Respiratory TractInfections

Dr. Muhammad Atif QureshiMBBS, FCPS

Associate Professor Medicine

Infections of Respiratory Tract

• Pharyngitis • Laryngitis• Tracheitis• Bronchitis• Alveolitis• Pneumonia• Tuberculosis• Aspergilosis

Laryngitis

• Clinical features– Weak or loss of voice– Hoarseness– Rawness in throat or tickling sensation– Dry cough– Dry throat– Sore throat

Laryngitis – Acute causes

• The majority of laryngitis cases is only temporary and gets better when the underlying illness improves.

• Vocal straining • Viral infections – common cold– mumps or measles

• Bacterial infections – Diphtheria

Laryngitis – Chronic causes

• Cases of laryngitis that last more than 3 weeks .• Vocal cord injuries or strain as well as vocal cord growths referred to as nodules

or polyps. • Irritants inhaled - chemical allergens, fumes or smoke• Chronic Sinusitis • GERD • Alcohol • Smoking• Habitual vocal overuse – such as cheerleaders or singers

• Fungal, bacterial infections

• The risk issues for laryngitis consist of:• Respiratory infection - bronchitis, a cold or sinusitis• Overuse of the voice • Exposure to irritants - alcohol, cigarette smoke, stomach acid, or workplace

chemicals

Laryngitis Treatment

• Acute viral Laryngitis usually becomes better on its own in 7 days.

• Treatments for chronic laryngitis – treat cause- smoking, excessive alcohol or heartburn.

Antibiotics• In viral laryngitis, antibiotics not very effective. • But bacterial infection usually need antibiotics.Corticosteroids• Corticosteroids may reduce inflammation of vocal

cords. But, only if very urgent need to treat laryngitis.

Treatment-Home Remedies • Breathing of moist air• Humidifier. • Rest the voice as much as conceivable• Avoid singing or talking too long or too loudly. • Drink lots of fluids• Avoid caffeine and alcohol• Keep the throat moist• Do this by sucking on a lozenge, chewing gum or gargling with salt

water.• Avoid using decongestants• These drugs dry the throat out.• Avoid whispering• This places more straining of the voice than speech that is normal

Laryngitis-Complications

• Laryngeal edema

Tracheitis

Tracheitis- causes

• Viral infections• Streptococcus pneumonia• Haemophilus influenza• Moraxella catarrhalis

Tracheitis- Clinical Features• Usually follow an upper respiratory infection, initial symptoms

such as cough, runny nose, or a low-grade fever may appear. • After two to five days, symptoms of infection and airway

obstruction may develop. These symptoms may include:• Deep, severe cough• Breathlessness• High fever• Wheezing• Cyanosis• Stridor - A high-pitched sound while breathing can be a sign of

serious infection and represents partial airway obstruction, a potentially fatal condition.

Tracheitis - Diagnosis

• Physical examination• Blood oxygen level• Nasopharyngeal culture• Tracheal culture • X-ray of the trachea

Acute Tracheitis: Complications

• Review possible medical complications related to Acute Tracheitis:

• Airway obstruction• Toxic shock syndrome• more complications

Acute Bronchitis

• Clinical Features

• Diagnosis

• Treatment

Chronic Bronchitis

• Clinical features

• Diagnosis

• Treatment

Pneumonia

• Bronchopneumonia

• Lobar pneumonia

Community-acquired pneumonia (CAP)

• Pneumonia in persons who have not recently been hospitalized.

• Can affect all ages. • CAP occurs throughout the world and is a

leading cause of illness and death. • Causes of CAP include bacteria, viruses, fungi

and parasites.

Causes of pneumonia

• H. influenza• S. pneumonae• Klebsiella Pneumonae

Symptoms of CAP

• Dyspnea • Cough with greenish or yellow sputum• High grade fever with sweating, chills, and rigors • Sharp or stabbing chest pain increased by breathing • Less commonly:• Hemoptysis • Headache • Anorexia • excessive fatigue• Cyanosis • Nausea and vomiting • Diarrhea • Arthralgias and muscle aches

Symptoms of CAP commonly include:

• In older people typical symptoms may not be present early in disease :

• New or worsening confusion• Hypothermia • Overly sleepy

Risk factors

• Some people have a high risk• Obstruction - foreign bodies especially in infants or

lung cancer in elders. • Underlying lung diseases - emphysema, smoking,

cystic fibrosis, pulmonary sequestration. • Immunocompromised people are more likely to get

CAP, like AIDS etc.

Diagnosis • Symptoms on history• Signs on physical examination• Laboratory investigations• Blood counts• Arterial blood gases• X-ray chest • VQ-scan• CT scan• Blood cultures

Chest auscultation

Ventilation perfusion scan

Treatment

General management• Rest• Antipyretics • Pain relief• Oxygen• Cough syrupsOral or intravenous antibiotics

Treatment

• Macrolides• Flouroquinolones• Doxycline first choice in UK for atypical

pneumonias

Complications

SEPSIS• Streptococcus pneumoniae is the most common cause. • Individuals with sepsis require hospitalization in an intensive

care unit, i.v. antibiotics. Sepsis can cause liver, kidney, and heart damage.

RESPIRATORY FAILURE• May need mechanical ventilationPLEURAL EFFUSION AND EMPYEMA • Thoracocentesis• Chest tube insertionLung Abscess

Pulse oxymetry

Prognosis • Mortality in CAP less than 1%. • Fever typically responds in the first two days

of therapy and other symptoms resolve in the first week.

• The x-ray, may remain abnormal for at least a month.

• Among individuals hospitalized, the mortality rate averages 12% overall, but is as much as 40% in people who have bacterimia and septicemia or require intensive care.

Thank You