This document discusses various respiratory tract infections including upper and lower respiratory tract infections. It defines respiratory tract infection and further classifies them as upper respiratory tract infections (URTIs) or lower respiratory tract infections (LRTIs), noting that LRTIs such as pneumonia are more serious. It then discusses specific URTIs including the common cold, tonsillitis, pharyngitis, laryngitis, sinusitis and their causes, symptoms, diagnoses and treatments. It also discusses specific LRTIs including bronchitis and pneumonia, their classifications, causes, symptoms, diagnoses and treatment approaches.

1. Respiratory Tract Infection
Dr. C.B.Pun

3. Respiratory Tract Infection.
Respiratory tract infection refers to any of a number of
infectious diseases involving the respiratory tract. An
infection of this type is normally further classified as an
upper respiratory tract infection (URTI) or a lower
respiratory tract infection(LRTI). Lower respiratory
infections, such as pneumonia, tend to be far more
serious conditions than upper respiratory infections,
such as the Respiratory Tract Infection common cold.

4. Upper respiratory tract infection
 the upper respiratory tract is generally considered to be the
airway above the glottis or vocal cords. This includes the
nose, sinuses, pharynx, and larynx.
 Typical infections of the upper respiratory tract include
tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, certain
types of influenza, and the common cold.Symptoms of URIs
can include cough, sore throat, runny nose, nasal congestion,
headache, low grade fever, facial pressure and sneezing.

5. Tonsillitis
Tonsillitis is inflammation of the tonsils most commonly caused
by viral or bacterial infection. Symptoms may include sore throat
and fever. When caused by a bacterium belonging to the group
A streptococcus

7. Signs and symptoms
 Common signs and symptoms include
• sore throat
• red, swollen tonsils
• pain when swallowing
• high temperature (fever)
• coughing
• headache
• tiredness
• chills
• a general sense of feeling unwell (malaise)
• swollen lymph nodes (glands) in the neck

8. Less common symptoms include:
• nausea
• vomiting
• furry tongue
• bad breath (halitosis)
• voice changes
• difficulty opening the mouth (trismus)

9. Causes
 The most common cause is viral infection and includes
adenovirus, rhinovirus, influenza and It can also be caused by
Epstein-Barr virus and cytomegalovirus.
 Less common bacterial causes include: Staphylococcus
aureus (including methicillin resistant Staphylococcus aureus
or
MRSA ),Streptococcus pneumoniae, Mycoplasma
pneumoniae.
chlamydia pneumonia.

10. Diagnosis
 The diagnosis of tonsillitis can be confirmed by culture of
samples obtained by swabbing.
 A single throat culture has a sensitivity of 90%-95% for the
detection of tonsillitis.

11. Treatment
 Treatments to reduce the discomfort from tonsillitis symptoms include:
•pain relief, anti-inflammatory, fever reducing medications
(acetaminophen/paracetamol and/or ibuprofen)
•sore throat relief (warm salt water gargle, lozenges, dissolved aspirin gargle
(aspirin is an anti inflammatory, do not take any other anti inflammatory drugs
with this method), and iced/cold liquids)

12.  If the tonsillitis is caused by group A streptococus, then antibiotics are
useful with penicillin or amoxicillin being primary choices.Cephalosporins
and macrolides are considered good alternatives to penicillin in the acute
setting.
 When tonsillitis is caused by a virus, the length of illness depends on
which virus is involved. Usually, a complete recovery is made within one
week; however, symptoms may last for up to two weeks. Chronic cases
may be treated with tonsillectomy (surgical removal of tonsils) as a choice
for treatment.

13. Pharyngitis
 It is an inflammation of the throat.
 In most cases it is quite painful, and is the most common cause of a sore
throat.
 Like many types of inflammation, pharyngitis can be acute – characterized by a
rapid onset and typically a relatively short course – or chronic
 can be accompanied by a cough or fever, for example, if caused by a systemic
infection.
 Most acute cases are caused by viral infections (40–80%), with the remainder
caused by bacterial infections, fungal infections, or irritants such as pollutants
or chemical substances. Treatment of viral causes are mainly symptomatic
while bacterial or fungal causes may be amenable to antibiotics and anti-fungal
respectively.

14. Pharyngitis

15. Cause
Viral
 Adenovirus – the most common of the viral causes.
 Orthomyxoviridae which cause influenza
 Herpes simplex virus can cause multiple mouth ulcers.
 Measles

16. Bacterial
 A number of different bacteria can infect the human throat.
The most common is Group A streptococcus, however others
include Corynebacterium diphtheriae, Neisseria gonorrhoeae,
Chlamydophila pneumoniae, and Mycoplasma pneumoniae.

