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16 Infections Of The Respiratory Tract


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16 Infections Of The Respiratory Tract

  1. 1. <ul><li>The Second Affiliated Hospital of Sun Yat-sen University </li></ul><ul><li>Tan Wei-ping </li></ul>Infections of the Respiratory Tract
  2. 2. 讲者的请求 上 课 切 莫 讲 话 不 利 吸 收 “消 化” 倘 若 心 情 不 佳 可 以 伏 案 打 哈 但 勿 鼾 声 太 大 以 防 惊 吓 大 家
  3. 3. Contents <ul><li>Upper Respiratory Infection </li></ul><ul><li>Acute infectious Laryngitis </li></ul><ul><li>Acute Bronchitis </li></ul><ul><li>Bronchiolitis </li></ul><ul><li>Pneumonia </li></ul>
  4. 4. Anatomy <ul><li>upper respiratory tract(URT) </li></ul><ul><li>Cricoid Cartilage </li></ul><ul><li>lower respiratory tract(LRT) </li></ul><ul><li>URT : Nose 、 pharynx 、 Uvula 、 Larynx 、 auditory tube 、 paranasal sinuses </li></ul><ul><li>LRT : Trachea 、 bronchia 、 bronchiole 、 the respiratory bronchiole 、 the alveolar duct and the alveolus </li></ul>
  5. 7. <ul><li>Anatomy characteristics </li></ul><ul><li>upper respiratory tract </li></ul><ul><li>Nose: cilia↓, capillary↑ </li></ul><ul><li>Sinuses: mucus </li></ul><ul><li>Auditory tube </li></ul><ul><li>tonsil </li></ul><ul><li>Larynx </li></ul>
  6. 8. <ul><li>lower respiratory tract : </li></ul><ul><li>Weak Cartilage Supporting , ciliary function impairment </li></ul><ul><li>Right bronchus :straight , large </li></ul><ul><li>Collagen and elastin fibers , capillary , interstitial tissue </li></ul><ul><li>Thorax : chest wall, respiratory mussle ; diaphragm , mediastinum </li></ul>
  7. 9. <ul><li>Physiological characteristics </li></ul><ul><li>The compensatory ability ↓ </li></ul><ul><li>Respiratory rate↑ </li></ul><ul><li>Pattern of respiration </li></ul><ul><li>Gas-exchanging membrane :diffuse rate </li></ul><ul><li>CO 2 > O 2 </li></ul><ul><li>Resistance of airway: child > adult </li></ul>
  8. 10. <ul><li>Arterial blood gas examination </li></ul><ul><li>(1) pH↓acidosis ; </li></ul><ul><li>(2) PaO 2 ↓ SaO 2 ↓ hypoxemia ; </li></ul><ul><li>(3)PaCO 2 ↑ carbon dioxide retention mal-ventilation </li></ul>
  9. 11. <ul><li>The Immunological Characteristics : </li></ul><ul><li>Impaired mucociliary clearance function </li></ul><ul><li>SIgA↓ 、 IgA↓ 、 IgG↓ subtype of IgG ↓ </li></ul><ul><li>Alveolar macrophages ↓ , lysozyme ↓ </li></ul><ul><li>lactoferrin ↓ 、 interferon ↓ </li></ul><ul><li>complement ↓ </li></ul>
  10. 12. Upper Respiratory Infection (URI, or Common Cold) <ul><li>1. Etiology 90% viruses, the majority of colds. </li></ul><ul><li>rhinoviruses ,coronaviruses. </li></ul><ul><li>parainfluenza virus, adenovirus, enterovirus, </li></ul><ul><li>respiratory syncytial virus. </li></ul><ul><li>2. season fall and winter </li></ul><ul><li>3. Frequency three to eight colds a year. </li></ul>
  11. 13. <ul><li>Inoculation by virus </li></ul><ul><li>Invasion of epithelium of </li></ul><ul><li>Release of nasopharynx,sinuses and URT cellular damage </li></ul><ul><li>Inflammatory of nasopharynx </li></ul><ul><li>mediators in Cholinergic </li></ul><ul><li>nasal secretions stimulation </li></ul><ul><li>Increased Increased </li></ul><ul><li>vascular mucus </li></ul><ul><li>permeability production </li></ul><ul><li>bronchial </li></ul><ul><li>constriction </li></ul><ul><li>Nasal Rhinorrhea postnasal sore </li></ul><ul><li>Stuffiness drip cough throat </li></ul>Pathophysiology of the common cold
