis?
What is the clinical significance of identifying Corynebacterium diphtheriae tox+ in a patient?
What is the clinical significance of identifying Corynebacterium diphtheriae tox+ in a patient?
What is the rationale behind using penicillin and metronidazole in the treatment of Plaut-Vincent angina?
What is the rationale behind using penicillin and metronidazole in the treatment of Plaut-Vincent angina?
What factor is most likely to shift the bacterial community composition in the upper respiratory tract (URT), leading to dysbiosis?
What factor is most likely to shift the bacterial community composition in the upper respiratory tract (URT), leading to dysbiosis?
What is the primary mechanism by which the mucociliary escalator protects the respiratory tract?
What is the primary mechanism by which the mucociliary escalator protects the respiratory tract?
What is the significance of detecting anti-streptolysin O (ASO) antibodies in a blood sample from a patient with a recent Streptococcus pyogenes infection?
What is the significance of detecting anti-streptolysin O (ASO) antibodies in a blood sample from a patient with a recent Streptococcus pyogenes infection?
A patient is diagnosed with acute bronchitis but lacks tachycardia, tachypnea, or fever. What diagnostic procedure should be performed to inform treatment?
A patient is diagnosed with acute bronchitis but lacks tachycardia, tachypnea, or fever. What diagnostic procedure should be performed to inform treatment?
What characterizes the cough associated with laryngotracheobronchitis?
What characterizes the cough associated with laryngotracheobronchitis?
What is a concerning diagnosis of a patient experiencing symptoms of otitis media and exhibiting the additional symptom of severe ear pain?
What is a concerning diagnosis of a patient experiencing symptoms of otitis media and exhibiting the additional symptom of severe ear pain?
A patient who is experiencing the symptoms of brochitis experiences a cough for more than the average of 14 days, what should be suspected?
A patient who is experiencing the symptoms of brochitis experiences a cough for more than the average of 14 days, what should be suspected?
A patient presents with fever, chills, and a productive cough. Auscultation reveals crackles in the lower lobe of the right lung. What is the best diagnosis?
A patient presents with fever, chills, and a productive cough. Auscultation reveals crackles in the lower lobe of the right lung. What is the best diagnosis?
What critical factor determines whether a patient with suspected diphtheria should receive immediate treatment?
What critical factor determines whether a patient with suspected diphtheria should receive immediate treatment?
Which of the following pathogens is most commonly associated with causing community-acquired pneumonia in adults?
Which of the following pathogens is most commonly associated with causing community-acquired pneumonia in adults?
In a patient with a suspected lower respiratory tract infection, which symptom is more indicative of pneumonia rather than bronchitis?
In a patient with a suspected lower respiratory tract infection, which symptom is more indicative of pneumonia rather than bronchitis?
Which of the following is the most common cause of bronchiolitis in infants and young children?
Which of the following is the most common cause of bronchiolitis in infants and young children?
When community-acquired pneumonia is suspected the most effective is test is a.
When community-acquired pneumonia is suspected the most effective is test is a.
If a patient gets over 3 cases of otitis media during 6 months what should be suspected.
If a patient gets over 3 cases of otitis media during 6 months what should be suspected.
What role is played by cilia?
What role is played by cilia?
What are some of the symptoms of bacterial pharyngitis?
What are some of the symptoms of bacterial pharyngitis?
For which form of an sinus infection a Microbiological investigation NOT recommended?
For which form of an sinus infection a Microbiological investigation NOT recommended?
With what kind of infection would you find symptoms of weakness and sore throat plus swollen.
With what kind of infection would you find symptoms of weakness and sore throat plus swollen.
In the upper respiratory tract which of the following are classified as colonization?
In the upper respiratory tract which of the following are classified as colonization?
Which of this factors won't disrupt of protective mechanism.
Which of this factors won't disrupt of protective mechanism.
A child presents with rapid onset of fever, difficulty swallowing, drooling, and is in a tripod position. What condition indicates these?
A child presents with rapid onset of fever, difficulty swallowing, drooling, and is in a tripod position. What condition indicates these?
