This document discusses respiratory tract infections, which are infections that involve the respiratory tract. It describes upper respiratory tract infections such as sinusitis, pharyngitis, and otitis media, and lower respiratory tract infections such as bronchitis, bronchiolitis, and pneumonia. For each infection, it discusses the typical causative agents, affected age groups, characteristics, clinical features, and treatment approaches. It provides an overview of the pathophysiology of upper and lower respiratory tract infections.

1. RESPIRATORY TRACT
INFECTIONS
Presented by;
Aiswarya.A.T
First year M.Pharm
Dept. of Pharmacy Practice
Grace College of Pharmacy

2. RESPIRATORY TRACT
INFECTIONS
Respiratory tract infections refers to any of a
number of infectious diseases involving
the respiratory tract .
It is classified in to 2 types they are:
UPPER RESPIRATORY TRACT INFECTIONS
LOWER RESPIRATORY TRACT INFECTIONS

3. AGENT FACTORS
BACTERIA AGE GROUP
AFFECTED
CHARACTERISTIC
CLINICAL FEATURES
Bordetella pertussis Infants & young
children
Poroxysmal cough
Corynebacterium
diphtheriae
Children diphtheria
Hemophilus influenzae Adults
Children
Acute ex of ch bronchitis
Acute epiglottitis
Klebsiella pneumoniae Adults Lobar pneumonia
Legionella pneumophila Adults Pneumonia
Staph. pyogenes All ages Lobar and
bronchopneumonia
Strep. pneumoniae All ages Pneumonia
Strep. pyogenes All ages Acute pharyngitis and
tonsillitis

4. VIRUSES AGE GROUP
AFFECTED
CHARACTERISTIC
CLINICAL FEATURES
Enterovirus All ages Febrile pharyngitis
Influenza A, B, C All ages variable
Measles Young children variable
Parainfluenza 1, 2, 3 Young children variable
Respiratory Syncytial
Virus
Infants and young
children
Severe bronchiolitis
and pneumonia
Rhinovirus All ages Common cold
Coronavirus All ages Common cold

5. LOWER RESPIRATORY TRACT INFECTIONS
(LRTI)
Inflammation of the air passages within the lungs.
Trachea(windpipe),and the large & small
bronchi(airways)within the lungs become inflamed
because of the infection.
The infections of LRT includes:
 BRONCHITIS
 BRONCHEOLITIS
 PNEUMONIA

6. Health care systems, Smoking, microorganisms, etc
Inflammation
Bradykinins, Histamines, Prostaglandins
Increasing capillary permeability
Fluid/ cellular exudation
Oedema of mucous membrane
Hypersecretion of mucous
Persistant cough
LRTI
General Pathophysiology of LRTI

7. Inflammatory disease of the bronchi
Peak age of onset : 6 months
Occurs mostly in winter/spring
BRONCHITIS

8. There are two types of bronchitis:
1. Acute bronchitis
Acute (i.e. recent onset) bronchitis is an
inflammation of the lower respiratory
passages (bronchi).
2. Chronic bronchitis
Chronic bronchitis is defined as a cough
that occurs every day with sputum production
that lasts for at least 3 months, two years in a
row.

9. CAUSES:
Viral infection
Bacteria
Chemical irritants ( tobacco smoke, gastric reflux solvents)

10. SIGNS AND SYMPTOMS
Cough persisting >5 days to wks
Production of clear, white, yellow, grey, or green mucus (sputum)
Wheezing
Fatigue
Chest pain or discomfort
Blocked or runny nose
Coryza, sore throat, malaise, headache
Dyspnea, cyanosis, or signs of airway obstruction rarely
Fever rarely >39°C

11. TREATMENT
Acute bronchitis
•Aspirin or acetaminophen
•Ibuprofen
•In combination with antihistamines, sympathomimetics, and
antitussives
•Hypnotics / sedatives in mild dose
•Routine antibiotic use is discouraged
•In elderly & immunocompramised patients, fluoroquinolones ,
azithromycin, amantadine or rimantadine (for influenza A),
neuraminidase inhibitors e.g., zanamivir and oseltamivir(for both
influenza A & B)

12. Chronic bronchitis

13. BRONCHIOLITIS
Inflammatory disease of the bronchioles
Peak age of onset : 6 months
Male : female :- 2:1
Occurs mostly in winter
Cause: Respiratory syncytial virus (RSV),
Parainfluenza viruses type 3, type 1 and type 2.
Bacteria serve as secondary pathogens in a minority of cases.

