Acute Upper Respiratory

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Acute Upper Respiratory

Infection And Acute Bronchitis

ZhangCheng Respiratory Medicine Affiliated Hospital of Jining Medicine college

23,Feb


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Acute Upper Respiratory

Infection

Acute Tracheobronchitis


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What is Acute Upper Respiratory

Infection

Acute onset sharply

Upper: nasal cavity, pharynx,and laryngeal

Infection: viral , bacteria Epidemiology (Incidence) Most common

infection

Prognosis (Outcome) mild self-limiting .


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THE COMMON COLD

Mild self-limited upper infection (Last5~7 nocomplications)

Etiologypathogen)

rhinoviruscoronavirusinfluenza virusparainfluenza virus respiratory syncytialadenovirus


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Peak incidence Occurs during the colder

months(winter,spring)

Symptoms develop 16 to 72 hours after

inoculation(being infected)

increased nasal

discharge sneezing nasal obstruction


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At first (initially) watery or mucoid,

Later purulent

Obstruction of the maxillary sinuses andEustachian tubes caused by mucosal edema

causes discomfort and actual pain in the

ear or face


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THE COMMON COLD

Sore throat often the firstsymptom heralding(predicting) the onsetof a cold.

Nature :adry or rough sensation Location:posterior part of the soft palate or

the uvula .

Systemic symptoms:Headache malaisemuscular aching lassitude and chilliness

Fever is uncommon

Generally lasts for 5 to 7 days


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PHARYNGITIS AND LARYNGITIS

Occur as part of the common cold

Caused by virus such as rhinovirusadenovirus influenza virus parainfluenza virus enterovirus respiratory syncytial

Group A streptococcus is the most important

bacterial cause of pharyngitis Symptoms and signs vary(mild

~severe) the dominat symptom is sorethroat


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PHARYNGITIS AND LARYNGITIS

A severe pharyngitis :

fever leukocytosis cervicallymphadenopathy

hoarseness and dysphonia(charcteristic)

Acute laryngitis is usually caused by the

same viruses that cause common cold

Physical examination PE may showpharyngeal and laryngeal

edema injection(congestion) tonsillarenlargement


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PHARYNGOCONJUNCTIVAL

FEVER

Caused by adenovirus and Coxsackievirus

Pharyngeal

symptoms photophobia lacrimationand congestion of pharynx conjunctiva

Which is common in the summer among

children and in swimming pool


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BACTERIAL PHARYNGITIS AND

TONSILLITIS Infecting organisms are streptococcus

hemolyticus Streptococcuspneumoniae staphylococcus

Sudden onset severe soarthoat chills fever temperature canreach more than 39 (hyperpyrexia).

PE shows injection of pharynx tonsillarenlargement with purulent exudates andtender lymph nodes in the upper part of theneck


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Laboratory Findings

Total white blood cell count

normal or decreased ( prominent with

lymphocyte) leukocytosis (if bacterial infection)

Aetiological tests such as

immunofluorescent

enzyme linkedimmunosorbent assay ELISA),viralisolation are helpful in identification of virus


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Complications

Sinusitis otitis tracheobronchitis Some patients may have rheumatic

fever glomerulonephritis myocarditis(uncommon,but have significant meanings)


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Diagnosis And Differential Diagnosis

Clinical diagnosis

epidemiology

symptoms signs blood routine test radiographic.


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Aetiological diagnosis

Viral serologic evidence( many hospitals can

not do it)

differential diagnosis:

acute upper respiratory tract infection

allergic rhinitisinfluenza infectious diseases

(measles,poliomyelitis,encephalitia)


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Treatment(symptomatic)

Relieving symptoms Antihistamines decongestants ipratropiumbromide nasal spray nonsteroidal anti-inflammatory

Antibiotic(evidence of bactrial infection)

Antiviral(as soon as possible)ribavirin(broad spectrumantivirus oseltamivir has strong inhibitionon the neuramidinase produced by influenzaAand B


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Influenza

Acute respiratory diseases caused by influenza

viruses

Upper and /or lower respiratory tract

Severe systemic symptoms:

fever

headache

myalgia catarrh symptoms(nasal discharge obstrction)


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Disseminating path: people to people(by

contact (intimate) and droplet

Usually result in outbreak in winter, extent

and severity vary, high-risk patients have

higher mortality rates main as pulmonary

complications.