The infection covers the entire lobe of a lung, running often with involvement of the pleura and pleural effusion in. what is the cause?
The infection covers the entire lobe of a lung, running often with involvement of the pleura and pleural effusion in. what is the cause?
Which of the factor below poses the biggest risk infection from infection?
Which of the factor below poses the biggest risk infection from infection?
What is this condition caused by? Sore throat Swollen tonsils (usually only one side)?
What is this condition caused by? Sore throat Swollen tonsils (usually only one side)?
A swab sample being tested must use a specific material, which one is it?
A swab sample being tested must use a specific material, which one is it?
When there's been reoccurence in Strep what is the second line of defense?
When there's been reoccurence in Strep what is the second line of defense?
What is the most accurate method for identifying the etiological agent in a case of acute bronchitis?
What is the most accurate method for identifying the etiological agent in a case of acute bronchitis?
What is given when someone has Diphtheria?
What is given when someone has Diphtheria?
Which of the treatment given below is the best to administer to patients between 4 months - 5 years that have penumonia.
Which of the treatment given below is the best to administer to patients between 4 months - 5 years that have penumonia.
In the upper respiratory tract, what distinguishes colonization from carriage in the context of bacterial presence?
In the upper respiratory tract, what distinguishes colonization from carriage in the context of bacterial presence?
What is the rationale behind the recommendation to avoid aminoglycosides in treating otitis externa when the tympanic membrane is perforated?
What is the rationale behind the recommendation to avoid aminoglycosides in treating otitis externa when the tympanic membrane is perforated?
What is the clinical implication of detecting both anti-streptolysin O (ASO) and anti-deoxyribonuclease B (Anti-DNaseB) antibodies in a patient suspected of Streptococcus pyogenes infection?
What is the clinical implication of detecting both anti-streptolysin O (ASO) and anti-deoxyribonuclease B (Anti-DNaseB) antibodies in a patient suspected of Streptococcus pyogenes infection?
How does the presence of a pseudomembrane in the throat or nose of a patient with suspected diphtheria affect the immediate course of treatment?
How does the presence of a pseudomembrane in the throat or nose of a patient with suspected diphtheria affect the immediate course of treatment?
What is the significance of identifying Corynebacterium diphtheriae tox+ in a microbiological investigation, and how does it influence treatment decisions?
What is the significance of identifying Corynebacterium diphtheriae tox+ in a microbiological investigation, and how does it influence treatment decisions?
In the context of acute rhinosinusitis, what is the primary rationale for recommending watchful waiting and symptomatic treatment for viral infections?
In the context of acute rhinosinusitis, what is the primary rationale for recommending watchful waiting and symptomatic treatment for viral infections?
What are the key risk factors that increase the likelihood of developing malignant otitis externa, and how does this inform treatment strategies?
What are the key risk factors that increase the likelihood of developing malignant otitis externa, and how does this inform treatment strategies?
Considering the bacterial etiology of acute otitis media, which factor most significantly influences the choice between amoxicillin and amoxicillin+clavulanic acid as initial treatment?
Considering the bacterial etiology of acute otitis media, which factor most significantly influences the choice between amoxicillin and amoxicillin+clavulanic acid as initial treatment?
In what circumstance would antibiotic treatment be most warranted in a patient presenting with acute bronchitis symptoms?
In what circumstance would antibiotic treatment be most warranted in a patient presenting with acute bronchitis symptoms?
How do bacterial-bacterial interactions in the upper respiratory tract (URT) influence the translocation of dysbiotic bacterial communities to the lower respiratory tract (LRT)?
How do bacterial-bacterial interactions in the upper respiratory tract (URT) influence the translocation of dysbiotic bacterial communities to the lower respiratory tract (LRT)?
In the context of protective mechanisms in the respiratory tract, how does the mucociliary escalator function differently in the trachea compared to the nasal cavity?
In the context of protective mechanisms in the respiratory tract, how does the mucociliary escalator function differently in the trachea compared to the nasal cavity?
