This document discusses various respiratory tract infections, including upper and lower respiratory tract infections. It covers topics such as otitis media (ear infection), pharyngitis (sore throat), sinusitis, bronchitis, bronchiolitis, and pneumonia. For each condition, it discusses etiology, clinical manifestations, diagnosis, treatment goals, and specific treatment options. Risk factors, pathogenesis, and monitoring of treatment response are also covered for some conditions. The document provides an overview of common respiratory infections seen in clinical practice.

1. RESPIRATORY
TRACT
INFECTIONS
BY
APOLLOJAMES,
ASSOCIATE PROFESSOR,
DEPT. OF PHARMACY PRACTICE,
NANDHA COLLEGE OF
PHARMACY, ERODE,
TAMILNADU

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

5. OTITS MEDIA IS AN INFLAMMATION OF THE MIDDLE EAR

6. TYPES OF OTITIS MEDIA
• Acute otitis media
Infection of rapid onset that usually presents
with otalgia
• Otitis media with Effusion(OME)
Also known as serous otitis media, secretory
otitis media, “Glue ear”
• Chronic suppurative otitis media
At least 6 month

7. Etiology
• Streptococcus pneumoniae(20% to 35%)
• Non typeable Haemophilus influenza(20% to
30%)
• Moraxella catarrhalis(20%)
• Staphylococcus aureus
• Streptococcus pyogenes
• Pseudomonas aeruginosa
• Viral Etiology(44%)

8. RISK FACTORS
• Age(Younger)
• Allergies
• Craniofacial abnormalities
• Exposure to environmental smoke or other respiratory
irritants
• Exposure to group day care
• Family history of recurrent acute otitis media
• Gastroesophageal reflux
• Immunodeficiency
• No breast feeding
• Pacifier use

9. CLINICAL MANIFESTATION
• Middle ear infection followed by cold symptoms
of runny nose, nasal congestions or cough
Signs and Symptoms
• Pain that can be severe
• children may be irritable
• Tug on the involved ear
• Difficulty in sleeping
• Fever
Physical examination: a discoloured, thickened
bulging ear drum, draining middle ear fluid

10. Diagnosis
• Physical examination: a dis-coloured,
thickened bulging ear drum, draining middle
ear fluid
• Pneumatic otoscopy (or)tympanometry
demonstrates an immobile ear drum
Laboratory tests:
Gram stain, culture and sensitivity of draining
fluids or aspirated fluid(Tympanocentesis)

12. TREATMENT
GOALS OF THERAPY
• Relieve symptoms(Pain, fever, irritability
• Sterilize the middle ear
• Prevent complications(Mastoiditis,
bacteremia, meningitis, auditory problems)

13. TREATMENT
• Non- Pharmacological
Surgical insertion of tympanostomy
tubes(T Tubes) for recurrent otitis media
(If 3 episodes in six month)

14. PHARMACOLOGICAL TREATMENT
• Systemic pain relief
• Acetaminophen
• Non-steroidal Anti-inflammatory Drugs (NSAIDs) like
ibuprofen
• Local pain relief (eardrops)
• Amethocaine, Benzocaine, Lidocaine
• Decongestants and antihistamines should not be used
due to lack of benefit and increased risk of adverse
effects
• Systemic and Local pain relief can be administered
together

15. PHARMACOLOGICAL

16. MONITORING
• Patients should be reassessed 3 days after initial visit
• Signs and symptoms of acute otitis media should be improved
• Worsening symptoms Would prompt the initiation of
antibiotics if delayed therapy strategy employed
• Would prompt change in antibiotic therapy if patient receiving
antibiotics
• Most children become asymptomatic by day 7
• Effusions in middle ear may persist even after symptom
improvement
• Hearing loss should warrant immediate reevaluation
• Early reexamination of the eardrum while signs and symptoms
are improving can be misleading because effusions can persist
past symptomatic improvement.

17. MONITORING
• Effusion during acute otitis media are due to pus but
becomes serous fluid as the infection clears. This moves
the patient from acute otitis media to otitis media with
effusion which does not indicate infection of further
need of antibiotics
• Two weeks after an acute otitis media episode, 60% to
70% of children still have a middle ear effusion—40% at 1
month and 10% to 25% at 3 months.
• Immediate reevaluation is appropriate if hearing loss
results from persistent middle ear effusions following
infection

18. SINUSITIS
• Sinusitis is an inflammation and/or infection
of the paranasal sinus mucosa.

19. ETIOLOGY
Community acquired bacterial sinusitis
• S.pneumoniae
• H. influenzae
• S. Pyogenes
Nosocomial sinusitis
• Seen in critically ill,
• mechanically ventilated
• S. aureus
• M. catarrhalis
• Pseudomonas aeruginosa
• Serratia marcescens
Fungal Species

20. CLINICAL MANIFESTATIONS
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

21. PATHOPHYSIOLOGY
 viral respiratory tract
infection
 mucosal inflammation.
 obstruction of the
sinus ostia
 Mucosal secretions
become trapped,
 local defenses are
impaired,
 bacteria from adjacent
surfaces begin to
proliferate.

