This document discusses various upper respiratory tract infections including tonsillitis-pharyngitis, acute otitis media, acute rhinitis/sinusitis, laryngitis, acute epiglottitis, acute bronchitis, the common cold, and influenza. It describes the etiology, signs and symptoms, diagnosis, and treatment of each condition. The majority of upper respiratory infections are caused by viruses like rhinovirus, though some can be caused by bacteria like Streptococcus pyogenes which may require antibiotic treatment.

1. DISORDERS OF THE
RESPIRATORY SYSTEM
Agegnehu Derbew,MD
Gondar College Of Medicine & Health Science
Department of Internal medicine
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2. 2
Upper Respiratory Tract InfectionsUpper Respiratory Tract Infections

3. DEFINITION
 Inflammation of the
respiratory mucosa from the
nose to the lower
respiratory tree, not
including the alveoli.
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4. UPPER RESPİRATORY TRACT
INFECTİONS
 Acute tonsillitis
 Acute pharyngitis
 Acute otitis media
 Acute sinusitis
 Acute rhinitis
 Otitis externa
 Mastoiditis
 Acute laryngitis
 Acute apiglottis
 Tracheobronchitis
 Common cold
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5. 1.TONSİLO-PHARYNGITIS
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Exudates

6. TONSİLİTİS-PHARYNGİTİS
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Bacteria
S. pyogenes
C. diphteriae
N. gonorrhoeae
Viruses
Rhinovirus
Epstein-Barr virus
Adenovirus
Influenza A, B
Coxsackie A
Parainfluenzae

7. CAUSATİVE ORGANİSMS
 < 3 year,mainly viral
 5-15 years
 15-30 % GABHS
 Adult
 10 % GABHS
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8. DUE TO STREPTOCOCCİ:
 Spreads by close contact and through air
 Spread more in crowded areas (KG, school, army..)
 Most common among 5-15 age group
 More frequent among lower socio-economic classes
 Most common during winter and spring
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9. SİGNS/SYMPTOMS
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 Sore throat
 Anterior cervical LAP
 Fever > 38 °C
 Difficulty in swallowing
 Headache, fatigue
 Muscle pain
 Nausea, vomiting
Tonsillar hyperemia /
exudates
Soft palate petechia
Absence of coughing
Absence of hoarseness

10. VİRAL TONSİLLİTİS/PHARYNGİTİS
• Viral tonsilo-pharyngitis is most common.
Rhinovirus (most common).
• Symptoms usually last for 3-5 days.
 Having additional rhinitis, hoarseness,
conjunctivitis and cough
 Pharyngitis is accompanied by conjunctivitis in
adenovirus infections
 Oral vesicles, ulcers point to viruses
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11. EXUDATES
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 GABHS
 EBV
 Adenovirus
 Primary HIV infection
 Candida albicans

12. LABORATORY
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 Throat swab culture
 Gold standard
 WBC count

13. TONSILLITIS DUE TO
STREPTOCOCCI
A.Supurative complications
 Abscess
 Sinusitis, otitis, mastoiditis
 Cavernous sinus thrombosis
 Toxic shock syndrome
 Cervical lymphadenitis
 Septic arthritis, osteomyelitis
 Recurrent tonsillitis/pharyngitis
B.Nonsupurative complications
 Acute rheumatic fever (type 5 M-protein)
 Acute glomerulonephritis (nephritogenic strains)
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14. AIM OF TREATMENT
 Prevention of complications
 Starting treatment within 9 days is enough to prevent
ARF
 Symptomatic improvement
 Bacterial eradication
 Prevention of contamination
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15. TREATMENT OF GABHS
A) Symptomatic: Saline gargles,
analgesics
B) Antibiotics:
a) Benzathine Pn-G 1.2 million units
IM x 1 OR Pn V orally for 10 days
b) For Pn allergic pts:
Erythromycin 500mg QID x 10 days
OR Azithro 500 mg Qdaily x 3 days.
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16. 2.ACUTE OTİTİS MEDİA
 The diagnosis of AOM
requires the presence of a
middle ear effusion and
acute signs of middle ear
inflammation
 AOM not responding to
treatment: Sustained
clinical and otoscopy findings
despite 48-72hr.therapy
 Recurrent otitis media: 3
AOM attacks within 6 moths
or 4 attacks within 1 year
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17. AOM CAUSES
 S. pneumoniae30%
 H. İnfluenzae 20%
 M. Catarrhalis15%
 S. pyogenes 3%
 S. aureus 2%
 No growth 10-30%
 Chronic otitis media: P. aeruginosa, S.
aureus, anaerobic bacteria
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18. ACUTE OTİTİS MEDİA
 85% of children up to 3 years experience at least
one,
 50% of children up to 3 years experience at least
two attacks
 AOM is usually self-limited. Rarely benefits from
antibiotics.
 81 % undergo spontaneus resolution.
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19. SİGNS AND SYMPTOMS
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Symptoms
Autalgia
Ear draining
Hearing loss
Fever
Fatigue
Irritability
Tinnitus, vertigo
Otoscopic findings
Tympanic membrane
erythema
Inflammation
Bulging
Effusion
Hearing loss

20. 20
 Rx
amoxacillin,augmentin

21. 3.ACUTE RHİNİTİS / SİNUSİTİS
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22. SİNUSİTİS
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Acute sinusitis
 Str. pneumoniae %41
 H. influenzae %35
 M. catarrhalis %8
 Others %16
Chronic sinusitis
 Anaerob bacteria:
Bactroides,
Fusobacterium
 S. aureus
 Strep. pyogenes
 Str. pneumoniae
 Gram (-) bakteria
 Fungi