What underlying mechanisms can explain why certain viral respiratory infections result in higher mortality rates compared to bacterial respiratory infections, despite advancements in antiviral therapies?
What underlying mechanisms can explain why certain viral respiratory infections result in higher mortality rates compared to bacterial respiratory infections, despite advancements in antiviral therapies?
What is the significance of fever in bacterial throat infection?
What is the significance of fever in bacterial throat infection?
How do the initial symptoms of viral and bacterial sinusitis typically differ?
How do the initial symptoms of viral and bacterial sinusitis typically differ?
A patient presents with Plaut-Vincent likely has what symptoms?
A patient presents with Plaut-Vincent likely has what symptoms?
What type of swab must a be used to get the sample?
What type of swab must a be used to get the sample?
What factor is the most important to avoid when you want to protect yourself from infection?
What factor is the most important to avoid when you want to protect yourself from infection?
In cases of acute epiglottitis, especially in children, what is the most concerning immediate risk that guides clinical management?
In cases of acute epiglottitis, especially in children, what is the most concerning immediate risk that guides clinical management?
What role does cough play as a protective mechanism of the respiratory system?
What role does cough play as a protective mechanism of the respiratory system?
If a 2 year old has gotten ear infections 3 times in a 6 month period what should be considered?
If a 2 year old has gotten ear infections 3 times in a 6 month period what should be considered?
What are the main etiological caused of Laryngitis?
What are the main etiological caused of Laryngitis?
What action should be taken when a patient has a score of 4 in a throat infection?
What action should be taken when a patient has a score of 4 in a throat infection?
What are some of the main viral infections?
What are some of the main viral infections?
In treating infections of lower respiratory tract, what are some of the main signs?
In treating infections of lower respiratory tract, what are some of the main signs?
At what stage is disease a pertussis most contagious?
At what stage is disease a pertussis most contagious?
Why are the infections related to respiratory tract the deadliest disease?
Why are the infections related to respiratory tract the deadliest disease?
What factors below don't disrupt the protective mechanisms of the respiratory tract?
What factors below don't disrupt the protective mechanisms of the respiratory tract?
What's true of the mucus membrane?
What's true of the mucus membrane?
What is the reasoning for the isolation of Diphtheria patients after they start antibiotic treatment?
What is the reasoning for the isolation of Diphtheria patients after they start antibiotic treatment?
Flashcards
Respiratory Tract Defenses
Respiratory Tract Defenses
Protective mechanisms of the respiratory tract include: epithelial tissue with short, thick hair in nostrils, mucous membrane in nasal cavity, cough reflex in throat, and mucous/cilia in trachea and bronchi.
Normal flora of URT
Normal flora of URT
The upper respiratory tract's normal microbiota includes Streptococcus viridans, coagulase-negative Staphylococcus, Corynebacterium spp., Neisseria spp., and Heamophilus spp. (excluding specific pathogenic strains).
Carriage Bacteria (URT)
Carriage Bacteria (URT)
Streptococcus pneumoniae, Staphylococcus aureus, Heamophilus influenzae, and Streptococcus pyogenes are bacteria commonly carried in the upper respiratory tract without causing active infection.
Colonization (URT)
Colonization (URT)
Gram-negative rods (ESBL, KPC, MBL), Enterococcus spp. (GRE/VRE), and Candida spp. commonly colonize the upper respiratory tract without necessarily causing an infection.
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Compromised Defenses
Compromised Defenses
Disorders affecting respiratory defenses that increase susceptibility to infection include advanced age, smoking, COPD, chemical exposure, anesthesia, mechanical injury, allergies, and structural abnormalities (nasal septum deviation, polyps).
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Impact of RTIs
Impact of RTIs
Respiratory tract infections are the deadliest infectious diseases, ranking as the fourth leading cause of mortality worldwide.
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Common cause of Sore throat
Common cause of Sore throat
Pharyngotonsillitis is caused by viral infections in 80% of cases.