24. SUPPORTIVE THERAPY
• Nasal decongestant sprays that reduce inflammation by vasoconstriction, such as
phenylephrine and oxymetazoline, are used often in sinusitis.
• Use should be limited to the recommended duration of the product to prevent
rebound congestion.
• Oral decongestants also may aid in nasal/sinus patency.
• Irrigation of the nasal cavity with saline and steam inhalation may be used to
increase mucosal moisture, and mucolytics (e.g., guaifenesin) may be used to
decrease the viscosity of nasal secretions.
• Antihistamines should not be used for acute bacterial sinusitis in view of their
anticholinergic effects that can dry mucosa and disturb clearance of mucosal
secretions.
• Second-generation antihistamines may play a role in chronic sinusitis where allergy
is a component.
• Glucocorticoids intra-nasally may decrease inflammation causing headache, nasal
congestion, and facial

25. PHARYNGITIS
Acute infection of the oropharynx or Nasopharynx.

26. ETIOLOGY
VIRUSES
• rhinovirus (20%),
• coronavirus (≥5%),
• adenovirus(5%),
• herpes simplex (4%),
• influenza virus (2%),
• Parainfluenza virus (2%),
and
• Epstein-Barr virus (<1%)
BACTERIA
• groups C and G
Streptococcus,
• Corynebacterium
diphtheriae,
• Neisseria gonorrhoeae,
• Mycoplasma
pneumoniae,
• Arcanobacterium
haemolyticum,
• Yersinia enterocolitica,
and
• Chlamydia pneumoniae.

27. CLINICAL MANIFESTATION(PHARYNGITIS)
• 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
• cough,
• conjunctivitis, coryza, and diarrhea
Laboratory tests
• Throat swab and culture or rapid antigen detection testing

28. MANAGEMENT

29. LOWER RESPIRATORY TRACT INFECTIONS
• 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

30. GENERAL PATHOPHYSIOLOGY
 Health care systems, Smoking, microorganisms, etc.,
 Impaired defense mechanism
 Compromised ciliary function
 Excessive inoculum invades lung parenchyma
 Inflammation
 Bradykinins, Histamines, Prostaglandins
 Increasing capillary permeability
 Fluid/ cellular exudation
 Edema of mucous membrane
 Hyper secretion of mucous
 Persistent cough
 LRTI

31. BRONCHITIS
• Inflammatory disease of the bronchi

32. TYPES OF BRONCHITIS
1. Acute bronchitis(All age group)
Acute (i.e. recent onset) bronchitis is an
inflammation of the lower respiratory passages
(bronchi).
2. Chronic bronchitis(Adults)
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.

33. ETIOLOGY (BRONCHITIS)
• Winter months
• Cold, damp climates
• Irritants(Air pollution,
cigarette smoke)
• The common cold
viruses (rhinovirus and
coronavirus) and lower
respiratory tract
pathogens (influenza
virus and adenovirus)
• parainfluenza viruses,
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Bordetella pertussis(agent
responsible for whooping
cough)
• bacteria, including
Streptococcus
pneumoniae,
• Streptococcus species,
• Staphylococcus species,
and Haemophilus species

34. CLINICAL MANIFESTATIONS
(BRONCHITIS)
Signs and symptoms
• Cough persisting >5 days to weeks
• Coryza, sore throat, malaise, headache
• Fever rarely >39°C
Physical examination
• Rhonchi or coarse, moist, bilateral rales
• Purulent sputum in ~50% of patients
Chest radiograph
• Normal

35. PATHOPHYSIOLOGY (BRONCHITIS)
• infection of the trachea and bronchi
• hyperemic and edematous mucous membranes with
an increase in
• bronchial secretions.
• Destruction of respiratory epithelium
• range from mild to extensive
• affect bronchial mucociliary function.
• increase in bronchial secretions,
• further impairs mucociliary activity.
• increased airway hyperreactivity
• DYSPNEA

36. TREATMENT
Acute bronchitis
• Aspirin or acetaminophen(650 mg in adults or 10–15 mg/kg per dose in
children; maximum daily pediatric dose 60 mg/kg; maximum daily adult
dose 4 g) or
• ibuprofen (200–800 mg in adults or 10 mg/kg per dose in children;
maximum daily pediatric dose 40 mg/kg; maximum daily adult dose 3.2 g)
should be administered every 4 to 6 hours.
• 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)

37. CHRONIC BRONCHITIS - TREATMENT

38. 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.

39. SIGNS AND SYMPTOMS (BRONCHIOLITIS)
• 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

40. TREATMENT - BRONCHIOLITIS
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)

41. PNEUMONIA
• Inflammation of the
lung parenchyma
and is associated
with the
consolidation of the
alveolar spaces

42. ETIOLOGY
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
• Mycoplasma PNEUMONIAE
• PNEUMOCOCCUS
• Chlamydophila .PNEUMONIAE
• H.INFLUENZA TYPE b

43. TYPES OF PNEUMONIA
• Community acquired Pneumonia
• Health care associated Pneumonia
• Pneumonia in HIV patients
• Pneumonia in neutropenic host
• 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)

44. Clinical manifestation
Signs and symptoms
• Abrupt onset of fever, chills, dyspnea, and productive cough
• Rust-colored sputum or hemoptysis
• Pleuritic chest pain
Physical examination
• Tachypnea and tachycardia
• Dullness to percussion
• Increased tactile fremitus, whisper pectoriloquy, and egophony
• Chest wall retractions and grunting respirations
• Diminished breath sounds over affected area
• Inspiratory crackles during lung expansion
Chest radiograph
• Dense lobar or segmental infiltrate
Laboratory tests
• Leukocytosis with predominance of polymorphonuclear cells
• Low oxygen saturation on arterial blood gas or pulse oximetry

45. TREATMENT

46. THE END