2011.04.03. Airwas infections - SOTE · 2011-12-07 · - In children < 5 years of age. 50 % of all...
Transcript of 2011.04.03. Airwas infections - SOTE · 2011-12-07 · - In children < 5 years of age. 50 % of all...
Airway’s infections
Epidemiology
- In children < 5 years of age. 50 % of all diseases are acuteairway’s infections- In children 5-12 years of age 30 % of all diseases are acuteairway’s infections- Most of the infections are in the upper airways, only 5 % a re inthe larynx and or in the lower airways
The natural history of the disease depends of
• the pathogen (microbe),• the host,• the environment
Localisation of the acute airways’ inflammations
1. Upper airways’ inflammation
2. Laryngo-tracheo-bronchitis (croup), epiglottitis
3. Acute bronchitis
4. Acute bronchiolitis
5. Pneumonia
Infectious agents of the upper respiratory tract I.
Viruses
Respiratory syncytial virus (RSV):bronchiolitis, pneumonia, croup, bronchitis
Parainfluenza viruses:croup syndorma, bronchitis, bronchiolitis
Influenza virus:in epidemics
Adenoviruses:pharyngitis, pharyngoconjunctivits
RhinovirusesCoronaviruses: rhinitis, common cold
Coxsackieviruses A and B:nasopharyngitis
Infectious agents of the upper respiratory tract II.
Mycoplasma pneumoniae:pharyngotonsilitis, otitis media, pneumonia, bronchitis
Bacterial causes:‘A” group streptococci, corynebacteriumdiphteria, Neisseria meningitidis, N gonorrhoeae, haemophilusinfluenzae, streptococcus pneumoniae(pneumococcus), staphylococcus aureus
Signs ofinclination for frequent infections
1. Too frequent infectionsAge/year Mean Maximum
1 6,1 8,71-2 5,7 8,73-4 4,7 7,65-9 5,5 8,1
10-14 2,7 4,92. Longer (> 4-5 days) and more serious infection than th e
usuals3. Bacterial second line infection4. Complications: otitis, sinusitis, pneumonia5. Multiorgan infections6. Failure to thrive
Bacterial infection is probable:
1. The discharge on the mucous membrane is purulent2. Polymorpho-nuclear granulocytes’ number is high in
the peripherial blood3. Positive bacterial laboratory findings (from throat or
sputum)4. The regional lymphnodes are swollen and painful5. Blood sedimentation rate is high6. There is no viral epidemy
Infection risk factors in the host
1. Preterm babies (< 1 year)2. Age less than 1 year (< 6 months in bronchiolitis)3. To be a boy4. Inborn errors of the immune system5. Congenital heart defects6. Lack of mother milk
Environmental factors
• Family care (+)
• Smoking in the family (-)
• More than one child (-)
• Good socio-economic situation (+)
• Polluted environment (-)
The aetiology of common flu
Antigen types Per cent of probability
Rhinovirus 100 types 30-40 %Coronavirus 3 types > 10 %Parainfluenza virus 4 typesRSV 2 typesInfluenza 3 types 10-15 %Adenovirus 47 types 5 %Others (enterovirus,morbilli, varicella,rubeola) 5 %Unknown viruses 25-30 %A-group beta-haemolytic
Streptococci 5-10 %
Upper airway diseases
Nasopharyngitis acuta: fever, headache, dry throat, coughing, nasal discharge, frequent conjuncticalinflammation, stuffed nose (feeding problems in infants)Tonsillo pharyngitis acuta: red mucous membrans, swollen families, swollen tonsils, swollen lymphnodes i nthe neck, fever, painTherapy: antipyretics, antiphlogistic nasal drops, enough fluid intake,Bacterial infection: penicillin, enythromycin (10 days) Non streptococcal infection: amoxycillin, macrolides, cephalosporinsComplications: otitis media acuta, peritonsillarretropharyngeal abscessSinusitis acutaFebris rheumatica, glomerulonephritis (now rare)
Pathogenesis of tonsillopharyngitis
Pathologic agents Features Per cent
Viruses (see before) 35-40 %+Coxsackievirus herpangina < 1 %EBV + CMV mononucleosis inf. < 2 %HIV primer HIV infection < 1 %
BacterialStreptococci pyogenes 15-30 %Beta-haemolytic
Streptococci 5-10 %Other bacteria < 5 %Unknown 20-30 %
Complications of upper airway inflammations
Otits mediaMastoiditis acutaParanasal sinusitisPeritonsillar, retropharyngeal
infiltration, abscessusPoststreptococcal diseases:
rheumatic fever, glomerulonephritis
Croup cyndrome
Acute epiglottitisAcute infectious laryngitisAcute laryngo-tracheo-bronchitisAcute spasmodic laryngitis
Laryngitis subglottica (croup syndrome)
Very frequentAetiology: viral, bacterial, mycoplasma
non infective: inclination, alllergic (?)