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Bacterial acute sore throat
Bacterial acute sore throat
Bacterial contributors to Acute sore throat include Streptococcus pyogenes, Corynebacterium diphtheriae, Bordetella pertussis, and Fusobacterium fusiforme/ Borrelia vincentii
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Viral vs. Bacterial Throat
Viral vs. Bacterial Throat
Viruses cause runny nose, diarrhea, muscle pain, cough, whereas exudate is more characteristic of bacterial throat infections.
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Centor/McIsaac Criteria
Centor/McIsaac Criteria
The Centor/McIsaac scores assess Streptococcus pyogenes sore throat likelihood using fever, cough, lymph nodes, and tonsillar exudates.
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Strep Test (RAT)
Strep Test (RAT)
A throat swab is needed for definitive bacterial diagnosis and treatment
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Treatment for Strep
Treatment for Strep
First line of the bacterial acute sore throat treatment consist of Penicillin or Amoxicillin.
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Diphtheria basics
Diphtheria basics
Corynebacterium diphtheriae causes diphtheria, spread via respiratory droplets or contact, characterized by a pseudomembrane in throat or nose.
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Plaut-Vincent Angina
Plaut-Vincent Angina
Plaut-Vincent angina is caused by mixed bacteria such as Bacillus fusiformis, Spirochaeta denticolata,, and anaerobic Streptococcus spp., leading to sore throat and swollen tonsils.
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Sinusitis Causes
Sinusitis Causes
Sinusitis often presents with viral etiology, but can also be initiated by bacteria like Streptococcus pneumoniae.
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Treating Bacterial Rhinosinusitis
Treating Bacterial Rhinosinusitis
Antibiotics like amoxicillin, or amoxicillin with clavulonic acid are a crucial treatment for bacterial Acute rhinosinusitis.
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Epiglottitis organisms
Epiglottitis organisms
Epiglottitis is often lead by Haemophilus influenzae or staphylococcus aureus, in addition to streptococcus pyogenes.
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Laryngitis causes
Laryngitis causes
Laryngitis or Larynx inflammation is usually caused by influenza viruses , leading to hoarseness, aphonia and disorder respiration.
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Croup's Cause
Croup's Cause
Croup is characterized by cough, generally caused by Parainfluenza virus (type 1).
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Otitis Externa
Otitis Externa
Otitis externa is inflammation of the external ear canal,
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Middle Ear Infection
Middle Ear Infection
The middle ear infection or Otitis media is caused by the ascending route through the auditory tube from pharynx.
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Bronchitis Causes
Bronchitis Causes
Bronchitis is often a viral infection with flu virus, COVID 19, adeno and rhino virus
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Causes of pneumonia: Typical vs Atipical
Causes of pneumonia: Typical vs Atipical
Typical pneumonia include exudatum in light, wheras in community-acquired the causes may vary from respiratory syncytial to mycoplasma, to haemophilus.
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Adult acquired pneumonia causes
Adult acquired pneumonia causes
Bacterial agents frequently causing pneumonia in adults include Streptococcus pneumoniae, Klebsiella pneumoniae, viral agents RSV Rhinovirus can also lead to infection.
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Treatment of Pneumonia
Treatment of Pneumonia
Treatment varies from antibiotic, clarythromycin azytro depending on the age and severity.
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- Respiratory tract infections are the deadliest infectious diseases, ranking fourth in worldwide mortality with 2,603,913 deaths reported in 2019.
Protective Mechanisms of the Repiratory Tract
- Nostrils feature epithelial tissue with short thick hairs to stop particles >10 microns
- The nasal cavity contains a multi-layered epithelium mucous membrane
- The nasal cavity is involved in filtration, heating, and humidification of air
- The throat uses a cough to expel material
- The trachea and bronchi have a mucous layer and ciliated epithelium
- Cilia accumulates and excretes particles ≤5 mm in the trachea and bronchi
Other Protective Measure
- Alveolar macrophages perform phagocytosis, which includes chemotactic factors for PMN.
- IgG in lower respiratory tract facilitates opsonization and lysis of bacteria with complement.
