This document provides information about upper respiratory infections including pneumonia, common cold, pharyngitis, and their causes, symptoms, diagnosis, treatment and prevention. Pneumonia can be caused by bacteria, viruses or other infectious agents and symptoms include fever, cough and shortness of breath. Common colds are usually viral and cause runny nose, sore throat and cough. Pharyngitis is inflammation of the throat which is commonly caused by viruses but sometimes bacteria like streptococcus. Diagnosis and treatment depend on the identified cause.

1. ‫الرحي‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬‫م‬

2. Upper respiratory track
infection

3. PRESENTED
BY
• NAZIA KOUSAR
• MAHA ASHRAF
• BAKHTAWAR YOUNAS
• AQSA TUFAIL
• AQEELA RAZA

4. PNEMONIA

5. •Pneumonia is an infection in one or
both of lungs.
•Characterized primarily by
inflammation of the alveoli in the
lungs (alveoli are microscopic sacs in
the lungs that absorb oxygen).

7. Types of pneumonia
According to areas involved

8. Sign &
symptoms
High fever
chills
Shortness
of breath
Inc breath
rate
Sharp
chest pain
Worsening
cough

9.  Many different germs can cause pneumonia.
There are five main causes of pneumonia:
• Bacteria
• Viruses
• Mycoplasmas
• Other infectious agents, such as fungi
• Various chemicals

10.  

11. Community-Acquired
Pneumonia
• CAP is the most common type of pneumonia.
• Community-acquired pneumonia (CAP) occurs
outside of hospitals and other health care
settings.
• Most people get CAP by breathing in germs
(especially while sleeping) that live in the
mouth, nose, or throat

12. Organism Comments
Streptococcus pneumoniae Classically causes labral pneumonia ,
Bronchopneumonia now common
Haemophilus influenzae Cause of bronchopneumonia, usually non capsulated strains
Staphylococcus aureus Severe pneumonia with abscess formation
Klebsiella pneumoniae Friedlander’s bacillus, causes uncommon but severe necrotising
pneumonia
Legionella pneumonia Causes lingerie's disease
Mycoplasma pneumonia Cause acute pneumonia in young people
Chlamydophilla pneumonia Mild but prolong illness usually seen in older people
Chlamydophilla psittaci Cause psittacosis
Coxiella burnetii Cause Q fever
Viruses Several viruses can cause pneumonia in adults including
influenza parainfluenza

13. Treatment of community acquired pneumonia
Targeted treatment

14. Types Treatment
Pneumococcal pneumonia  Choice of treatment is Benzyl penicillin or amoxicillin
 Erythromycin is use penicillin allergic patients
 Retrospective evidence : B-lactam & macrolide can
reduce mortality rate in patients
H. Influenzae  Amoxicillin + co amoxicillin is a choice of treatment
 Parenteral cefuroxime, cefixime or ciprofloxacin as
alternatives
 Erythromycin is poorly active
 Newer macrolides such as clarithromycin and azalide
azithromycin possess more activity
M.Pneumoniae  Not susceptible to B-lactam
 Tetracycline and macrolides are suitable alternatives
 TC are also effective against C.pneumoniae ,
C.psittaci, & C.burnetii but erythromycin is less
effective
 Quinolones are also highly active against these
organism

15. Types Treatment
Staphylococcal pneumonia Usually treated with flucloxacillin +
rifampicin or fusidic acid
Legionnaire's disease • Azithromycin is effective
• Other agents having good clinical efficacy
are quinolone and rifampicin
• Observational studies suggested that
• Non severe cases can treated with oral
fluoroquinolone
• Severe cases can treat with
fluoroquinolone + either macrolides or
rifampicin

16. Empiric treatment
According to British thoracic society
For mild
disease
• Treatment with amoxicillin
• Doxycycline & clarithromycin are
alternatives
For
moderate
to severe
• Combination of B-
lactam+macrolides
• Treatment should cover both typical
& A-typical causes

17. Prevention
•Pneumococcal 23-valent polysaccharide
vaccine & influenza vaccine should be
offered to all those at high risk of infection
•For pneumococcal infection this include
patients who fulfil the following criteria
•A splenia
•Chronic respirato

