The document defines respiratory tract infections as infectious diseases of the upper or lower respiratory tract. It notes that every year 3.9 million deaths occur due to acute respiratory infections in young children worldwide, with 15-30% of these deaths occurring in India. The document then proceeds to describe the different types of upper and lower respiratory tract infections in detail, including causative organisms, risk factors, clinical presentation, diagnosis, treatment options and common drugs used for treatment. It provides an overview of the pathogenesis and complications of respiratory tract infections.

1. V.S.Swathi
Assistant Professor
VIPT, Duvvada
RESPIRATORY TRACT
INFECTIONS

2. Definition
Respiratory tract infection (RTI) is defined by any
infectious disease of upper or lower respiratory tract

3. Epidemiology
 Every year 3.9 million deaths occurs due to acute
respiratory tract infections in young children in world
 Among them 15%-30% deaths occurs in India

4. Types
Upper Respiratory Tract Infections
 Cold and Flu
 Influenza
 Pharyngitis (Sore throat)
 Acute Epiglottitis
 Otitis media
 Acute Sinusitis

6. Lower Respiratory tract infections
 Acute Bronchitis
 Bronchiolitis
 CommunityAcquired Pneumonia (CAP)
 Hospital Acquired Pneumonia (HAP)
 Cystic Fibrosis

8. Upper Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Cold and
Flu
 Rhino virus
 Corona virus
 Influenza virus
 Parainfluenza
virus
 Respiratory
syncytial virus
 Young children
 Elders
 Immunocomprimised
patients
 Running nose
 Sore throat
 Fever (Some
times)
 Body ache
 Headache
 Severe fatigue
Clinical
presentation

9. Upper Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Influenza Influenza
virus A, B
and C
 Winter
 Elders
 Long stay care facilities
 Carers
 Health care workers
 COPD patients
 CKD patients
 Diabetes patients
 Chronic liver disease patients
 Severe malaise
 Myalgia
 Cough
Clinical
presentation

10. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Pharyngitis
(Sore throat)
 Epstein Barr virus
 Streptococcus pyogenes
 Arcanobacterium
haemolyticum
 Neisseria gonorrhoea
 Cornybacterium
diphtheriae
 Travellers  Running nose
 Sore throat
 Fever
 Body ache
 Headache
 Severe fatigue
 Lymph node
enlargement
 White excudate
in tonsils
 Throat
swab
culture

11. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Acute
Epiglottitis
 H. influenzae
 Pneumococci
 Streptococci
 Staphylococci
 Children  Swollen
cherry red
epiglottis
 Fever
 Difficulty in
speaking and
breathing
 Droolong
Culture test

12. Upper Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Otitis media  S. pneumonia
 H. influenzae
 Influenza virus
 Rhinovirus
 Children  Ear pain
 Purulent
discharge
from ear
 Hearing loss
Culture test
Acute
Sinusitis
 S. pneumonia
 H. influenzae
 Influenza virus
 Rhinovirus
 Dental disease  Facial pain
 Tenderness
 Head ache
 Purulent nasal
discharge
Sinus
washout
culture

13. Lower Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Acute
Bronchitis
 Rhino virus
 Corona virus
 Influenza virus
 Adeno virus
 Bordetella pertusis
 Mycoplasma
pneumoniae
 Chlamydophilia
pneumoniae
 COPD
patients
 Productive
cough with
green or
yellow
sputum
Culture test

14. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Bronchiolitis  Respiratory
syncytial
virus
 Parainfluenz
a virus
 Rhino virus
 Adeno virus
 Children
 Newborn
babies
 Pre meature
babies
 Patients with
congenital
heart disease
 Fever
 Wheezing
 Respiratory
distress
 Hypoxia
• Rapid antigen
detection test
• Viral culture
of respiratory
secretions

15. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Community
Acquired
Pneumonia
(CAP)
 S.pneumoniae
 S.aureus
 H.influenzae
 Klebsiella
pneumoniae
 People live in
crowdy areas
 Blood stained
cough
 Dyspnea
 Fever
 Pleuritic chest
pain
 Consolidation in
lobes
 X-Ray
 Sputum
microscopy
 Sputum
cultureBronc
ho alveolar
lavage

16. Lower Respiratory Tract Infections
Disease Causative
Organism
Risk Factors Clinical
Presentation
Diagnosis
Hospital
Acquired
Pneumonia
(HAP)
 Enterobacteri
ciae
 Pseudomonas
 Acinobactor
 E.coli
 Klebseilla
 HCV
 Cytomegalay
virus
 candida
 Aspergillus
 ICU patients
 Stroke
patients
 Ventilated
patients
 Sepsis
 Respiratory
failure
 Sputum
culture
 Blood
culture
 Broncho
alveolar
lavage

17. Lower Respiratory Tract Infections
Disease Causative Organism Risk Factors Clinical
Presentation
Diagnosis
Cystic
Fibrosis
 S. aureus
 H. influenza
 P.aureginosa
 Infants
 Young
children
 Persistant
sputum
with cough
 Shortness
of breath
 Culture
test

18. Pathogenesis
Bacteria, Virus, and Fungi
Risk Factors Risk Factors
Enter in to Upper RTI Enter in to Lower RTI
↓ ↓
Nasal tract- COLD Bronchi- Bronchitis
Nasal tract- Flu Bronchioles- Bronchiolitis
Nasal tract- Influenza Alveoli- Pneumonia
Epiglottis- Epiglottitis Alveoli- Cystic Fibrosis
Pharynx- Phryngitis
Middle Ear- Otitis media
Sinus- Acute Sinusitis
Inflammatory changes in respiratory tract

