Engidaw Ambelu

1. DISORDERS OF THE
RESPIRATORY SYSTEM
Agegnehu Derbew,MD
Gondar College Of Medicine & Health Science
Department of Internal medicine
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2. 2
Upper Respiratory Tract InfectionsUpper Respiratory Tract Infections

3. DEFINITION
 Inflammation of the
respiratory mucosa from the
nose to the lower
respiratory tree, not
including the alveoli.
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4. UPPER RESPİRATORY TRACT
INFECTİONS
 Acute tonsillitis
 Acute pharyngitis
 Acute otitis media
 Acute sinusitis
 Acute rhinitis
 Otitis externa
 Mastoiditis
 Acute laryngitis
 Acute apiglottis
 Tracheobronchitis
 Common cold
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5. 1.TONSİLO-PHARYNGITIS
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Exudates

6. TONSİLİTİS-PHARYNGİTİS
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Bacteria
S. pyogenes
C. diphteriae
N. gonorrhoeae
Viruses
Rhinovirus
Epstein-Barr virus
Adenovirus
Influenza A, B
Coxsackie A
Parainfluenzae

7. CAUSATİVE ORGANİSMS
 < 3 year,mainly viral
 5-15 years
 15-30 % GABHS
 Adult
 10 % GABHS
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8. DUE TO STREPTOCOCCİ:
 Spreads by close contact and through air
 Spread more in crowded areas (KG, school, army..)
 Most common among 5-15 age group
 More frequent among lower socio-economic classes
 Most common during winter and spring
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9. SİGNS/SYMPTOMS
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 Sore throat
 Anterior cervical LAP
 Fever > 38 °C
 Difficulty in swallowing
 Headache, fatigue
 Muscle pain
 Nausea, vomiting
Tonsillar hyperemia /
exudates
Soft palate petechia
Absence of coughing
Absence of hoarseness

10. VİRAL TONSİLLİTİS/PHARYNGİTİS
• Viral tonsilo-pharyngitis is most common.
Rhinovirus (most common).
• Symptoms usually last for 3-5 days.
 Having additional rhinitis, hoarseness,
conjunctivitis and cough
 Pharyngitis is accompanied by conjunctivitis in
adenovirus infections
 Oral vesicles, ulcers point to viruses
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11. EXUDATES
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 GABHS
 EBV
 Adenovirus
 Primary HIV infection
 Candida albicans

12. LABORATORY
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 Throat swab culture
 Gold standard
 WBC count

13. TONSILLITIS DUE TO
STREPTOCOCCI
A.Supurative complications
 Abscess
 Sinusitis, otitis, mastoiditis
 Cavernous sinus thrombosis
 Toxic shock syndrome
 Cervical lymphadenitis
 Septic arthritis, osteomyelitis
 Recurrent tonsillitis/pharyngitis
B.Nonsupurative complications
 Acute rheumatic fever (type 5 M-protein)
 Acute glomerulonephritis (nephritogenic strains)
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14. AIM OF TREATMENT
 Prevention of complications
 Starting treatment within 9 days is enough to prevent
ARF
 Symptomatic improvement
 Bacterial eradication
 Prevention of contamination
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15. TREATMENT OF GABHS
A) Symptomatic: Saline gargles,
analgesics
B) Antibiotics:
a) Benzathine Pn-G 1.2 million units
IM x 1 OR Pn V orally for 10 days
b) For Pn allergic pts:
Erythromycin 500mg QID x 10 days
OR Azithro 500 mg Qdaily x 3 days.
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16. 2.ACUTE OTİTİS MEDİA
 The diagnosis of AOM
requires the presence of a
middle ear effusion and
acute signs of middle ear
inflammation
 AOM not responding to
treatment: Sustained
clinical and otoscopy findings
despite 48-72hr.therapy
 Recurrent otitis media: 3
AOM attacks within 6 moths
or 4 attacks within 1 year
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17. AOM CAUSES
 S. pneumoniae30%
 H. İnfluenzae 20%
 M. Catarrhalis15%
 S. pyogenes 3%
 S. aureus 2%
 No growth 10-30%
 Chronic otitis media: P. aeruginosa, S.
aureus, anaerobic bacteria
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18. ACUTE OTİTİS MEDİA
 85% of children up to 3 years experience at least
one,
 50% of children up to 3 years experience at least
two attacks
 AOM is usually self-limited. Rarely benefits from
antibiotics.
 81 % undergo spontaneus resolution.
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19. SİGNS AND SYMPTOMS
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Symptoms
Autalgia
Ear draining
Hearing loss
Fever
Fatigue
Irritability
Tinnitus, vertigo
Otoscopic findings
Tympanic membrane
erythema
Inflammation
Bulging
Effusion
Hearing loss

20. 20
 Rx
amoxacillin,augmentin

21. 3.ACUTE RHİNİTİS / SİNUSİTİS
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22. SİNUSİTİS
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Acute sinusitis
 Str. pneumoniae %41
 H. influenzae %35
 M. catarrhalis %8
 Others %16
Chronic sinusitis
 Anaerob bacteria:
Bactroides,
Fusobacterium
 S. aureus
 Strep. pyogenes
 Str. pneumoniae
 Gram (-) bakteria
 Fungi