18. Hospital acquired
pneumonia

20. Causative agents
• Common organism
Gram negative bacteria
Pseudomonas aeruginosa
E.coli
Klebsiella spp

21. • Less common organism
1.Other coliforms such as
Enterobacter spp, Marcescens , Citrobacter spp etc
Acinetobacter spp
Other pseudomonas and related spp such as S.maltophilla
L.pneumophilla
2.Anaerobic bacteria
3. Fungi
Candida albicans
Aspergillus fumigatus
4.Viruses
Cytomegalovirus
Herpes simplex virus

22. Clinical features
•Nosocomial pneumonia accounts for 10-15% of all hospital- acquired
infections , usually presenting with sepsis and/or respiratory failure
•Up to 50% of cases are acquired on intensive care units
•Predisposing features includes stroke, mechanical ventilation, chronic
lung diseases, recent surgery and previous antibiotic exposure

23. Treatment of hospital
acquired pneumonia

24. Regimen comments
Co amoxiclav • Good activity against community- associated
pathogen
• Recommended for early onset HAP in antibiotic
naïve patient without other risk factors
Uriedopencilin+aminoglycoside Good activity against gram negative bacilli such as
P.Aeruginosa and also against pneumococci.
Cephalosporin + aminoglycosides • Good activity against gram negative bacilli such as
E.coli, klebseilla and gram positive
• But poor activity against p.aeruginosa and
anaerobes
Clindamycin + aminoglycosides Good activity against gram positive organism and
anaerobes but much less against gram negative
Ciprofloxacin + glycopeptide Cipro provides good activity against most gram
negative bacilli including p.aeruginosa
Glycopeptide provides activity against S.Aureus and
pneumococci ,

25. regimen comments
Meropenem Broad spectrum agents including activity
against extent spectrum beta lactam producing
Enterobactriacae not active against MRSA
Linezolid combination It is increasingly necessary to cover MRSA in
empiric or targeted treatment of HAP
Aztreonam combination Good activity against gram negative bacilli
including pseudomonas but offers no activity
against anaerobic and gram positive organism
Temocillin Excellent activity against gram negative
organism
Including ESBL producing Enterobacteriacae
No activity against gram positive organism and
pseudomonas
Ceftazidime Very active against gram negative bacilli
including pseudomonas but less so against
gram positive and anaerobes

29. Pneumonia:
A 61 years old man is found collapsed at home and taken to
hospital. His family report him complaining of a sore throat a few
days before admission. On examination he is pyrexial, hypoxic and
tachycardia with reduced air entry to auscultation at the right base.

30. • Chief complaints:
• Pyrexia
• Hypoxia
• tachycardia
• sore throat
• Physical findings:
• Respiration rate: 40 breaths per minute.
• Body temperature: 100 degrees
• Pulse rate: 105 beats per minute
• On examination of chest there are bilateral
crepitations
Patient history
Family history:
Both parents were died by natural death.
Drug history:
Patient was taking paracetamol by himself for fever
Allergy history:
He had no previous allergic history.

31. Diagnosis
Chest X-ray reveals a right basal pneumonia.
Treatment:
Pharmacological treatment:
beta lactam and macrolide are preferred.

32. COUNSELLING
These tips can help TO recover more quickly and decrease your
risk of complications:
• Get plenty of rest. Don't go back to school or work until after
your temperature returns to normal and you stop coughing up
mucus. Even when you start to feel better, be careful not to
overdo it. Because pneumonia can recur, it's better not to jump
back into your routine until you are fully recovered. Ask your
doctor if you're not sure.
• Stay hydrated. Drink plenty of fluids, especially water, to help
loosen mucus in your lungs.
• Take your medicine as prescribed. Take the entire course of
any medications your doctor prescribed for you. If you stop
medication too soon, your lungs may continue to harbor
bacteria that can multiply and cause your pneumonia to recure

34. What Is a Common Cold ?
• A common cold is an illness caused by a virus
infection located in the upper respiratory tract.
• Colds last on average for one week.
• Mild colds may last only 2 or 3 days
• while severe colds may last for up to 2 weeks

