AIR BORNE, DROPLET OR RESPIRATORY TRACT INFECTIONS

1. Dr. Dalia El-Shafei
Assist. Prof., Community Medicine Department, Zagazig University

2. Respiratory
tract infection
Viral
With rash
Measles
Rubella
Chicken pox
Herpes zoster
Small pox
Without rash
Mumps
Influenza
Common cold
SARS
Bacterial
Meningitis
Strepto-coccal
pharyngitis
Scarlet fever
Pertussis
Diphtheria
TB

7. Respiratory
tract infection
Viral
With rash
Measles
Rubella
Chicken pox
Herpes zoster
Small pox
Without rash
Mumps
Influenza
Common cold
SARS
Bacterial
Meningitis
Streptococcal
pharyngitis
Scarlet fever
Pertussis
Diphtheria
TB

8. Measles
“Rubeola”
German measles
“Rubella”
Source
of
infection
Man only case or contact
healthy carrier (in resp.
secretion)
Cases & incubatory Carriers. Congenitally
Infected infants act as reservoir for 1 year “in
respiratory secretion, blood, urine, & stool”
IP 10 days 14-18 days
Period of
infectivity
In prodromal stage & 5 days
after rash
1 week before & 7 days after rash

9. C/P Measles
“Rubeola”
German measles
“Rubella”
Prodromal
stage
- 3-4 days
Fever, Catarrh, Conjunctivitis
- Koplik's spots on 2nd day “Tiny bluish
white spots on buccal mucosa”.
- 1 day
- Mild symptom
- Cervical lymph adenopathy.
Rash
On 4th day red blotchy appears on face,
root of hair then generalized. Branny
desquamation after 1 week.
- Lasts for 3 days.
- Maculo-papular or uniform red all over
body.
Complication
- Encephalitis
- Pneumonia
- Otitis media
- Congenital rubella syndrome “CRS”:
infection during 1st trimester. Causes
cataract, deafness, heart anomaly, mental
retardation.
- Otitis media, cervical adenitis

10. Clinical course of measles

11. Measles
Rubella

13. Prevention Measles
“Rubeola”
German measles
“Rubella”
Vaccination
Live attenuated, 0.5ml SC at 9th
month compulsory.
MMR vaccine at 12-15th month.
Booster dose at 4th year.
Life long immunity
Rubella alone or MMR live attenuated,
single dose 0.5ml SC. given at 12-15th
month. Given to adolescent girls or females
at any age before pregnancy.
Life long immunity.
seroprophyl
axis
Within 6 days of exposure
Sero-prevention: Human Ig.
Sero-attenuation: smaller dose to
give mild C/P.
Pregnant exposed to infection & refuse
abortion.

18. Small pox “Variola” Chicken pox “Varicella” Herpes zoster
Source of
infection
Cases only “respiratory & skin rash vesicle”
Can be used in biological
terrorism.
“Rarely from
chicken pox cases”
IP 2 Weeks 2-3 Weeks
Period of
infectivity
From beginning of rash till
disappearance (3 weeks).
2 days before & 6 days after rash
C/P - High fever, arthralgia for
2 days then fever drops.
- Rash: limbs then trunk.
“One stage at a time:
macule, papule, vesicle,
pustule”. Form scabs then
fall leaving scars.
Prodroma: as common cold
Rash: pruritis, in successive
crops, on trunk then limbs
“macules, papules, vesicle,
pustule all at the same
time”.
No skin scars
Localized painful
vesicular rash along
sensory nerve endings
between ribs.
Recurrent in adults
Complica
tions
Skin scars.
Fatality is high
Rare: pneumonia,
encephalitis.
Neuralgia, nerve palsy,
sensory loss, deafness

23. Small pox “Variola” Chicken pox “Varicella” Herpes zosterVaccination
Calf lymph vaccine by
scratching. Very
effective. Can be given
during IP, for contacts.
- Quarantinable disease
“Eradicated in 1979”.
Live attenuated vaccine, 0.5ml SC
once for ages below 13 & 2 doses
after 13years.
Gives 95% immunity
Not very
effective
Sero-
prophylasxix
Immunoglobulin within 4 days after
exposure to immuno-compromised.

27. Respiratory
tract infection
Viral
With rash
Measles
Rubella
Chicken pox
Herpes zoster
Small pox
Without rash
Mumps
Influenza
Common cold
SARS
Bacterial
Meningitis
Streptococcal
pharyngitis
Scarlet fever
Pertussis
Diphtheria
TB

28. Mumps Common
cold
influenza Avian flu SARS
Agent Virus Rhino v. Virus types
A:mutation
&pandemics
B:epidemic
C:outbreaks
Virus A
Type H5N1
Virus
quarantinable
disease.
Notification to
WHO”.
Source of
infection
Cases &
incubatory carriers
(saliva & in utero)
Cases Human cases only
“may be Avian, swine,
horses”
Birds feces,
feather, Nasal
discharge
Cases
IP 18 days 1-3 days 2-10 days
Period of
infectivity
1 week before
parotitis till
disappearance of
swelling.
All course of disease No human to
human
transmission
till now
All course of
disease