- Antimicrobial agents (lysozyme and IgA), sneezing, expectoration, and swallowing impulses provide non-specific and specific protection
- Normal microbiota is present only in the upper respiratory tract
Bacterial Microbiota of the Upper Respiratory Tract
- The Streptococcus viridans group is normal microbiota
- Coagulase-negative Staphylococcus is normal microbiota
- Corynebacterium spp. is normal microbiota (excluding C. diptheriae and C. ulcerans)
- Neisseria spp. is normal microbiota (excluding N. meningitidis and N. gonnhorraea)
- Haemophilus spp. is normal microbiota (excluding H. influenzae)
Bacterial Carriage
- Streptococcus pneumoniae
- Staphylococcus aureus
- Haemophilus influenzae
- Streptococcus pyogenes
Bacterial Colonisation
- Gram-negative rods (ESBL, KPC,MBL)
- Enterococcus spp. (GRE/VRE)
- Candida spp.
Disorders of Protective Mechanisms
- Risk factors include age >65, smoking, chronic obstructive pulmonary disease (COPD), chemical compounds, general anesthesia drugs, mechanical injury via ventilator equipment, allergies and asthma, nasal septum issues, polyps and mucosal injury
Upper vs Lower Respiratory Tract Infection
- Imbalances in upper respiratory tract (URT) bacterial communities may result in translocation of dysbiotic bacterial communities to the lower respiratory tract (LRT), causing infection.
- Commensal bacteria with low pathogenic potential confer colonization resistance against potential pathogens
- Bacterial communities from the URT translocate to the lungs and are detected as stable resident or transient LRT communities
- URT Bacterial-bacterial interactions can be competitive or synergistic, allowing potential pathogens to colonize
- Environmental exposures directly impact on select bacteria within the community.
- Pathogen exposure, viral-bacterial & bacterial-bacterial interactions & environmental risk factors can cause damage to the URT epithelium.
- Dysbiotic bacterial communities can translocate to the LRT and cause inflammation
Infections of the Upper Respiratory Tract
- Pharyngitis and tonsillitis
- Inflammation of the nasal cavity and paranasal sinuses
- Inflammation of the epiglottis
- Inflammation of the larynx
- Otitis externa (external acoustic meatus) and otitis media (middle ear cavity)
Infection Progression
- Typically progress from Viruses to Bacterial
Pharyngitis and Tonsillitis Details
- Also known as pharyngotonsillitis or acute sore throat
Viral causes of Pharyngitis and Tonsillitis (~80% of cases)
- Adenoviral pharyngitis
- Epstein-Barr Virus (EBV)
- Acute herpetic pharyngitis - Herpes simplex virus (HSV, type 1)
- Enteroviral pharyngitis - Coxsackie Virus (type A)
- Cytomegalovirus (CMV)
Bacterial causes of Pharyngitis and Tonsillitis (~20% of cases)
- Streptococcus pyogenes, Streptococcus A, C or G group - streptococcal sore throat
- Corynebacterium diphtheriae - diphtheria sore throat
- Bordetella pertussis – pertussis – whooping cough
- Fusobacterium fusiforme, Borrelia vincentii - Plaut-Vincent angina
Differentiation of bacterial vs viral infection
| Differentiation point | Viruses | Bacteria |
|---|---|---|
| Medical Evaluation | Runny nose, diarrhea, muscle pain, cough, hoarseness, low-grade fever | Sudden onset, contact with bacterial pathogen in past two weeks, fever, nausea, age 5-15 |
| Physical exam | Conjunctivitis, edema and erythema of the pharynx, no exudate on tonsils | exudate and swelling of mucous membrane of the tonsils, swollen and painful glands in neck front |
- exudate is present in adenovirus infections and in cystic fiber patients
Centor/McIsaac criteria for diagnosing Strep throat.