19. ↓
Excess mucus production
↓
Hypoxia
↓
Structural damage to Respiratory tract
↓
Failure of exchange of gases
↓
Respiratory failure

21. Complications
Otitis media
 Mastoiditis
 Meningitis
 Septecemia
Acute Sinusitis
 Fronal bone osteomyelitis
 Meningitis
 Brain abscess
Pneumonia
 Sepsis
 Respiratory failure
Cystic Fibrosis
 Bronchiectasis
 Permenant lung disease

22. Non Pharmacological Treatment
 Vaccination
 Oxygen therapy
 Chest physiotherapy
 Ventilation
 Post operative mobilisation
 Lung transplantation

23. •Antipyretics
•Analgesics
•Antihistamines
Neuroaminadase
inhibitors
•Zanamivir-
Inhalor
•Oseltamavir-
oral Tab
Viral infection-
Self limited
Bacterial
infections-
Antibiotics
•Pencillins
•Cephalosporins
•Macrolides
Antibiotics
•Pencillins
•Cephalosporins
Antibiotics
•Pencillins
•Cephalosporins
Antibiotics
•Pencillins
•Cephalosporins
•Metronidazole
•Doxycycline
COLD&
Flu
Influenza
Pharyngitis
(Sore throat)
Otitis
media
Acute
Epiglottiti
s
Acute
Sinusiti
s
UPPER RTI

24. •Pencillins
•Cephalosporins
•Macrolides
•Tetracyclines
•Ribavarin
•Pencillins
•Cephalosporins
•Macrolides
Mild to Moderate
•Pencillin+
•Macrolide
Severe
•Cephalosporin+
Macrolide
•Coamoxyclav+
Macrolide
•Flucloxacillin
•Linezolid
Pencillin+
Aminoglycosides
or
Cephalosporins+
Aminoglycosides
or
•Fluroquinolones+
•Aminoglycosides
•Meropenam
or
•Teicoplanin
or
•Linezolid
or
•Vancomycin
•Flucloxacillin
•Macrolide
•Fluroquinolone
•Colistin nebuliser
Betalactum+Aminog
lycoside
Acute
Bronchiti
s
Bronchioliti
s
CAP HAP
Cystic
Fibrosis
LOWER RTI

25. Drugs used in treatment of RTI
Drug Category Mode of action Dose Adverse effects
Amoxicillin Pencillins Inhibit cell wall synthesis in
bacteria
250mg-TID
500mg-BD
875mg-BD
(Severe
Pneumonia)
 Anemia
 Hepatotoxicity
 GI disturbances
 Pseudomembranous colitis
Amoxiclav
Amoxicillin
+
Clavulanic acid
Inhibit cell wall synthesis in
bacteria
+
Prevents antibiotic
resistance
500/125mg-
BD/ TID
250/125mg-
875/125mg-
BD
 Diarrhea
 Mycosis
 CNS disturbances
 Candidiasis
 Vaginitis
Cephalexin Cephalosporin Inhibit cell wall synthesis in
bacteria
250mg-QID
500mg-BD
 Abdominal pain
 Anemia
 Angioedema
 Transaminitis
 Pseudomembranous colitis
Cefotaxime Cephalosporin Inhibit cell wall synthesis in
bacteria
1g- BD-IV
2g-TID-IV
 Pseudomembranous colitis
 Diarrhea
 Hepatotoxicity
 Nephrotoxicity
 Injection site pain
Ceftrixone Cephalosporin Inhibit cell wall synthesis in
bacteria
50mg/kg-OD  Induration at injection site
 Eosinophilia
 Thrombocytopenia
 Diarrhea
 Hepatotoxicity

26. Azithromycin Macrolides Inhibit protein
synthesis in bacteria
500mg-OD
First day
↓
250mg- OD
for 4 days
 GI disturbances
 Cramping
 Vaginitis
 Dyspepsia
 Agitation
Ciprofloxacin Fluroquinolone Inhibit protein
synthesis in bacteria
500mg-BD  GI disturbances
 Hepatoxicity
 Nephrotoxicity
 Restlessness
 Rashes
Linezolid Miscellaneous
antibiotic
Inhibit protein
synthesis in bacteria
600mg- BD  GI disturbances
 Diarrhea
 Hepatotoxicity
 Taste disturbances
 Tonugue discoloration
Meropenam Carbepenams Inhibit cell wall
synthesis in bacteria
500mg-TID for
five days
 GI disturbances
 Injection site reactions
 Phlebitis
 Bleeding
 Sepsis
Doxycycline Tetracyclines Inhibit protein
synthesis in bacteria
200mg-OD  Glossitis
 Teeth discoloration
 GI disturbances
 Esophagitis

27. Resources
 https://www.ncbi.nlm.nih.gov/pubmed/30921179
 https://www.ncbi.nlm.nih.gov/pubmed/30832720
 https://www.ncbi.nlm.nih.gov/pubmed/30612559
 https://www.ncbi.nlm.nih.gov/pubmed/30407312
 https://www.ncbi.nlm.nih.gov/pubmed/30329199