  12. 14. <ul><li>The clinical manifestation </li></ul><ul><li>Common cold </li></ul><ul><li>congestion </li></ul><ul><li>a runny nose </li></ul><ul><li>sneezing </li></ul><ul><li>Cough,sore throat </li></ul><ul><li>sometimes vomiting and diarrhea </li></ul><ul><li>Fever,malaise,abdominal pain </li></ul>
  13. 15. <ul><li>Specific type of URI </li></ul><ul><li>Herpangina: coxsackie-viruses group A. </li></ul><ul><li>summer /fall.High fever, sore throat , </li></ul><ul><li>1-4mm vesicles /ulcers on anterior tonsillar pillars, softpalate,uvula,tonsils pharyngeal wall. </li></ul><ul><li>Pharyngoconjunctival fever : type 3,7 adenovirus, spring /summer. </li></ul><ul><li>High fever, sore throat , pharyngitis, conjunctivitis, cervical lymphadenopathy. </li></ul>
  14. 16. <ul><li>Complications </li></ul><ul><li>sinusitis </li></ul><ul><li>otitis media </li></ul><ul><li>cervical lymphadenopathy </li></ul><ul><li>Mesentery lymphadenopathy </li></ul><ul><li>retropharngeal abscess </li></ul><ul><li>pneumonia </li></ul><ul><li>rheumatic fever </li></ul><ul><li>acute glomerulonephritis </li></ul>
  15. 17. Differential diagnosis <ul><li>Flu </li></ul><ul><li>Appendicitis </li></ul><ul><li>Early phase of acute infectious disease </li></ul>
  16. 18. Sometimes sore throat Sore throat Fatigue, may persist Mild fatigue severe aches and pains Slight aches and pains Cough, may progress Mild, hacking cough Sometimes sneezing Sneezing Sometimes stuffy nose Stuffy, runny nose Commonly headache Sometimes headache High fever Low or no fever Flu Cold
  17. 19. <ul><li>Treatment </li></ul><ul><li>increased fluid intake </li></ul><ul><li>avoidance of secondhand smoke </li></ul><ul><li>Saline nose drops </li></ul><ul><li>bulb syringe remove the mucus </li></ul><ul><li>cool mist humidifier </li></ul><ul><li>antipyretics, such as acetaminophen,ibuprofen, decrease the discomfort of colds. </li></ul><ul><li>Do not give aspirin (associated with Reye syndrome) </li></ul>
  18. 20. Prevention <ul><li>Keep your child away from a person with a cold. </li></ul><ul><li>Encourage your child to wash his/her hands frequently and not to touch his/her mouth, eyes, or nose until their hands are washed. </li></ul><ul><li>Make sure toys and play areas are properly cleaned, especially if multiple children are playing together. </li></ul>
  19. 21. Acute infectious Laryngitis <ul><li>Etiology </li></ul><ul><li>Virus or bacteria </li></ul><ul><li>Typical anatomy </li></ul>
  20. 22. <ul><li>Clinical manifestations </li></ul><ul><li>Brassy cough, hoarseness, inspiratory stridor, nasal flaring, suprasternal , infrasternal, intercostal retraction </li></ul><ul><li>Fever, dyspnea, cyanosis restlessness, tachycardia . Worse at night. </li></ul><ul><li>Congestion of pharynx, vocal cord edema </li></ul>