- Fever of >38°C (+1)
- Cough Absent (+1)
- Swollen or Painful Anterior Cervical Nodes (+1)
- Tonsillar Exudate or Swelling (+1)
- Age 3-14 yr (+1)
- Age 15-44 (+0)
- Age Over 45 yr (-1)
Recommended Testing and Treatment Options According to Score
- 0-1 points: no antibiotics or testing
- 2-3 points: Rapid strep test or throat swab
- 4+ points: Throat swab + antibiotics
Streptococcal pharyngitis - microbiological investigation
- Tonsil swab:
- RAT: Rapid Strep Test only for Streptococcus pyogenes
- If RAT negative in adults, it is negative
- If RAT negative in children, throat swab necessary
- Culture all beta-hemolytic Strepto strains and other pathogens to confirm pharyngitis caused by Streptococcus pyogenes
- RAT: Rapid Strep Test only for Streptococcus pyogenes
Blood sample (only for non suppurative complications of S. pyogenes infections)
- Anti-streptolysin O antibodies (ASO) – tested to check carrier status
- Anti-deoxyribonuclease B antibody (Anti-DNaseB) tested for illness
Recommended Treatments
- Viruses - no antibiotics
- Streptococcus pyogenes
- First-line therapy:
- Penicilin V / Phenoxymethyl penicillin – oral for 10 days
- Cefadroxil, cefaclor - for people with penicillin allergy, for 10 days
- eradicates S. pyogenes carriers
- Marcolides – only in patients with allergy to beta-lactams and after susceptibility confirmation
- First-line therapy:
- Streptococcus pyogenes is inherently resistant to co-trimoxasole
Second-line treatment if initial treatment of Step throat failed
- Cefadroxil for 10 days
- Clindamicin for 10 days
- Benzylpenicillin – one dose in muscle injection
- Tonsillectomy – not proven, nor recommended to reduce GAS pharyngitis
Consequences of untreated Strep Throat
- Untreated Streptococcus pyogenes infection leads to complications: acute rheumatic fever and poststreptococcal glomerulonephritis
Diphtheria Details
- Diphtheria caused by Corynebacterium diphtheriae bacterium
- Spread: Person to person, Respiratory droplets, Contact with an infected object (toy, cloths)
- Corynebacterium diphteriae tox+ forms a thick, gray "pseudomembrane" coating in the throat or nose within 2-3 days.
- Symptoms of diphtheria include weakness, sore throat, fever, swollen neck glands.
- The toxin can damage the heart, kidneys, and nerves via the bloodstream.
- Diagnosed by signs, symptoms, swab of throat back (dacron swab), skin lesion (sample), Neisser/Albert staining Blood test -IgM & IgG are the common markers for detection
- Start treatment ASAP, if doctor suspect diphtheria
- Treatment: Use diphtheria antitoxin to stop the toxin, use antibiotics: penicillin and erythromycin Diphtheria patients are usually kept in isolation for ~48 hours after starting antibiotics.
Plaut-Vincet Angina
- Is caused by mixed bacteria: Bacillus fusiformis, Spirochaeta denticolata, anaerobic Streptococcus spp.
- Usually in men
- Signs and symptoms: Sore throat, swollen tonsils (usually only one side) Microscopic slides as microbiological investigation, no need culture! Penicillin + metronidasole for the treatment.