17. Diagnostic approach
 It is hard to differentiate a viral and a bacterial cause of a sore
throat based on symptoms alone. Thus often a throat swab is
done to rule out a bacterial cause.

18. Management
 The majority of time treatment is symptomatic. Specific
treatments are effective for bacterial, fungal, and herpes
simplex infections.
 Analgesics such as NSAIDs and acetaminophen can help
reduce the pain associated with a sore throat.
 Antibiotics are useful if a bacterial infection is the cause of the
sore throat. For viral infections, antibiotics have no effect.
 Oral analgesic solutions.

19. Laryngitis
 Laryngitis is an inflammation of the larynx. It causes hoarse
voice or temporary complete loss of the voice because of
irritation to the vocal folds (vocal cords). Dysphonia is the
medical term for a vocal disorder, of which laryngitis is one
cause.
 Laryngitis is categorized as acute if it lasts less than a few
days. Otherwise it is categorized as chronic, and may last
over three weeks.

20. Laryngitis

21. Causes
 Noninfectious causes
• Acid reflux disease, resulting in laryngitis gastrica.
• Allergies.
• Excessive coughing, smoking, or alcohol consumption.
• Inflammation due to overuse of the vocal cords
• Prolonged use of inhaled corticosteroids for asthma treatment.
• Thermal or chemical burns.
• Laryngeal trauma, including iatrogenic one caused by endotracheal
intubation.

22. Infectious causes
•Viral infections can be caused by rhinovirus, influenza virus,
coronavirus..
•Bacterial infections can be caused by group A streptococcus,
C. diphtheriae, M.catarrhalis, and M.tuberculosis. Bacterial
infections usually follow pre-existing viral infection.
•Fungal infections can be caused by Histoplasma, Blastomyces,
Candida.

23. Symptoms
• Dysphonia (hoarseness) or aphonia (inability to speak)
• Dry, sore, burning throat
• Coughing
• Dysphagia (difficulty in swallowing)
• Sensation of swelling in the area of the larynx
• Cold or flu-like symptoms
• Swollen lymph nodes in the throat, chest, or face
• Fever
• Dyspnea (difficulty in breathing)
• Increased production of saliva

24. Treatment
 General measures: Voice rest is important
 If laryngitis is due to gastroesophageal reflux, an H2-inhibitor (such as
ranitidine) or proton-pump inhibitor (such as omeprazole) is used to
reduce gastric acid secretions
 In viral laryngitis, drinking sufficient fluids is helpful.
 If laryngitis is due to a bacterial or fungal infection, appropriate antibiotic
or antifungal therapy is given.

25. Sinusitis
 Sinusitis is inflammation of the paranasal sinuses, which may
be due to infection, allergy, or autoimmune issues. Most
cases are due to a viral infection and resolve over the course
of 10 days.

26. Sinusitis

27. Classification
•acute sinusitis — a new infection that may last up to four weeks.
•subacute sinusitis — an infection that lasts between four and 12
weeks, and represents a transition between acute and chronic
infection;
•chronic sinusitis — when the signs and symptoms last for more
than 12 weeks.

28. Signs and symptoms
 Headache/facial pain or pressure of a dull, constant, or aching sort over the
affected sinuses is common with both acute and chronic stages of sinusitis.
This pain is typically localized to the involved sinus and may worsen when the
affected person bends over or when lying down. Pain often starts on one side
of the head and progresses to both sides.
 Sinus infections can also cause inner ear problems due to the congestion of
the nasal passages. This can be demonstrated by dizziness, "a pressurized
or heavy head", or vibrating sensations in the head. Other symptoms of
sinusitis include bad breath and Post-nasal drip.

29.  Recent studies suggest that up to 90% of "sinus headaches"
are actually migraines.
 due to the autonomic nerve stimulation that can also cause
tearing (lacrimation) and a runny nose (rhinorrhea).

30. cause:
 Factors which may: predispose someone to developing
sinusitis include allergies

31. Diagnosis
 Acute
Bacterial and viral acute sinusitis are difficult to
distinguish. However, if symptoms last less than 10 days, it is
generally considered viral sinusitis. When symptoms last more
than 10 days, it is considered bacterial sinusitis. At this point
30% to 50% of cases are bacterial.
 Chronic
For sinusitis lasting more than 12 weeks

32. Antibiotics
 The vast majority of cases of sinusitis are caused by viruses
and will therefore resolve without antibiotics.However, if
symptoms do not resolve within 10 days, amoxicillin is a
reasonable antibiotic to use first for treatment with
amoxicillin/clavulanate being indicated when the person's
symptoms do not improve after 7 days on amoxicillin
alone.Antibiotics are specifically not recommended in those
with mild / moderate disease during the first week of infection

33. Common cold
 The common cold (also known as nasopharyngitis, rhinopharyngitis) is a
viral infectious disease of the upper respiratory tract which affects
primarily the nose. Symptoms include coughing, sore throat, runny nose,
sneezing, and fever which usually resolve in seven to ten days, with some
symptoms lasting up to three weeks.
 the cause of the common cold; the rhinoviruses are the most common.