  21. 23. <ul><li>Grade of laryngic obstruction </li></ul><ul><li>Ⅰ : inspiratory stridor, respiratory </li></ul><ul><li>difficulty only after activity </li></ul><ul><li>Ⅱ : symptoms occurs at rest. </li></ul><ul><li>tachycardia, rhonchi </li></ul><ul><li>Ⅲ : Ⅱ + hypoxia, diminished breath </li></ul><ul><li>sounds </li></ul><ul><li>Ⅳ : exhaustion, lethargy , pallor , </li></ul><ul><li>breath sounds diminish or </li></ul><ul><li>disappear. dull of heart sounds, </li></ul><ul><li>arrhythmia </li></ul>
  22. 24. Diagnosis /differential diagnosis <ul><li>laryngeal diphtheria </li></ul><ul><li>laryngeal spasm </li></ul><ul><li>bronchial foreign bodies </li></ul>
  23. 25. treatment <ul><li>Maintaining of airway : steam inhalation, clearing of secretion. </li></ul><ul><li>antibiotics </li></ul><ul><li>corticosteroid </li></ul><ul><li>oxygen supply </li></ul><ul><li>sedatives (phenergan) </li></ul><ul><li>Ⅲ ↑ tracheotomy </li></ul>
  24. 26. Acute Bronchitis( tracheobronchitis ) <ul><li>Etiology </li></ul><ul><li>Virus or bacteria </li></ul><ul><li>Allergy, climate, air pollution, chronic infection of URT, particularly sinusitis. </li></ul><ul><li>Rickets, malnutrition </li></ul>
  25. 27. <ul><li>Clinical manifestations </li></ul><ul><li>unproductive cough 3~4days -> productive cough, purulent sputum -> 5~10days </li></ul><ul><li>Chest pain, shortness of breath </li></ul><ul><li>Vomiting </li></ul><ul><li>Physical finding: low-grade fever, roughening of breath sounds, rhonchi, coarse moist rales. </li></ul>
  26. 28. <ul><li>Asthmatic bronchitis : </li></ul><ul><li>﹤ 3yrs old, eczema, allergy </li></ul><ul><li>symptoms resemble asthma </li></ul><ul><li>recurrent episodes reduced after 3~4yrs old. </li></ul>
  27. 29. <ul><li>Treatment </li></ul><ul><li>increased fluid intake </li></ul><ul><li>frequent shifts of position </li></ul><ul><li>antibiotics </li></ul><ul><li>cough suppressants </li></ul><ul><li>expectorants , antihistamines </li></ul><ul><li>acetaminophen </li></ul>
  28. 30. Bronchiolitis <ul><li>Etiology and epidemiology </li></ul><ul><li>50 % respiratory syncytial virus(RSV) </li></ul><ul><li>parainfluenza 3 virus, mycoplasma, adenoviruses </li></ul><ul><li>north——winter and early spring </li></ul><ul><li>Guangdong——spring ,summer and early autumn </li></ul>
  29. 31. 2.Pathophysiology <ul><li>Lesion: small air passages </li></ul><ul><li>(diameter75 ~ 300um) </li></ul><ul><li>Edema, accumulation of mucus and cellular debris, spasm of smooth mussle-> ↑ resistance of small airway ->expiratory difficulty ->overinflation or atelectasis ->hypoxemia, hypercapnia, acidosis </li></ul>
  30. 32. Clinical manifestation <ul><li>Infant ﹤2yrs old, peak at 3~ 6 mo of age, male, non breast-fed </li></ul><ul><li>URI 3 ~ 4days </li></ul><ul><li>paroxysmal wheezy cough </li></ul><ul><li>dyspnea develop rapidly </li></ul><ul><li>mild or moderate fever </li></ul>
  31. 33. Physical examination <ul><li>R 60~80/min </li></ul><ul><li>HR 160 ~ 200/min </li></ul><ul><li>Nasal flare, intercostal and subcostal retractions </li></ul><ul><li>Pallor, cyanosis </li></ul><ul><li>Hyperexpanded chest , expiratory phase ↑ wheezes , widespread fine crackles </li></ul><ul><li>Liver and spleen palpable below the costal margin </li></ul><ul><li>Critical phase 48 ~ 72h afer onset of dyspnea; recover during 5 ~ 15days </li></ul>
