This document discusses the respiratory system and respiratory infections such as pneumonia. It covers the respiratory defense mechanisms, common respiratory infections like influenza and coronaviruses. It provides details about COVID-19 symptoms, transmission, and prevention methods. Pneumonia pathophysiology is explained involving cytokine storm and acute respiratory distress syndrome. Prevention methods include vaccines, isolation of infected individuals, and maintaining strong immunity through healthy habits.

2. CONTENTS
1. Respiratory System
2. Respiratory Defense
3. Respiratory Infections
4. Influenza virus
5. Corona virus
6. Pneumonia
7. Pneumonia pathophysiology
8. Pneumonia complications
9. Pneumonia assessment score
10.Prevention

3. RESPIRATORY SYSTEM

5. RESPIRATORY DEFENSE
☞ HAIRS AND TURBINATES OF NARES – captures large
inhaled particles.
☞ BRANCHING ARCHITECTURE OF
TRACHEOBRONCHIAL TREE – traps microbes on the
airway lining and in mucous.
☞ MUCOCILLIARY CLEARANCE BY Pseudostratified
columnar ciliated epithelium.
☞ GAG REFLEX AND COUGH REFLEX for protection
against aspiration.
☞ RESIDENT ALVEOLAR MACROPHAGES in epithelium of
respiratory tract.

6. RESPIRATORY INFECTIONS
⫸ MOST COMMON INFECTIONS THAN ANY OTHER ORGAN INFECTIONS.
⫸ MAJORITY OF THESE RESPIRATORY INFECTIONS HAPPEN IN UPPER RESPIRATORY
TRACT. [UPPER RESPIRATORY TRACT INFECTIONS – URTI]
☞ COMMON COLD – RHINITIS
☞ FLU – INFLUENZA
☞ SORE THROAT - PHARYNGITIS
☞ HAORSENESS - LARYNGITIS
MAJORILY THEY ARE VIRAL INFECTIONS
Rhino virus, Influenza virus,
Corona virus, Respiratory Syncytial virus,
Adeno virus, Entero virus, Boca virus etc.

7. RESPIRATORY INFECTIONS
⫸ MOST COMMON INFECTIONS THAN ANY OTHER ORGAN INFECTIONS.
⫸ MAJORITY OF THESE RESPIRATORY INFECTIONS HAPPEN IN UPPER RESPIRATORY
TRACT. [UPPER RESPIRATORY TRACT INFECTIONS – URTI]
☞ COMMON COLD – RHINITIS
☞ FLU – INFLUENZA
☞ SORE THROAT - PHARYNGITIS
☞ HAORSENESS - LARYNGITIS
MAJORILY THEY ARE VIRAL INFECTIONS
Rhino virus, Influenza virus,
Corona virus, Respiratory Syncytial virus,
Adeno virus, Entero virus, Boca virus etc.

8. INFLUENZA VIRUS
⫸ COMMONLY CALLED AS “ FLU ”
⫸ SUDDEN ONSET OF HIGH GRADE FEVER WITH OR WITHOUT
CHILLS.
⫸ HEADACHE MALAISE, COUGH, MYALGIA , RHINORRHOEA.
(FEVER IS HIGHER AND LONGER DURATION THAN RHINO VIRUS)
⫸ MAY LEAD TO SERIOUS SEQUELAE OF PNEUMONIA OR
ENCEPHALOPATHY OR OTHER SECONDARY BACTERIAL
INFECTIONS.

9. SPANISH FLU PANDEMIC
“GREATEST LESSONS TO MANKIND ARE TAUGHT BY
HISTORY ITSELF.”

10. SPANISH FLU PANDEMIC
THE SPANISH FLU PANDEMIC OF 1918, THE 2ND DEADLIEST IN HISTORY, INFECTED
AN ESTIMATED 500 MILLION PEOPLE WORLDWIDE—ABOUT ONE-THIRD OF THE
PLANET’S POPULATION—AND KILLED AN ESTIMATED
50 MILLION TO 100 MILLION VICTIMS.
TOTAL NUMBER OF DEATHS IN WORLD WAR 1 WAS 20 MILLION.
MALNOURISHMENT, OVERCROWDED MEDICAL CAMPS AND HOSPITALS, AND
POOR HYGIENE PROMOTED BACTERIAL SUPERINFECTION WITH NON AVAILABILITY
OF ANTIBIOTICS AND VACCINES.
“Flu condemns & additional infection executes.”
- Dr. Louis Cruveilhier.
“GREATEST LESSONS TO MANKIND ARE TAUGHT BY
HISTORY ITSELF”