29. Mumps Common cold influenza Avian
flu
SARS
C/P Prodroma: 1-2 days
fever, malaise,
headache, body aches.
Enlarged painful
salivary gland (parotid,
sublingual,
submaxillary)
Sudden onset
catarrh, running
nose, sneezing,
sore throat,
cough. Usually
no fever
Sudden high fever,
body aches,
arthralgia, sore
throat, cough.
Severesymptoms
Fluelikesymptoms
Complicati
on
Orchitis, oophritis,
aseptic meningitis,
pancreatitis, mastitis,
nephritis, neuritis
Rare. Pneumonia, otitis
media, sinusitis,
pericarditis,
bronchitis
Pneumonia,
respiratory failure,
death

31. Mumps Common
cold
influenza Avian
flu
SARSVaccination
MMR 0.5ml SC or
mumps vaccine alone.
Must be before puberty.
Life long immunity.
No Live attenuated intra
nasally or inactivated IM.
“short duration immunity
1year”.
- Before winter
- Immunity to one strain
No
Seroprophylaxis:
doubtful in action
Chemoprophylaxis:
Amantadin HCL against
type A only.

34. Respiratory
tract infection
Viral
With rash
Measles
Rubella
Chicken pox
Herpes zoster
Small pox
Without rash
Mumps
Influenza
Common cold
SARS
Bacterial
Meningitis
Streptococcal
pharyngitis
Scarlet fever
Pertussis
Diphtheria
TB

35. Diphtheria Streptococcal
pharyngitis
Scarlet fever
Agent Coryne Bacterium Diphtheria, mitis,
Intermedius, gravis
Group A hemolytic streptococci
Source of
infection
Case & Carrier
Milk
Cases & Carriers
IP 2-6 days 1-3 days
Period of
infectivity
2 weeks or Just after treatment All stages if not treated or 24 hr after ttt
C/P Low fever, grayish yellow membrane
on pharynx, difficult to remove,
odema, Congestion, enlarged lymph
nodes (bull neck), toxemia
High fever,
headache, sore
throat, cervical
adenopathy, red
pharynx with
purulent exudate
High fever, pharyngitis,
strawberry tongue, rash
puncitate, blanch on pressure,
felt as sandpaper, on neck,
chest, axilla, elbow, groin. Not
in face(circum-oral Pallor)
Complicat
ion
Carditis, paralysis of pharynx, soft
palate, eye muscles, limbs
Peri-tonsillar abscess, sinusitis, otitis media,
Pneumonia, rheumatic fever, enteritis,
Glomerulonephritis

37. Diphtheria Streptococcal
pharyngitis
Scarlet fever
Vaccination Active immunization by toxoid. DPT or DT
or alone “99%effective”.
Compulsory at 2,4,6 months, booster at 12-
18 months. Also given to contact.
Sero-
prophylaxis
Antitoxin for non-immunized contacts & for
ttt of cases
Chemoprop
hylaxis
Antibiotics to all contacts Antibiotics “Penicillin,
streptomycin. Sulphonamides”

38. Meningitis Pertussis “Whooping cough” TB
Agent Neisseria Meningitidis: A:
epidemic, B: sporadic, C: outbreaks
Bordetella pertussis Mycobacterium tuberculosis
Source of
infection
Carriers “common source”.
Cases
Cases Cases
Animals
IP 2-7 days 1-2 weeks 2-8 weeks
Period of
infectivity
All stages if not treated or 24 hr
after treatment
Start of symptoms till 3weeks
after typical cough or 5 days
after ttt
Open cases infective for
years if not treated
C/P Sudden fever, headache, nausea
Catarrhal symptoms, petechial rash.
Neck rigidity, +ve Kernig's sign,
Brudziniski sign. ↑ CSF pressure.
Catarrhal symptoms, slight
fever, spasmodic cough in
attacks followed by whoop,
vomiting. May be without
classic whoop.
Pulmonary TB: anorexia, wt
loss, night sweating,
hemoptysis “90% of cases”.
Complica
tion
deafness, optic neuritis, nephritis,
hydrocephalus, DIC.
Hernia, convulsions
Hemorrhage
2ry bacterial infection
Extra-pulmonary TB: bones,
meningitis, Intestinal, joint,
kidney

42. Meningitis Pertussis
Whooping cough
TB
Vaccination Capsular polysaccharides of groups
A,C,Y,W.
1 dose SC gives 3 years immunity.
“90%effective”
DPT “80% protective”.
Vaccine is not given to
children>4 years “epilepsy,
convulsions, high fever”
BCG vaccine in 1st
3 months of life
0.1ml intradermal.
“80% protective”.
Chemoprophy
laxis
Rifampicin 600mg b.i.d. for 2 days
“contacts during outbreaks, carriers,
pilgrims”.
Erythromycin for 10 days
to contacts
INH for tuberculin
+ve contacts.
International
measures
International immunization
certificate for travelers from endemic
areas