14. Signs and symptoms
•Prodrome with irritability, restlessness, and mild fever
•Cough and coryza
•Vomiting, diarrhea, noisy breathing, and increased
respiratory rate as symptoms progress
•Labored breathing with retractions of the chest wall,
nasal flaring, and grunting

15. TREATMENT
Mainly supportive
Oxygen inhalation
If tachypneic, limit the oral feeds and use a nasogastric tube
for feeding
Parenteral fluids to limit dehydration
Correct respiratory acidosis and electrolyte imbalance
Bronchodilators for wheeze (nebulized adrenaline)
Mechanical ventilation (severe resp distress or apnoea)

16. Inflammation of the lung parenchyma and is associated with the
consolidation of the alveolar spaces
Developed world :
Viral infections
Low morbidity and mortality
ŠDeveloping world :
Common cause of death
ŠARI case management -WHO :
84% reduction in mortality
Respiratory rate, recession, ability to drink
Cheap, oral and effective antibiotics, Co-trimoxazole, amoxycillin
Maternal education
Referral
PNEUMONIA

17. AGE GROUP CAUSATIVE ORGANISM
NEONATES GROUP B STREPTOCOCCUS
E.COLI
KLEBSIELLA
STAPH AUREUS
INFANTS PNEUMOCOCCUS
CHLAMYDIA
RSV
H.INFLUENZA TYPE b
CHILDREN 1 TO 5 YRS RESPIRATORY VIRUSES
PNEUMOCOCCUS
H.INFLUENZA TYPE b
C.TRACHOMATIS
M.PNEUMONIAE
S.AUREUS
GP A STREPTOCOCCUS
CHILDREN 5 TO 18 YRS M.PNEUMONIAE
PNEUMOCOCCUS
C.PNEUMONIAE
H.INFLUENZA TYPE b

18. NO PNEUMONIA COUGH
NO TACHYPNEA
-HOME CARE
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 5 DAYS IF NOT
IMPROVING
PNEUMONIA -COUGH
-TACHYPNEA
-NO RIB OR STERNAL
RETRACTION
-ABLE TO DRINK
- NO CYANOSIS
-HOME CARE
-ANTIBIOTICS FOR 5 DAYS
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH
-TACHYPNEA
-RIB AND STERNAL RETRACTION
-ABLE TO DRINK
-NO CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
VERY SEVERE
PNEUMONIA
-COUGH
-TACHYPNOEA
-CHEST WALL RETRACTION
-UNABLE TO DRINK
-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-OXYGEN
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
WHO Classification and management

19. Significant risk factors are younger age (2-6 months), low parental
education, smoking at home, prematurity, low birth weight,
weaning from breast milk at < 6 months, a negative history of
diphtheria, pertussis and tetanus vaccination, anaemia, malnutrition
and overcrowding.
Infection rate higher in siblings of school children who introduce
infection in the household.
Other risk factors
Congenital lung cysts
Chronic lung disease
Immunodeficiency
Cystic fibrosis
Sickle cell disease
Tracheostomy in situ
HIGH RISK CHILDREN FOR PNEUMONIA

20. Community acquired Pneumonia
Health care associated Pneumonia
Pneumonia in HIV patients
Pneumonia in neutropenic lost
Hospital acquired Pneumonia / Nosocomial Pneumonia
Ventilator associated Pneumonia
Atypical Pneumonia/ Nonbacterial Pneumonia
Legionella Pneumophila
Mycoplasma Pneumonia
Chlamydophila Pneumonia
Viral Pneumonia
Tuberculosis
Severe Acute Respiratory Syndrome(SARS)
H1 N1 influenza (swine flu)
Avian influenza (bird flu)
TYPES OF PNEUMONIA

21. BACTERIAL VIRAL
MYCOPLASMIC ASPIRATION

22. FUNGAL

23. Many other causes of Pneumonia with
Acute Respiratory Disease & Fever
Plague Tularemia RICIN toxin
Staphylococcal
Enterotoxin B
TBLegionella
SARS
S.Pneumoniae