Croup score:stridor, cough, dyspnoe, cyanosis, inspiratoricsound, jugular dystraction (0-1-2)
3-5 moderate6 or more serious
Therapy: cold vaporizationepinephrin (racem) vaporizedsteroid (systemic or vaporized)antibiotics (if proved bacterial aetiology)intubation, artificial ventillation
Acute bronchitis, tracheo bronchitis
Cough, sputum, bronchial noises, substernaldyscomfort, low grude feverCoarse and fine moist rales and rhonchi
Etiology: viral or bacterial
Therapy: symptomatic (to be at home, antipyretics, fluid intake)
Bacterial aetiology proven: antibiotics
Pneumonia I.
Actiology: viral, bacterial, fungalClinical manifestations: lobar, lobular, broncho-alveolar,
interstitialcommunity acquired pneumonianosocomial (hospital) acquired
pneumoniaBacterial:a) Typical pneumonia: streptococcus pneumoniaeHaemophylus influenzae B type (vaccination!)Streptococcus B Group: neonatologySeldom: staphilococcus auerus, pyogenes, legionellab) Atypical: Mycoplasma pneumoniaec) Chlamydia pneumoniaed) Neonates: Chlamydia trachomatis, Ureaplasma,
Uraeliticum
Pneumonia II.
Viral: RSV, influenza, adenovirus, rhinovirus, enterovirusVZV, CMV, HSV (immuncompromised host)
Fungal: immuncompromised host
Protozoons: Pneumocystic carinil (AIDS, immuncompromised host)
Pneumonia III.
Clinical signs: fever, cough, malaise, sputum, dyspnoe, cyanosis, tachypnoe
Physical signs: duffness of percussion pneumoniabronchial breath soundsX ray (sonography: pleural effusionCT and MR: abscess, mediastinum problems
Laboratory signs: BSR, CRP, blood smear
Actiology: haemocultureBAL, Pleural drainage (if effusion)induced sputum (?)
Hamophilus influenzae pneumonia
Pneumocystis carinii pneumonia
Right upper lobe pneumonia
candidiasis aspergillosis
patients with leukaemia
Therapy of pneumonia
• symptomatic• antibiotics
- based on aetiology and resistance- based on empirical facts:
macrolidsCephalosporinsaminoglycosids
HSV/VZV: acyclovir.CMV: gancyclovirRSV: ribavirin
Acute nasophayngitis:
Aetiology: viruses, mycoplasma pneumonieae, bacterial mycotic
Epidemilogy
Clinical manifestations
Therapy: aspecific, antiinflammatory drugs, nasal drops andsuction
Acut pharyngitis, pharyngo-tonsillitis:
Aetiology: viruses, beta-haemolytic streptococcus (group A)H. influenzae
Epidemiology
Clinical manufestations
Treatment: aspecific, penicillin, erythromycin
The pathogens I.
Virus
RS virus: acute bronchiolitis in infants and toddlers (80 %)croup (12 %), bronchitis (15 %), pneumonia (30 %)
Parainfluenza virus: laryngo-tracheo bronchitis, pneumonia
Influenza virus: upper airway disease anywhereinflammation in the airways
Rhinovirus: common cold, rhinitis, bronchitisAdenovirus: mostly upper airways’ disease serious
pneumonia with serious late consequencesCoxsacie and echovirus: mostly upper airway disease
The pathogens II.
Bacteria
Streptococcus pneumoniae: often in pneumoniaHaemophilus influenzae B type: epiglottitis (!), pneumonia, otitisStaphylococcus aureus: pneumonia, pleuritis ininfants and toddlersβ-haemolytic streptococcus’ mostly upper airwayinflammation, tonsillitisMycoplasma pneumoniae: pneumonia in biggerchildrenChlamydia trachomatis: pneumonia in infantsChlamydia pneumoniae: bronchitis, seldompneumoniaBronchamella catarrhalis: otitis, sinusitis in childre n