Inflammation of the nasal cavity and paranasal sinuses
- is Sinusitis
- Etiology:
- Viruses: Rhinovirus and Parainfluenza viruses
- Bacteria: Streptococcus pneumoniae, Streptococcus group A, C and G, Staphylococcus aureus and Corynebacterium ulcerans
- Rare forms:
- Nasal diphtheria via Corynebacterium diphtheriae
- scleroma via Klebsiella rhinoscleromatis
- Ozaenae via Klebsiella ozaenae
- Etiology:
Acute rhinosinusitis
- Diagnostics are based on symptoms
- Viral: Symptoms <10 days
- Postviral: Symptoms worsen after 5 days/persist more than 10 days
- Bacterial: ≥3 symptoms at the same time:
- Purulent nasal discharge
- Severe local pain
- Fever >39°C, increase in CRP, worsened initial symptoms
Acute Rhinosinusitis Testing
- Is usually not recommended
- Only done if severs
- Specimen:
- Fluid collected during sinus puncture
- Collected from the middle nasal turbinate under endoscope control
Acute Rhinosinusitis Treatment
- Viral Acute Infection:
- Watchful Observation
- Care nasal cavity rinses
- Anti-inflammatory use, like ibuprofen
- Antihistamine use, like pseudoephedrine
- Postviral Acute Infection:
- Secretolytic herbal medicines
- Topical steroids
- Bacterial Acute infection:
- Antibiotic
- Amoxicillin / amoxicillin with clavulonic acid at a high dose for 10 days
- topical steroids
Inflammation of the Epiglottis
- Typically effects children <5 years old
- Etiology: Haemophilus influenzae type B, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, viruses
- Prophylaxis using the Hib vaccine
- Treatment Clindamicin/Vancomicin + Cefotaxim/Ceftriaxon
Inflammation of the Larynx (laryngitis)
- Symptoms: hoarseness, aphonia, difficulty breathing
- 90% from viral causes: Influenza Virus, Parainfluenza (types 1, 2, 3), Rhinoviruses and Adenoviruses
- Only 10% from Bacterial causes: Streptococcus pyogenes, Moraxella catarrhalis, and Chlamydia pneumoniae
- Treatment: clarythromycin or azithromycin
Croup Details
- Croup is also know as laryngotracheobronchitis
- Etiology Parainflunza virus (type 1) in 75% of cases, all respiratory viruses
- Signs and symptoms take 2–5 days:
- Fever
- Hoarseness
- Sore throat
- "Barking seal" cough- harsh, raspy sound („stridor”) during inspiration
- Diagnosis: Signs and Symptoms
- Treatment:
- Steroids, Oral or Muscle
- Epinephrine by Nebulization
- Ibuprofen
Otitis Externa
- Is inflammation of the external acoustic meatus
Otitis Externa Etiology
- "Skin pathogens”
- Pseudomonas aeruginosa – swimmer's ear
- Risk factors: Local trauma, Furunculosis, foreign bodies, Excessive moisture (maceration of external ear epithelium)
Malignant Otitis Externa
- It is more severe
- Can progress to cartilage/bone invasion
- Rare - can lead to cranial nerve palsy and death
- Specific for the elderly, specific for those with diabetes, hosts of any age
Otitis Externa Treatment
-
For Middle Form: Local antibiotic therapy ciprofloxacin +/ steroids
-
gentamicin
note: ototoxicity of aminoglycosides increases with time
Note: do not use aminoglycosides with tympanic membrane perforation - For Acute form: Local antibiotic therapy + antibiotic in vena (4-6 weeks) - cephalosporins - co-trimoxazole - aminoglycosides + ciprofloxacin when in hospitals
- Note on ciprofloxacin in local treatment is 1,000 more effective than intravenous
Otitis Media
Acute form - sudden occurence of otitis media symptoms Recurrence - 3 and more otitis media cases during 6 months Children < 3 years old – 50-84% cases of otitis media Etiology: Viruses: RS Virus, Rinovirus, Coronavirus, Flu Virus Bacteria (ascends through auditory tube): Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Symptoms may lead to self-limited Ussullay, or Treatment (antibiotics) based on otoscopic exam
- Runny nose
- Cough
- Severe pain
- Fever
- Vomiting
- Secretion form the ear
- Sudden sign occurence
- Red tympanic membrane
- Fluid in tympanum
- acute – sudden onset of symptoms, ailments; inflammatory process of middle ear
- recurrent – at least 3 cases in 6 months or at least 4 in 12 months
Otitis Media Treatment
- Immediate antibiotic treatment is needed
- Immediate antibiotic therapy:
- Children <6 months old
- Children aged 6-24 months old w/ vomiting, high fever, bilateral otitis
- Children w/ craniofacial malformations
- Pts w/ secretion from era
- Use:
- Amoxicilin for 10 days
- If doubtful
- Give adults over 6 months old
Use:
- Ibuprofen/paracemol -Amoxicillin Then If pt. has improv. 5 days adults/children >2yrs 10 days children <2 yrs Second line drugs - - therapeutic failure / children from nurseries / antibiotic therapy last year
- Amoxicillin+clavulonic acid
- amoxicilin
- cefuroxim
- Macrolides
Infections of Lower Respiratory Tract
- Inflammation of the bronchi (bronchitis),
- Bronchiolitis in newborn babies children < 2 years
- Inflammation of the lungs (pneumonia)
- Lung abscess
Details regarding deaths according to age group
- Increasing in accordance to the age
Infections details
- Diagnostics: Clinical ,Radigical,Microbiological exams
- Symptoms are
- Cough
- Fever >38°C
- Increased mucus expectoration
- Wheezing
Risk Factors
- Massive Invasion bacteria
- Highly Virulent or toxic bacteria
- Affinity for lungs like:
- Streptococcus pnaumoniae
- Klebsiella Pnaumoniae
- Legionella Pnaumoniae
- Weak defence mechanisms
Routes of infections
- Exogenous air
- Endogenous from bacteria
- Medical like VAP- ventilation acquired pnaumonia
- The blood system
Bronchitis Details
- 99% caused by viruses, : flu, COVID-19, flu-like, adenoviruses, rhinoviruses, coronaviruses, RSV, Coxsackie Virus.