23. SIGNS AND SYMPTOMS
 Feeling of fullness and pressure over the
involved sinuses, nasal congestion and
purulent nasal discharge.
 Other associated symptoms: Sore throat,
malaise, low grade fever, headache,
toothache, cough > 1 week duration.
 Symptoms may last for more than 10-14
days.
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25. PREDISPOSITION TO SINUSITIS
 Anatomical: septal deviation,
 Mukociliary functions: cystic fibrosis, immotile
cilia syndrome
 Systemic dis., immune deficiency.: DM, AIDS
 Allergy: Nasal poliposis, asthma
 Neoplasia
 Environmental: smoking, air pollution, trauma...
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26. DIAGNOSIS
 Based on clinical signs and symptoms
 Physical Exam: Palpate over the sinuses,
look for structural abnormalities
 X-ray sinuses: not usually needed but may
show cloudiness and air fluid levels
 Limited coronal CT are more sensitive to
inflammatory changes and bone destruction
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27. TREATMENT
 About 2/3rd
of patients will improve without
treatment in 2 weeks.
 Antibiotics: Reserved for patients who have
symptoms for more than 10 days or who experience
worsening symptoms.
 Supportive therapy: Humidification, analgesics,
antihistaminics
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28. ANTIBIOTICS
a) Amoxicillin (500mg TID) OR
b) TMP/SMX ( one DS for 10 days).
c) Alternative antibiotics: High dose amoxi/clavunate,
Flouroquinolones, macrolides
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29. 4.LARYNGITIS
 Most commonly upper respiratory viruses
 Diphtheria
 C. diphtheriae produces a cytotoxic exotoxin causing
tissue necrosis at site of infection with associated
acute inflammation. Membrane may narrow airway
and/or slough off (asphyxiation)
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30. 5.ACUTE EPIGLOTTITIS
 H. influenza type B
 Another cause of acute severe
airway compromise in childhood
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31. 6.ACUTE BRONCHITIS
 Inflammation of the bronchial respiratory mucosa
leading to productive cough.
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32. ACUTE BRONCHITIS
 The cough in acute bronchitis most often lasts from
10 to 20 days
 Chronic bronchitis: cough and sputum production on
most days of the month for at least three months of the
year during two consecutive years
 Etiology: A)Viral
B) Bacterial (Bordetella pertussis,
Mycoplasma pneumoniae, and Chlamydia pneumoniae)
 Diagnosis: Clinical
 S/S: Productive cough, rarely fever or tachypnea.
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33. TREATMENT
A) Symptomatic
A) If cough persists for more than 10 days:
 Azithromycin x 5 days OR
 Clarithromycin x 7 days
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34. NON SPECIFIC URI’S
 7.Common Cold
• Etiology: Rhinovirus
 Adenovirus
 RSV
 Parainfluenza
 Enteroviruses
• Diagnosis: Clinical
• Treatment: Adequate fluid intake, rest, humidified air,
and over-the-counter analgesics and antipyretics.
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35. COMMON COLD
 Adults Rhinovirus
 Children Parainfluenzae and RSV
 Clinical feature
 Fatigue
 Feeling cold, shuddering
 Nose burning, obstruction, running
 Sneezing
 Fever
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36. INFLUENZA (FLU)
 Causes epidemics and pandemics
 Highly contagious
 Viral infection.
• 80 % Influenzae virus
• Parainfluenza 2-9 %
• Rhinovirus 3 %
• Adenovirus 4 %
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37. INFLUENZA
 Sudden onset after 12-24 hours incubation
 General weakness and fatigue
 Feeling cold, shivering, temp. Up to 39-40 C
 No sore throat or running nose
 Severe back, muscle and joint pain
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38. DISEASE
 Influenza A virus cause
 worldwide epidemics (pandemic)
 major outbreaks of influenza
 occurs virtually every year.
 Influenza B virus cause
 major outbreaks of influenza
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39. VIRUS
 Segmented (8 segments in types A & B, 7 in type C)
ssRNA genome
 Helical nucleocapsid
 Outer lipoprotein envelope
 The envelope is covered with two different types of spikes,
hemagglutinin and a neuraminidase.
 Hemagglutinin binds cell surface receptor, to initiate
infection.
 Neuraminidase releases progeny virus from infected cells.
 The internal ribonucleoprotein is the group specific
antigen that distinguishes influenza A, B and C.
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40. ORTHOMYXOVIRUSES
M1 protein
helical nucleocapsid (RNA plus
NP protein)
HA - hemagglutinin
polymerase complex
lipid bilayer membrane
NA - neuraminidase
Type A, B, C : NP, M1 protein
Sub-types: HA or NA protein 40

41. ANTIGENIC CHANGES
 Influenza viruses especially type A show changes
in antigenicity of hemagglutinin (H) and
neuraminidase (N) proteins.
 Antigenic shifts:
 major changes based on the reassortment of RNA
segments. It occurs only with influenza A.
 Other theories of antigenic shift includes:
 Recirculation of existing subtypes
 Gradual adaptation of animal viruses to human
transmission
 Antigenic drifts:
 minor changes based on mutations in the RNA
genome. 41

42.  TRANSMISSION
 Airborne respiratory droplets
 EPIDEMIOLOGY
 Winter months
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43. COMPLICATIONS
 Tracheobronchitis and bronchiolitis
 Primary viral pneumonia
 Secondary bacterial pneumonia
S. aureus is most commonly involved although S.
pneumoniae and H. influenzae may be found.
 Myositis and myoglobinuria
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44. TREATMENT
 Amantidine
 The only effective against influenza A.
 Act at the level of virus uncoating.
 Both therapeutic and prophylactic effects.
 Vaccine.
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