35. Sign and
symptoms
Runny
or stuffy
nose
Itchy or
sore
throat
Cough)
Congesti
on
Slight
body
aches or
a mild
headach
e
Watery
eyes
Low-
grade
fever (up
to 1020
F)

39. Prevention
 Exclusion from childcare, preschool, school or work is not
necessary, but a person with a cold should stay home until
he or she feels well.
 Wash hands after contact with soiled tissues or with nose
and throat discharges.
 Cover your mouth and nose when sneezing or coughing.
 Some viruses live for several days on surfaces (for
example telephones, door handles, computer keyboards).
Wipe down all frequently touched surfaces with a cloth
dampened with detergent

40. Treatment
Most colds go away in a few days. Some things you can do to take
care of yourself with a cold include:
• Get plenty of rest and drink fluids.
• Over-the-counter cold and cough medicines may help ease
symptoms in adults and older children. They do not make your
cold go away faster, but can help you feel better. Over-the-counter
(OTC) cough and cold medicines are not recommended for
children under age 4.
• Antibiotics should not be used to treat a common cold.
• Many alternative treatments have been tried for colds, such as
vitamin C, zinc supplements, and Echinacea. Talk to your doctor
before trying any herbs or supplements.

43. Pharyngitis
•Pharyngitis is inflammation of
the pharynx, which is in the
back of the throat. It’s most
often referred to simply as
“sore throat.” Pharyngitis
can also cause scratchiness
in the throat and difficulty in
swallowing.

44. According to the
American Osteopathic Association (AOA),
• Pharyngitis-induced sore throat is one
of the most common reasons for
doctor visits.
• More cases of pharyngitis occur
during the colder months of the year.
• It’s also one of the most common
reasons why people stay home from
work.
• In order to properly treat a sore
throat, it’s important to identify its
cause. Pharyngitis may be caused by
bacterial or viral infections.

45. Etiology
There are numerous viral and bacterial agents that can cause
pharyngitis.
measles
adenovirus, which is
the cause of the
common cold
chickenpox
croup, which is a
childhood illness
distinguished by a
barking cough
whooping cough

46. • Viruses are the most common cause of sore throats. Pharyngitis is
most commonly caused by viral infections such as the common
cold, influenza, or mononucleosis.Viral infections don’t respond
to antibiotics, and treatment is only necessary to relieve
symptoms.
• Less commonly, pharyngitis is caused by a bacterial infection.
Bacterial infections require antibiotics.The most common
bacterial infection of the throat is strep throat, which is caused
by Group A streptococcus. Rare causes of bacterial pharyngitis
include gonorrhea, chlamydia, and Corynebacterium.
• Frequent exposure to colds and flus can increase your risk for
pharyngitis.This is especially true for people with jobs in
healthcare, allergies, and frequent sinus infections. Exposure to
secondhand smoke may also raise your risk.

47. •Physical Exam:-
white or grey patches, swelling, and redness of throat
To check for swollen lymph nodes, they will feel the sides
of your neck.

48. • Throat Culture
If doctor suspects that patients have strep throat,
they will likely take a throat culture.This involves using a
cotton swab to take a sample of the secretions from your
throat. Most doctors are able to do a rapid strep test in
the office.This test will tell your doctor within a few
minutes if the test is positive for streptococcus. In some
cases, the swab is sent to a lab for further testing and
results are not available for at least 24 hours.

49. • Blood Tests
A small sample of blood from your arm
hand is drawn and then sent to a lab for
testing. This test can determine whether
patient have mononucleosis. A complete
blood count (CBC) test may be done to
determine if patient have another type of
infection.

50. Carriers
• Streptococcal carriers appear to be at little risk for developing rheumatic fever. In
general, chronic carriers are not considered to be important in the spread of Group A
Streptococcus to individuals who live and work around them.
• Up to 20% of the pediatric population may carry Group A Streptococcus
asymptomatically. Carriage rates in older adolescents and adults is much lower at 2.4-
3.7%.
• These asymptomatic carriers do NOT need to be identified or treated except in high
risk settings:
• family member with rheumatic fever or post Streptococcal glomerulonephritis
• outbreak of rheumatic fever
• outbreak of pharyngitis in a closed community
• repeat transmission within families
• multiple (≥ 3/year) culture confirmed episodes of symptomatic pharyngitis

51. Treatment protocol of pharyngitis
For viral sore throat:
Treatment of viral sore throat is directed at
symptomatic relief, for example with rest,
antipyretics and aspirin gargles.