24. TREATMENT
ADULTS

25. Age Usual Pathogen(s) Presumptive Therapy
1 month Group B streptococcus, Haemophilus
influenzae (nontypeable),
Escherichia coli,
Staphylococcus aureus, Listeria,
CMV, RSV, adenovirus
Ampicillin–sulbactam,
cephalosporin
carbapenem
Ribavirin for RSV
1–3 months Chlamydia, possibly Ureaplasma,
CMV, Pneumocystis carinii (afebrile
pneumonia syndrome)
RSV
Pneumococcus, S. aureus
Macrolide/azalide,
trimethoprim-
Sulfamethoxazole
Ribavirin
Semisynthetic penicillin or
Cephalosporin
3 months–
6 years
Pneumococcus, H. influenzae,
RSV, adenovirus, parainfluenza
Amoxicillin or cephalosporin
Ampicillin–sulbactam,
amoxicillin–
clavulanate
Ribavirin for RSV
>6 years Pneumococcus, Mycoplasma
pneumoniae, adenovirus
Macrolide/azalide
cephalosporin,
amoxicillin–clavulanate
PEDIATRICS

26. UPPER RESPIRATORY TRACT INFECTIONS
(URTI)
Upper respiratory tract infections (URI or URTI) are the
illnesses caused by an acute infection which involves the
upper respiratory tract; i.e. nose, sinuses, pharynx or larynx.
It include otitis media, sinusitis, pharyngitis, laryngitis(croup),
tonsillitis, rhinitis(Common cold), Diphtheria and epiglottitis.

27. General Pathophysiology of URTI
Bacteria, viruses
Direct hand-hand contact droplet infection
Enters the nose by inhaling
Immune defences
Hair lining filters & trap some pathogens
Traps in upper respiratory tract which coats by mucous
Junction of the posterior nose to pharynx
Impinge on the back of the throat
Transport pathogens upto pharynx
Inflammatory response to immune system
Increased mucous secretion, fever, swelling, runny nose, etc..

28. OTITIS MEDIA
Critical role of eustachian tube as
conduit between nasopharynx,
middle ear, and mastoid air cells
Children have shorter, wider
eustachian tubes than adults
S. pneumoniae is the most common bacterial cause . Non typeable
Haemophilus influenzae and Moraxella catarrhalis is also
responsible.
Bacterial organisms that have been associated less frequently with
otitis media include Staphylococcus aureus, Streptococcus
pyogenes, and gram-negative bacilli such as Pseudomonas
aeruginosa.

30. Signs and symptoms
•Pain that can be severe
•Children may be irritable, tug on the involved ear, and have
difficulty sleeping
•Fever is present in less than 25% of patients and, when present,
occurs more often in younger children
•Examination shows a discolored (gray), thickened, bulging
eardrum
•Pneumatic otoscopy or tympanometry demonstrates an immobile
eardrum; 50% of cases are bilateral
•Draining middle ear fluid occurs (less than 3% of patients) that
usually reveals a bacterial etiology

31. TREATMENT

32. SINUSITIS
•Community acquired bacterial
sinusitis
S.pneumoniae
H. influenzae
S. Pyogenes
•Nosocomial sinusitis
Seen in critically ill,
mechanically ventilated
S. aureus
Pseudomonas aeruginosa
Serratia marcescens
•fungal

34. Signs and symptoms
Acute:
Adults
•Nasal discharge/congestion
•Maxillary tooth pain, facial or sinus pain that may radiate (unilateral in
particular) as well as deterioration after initial improvement
•Severe or persistent (beyond 7 days) signs and symptoms are most likely bacterial
and should be treated with antimicrobials
Children
•Nasal discharge and cough for greater than 10 to 14 days or severe signs
•and symptoms such as temperature above 39°C (102.2°F) or facial swelling or
pain are indications for antimicrobial therapy
Chronic:
•Symptoms are similar to acute sinusitis but more nonspecific
•Rhinorrhea is associated with acute exacerbations
•Chronic unproductive cough, laryngitis, and headache may occur
•Chronic/recurrent infections occur three to four times a year and are unresponsive
to steam and decongestants

36. TREATMENT

37. PHARYNGITIS
Inflammatory syndrome of the pharynx(oro/nasopharynx)
Most cases are viral
Most important bacterial cause is Streptococcus pyogenes
Presents with sore or scratchy throat
In severe bacterial cases there may be odynophagia, fever, headache