11. CORONA VIRUS
CORONAVIRUSES (COV) ARE A LARGE FAMILY OF VIRUSES
THAT CAUSE ILLNESS RANGING FROM THE COMMON COLD
(1/4 CAUSE OF ALL COMMON COLD) TO MORE SEVERE
PNEUMONIAS SUCH AS
 SEVERE ACUTE RESPIRATORY SYNDROME (SARS-COV)
2003
 MIDDLE EAST RESPIRATORY SYNDROME (MERS-COV)
2012
CORONAVIRUSES ARE ZOONOTIC, MEANING THEY ARE
TRANSMITTED BETWEEN ANIMALS AND PEOPLE.

12. COVID - 19

13. COVID - 19
IN DEC-2019 A NEW STRAIN OF CORONA VIRUS WAS FOUND IN CHINAAND IS
NAMED AS -
Disease - Coronavirus disease (COVID-19)
Virus - Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2)

15. COVID-19
SYMPTOMS
☞ FEVER, TIREDNESS, DRY COUGH, MYALGIA, NASAL
CONGESTION, RUNNING NOSE, SORE THROAT,
DIARRHEA.
☞ THESE SYMPTOMS ARE USUALLY MILD AND BEGIN
GRADUALLY.
☞ SOME PEOPLE BECOME INFECTED BUT DON’T DEVELOP
ANY SYMPTOMS AND DON'T FEEL UNWELL.

16. COVID-19
IS IT FATAL ?
☞ MOST PEOPLE (ABOUT 80%) RECOVER FROM THE DISEASE
WITHOUT NEEDING SPECIAL TREATMENT.
☞ AROUND 1 OUT OF EVERY 6 PEOPLE WHO GETS COVID-19
BECOMES SERIOUSLY ILL AND DEVELOPS DIFFICULTY BREATHING.
☞ OLDER PEOPLE, AND THOSE WITH UNDERLYING MEDICAL
PROBLEMS LIKE HTN, LUNG DISEASES, HEART PROBLEMS OR
DIABETES, ARE MORE LIKELY TO DEVELOP SERIOUS ILLNESS.
☞ ABOUT 2% OF PEOPLE WITH THE DISEASE HAVE DIED.

17. WHO APPOINTED COVID-19 REFERRAL
LABORATORIES

19. CORONA UPDATES INDIA
(2ND MARCH 2020)
☞ TOTAL POSITIVE CASES IN INDIA TILL NOW IS 5.
☞ 3 (KERELA) HAVE BEEN DISCHARGED AND 2 (JAIPUR AND TELANGANA) ARE BEING
TREATED.
☞ BOTH NEW CASES HAVE TRAVEL HISTORY OF ITALYAND DUBAI.
☞ TRAVEL RESTRICTION TO CHINAAND IRAN
☞ TRAVELADVISORY TO AVOID NON-ESSENTIAL TRAVEL TO – SINGAPORE, S. KOREA, ITALY.
☞ PASSENGERS FROM 12 COUNTRIES WILL NOW BE SCREENED.
☞ 5, 57,431 PASSENGERS HAVE BEEN SCREENED SO FAR AT AIRPORTS AND 12,431 PASSENGERS
HAVE BEEN SCREENED ON MINOR AND MAJOR SEAPORTS
☞ SCREENING OF PASSENGERS BEING CONDUCTED AT 21 AIRPORTS, 12 MAJOR SEAPORTS, AND 65
MINOR SEAPORTS

22. PNEUMONIA
☞ LRTI “ INFECTION OF LUNG PARENCHYMA”
☞ PNEUMONIA MORTALITY = MALARIA + TB + AIDS
☞ DESPITE BEING THE CAUSE OF SIGNIFICANT MORBIDITY AND
MORTALITY , IT IS MISDIAGNOSED, MISTREATED AND
UNDERESTIMATED.
☞ VIRAL, BACTERIAL OR FUNGAL INFECTIONS
☞ VIRAL – INFLUENZA IN ADULTS AND RSV IN CHILDREN ARE
COMMON.
☞ BACTERIAL – STREPTOCOCCUS PNEUMONIAE ARE MOST COMMON
☞ FUNGAL - PNEUMOCYSTIS JIROVECII ARE MOST COMMON