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Etiologic Agent

RNA virus

Members of orthomyxoviridae family

Lipid envelop,its surface hashemagglutini(H) and neuraminidase(N)

proteins project.

Influenza A B viruses belong to same genus, Influenza C constitute the other.


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Designation of typing is based on antigenic

characteristics of the nucleoprotein(NP) and

matrix protein antigens.

The most extensive and severe outbreaks

are caused by influenza Aviruses.because H

and N antigens are liable to variation


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Pathogenesis

Transmission occurs via aerosols(droplets)

generated by coughs and

sneezes.respiratory epithelium is infected by

respiratory of acutely infected individuals.

The hemagglutinin of virus binds to cell

receptors,neuraminidase degrades the

receptors and release virus from infectedcells and replication.


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Influenza viruses enter cells by receptor-

mediated endocytosis ,forming a virus

containg endosome.The viral hemagglutinin

mediates fusion of the endosomal

membrane with the virus envelope,and

nucleocapsides are subsequently released

into the cytoplasm,virus replicates andvirus is released to infect adjaceng or

nearby cells


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Histopathologic reveals degenerative

changes ,including granulation

vacuolization ,swellingand pyknotic nuclei

The cells eventually become necrotic and

desqumate.


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Clinical manifestations

Systemic symptoms(abrupt onset)

headache, feverishness

chills myalgia malaise, cough and sore throat

Some patients may have anorexia(no

appetite),abdominal pain ,and diarrhea. So called abdomen-type cold(influenza)


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Treatment

Sympotom-based therapy withacetaminophen is considered for relief ofheadache myalgia ang fever with no

complication. Specific antiviral therapy is available for

influenza:amantadineand rimantadine forinfluenza A,neuraminidine inhibitorszanamivir and oseltamivir for bothinfluenza A and B


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If begun within 48h of the onset of the

illness treatment with amantadine or

rimantadine has reduced the duration of

systemic and respiratory symptoms of

influenza by 50%


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What is Acute Tracheobronchitis

Acute tracheobronchitis is an inflammation

of the tracheobronchitis tree usually inassociation with infection.Physical or

chemical irritants and antigens aspirationcan also play a role.Cough is the most

prominent manifestation


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Aetiology and Pathogenesis

Physical or Chemical Factor

Aspiration of cold air dust irritant gasor smoke

Anaphylaxis

Varied allergens can produce the

inflammation of bronchus such aspollen organic dust fungalspore tropina and the migration ofparasites in lung


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Pathology

Congestion oedema and infiltration oflymphocytes and neutrophils in the trachea

and bronchus mucus membrane

Impairment and shedding of ciliated cells

Hyperplasia and hypertrophy of mucous

gland

Purulent secretion complicated with bacterial

infection


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Clinical Manifestations

Sudden onset and initiated with the symptoms

of upper respiratory tract infection

Cough nonproductive initially latermucoid sputum purulent sputum

Retrosternal soreness

Rhonchi and coarse crackles

symptoms will persist 2to3weeks


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Laboratory Findings

White blood cell count and differential count

normal but will be increased in the severe

bacteria infection

Sputum smear and culture detect the

pathogenic organisms

Chest radiograph


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History clinical features and combinedwith the laboratory detections

The following diseases are need to

differentiate from Acute Tracheobronchitis

a.Influenza. Epidemical outbreaks andhave severer systemic symptoms


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b. Acute Upper Respiratory Tract

Infection Nasopharynx symptoms PEand chest X-ray are normal

c.OthersBronchopneumonia pulmonarytuberculosis bronchial asthma lungabscess measles


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Treatment

Relieving cough

Antibiotic therapy fever purulentsputum

Most patients do not require antibiotic

therapy


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Acute Upper Respiratory

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