  32. 34. Laboratory examination <ul><li>WBC and differential cells count normal </li></ul><ul><li>Virus detected by antigen detection, PCR, or culture. </li></ul><ul><li>X-ray: hyperinflation of the lungs, emphysema, scattered areas of consolidation </li></ul>
  33. 35. Differential diagnosis <ul><li>Asthma </li></ul><ul><li>Cystic fibrosis </li></ul><ul><li>Heart failure </li></ul><ul><li>Foreign body in the trachea </li></ul><ul><li>pertussis </li></ul>
  34. 37. 两侧肺纹理粗重。两肺中内带多数小斑片状及小结节病灶影。无病灶之肺部透过度增高。
  35. 38. Treament <ul><li>Supportive treatment </li></ul><ul><li>cool, humidified oxygen supply, maintain SaO2 94%~96%; </li></ul><ul><li>increased fluid intake : oral intake, intravenous solutions </li></ul><ul><li>head and chest slightly elevated </li></ul>
  36. 39. <ul><li>Ribavirin </li></ul><ul><li>Antibiotics </li></ul><ul><li>corticosteroids </li></ul>
  37. 40. Pneumonia <ul><li>Pneumonia is results from direct inflammation of the lung tissue </li></ul><ul><li>infections (bacterial, viral or fungal) </li></ul><ul><li>chemical injury (gastric acid/ aspiration of food/ hydrocarbon and lipoid pneumonia/ radiation induced pneumonia) </li></ul>
  38. 41. Clinical manifestation <ul><li>fever </li></ul><ul><li>cough </li></ul><ul><li>Dyspnea (Tachypnea,cyanosis) </li></ul><ul><li>Localized rales(fine moist rales) </li></ul><ul><li>Abnormal chest x-ray </li></ul>
  39. 42. Classification <ul><li>Pathologic </li></ul><ul><li>pathogenic </li></ul><ul><li>course of disease </li></ul><ul><li>State of disease </li></ul><ul><li>Clinical manifestation </li></ul><ul><li>Where acquired </li></ul>
  40. 43. Bronchopneumonia <ul><li>1.Etiology viruses, bacteria, MP, CP. 2~3yrs old </li></ul><ul><li>2.pathology edema,infiltration </li></ul>
  41. 44. <ul><li>3 pathophysiology </li></ul><ul><li>hypoxemia, hypercapnia, toxemia </li></ul><ul><li>respiratory insufficiency </li></ul><ul><li>acidosis </li></ul><ul><li>myocarditis, heart failure, shock, DIC </li></ul><ul><li>toxic encephalopathy </li></ul><ul><li>toxic intestinal paralysis </li></ul>
  42. 45. <ul><li>4.Clinical manifestation </li></ul><ul><li>( 1) mild pneumonia : </li></ul><ul><li>fever </li></ul><ul><li>cough </li></ul><ul><li>dyspnea ( tachypnea, cyanosis) </li></ul><ul><li>rales </li></ul><ul><li>Chest x-ray </li></ul>
  43. 46. 两肺纹理增粗。两肺中下野中内带见斑片状阴影,密度较均匀。部分病灶融合成范围稍大的片状影
  44. 47. <ul><li>(2) Severe pneumonia : </li></ul><ul><li>other systems involved </li></ul><ul><li>myocarditis, heart failure </li></ul><ul><li>toxic encephalopathy </li></ul><ul><li>toxic intestinal paralysis </li></ul>
  45. 48. <ul><li>5.Complications </li></ul><ul><li>Empyema </li></ul><ul><li>Pyopneumothorax </li></ul><ul><li>pneumatocele </li></ul>
  46. 49. <ul><li>6.Laboratory findings: </li></ul><ul><li>WBC, NBT,CRP </li></ul><ul><li>Pathogen(antigen and/or antibody) </li></ul><ul><li>chest x-ray </li></ul>
  47. 50. <ul><li>7.diagnosis </li></ul><ul><li>Fever, cough, tachypnea, dyspnea, localized fine moist rales, chest x-ray </li></ul><ul><li>8.differential diagnosis </li></ul><ul><li>acute bronchitis </li></ul><ul><li>tuberculosis </li></ul><ul><li>foreign bodies of trachea </li></ul>