23. SIGNS AND SYMPTOMS
 Feeling of fullness and pressure over the
involved sinuses, nasal congestion and
purulent nasal discharge.
 Other associated symptoms: Sore throat,
malaise, low grade fever, headache,
toothache, cough > 1 week duration.
 Symptoms may last for more than 10-14
days.
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24. 24

25. PREDISPOSITION TO SINUSITIS
 Anatomical: septal deviation,
 Mukociliary functions: cystic fibrosis, immotile
cilia syndrome
 Systemic dis., immune deficiency.: DM, AIDS
 Allergy: Nasal poliposis, asthma
 Neoplasia
 Environmental: smoking, air pollution, trauma...
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26. DIAGNOSIS
 Based on clinical signs and symptoms
 Physical Exam: Palpate over the sinuses,
look for structural abnormalities
 X-ray sinuses: not usually needed but may
show cloudiness and air fluid levels
 Limited coronal CT are more sensitive to
inflammatory changes and bone destruction
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27. TREATMENT
 About 2/3rd
of patients will improve without
treatment in 2 weeks.
 Antibiotics: Reserved for patients who have
symptoms for more than 10 days or who experience
worsening symptoms.
 Supportive therapy: Humidification, analgesics,
antihistaminics
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28. ANTIBIOTICS
a) Amoxicillin (500mg TID) OR
b) TMP/SMX ( one DS for 10 days).
c) Alternative antibiotics: High dose amoxi/clavunate,
Flouroquinolones, macrolides
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29. 4.LARYNGITIS
 Most commonly upper respiratory viruses
 Diphtheria
 C. diphtheriae produces a cytotoxic exotoxin causing
tissue necrosis at site of infection with associated
acute inflammation. Membrane may narrow airway
and/or slough off (asphyxiation)
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30. 5.ACUTE EPIGLOTTITIS
 H. influenza type B
 Another cause of acute severe
airway compromise in childhood
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31. 6.ACUTE BRONCHITIS
 Inflammation of the bronchial respiratory mucosa
leading to productive cough.
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32. ACUTE BRONCHITIS
 The cough in acute bronchitis most often lasts from
10 to 20 days
 Chronic bronchitis: cough and sputum production on
most days of the month for at least three months of the
year during two consecutive years
 Etiology: A)Viral
B) Bacterial (Bordetella pertussis,
Mycoplasma pneumoniae, and Chlamydia pneumoniae)
 Diagnosis: Clinical
 S/S: Productive cough, rarely fever or tachypnea.
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33. TREATMENT
A) Symptomatic
A) If cough persists for more than 10 days:
 Azithromycin x 5 days OR
 Clarithromycin x 7 days
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34. NON SPECIFIC URI’S
 7.Common Cold
• Etiology: Rhinovirus
 Adenovirus
 RSV
 Parainfluenza
 Enteroviruses
• Diagnosis: Clinical
• Treatment: Adequate fluid intake, rest, humidified air,
and over-the-counter analgesics and antipyretics.
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35. COMMON COLD
 Adults Rhinovirus
 Children Parainfluenzae and RSV
 Clinical feature
 Fatigue
 Feeling cold, shuddering
 Nose burning, obstruction, running
 Sneezing
 Fever
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36. INFLUENZA (FLU)
 Causes epidemics and pandemics
 Highly contagious
 Viral infection.
• 80 % Influenzae virus
• Parainfluenza 2-9 %
• Rhinovirus 3 %
• Adenovirus 4 %
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37. INFLUENZA
 Sudden onset after 12-24 hours incubation
 General weakness and fatigue
 Feeling cold, shivering, temp. Up to 39-40 C
 No sore throat or running nose
 Severe back, muscle and joint pain
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38. DISEASE
 Influenza A virus cause
 worldwide epidemics (pandemic)
 major outbreaks of influenza
 occurs virtually every year.
 Influenza B virus cause
 major outbreaks of influenza
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39. VIRUS
 Segmented (8 segments in types A & B, 7 in type C)
ssRNA genome
 Helical nucleocapsid
 Outer lipoprotein envelope
 The envelope is covered with two different types of spikes,
hemagglutinin and a neuraminidase.
 Hemagglutinin binds cell surface receptor, to initiate
infection.
 Neuraminidase releases progeny virus from infected cells.
 The internal ribonucleoprotein is the group specific
antigen that distinguishes influenza A, B and C.
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40. ORTHOMYXOVIRUSES
M1 protein
helical nucleocapsid (RNA plus
NP protein)
HA - hemagglutinin
polymerase complex
lipid bilayer membrane
NA - neuraminidase
Type A, B, C : NP, M1 protein
Sub-types: HA or NA protein 40

41. ANTIGENIC CHANGES
 Influenza viruses especially type A show changes
in antigenicity of hemagglutinin (H) and
neuraminidase (N) proteins.
 Antigenic shifts:
 major changes based on the reassortment of RNA
segments. It occurs only with influenza A.
 Other theories of antigenic shift includes:
 Recirculation of existing subtypes
 Gradual adaptation of animal viruses to human
transmission
 Antigenic drifts:
 minor changes based on mutations in the RNA
genome. 41

42.  TRANSMISSION
 Airborne respiratory droplets
 EPIDEMIOLOGY
 Winter months
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43. COMPLICATIONS
 Tracheobronchitis and bronchiolitis
 Primary viral pneumonia
 Secondary bacterial pneumonia
S. aureus is most commonly involved although S.
pneumoniae and H. influenzae may be found.
 Myositis and myoglobinuria
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44. TREATMENT
 Amantidine
 The only effective against influenza A.
 Act at the level of virus uncoating.
 Both therapeutic and prophylactic effects.
 Vaccine.
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