23. PNEUMONIA
☞ VIRAL PNEUMONIAARE MILD AND GET BETTER IN 1-3 WEEKS WITHOUT
TREATMENT.
☞ HOWEVER VIRAL PNEUMONIA INCREASES THE RISK OF SECONDARY
BACTERIAL INFECTION AND THUS ARE DANGEROUS.
☞ RISK FACTORS INCLUDE
⫸ SMOKING, ALCOHOL, MALNOURISHMENT, AGE <2YRS & >65 YRS
⫸ POLLUTION, NON AMBULATORY PATIENT, PRE EXISTING LUNG DISORDERS, HF,
DIABETES, STROKE
⫸ LONG TERM STEROID USE, IMMUNOSUPPRESSIVE DRUGS, HIV
☞ VACCINES
⫸ PNEUMOCOCCAL PNEUMONIA VACCINE
⫸ SEASONAL INFLUENZA VACCINE
⫸ HIB VACCINE

24. PNEUMONIA PATHOPHYSIOLOGY
☞ MICROORGANISM GAINS ACCESS TO LRT THROUGH
⫸ ASPIRATION FROM OROPHARYNX
⫸ INHALED AEROSOLIZED DROPLETS
⫸ HAEMATOGENOUS SPREAD
☞ LOCAL DEFENSE MECHANISMS OF RESPIRATORY TRACT ARE
IMPAIRED
☞ THEREBY RESULTS IN PROLIFERATION OF PATHOGENS AT
ALVEOLAR LEVEL.

25. PNEUMONIA PATHOPHYSIOLOGY
☞ PATHOGENS ARE INGESTED BY RESIDENT MACROPHAGES IN EPITHELIUM.
☞ WHEN THERE CAPACITY IS EXCEEDED THEN THEY INITIATES THE
INFLAMMATORY RESPONSE TO INCREASE THE DEFENSES.
☞ THE RELEASE OF INFLAMMATORY MEDIATORS
⫸ CYTOKINES LIKE IL1 , TNF CAUSES LOCAL AND SYSTEMIC INFLAMMATORY
CHANFGES LIKE FEVER, MYALGIA ETC
⫸ CHEMOKINES – TO RECRUIT THE NEUTROPHILS TO THE AFFECTED SITE
⫸ ACTIVATED NEUTROPHILS ENGULF AND KILL THE PATHOGENS
THROUGH PHAGOCYTOSIS
⫸ IN THE IDEAL SCENARIO, THE ACUTE LUNG INFLAMMATION IS PROTECTIVE AND
SELF-LIMITED, AND ONCE THE INFECTION HAS BEEN CONTROLLED, CYTOKINES ALSO
FUNCTION TO RESTORE HOMEOSTASIS, INCLUDING THE MODULATION OF
NEUTROPHIL APOPTOSIS.

26. CYTOKINE STORM
☞ AN OVERLY AGGRESSIVE AND DYSREGULATED CYTOKINE RESPONSE TO PATHOGEN
☞ RESULTS IN ACUTE RESPIRATORY DISTRESS SYNDROME AND SHOCK

28. PNEUMONIA PATHOPHYSIOLOGY
☞ THE INFLAMMATORY MEDIATORS FROM MACROPHAGES ,
NEUTROPHILS CREATE ALVEOLAR CAPILLARY LEAK LEADING TO
INTRAALVEOLAR FILLING OF EXUDATES.
☞ CONSOLIDATION / SOLIDIFICATION OF LUNG.
☞ DECREASED GASEOUS EXCHANGE.
☞ TYPE 1 RESPIRATORY FAILURE
☞ SHOCK
☞ MODS
☞ DEATH

29. It is only a matter of a few hours then until death comes, & it is
simply a struggle for air until they suffocate, its horrible”
- US army Dr. Roy Grist

30. PNEUMONIA ASSESSMENT SCORE
C U R B – 65
CONFUSION
UREA > 20mg/dl
R.R > 30/min
B.P ≥ 90/60 mm of hg
Age ≥ 65 yrs
OPD Rx IPD Rx ICU Rx
0 2 3

31. PREVENTION
2° PREVENTION
✔ ISOLATING INDIVIDUALS WITH
COVID-19
✔ MASS AWARENESS
✔ AVOIDING TRAVEL TO
OUTBREAK AREAS
✔ MAINTAINING HYGIENE
1° PREVENTION
✔ SMOKING CESSATION
✔ KEEPING IMMUNE SYSTEM
STRONG* -
✔ REST
✔ PHYSICAL ACTIVITY
✔ HEALTHY DIET
* Source – National Heart, Lung and Blood Institute. (US Department of Health and Human Services)

32. Presenter – Dr. Kamal Kishore M.D. Ayu