  48. 52. 男 2 岁半。 4 个月前吃蚕豆后发生呛咳,经常发烧,左侧呼吸音低。胸片:左侧阻塞性肺气肿。心 影稍右移,经支气管检查于左支气管取出蚕豆碎块。
  49. 54. <ul><li>9. treament </li></ul><ul><li>(1) general therapy </li></ul><ul><li>(2) antipathogen therapy </li></ul><ul><li>antibiotics </li></ul><ul><li>antivirus </li></ul>
  50. 55. <ul><li>(3)symptomatic therapy </li></ul><ul><li>oxygen supply </li></ul><ul><li>airway management </li></ul><ul><li>abdominal distention </li></ul><ul><li>fever </li></ul><ul><li>(4) Corticosteroid </li></ul><ul><li>(5) complications /underling disease </li></ul><ul><li>(6)Immunotherapy </li></ul>
  51. 56. Characteristics of pneumonia caused by different pathogen
  52. 57. <ul><li>1.respiratory syncytial virus pneumonia </li></ul><ul><li>age: 2~7mon </li></ul><ul><li>fever:mild or moderate </li></ul><ul><li>main signs: acute onset, wheeze, expiratory difficulty, palpable liver and spleen. </li></ul><ul><li>Pallor, cyanosis, restlessness </li></ul><ul><li>Auscultation: diffuse rhonchi, fine rales </li></ul><ul><li>Chest X-ray:peribronchial thickening or interstitial pneumonia </li></ul>
  53. 58. <ul><li>2.Adenovirus pneumonia </li></ul><ul><li>Age: 6mon-2yrs </li></ul><ul><li>main signs: acute onset, long duration of high fever , 7~ 10days or 2~3weeks then pelter </li></ul><ul><li>Systemic toxic symptoms are obvious </li></ul><ul><li>Frequent cough , paroxysmal wheeze, dyspnea,cyanosis </li></ul>
  54. 59. <ul><li>late appearance of rales(3~7days) </li></ul><ul><li>myocarditis, heart failure, and </li></ul><ul><li>encephalopathy </li></ul><ul><li>X-ray changes early </li></ul>
  55. 60. 右肺中上野散在小灶状浸润阴影。左肺野中外带见大片状融合状阴影。其余肺野含气量增高。
  56. 61. <ul><li>3.Staphylococcal aureus pneumonia </li></ul><ul><li>< 1 year are most commonly affected </li></ul><ul><li>Acute onset, severe systemic symtoms </li></ul><ul><li>High fever, respiratory distress, GI . </li></ul><ul><li>Physical examinations: early appearance of rales </li></ul><ul><li>Effusion, empyema, pyopneumothorax , abscess of other organs , Sepsis </li></ul><ul><li>WBC↑, polymorphonuclear cells ↑ </li></ul><ul><li>chest x-ray:infiltration, multiple abscesses </li></ul>
  57. 64. <ul><li>4. Gram-negative bacillary pneumonia, GNBP </li></ul><ul><li>Haemophilus influenza , pneumonia bacilli </li></ul><ul><li>severe, hard to treament, poor prognosis </li></ul><ul><li>Systemic toxic symptoms , shock </li></ul><ul><li>Rales, </li></ul><ul><li>Infiltration, consolidation, hemorrhagic necrosis </li></ul><ul><li>X-ray: lobar, or segmental, effusion, abscess </li></ul>
  58. 65. <ul><li>5. Mycoplasma pneumonia </li></ul><ul><li>Usually over 5yrs, also infant </li></ul><ul><li>sore throat, headache </li></ul><ul><li>Mild or moderate fever, 1~3weeks </li></ul><ul><li>Unproductive cough, wheeze in infant </li></ul><ul><li>Multiple system damage </li></ul><ul><li>Auscultation: scattered rhonchi or rales. </li></ul><ul><li>X-ray: “walking pneumonia”, effusions </li></ul>
  59. 66. <ul><li>6. Chlamydial pneumonia </li></ul><ul><li>age: 2~12weeks </li></ul><ul><li>Chronic onset, nasal stuffiness, cough, tachypnea, rales, few wheezes </li></ul><ul><li>no fever </li></ul>
  60. 67. THANKS