52. • Streptococcal sore throat is usually treated with antibiotics
although the extent to which they shorten the duration of
symptoms and reduce the incidence of supportive
complications is modest.
• Antibiotics also reduces the incidence of non-supportive
complications so is likely to be of greater benefit where these
are common.
• Treating to eradicate streptococcal carriage might reduces the
risks of relapse or later streptococcal infection at other sites.

53. Broadly there are three treatment strategies
• Give antibiotics to all patients with suspected
streptococcal infection and do not investigate unless
symptoms persist
• Give antibiotics to all patients with suspected
streptococcal infection but stop them if a throat swab
is negative or
• Wait for throat swab culture results before starting
antibiotics

54. According to NICE,2010:
Antibiotics should not be routinely prescribed in
conditions such as pharyngitis that are frequently viral,
except where there is a high risk of severe infection , for
instance, in immunocompromised patients.

55. PharmacologicalTreatment
Antibiotics Members Dose
Penicillin PenicillinG &V Children:40mg/kg/day bid
PO for 10days
Adults:
300mg or 600mg bid PO
for 10 days
Alternative drugs to
penicillin's
Clindamycin Children:20mg/kg/day PO
tid for 10 days
Adults:300mg PO tid for
10 days
Erythromycin Children:40mg/kg/day PO
tid for 10 days
Adults:250mg PO qid or
333mg PO tid for 10 days

56. Second lineTherapy
•Cephalosporin's such as cephalexin is preferred
•Macrolides e.g. erythromycin but it is rarely prescribed
because it is less effective than beta lactam antibiotics.

57. Non-PharmacologicalTreatment
• Rest. Get plenty of sleep and rest your voice.
• Drink fluids. Drink plenty of water to keep the throat moist and prevent dehydration.
• Try comforting foods and beverage.Warm liquids — broth, caffeine-free tea or warm
water with honey — and cold treats such as ice pops can soothe a sore throat.
• Gargle saltwater. A saltwater gargle of 1 teaspoon (5 grams) of table salt to 8 ounces (237
milliliters) of warm water can help soothe a sore throat. Gargle the solution and then spit it
out.
• Consider lozenges. Lozenges can soothe a sore throat.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can
irritate the throat.

58. Management of Relapses
• Despite universal susceptibility of GroupA Streptococcus to penicillin,
penicillin therapy may fail due to β−lactamase production of oral anaerobes.
• In a patient presenting with acute symptoms 2 to 7 days after completion of
appropriate antibiotic therapy, a repeat throat culture should be performed.
• If the culture is positive forGroupA Streptococcus, consider prescribing an
inhibitor such as a β-lactam/ β-lactamase agent, amoxicillin-clavulanate, or
non- β−lactam antibiotics such as clindamycin or erythromycin (if not given
as first line therapy).
• The patient should be reassessed for concurrent viral infection and non-
compliance and with treatment recommendations

59. Children Duration
PenicillinV 40mg/kg/day PO bid 10 days
Clindamycin 20mg/kg/d PO tid 10 days
Amoxicillin-clavulanate 40 mg/kg/day PO tid 10 days
Erythromycin 40mg/kg/day PO tid 10 days
Adults
PenicillinV 600mg PO bid or 300mg PO tid 10 days
Clindamycin 300mg PO tid 10 days
Amoxicillin-clavulanate 875 mg PO bid or 500 mg
PO tid
10 days
Erythromycin 250mg PO qid or 333mg PO tid 10 days
Late relapse or
recurrent:

61. Case
A 40 year old women presents to her GP with a 1 week history of
sore throat. She is normally fit and well and has had no other
symptoms other than lethargy.
The GP decides to prescribe a 10 day course of penicillinV to cover
possible streptococcal infection. 2 weeks later the patient returns.
She is feeling worse and now experiencing difficulty in swallowing.
Examination of the throat reveals widespread white plagues.