34. Signs and symptoms
 The typical symptoms of a cold include cough, runny nose,
nasal congestion and a sore throat, sometimes accompanied
by muscle ache, fatigue, headache, and loss of appetite.

35. Cause
 Viral
The common cold is a viral infection of the upper respiratory
tract. The most commonly implicated virus is a rhinovirus (30–
80%), a type of picornavirus with 99 known serotypes. Others
include: coronavirus (10–15%), influenza viruses (10-15%)
adenoviruses (5%), enteroviruses, and metapneumovirus.

36. Transmission
The common cold virus is typically transmitted via airborne
droplets (aerosols), direct contact with infected nasal secretions,
or fomites (contaminated objects).Which of these routes is of
primary importance has not been determined, however hand-to-
hand and hand-to-surface-to-hand contact seems of more
importance than transmission via aerosols.

37. Diagnosis
 The distinction between different viral upper respiratory tract infections is
loosely based on the location of symptoms with the common cold
affecting primarily the nose, pharyngitis the throat, and bronchitis the
lungs.
 Self-diagnosis is frequent.
Prevention
 The only possibly useful ways to reduce the spread of cold viruses are
physical measures such as hand washing and face masks; in the
healthcare environment, gowns and disposable gloves are also used.

38. Management
 Symptomatic
Treatments that help alleviate symptoms include simple
analgesics and antipyretics such as ibuprofen and
acetaminophen/paracetamol.
In adults the symptoms of a runny nose can be reduced by first-
generation antihistamines; however, these sometimes have
adverse effects such as drowsiness

39. Antibiotics and antivirals
 Antibiotics have no effect against viral infections and thus
have no effect against the viruses that cause the common
cold

40. Lower respiratory tract infection
 Bronchitis
 Pneumonia

41. Bronchitis
 Bronchitis is an inflammation of the mucous membranes of
the bronchi (the larger and medium-sized airways that carry
airflow from the trachea into the more distal parts of the lung
parenchyma).
 Cough, a common symptom of acute bronchitis, develops in
an attempt to expel the excess mucus from the lungs.
 Other common symptoms of acute bronchitis include: sore
throat, shortness of breath, fatigue, runny nose, nasal
congestion, low-grade fever, pleurisy, malaise, and the
production of sputum.

42.  Bronchitis may be diagnosed by a physician during a
thorough physical examination. Due to the nonspecific signs
and symptoms exhibited by individuals with bronchitis,
diagnostic tests such as a chest x-ray to rule out pneumonia,
a sputum culture to rule out whooping cough or other bacterial
respiratory infections, or a pulmonary function test to rule out
asthma or emphysema may be used.
 Treatment for acute bronchitis is primarily symptomatic. Non-
steroidal anti-inflammatory drugs (NSAIDs) may be used to
treat fever and sore throat. Even with no treatment, most
cases of acute bronchitis resolve quickly.

43. Chronic bronchitis
 Chronic bronchitis, a type of chronic obstructive pulmonary disease, is
defined by a productive cough that lasts greater than three months each
year for at least two years in the absence of other underlying disease.
Bacterial bronchitis is defined as a chronic productive cough with a positive
bronchoalveolar lavage that resolves with antibiotics.
 Symptoms of chronic bronchitis may include wheezing and shortness of
breath, especially upon exertion and low oxygen saturations.The cough is
often worse soon after awakening and the sputum produced may have a
yellow or green color and may be streaked with specks of blood.
 Chronic bronchitis is treated symptomatically

44. Pneumonia
 Pneumonia is an inflammatory condition of the lung—affecting
primarily the microscopic air sacs known as alveoli. It is usually
caused by infection with viruses or bacteria and less commonly other
microorganisms,and other conditions such as autoimmune diseases.
 Typical symptoms include a cough, chest pain, fever, and difficulty
breathing. Diagnostic tools include x-rays and culture of the sputum.
Vaccines to prevent certain types of pneumonia are available.
Treatment depends on the underlying cause. Bacterial pneumonia is
treated with antibiotics. If the pneumonia is severe, the affected
person is generally admitted to hospital.

46. Thank you….