38. Signs and symptoms
Sore throat
Pain on swallowing
Fever
Headache, nausea, vomiting, and abdominal pain (especially
children)
Erythema/inflammation of the tonsils and pharynx with or
without patchy exudates
Enlarged, tender lymph nodes
Red swollen uvula, petechiae on the soft palate, and a
scarlatiniform rash
Several symptoms that are not suggestive of group A
Streptococcus are cough, conjunctivitis, coryza, and diarrhea

39. TREATMENT

40. RHINITIS/ COMMON COLD
Children average 8 episodes per year, adults 3 episodes
per year
Etiologies :
Rhinoviruses 30 to 35%
Coronaviruses about 10%
Miscellaneous known viruses about 20%
Influenza and adenovirus-30%
Presumed undiscovered viruses up to 35%
Group A streptococci 5% to 10%
Seasonal variation:
Rhinovirus early fall
Coronavirus- winter

41. Common symptoms are sore throat, runny nose, nasal congestion,
sneezing,
Sometimes accompanied by conjunctivitis, myalgias, fatigue

42. ACUTE EPIGLOTTITIS
Life-threatning infection of the epiglottis, the aryepiglottic folds
and arytenoid soft tissue
Occurs mostly in winters
Peak incidence :- 1 – 6 years
Male affected more
bacterial infection (Hemophilus influenza type b)
Concomitant bacteremia, pneumonia, otitis media, arthritis and
other invasive infections caused by H.influenza type b may be
present

43. INTRAVENOUS AMPLICILLIN 100 mg/kg/day OR
CEFTRIAXONE 100 mg/kg/day .
OTHER OPTIONS:
(CEFUROXIME OR CEFOTAXIME) TOTAL TREATMENT :-7-
10 DAYS
CHOLRAMPHENICOL 50-75 mg/kg/day IV
RIFAMPICIN PROPHYLAXIS TO CLOSE CONTACTS
TREATMENT

44. TONSILLITIS
Tonsillitis is a viral or bacterial infection in the throat that causes
inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the
pharyngeal cavity.
In the first six months of life tonsils provide a useful defense against
infections. Tonsillitis is one of the most common ailments in pre-school
children, but it can also occur at any age.
Children are most often affected from around the age of three or
four, when they start nursery or school and come into contact with many new
infections.
A child may have tonsillitis if he/she has a sore throat, a fever and is off food.

45. Symptoms
Pain in the throat (sometimes
severe) that may last more than 48
hours and be associated with
difficulty in swallowing. The pain
may spread to the ears.
The throat is reddened, the tonsils
are swollen and may be coated or
have white spots on them.
Possibly a high temperature.
Swollen lymph glands under the
jaw and in the neck.
Headache.
Loss of voice or changes in the
voice.

46. Encourage bed rest.
Introduce soft liquid diet according to the child's
preferences.
Provide cool mist atmosphere to keep the mucous
membranes moist during periods of mouth breathing.
Warm saline gargles & paracetamol are useful to
promote comfort.
If antibiotics are prescribed, counsel the child's parents
regarding the necessity of completing the treatment period
The controversy of tonsillectomy:
Surgical removal of chronic tonsillitis (tonsillectomy) is
controversial. Generally, tonsils should not removed before
3 or 4 yrs of age, because of the problem of excessive blood
loss & the possibility of re-growth or hypertrophy of
lymphoid tissue, in young children.
TREATMENT

47. DIPHTHERIA
Classic diphtheria (Corynebacterium diphtheriae): slow
onset, then marked toxicity
Arcanobacterium hemolyticum (formerly Cornyebacterium
hemolyticum): exudative pharyngitis in adolescents and
young adults with diffuse, sometimes pruritic maculopapular
rash on trunk and extremities

48. TREATMENT
Symptomatic
Penicillin for Strep throat
Macrolides for penicillin allergic patients

49. CROUP/ LARYNGOTRACHEOBRONCHITIS
Rhinorrhea, sore throat, mild cough, fever
Parainfluenzae and influenza can be identified by
nasopharyngeal swab
Rapid tests are available
Treat with vaporizers, nebulized adrenaline
Systemic or nebulized corticosteroids in the severely
sick

50. THANK YOU !