- 1% – bacteria: Mycoplasma spp., Chlamydophila pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
acute bronchitis recognition:
- Symptoms of Cough, tachycardia, tachypnoe fever auscultation
- Patients > 75 years old needs RTG
- Patients from risk groups needs aFLU
- In children use of bronchiolitis use aRSV
- Diagnostics antigen/RNA RSV in nasopharyngeal aspirate
- Diagnosis is not routine -Tests with use Throat swab BAL Sputum Nasal aspirates
| Symptom | Flu | Common cold |
|---|---|---|
| Begin | Rapid | Slowly |
| Fever | 37.7-40°C | Rare, below 37.7°C |
| Muscul pain | Often, strong | Rare |
| Join pain | Often, strong | Rare |
| Lack of appetite | Often | Rare |
| Head pain | Often, strong | Rare |
| Couhg | Often, strong | Restrainedly |
| Weakness | Strong, 2-3 weeks | Restrainedly |
| Pain in the chest | Often, strong | Restrainedly |
| Troat infection | Rare | Often |
| Sneezing | Rare | Often |
| Stuffy nose | Rare | Often |
Treatment and what to use
- Symptomatic: nebulization in hospital-treatment
- Anti-viral: Adamantanes only flu A treat, high resistant strains.
- Neuraminidase inhibitor , use - oseltamivir – prophylactic and flu cases
- Antibacterial: macrolides (cough > 14 days, pertussis suspect
Pertussis(whooping cough)
- Is a diease caused by Berdetella pertussis
- Stage:
- Catarrhal; 1-2 weeks;contagious. Runny high contagious
- Paroxysmal last for week, rapid coughs, followed by whoop sound vomiting
- Covalescent lasts for weeks in respect to others respiratory infections, caughing return
- It means test and investigate
- Contgious
- Swab is recommended
- Vaccinate test use
- Macrolides 7 day
- Co-trimoxazole to 14 days Pneumonia :is a Inflammation of the lungs (pneumonia) defined if fever, chills, cough, Tachypnoe , in adults or adults Changes in sounds/ wheezing and crackles Percussion resanance / bronchial
Exudatum in is is exudatum
- bronchopneumonia /bronchitis
- Covers lobe effusion
Atypical - interstitial pneumonia
Pneumonia/atypical
- Incubation period , infection in wintermonths
- Causes is headaches
- Treatment , macrolides Agents - Causes by Severe /Respiratory Syndroms - middle east
pneumonia aetiology
Newbron infants ( <= 20 years old
- S, Group , Eschrichia & Cytomegaloviru
Children s ( 3 weeks 3 months old )
Chlaysidia virus Rsv , Para influenza
Children ( 4month -<=4 year old
Comminity-acquired/RSV.Influenz and Rhinoviusr
children (5 -15 years old)
. Streptococcus pneumoniaa & Mycoplama pneumonia
Hospital aquired
- Klebsiella and Pseudomonas
Community
strepcus pnaoumonea, klebseuul apnuemonise and Virus
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