62. Chief complaints:
Fever
pain
lethargy
difficulty in swallowing
Physical findings
• Blood pressure: 110/70 mmHg
• Respiratory rate: 18 breaths per minute
• Pulse rate: 78 beats per minute
• Body temperature: 101 degrees
• Examination of throat reveals white plaques
History
Family history:
No significant disease is seen.
Drug history:
Patient has no previous drug history
Allergy history:
She had no allergic history.

63. • Diagnose:
Patients is suffering from sore throat
• Treatment:
symptomatic treatment is required, patient is advised to take rest,
antipyretics or aspirin gargales
• Diet
Allow a regular diet as tolerated in patients with pharyngitis. Warm liquids
may provide symptomatic relief

65. T O N S I L L I T I S I S T H E I N F L A M M A T I O N O F
T H E T O N S I L S .
I T I S T H E N A M E G I V E N T O S W O L L E N ,
R E D , A N D T E N D E R T O N S I L S . T H I S I S
U S U A L L Y
C A U S E D B Y A N I N F E C T I O N O F T H E
T O N S I L S

67. TONSILS
• At the back of your throat, two masses of tissue are present,
called tonsils.
• These act as filters, trapping germs that could otherwise
enter your airways and cause infection.
• They also produce antibodies and white blood cells
(lymphocytes) to attack germs inside your mouth. This
makes the tonsils part of your first line of defence against
MO in food or air.
• But sometimes the tonsils themselves become infected.
Overwhelmed by bacteria or viruses, they swell and become
inflamed, a condition known as tonsillitis.

68. ETIOLOGY
• The majority of cases of tonsillitis are caused by
viruses, with only 15 to 30% of cases being
caused by bacteria.

69. Typesoftonsillitis
Viral tonsillitis
Bacterial
tonsillitis

70. VIRAL TONSILLITIS:
• Many different types of virus can cause viral tonsillitis, but the cold virus is the
most common cause. The Epstein-Barr virus, which is responsible for
glandular fever, and the measles virus can also cause tonsillitis.
Other common viruses include:
• Adenoviruses
• Influenza virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus
Inflammation of tonsils with associated symptoms of
fever, cold, runny and stuffy nose, sneezing and
coughing are commonly seen in viral tonsilitis.

71. BACTERIAL TONSILLITIS
• Most cases of bacterial tonsillitis are associated with a
particular type of bacterium called group A beta-hemolytic
Streptococcus pyogenes (GABHS),which is the most
common cause of strep throat.
• Inflammation of tonsils with associated
symptoms of severe fever and swollen
lymph nodes without cold or cough is
commonly seen in bacterial tonsilitis.

73. FORMS OF TONSILLITIS
Acute: with
rapid onset of
significant
symptoms
Subacute:
with a slow
onset of less
obvious
symptoms
Chronic: with
intermittent
symptoms
that persist
over time

74. ACCUTE CHRONIC SUBACCUTE
INTRODUCTION  Often affect school
going children but can
also occur in adults.
 Rare in infants n
persons above 50yrs.
 Mostly affect children
and young adults.
 Can last for long
periods if not treated
properly.
Often affects adults.
AETIOLOGY • viral or bacterial in
origin
• Hemolytic
streptococcus is the
most commonly
infecting organism
• Other causes:
staphylococci,
pneumococci or
H.influenzae
• Mostly bacterial in
origin.
• Can be due to
incomplete resolution
of Acute tonsillitis.
• Chronic infection in
sinuses or teeth may
be a predisposing
factor also.
• Caused by Actinomyces, a
normal mouth bacterium that can
cause infection.
• Can be due to poor dental
hygiene, oral surgery or dental
procedures or trauma to the oral
cavity.
SYMPTOMS fever.
sore throat
foul breath
Dysphagia
 Odynophagia
Airway obstruction.
Lethargy
 Enlarged, mildly red
tonsils
 Recurrent attacks of
sore throat
 Chronic irritation in
throat with cough
 Thick speech
 infected material collects inside
pits of tonsils
 Fluctuating mild to moderate sore
throat
 foul breath
 bad taste in the mouth
 mildly swollen tender lymph

75. DIAGNOSIS
Two tests are used for the diagnosis of tonsillitis
1. Rapid strep test
2. Throat swab culture
Both tests involve gently swabbing the back of the throat close to the tonsils
with a cotton swab.
The diagnosis of GABHS tonsillitis can be confirmed by culture of samples
obtained by swabbing both tonsillar surfaces and plating them on sheep blood
agar medium. The isolation rate can be increased by incubating the cultures
under anaerobic conditions and using selective growth media
A lab test can detect a bacterial infection. A viral infection will not show on the
test, but may be assumed if the test for bacteria is negative.

