Infections of the Respiratory Tract
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Infections of the Respiratory Tract
Dr. Raid Jastania
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Infections of the Respiratory Tract
• Upper Respiratory Tract
• Lower Respiratory Tract
• Bacterial, Viral, Fungal, T.B, Parasitic– Most URT infections are viral– Most LRT infections are bacterial
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Upper Respiratory Tract Infections
• Common cold (Acute coryza)– Viral infection of URT– Organisms:
• Rhinoviruses: Coronaviruses, Enteroviruses, Adenoviruses, Respiratory syncytial virus)
• Influenza A and B
• Croup (Parainfluenza 1,2,3)
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Upper Respiratory Tract Infections
• Tonsillitis (mostly bacterial)• Otitis media (mostly bacterial)• Epiglottitis• Laryngitis• Laryngotrachiobronchitis• Bronchitis• Bronchiolitis• Pneumonia
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Pneumonia• Pneumonia is inflammation of the lung
(lower respiratory tract) caused mainly by infection.– Pneumonia can be caused by Bacterial infection
and less commonly by other organisms eg. Viruses, Fungi
– The term Pneumonia is sometimes used to indicated inflammation of lungs due to other causes eg. Including interstitial lung disease (interstitial pneumonia)
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Types of Pneumonia
• Different ways of classification
– Problematic, confusing
– Classification is Based on
• etiology,
• anatomic site involved,
• clinical presentation,
• pathological type of inflammation
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Types of Pneumonia
• One of the classification divides pneumonia into:– Primary (community-acquired)– Secondary – Others
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Types of Pneumonia
• One of the classification divides pneumonia into:– Primary (community-acquired)
• Typical pneumonia– Lobar pneumonia
– Bronchopneumonia
• Atypical pneumonia
– Secondary • Aspiration pneumonia
• Nosocomial (hospital-acquired) pneumonia
• Pneumonia in immunosuppression
– Others:• Chronic pneumonia
• Necrotizing pneumonia/Supporative pneumonia/Lung Abscess
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Risk of Pneumonia
• Underlying disease– COPD– Heart failure– Diabetes
• Immunodeficiency
• Absent splenic function (sickle cell disease)
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Primary, Community-Acquired Pneumonia
Typical Pneumonia
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Clinical Presentation• Fever, rigor, malaise, weakness, vomiting, loss of
appetite, headache• Cough with sputum• Dyspnea• Chest pain, pleuritic pain• Sick, ill , distressed• High respiratory rate >30 / mint• In lobar pneumonia: localized area of dullness on
percussion, increased tactile fremitus, bronchial breath sounds, and crepitation, pleural rub
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Morphology• Common in lower lobes and right middle lobe• In Lobar pneumonia: there is a localized area of
inflammation• Stages:
– Congestion• Vascular congestion, edema, few neutrophils
– Red hepatization• Fibrin, RBC, neutrophils in alveolar spaces
– Gray hepatization• Fibrin, RBC lysis
– Resolution
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• Bronchopneumonia– Inflammation of the bronchi and bronchioles
with collapse of the distal airspaces– Multiple, patchy bilateral small infiltrates– Affect lower lobes usually
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Outcome and complications
• Resolution
• Fibrosis
• Abscess
• Empyema
• Dissemination of infection– Meningitis, arthritis, endocarditis
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Investigations
• CBC
• Arterial blood gases
• Radiological exam: chest x-ray
• Sputum exam and culture
• Nose and throat swabs
• Blood culture
• Serological tests
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• Pneumonia: Features of different organisms (community-acquired pneumonia)– Strep. Pneumoniae
• commonest
– Staph. Aureus• Common following viral infection• Risk of complications: abscess• Common in IV drug abusers
– Legionella• Legionnaire’s disease, epidimics• Grow in water reservoir, humidifiers• People with heat disease, renal disease, immunosuppressed• Presentation with GIT symptoms, mental confusion
– Hemophilus influenzae• Common in COPD, chronic bronchitis, bronchiectasis, cystic
fibrosis
– Klebsiella• Chronic alcoholics and malnourished persons
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Primary, Community-Acquired Pneumona
Atypical Pneumonia
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Atypical Pneumonia
• Viruses, Mycoplasma, Chlamydia• Fever and malaise precede the respiratory
symptoms by few days• Severe headache, malaise, anorexia• No localized sings on chest exam, No
consolidation on chest x-ray• Spleen may be enlarged• WBC normal, cultures negative• No improvement with Penicillin
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– Atypical Pneumonia (community-acquired)
• Mycoplasma
–Sporadic or epidemics
• Viruses
–Influenza, Parainfluenza, Adenovirus, respiratory syncytial virus, measles, chicken pox
• Chlamydia
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Atypical pneumonia
• Morphology:– Patchy or involve whole lobe– Inflammation is confined to the alveolar walls– Widening of alveolar walls by edema,
mononuclear cell infiltration (lymphocytes, plasma cells, macrophages)
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Secondary Pneumonia
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• Secondary pneumonia
• Aspiration pneumonia
• Nosocomial (hospital-acquired) pneumonia
• Pneumonia in immunosuppression
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Secondary Pneumonia• Pre-existing disease of lung or factors
increasing the risk of infection– Low virulence organisms: Hemophilus
infleunzae, viruses, fungi– Anaerobic bacteria– Gram negative bacteria– Staph aureus– All the others in commuity-acquired
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Aspiration Pneumonia
– Aspiration of gastric contents
– During surgery, anesthesia, surgery of tonsils, dental work
– Infection following Aspiration of vomitus in coma, anesthesia, or sleep
– Ineffective coughing (post operative)
– Can result in severe hemorrhage in lungs
– Chemical injury + infection (Anaerobic)
– Destruction of lung parenchyma with cavitations
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Nosocomial Pneumonia
– Patients admitted to hospital– Organisms
• Same as community acquired and
• Gram-negative (Klebsiella, E.coli, Pseudomonas)
• Staph. Aureus
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Pneumonia in Immunosuppression
• Congenital or acquired• AIDS, Immunosuppression• Humoral and Cellular immunity• Infection by
– Pneumocystis carinii– Gram negative bacteria– The common bacteria– Opportunistic pathogens: CMV, Herpes, Aspergillus,
TB, mycobacteria
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Lung Abscess
• Suppurative pneumonia
• Necrotizing pneumonia
• Cavity
• Localized suppurative necrosis
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Lung Abscess
• Mechanisms:– Aspiration of infective material: teeth, tonils,
coma, alcoholics– Aspiration of gastric conetnets– Complication of necrotizing pneumonia– Bronchial obstruction– Septic emboli– Hematogenous spread
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Lung Abscess
• Morphology– Cavity 1-2mm to 5-6 cm
– Filled with pus, cellular debris
– Surrounded by fibrosis and chronic inflammation
– Aspiration tend to involve the right lung
– May rupture in airways resulting in Air-fluid levels
– May rupture in pleura resulting in pneumothorax and empyema