76. TREATMENT
Viral tonsillitis:-
• There's no specific treatment for viral tonsillitis, but there are several things that can help
alleviate the symptoms. For example:
• taking paracetamol or ibuprofen to help relieve pain.
• drinking plenty of fluids & have regular meals (soft foods and smoothies are best)
• getting plenty of rest.
• Gargling salt water (half teaspoon of salt to a cup of warm water)
may provide some symptom relief as may sucking on
throat lozenges containing ingredients that are cooling,
anesthetic, anti-septic, or anti-inflammatory.

77. TREATMENT
Bacterial tonsillitis:-
• If culture test results confirm that your tonsillitis is caused by a bacterial infection, a short course
of oral antibiotics may be prescribed.
• Antimicrobial therapy: Most of the infections are due to streptococcus, and penicillin is the drug of
choice. Patients allergic to penicillin can be treated with
erythromycin(macrolide). Antibiotics should be continued for7-10 days.
• If oral antibiotics are ineffective at treating bacterial tonsillitis, intravenous antibiotics (given
directly into a vein) may be needed in hospital.
• In most cases, tonsillitis gets better within a week. However, a small number of children and
adults have tonsillitis for longer or it keeps returning (chronic tonsillitis)
then surgical treatment may be needed.

78. TONSILLECTOMY
Surgery to remove the tonsils (a tonsillectomy) is usually only
recommended in cases where there have been several severe
episodes of tonsillitis over a long period of time, chronic tonsillitis
or bacterial tonsillitis that doesn't respond to antibiotic treatment.
 A tonsillectomy may also be performed if tonsillitis disrupt normal
activities and results in difficulty to manage complications such as:
• Obstructive sleep apnea
• Breathing difficulty
• Swallowing difficulty, especially meats and other chunky foods
• An abscess that doesn't improve with antibiotic treatment

79. COMPLICATIONS
Peritonsillar abscess: is collection of pus that develops near/beside one of
the tonsils and the wall of the throat. It's a rare complication of tonsillitis
that often affects teenagers and young adults. It is also known as quinsy.
Otitis Media: A middle ear infection where the fluid in the middle ear,
between the eardrum and inner ear, becomes infected by bacteria.
scarlet fever: a condition that causes a distinctive pink-red skin rash
rheumatic fever: this causes widespread inflammation throughout the
body, leading to symptoms such as joint pain, rashes and jerky body
movements
Glomerulonephritis: an infection (swelling) of the filters in the kidneys that
can cause vomiting and a loss of appetite

80. PREVENTIVE MEASURES
It can be prevented by following steps:
• Avoiding close contact with people who have
tonsillitis is advisable to prevent passing on the
infection.
• Children and other family members should be kept
away from people with tonsillitis as much as
possible.
• Hygiene measures should also be used to prevent
spread of infection. These include:
Covering the mouth and nose with a tissue when
sneezing or coughing
Frequent and thorough washing and drying of
hands
Not sharing food, liquids, or eating or drinking
utensils with an infected person

81. REFERENCES
http://www.nhs.uk/conditions/Tonsillitis/Pages/Introduction.aspx
https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm
http://www.mayoclinic.org/diseases-conditions/tonsillitis/basics/causes/con-20023538
http://www.webmd.com/oral-health/guide/tonsillitis-symptoms-causes-and-treatments
http://www.entnet.org/content/tonsillitis
https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tab
id/178/vw/1/ItemID/532/Tonsillitis-causes-symptoms-treatment.aspx
http://earnosethroatclinic.blogspot.com/2010/12/chronic-tonsillitis-causes-types-
signs.html
http://emedicine.medscape.com/article/871977-overview#a5
Roger walker