Airway’s infections
Epidemiology
- In children < 5 years of age. 50 % of all diseases are acute airway’s infections
- In children 5-12 years of age 30 % of all diseases are acute airway’s infections
- Most of the infections are in the upper airways, only 5 % are in the larynx and or in the lower airways
The natural history of the disease depends of
• the pathogen (microbe),• the host,• the environment
Localisation of the acute airways’ inflammations
1. Upper airways’ inflammation
2. Laryngo-tracheo-bronchitis (croup), epiglottitis
3. Acute bronchitis
4. Acute bronchiolitis
5. Pneumonia
Infectious agents of the upper respiratory tract I.
Viruses
Respiratory syncytial virus (RSV):bronchiolitis, pneumonia, croup, bronchitis
Parainfluenza viruses:croup syndorma, bronchitis, bronchiolitis
Influenza virus:in epidemics
Adenoviruses:pharyngitis, pharyngoconjunctivits
RhinovirusesCoronaviruses: rhinitis, common cold
Coxsackieviruses A and B:nasopharyngitis
Infectious agents of the upper respiratory tract II.
Mycoplasma pneumoniae:pharyngotonsilitis, otitis media, pneumonia, bronchitis
Bacterial causes:‘A” group streptococci, corynebacterium
diphteria, Neisseria meningitidis, N gonorrhoeae, haemophilus influenzae, streptococcus pneumoniae
(pneumococcus), staphylococcus aureus
Signs ofinclination for frequent infections
1. Too frequent infectionsAge/year Mean Maximum 1 6,1 8,7 1-2 5,7 8,7 3-4 4,7 7,6 5-9 5,5 8,110-14 2,7 4,9
2. Longer (> 4-5 days) and more serious infection than the usuals
3. Bacterial second line infection4. Complications: otitis, sinusitis, pneumonia5. Multiorgan infections6. Failure to thrive
Bacterial infection is probable:
1. The discharge on the mucous membrane is purulent2. Polymorpho-nuclear granulocytes’ number is high in
the peripherial blood3. Positive bacterial laboratory findings (from throat or
sputum)4. The regional lymphnodes are swollen and painful5. Blood sedimentation rate is high6. There is no viral epidemy
Infection risk factors in the host
1. Preterm babies (< 1 year)2. Age less than 1 year (< 6 months in bronchiolitis)3. To be a boy4. Inborn errors of the immune system5. Congenital heart defects6. Lack of mother milk
Environmental factors
• Family care (+)
• Smoking in the family (-)
• More than one child (-)
• Good socio-economic situation (+)
• Polluted environment (-)
The aetiology of common flu
Antigen types Per cent of probability
Rhinovirus 100 types 30-40 %Coronavirus 3 types > 10 %Parainfluenza virus 4 typesRSV 2 typesInfluenza 3 types 10-15 %Adenovirus 47 types 5 %Others (enterovirus,morbilli, varicella,rubeola) 5 %Unknown viruses 25-30 %A-group beta-haemolytic Streptococci 5-10 %
Upper airway diseases
Nasopharyngitis acuta: fever, headache, dry throat, coughing, nasal discharge, frequent conjunctical inflammation, stuffed nose (feeding problems in infants)Tonsillo pharyngitis acuta: red mucous membrans, swollen families, swollen tonsils, swollen lymphnodes in the neck, fever, painTherapy: antipyretics, antiphlogistic nasal drops, enough fluid intake,Bacterial infection: penicillin, enythromycin (10 days) Non streptococcal infection: amoxycillin, macrolides, cephalosporinsComplications: otitis media acuta, peritonsillar retropharyngeal abscessSinusitis acutaFebris rheumatica, glomerulonephritis (now rare)
Pathogenesis of tonsillopharyngitis
Pathologic agents Features Per cent
Viruses (see before) 35-40 %+Coxsackievirus herpangina < 1 %EBV + CMV mononucleosis inf. < 2 %HIV primer HIV infection < 1 %
BacterialStreptococci pyogenes 15-30 %Beta-haemolytic Streptococci 5-10 %Other bacteria < 5 %Unknown 20-30 %
Complications of upper airway inflammations
Otits mediaMastoiditis acutaParanasal sinusitisPeritonsillar, retropharyngeal
infiltration, abscessusPoststreptococcal diseases:
rheumatic fever, glomerulonephritis
Croup cyndrome
Acute epiglottitisAcute infectious laryngitisAcute laryngo-tracheo-bronchitisAcute spasmodic laryngitis
Laryngitis subglottica (croup syndrome)
Very frequentAetiology: viral, bacterial, mycoplasma
non infective: inclination, alllergic (?)
Croup score:stridor, cough, dyspnoe, cyanosis, inspiratoric sound, jugular dystraction (0-1-2)
3-5 moderate6 or more serious
Therapy: cold vaporization epinephrin (racem) vaporized steroid (systemic or vaporized) antibiotics (if proved bacterial aetiology) intubation, artificial ventillation
Acute bronchitis, tracheo bronchitis
Cough, sputum, bronchial noises, substernal dyscomfort, low grude feverCoarse and fine moist rales and rhonchi
Etiology: viral or bacterial
Therapy: symptomatic (to be at home, antipyretics, fluid intake)
Bacterial aetiology proven: antibiotics
Pneumonia I.
Actiology: viral, bacterial, fungalClinical manifestations: lobar, lobular, broncho-alveolar,
interstitialcommunity acquired pneumonianosocomial (hospital) acquired
pneumoniaBacterial: a) Typical pneumonia: streptococcus pneumoniaeHaemophylus influenzae B type (vaccination!)Streptococcus B Group: neonatologySeldom: staphilococcus auerus, pyogenes, legionellab) Atypical: Mycoplasma pneumoniaec) Chlamydia pneumoniaed) Neonates: Chlamydia trachomatis, Ureaplasma,
Uraeliticum
Pneumonia II.
Viral: RSV, influenza, adenovirus, rhinovirus, enterovirus
VZV, CMV, HSV (immuncompromised host)
Fungal: immuncompromised host
Protozoons: Pneumocystic carinil (AIDS, immuncompromised host)
Pneumonia III.
Clinical signs: fever, cough, malaise, sputum, dyspnoe, cyanosis, tachypnoe
Physical signs: duffness of percussion pneumonia bronchial breath soundsX ray (sonography: pleural effusionCT and MR: abscess, mediastinum problems
Laboratory signs: BSR, CRP, blood smear
Actiology: haemoculture BAL, Pleural drainage (if effusion) induced sputum (?)
Hamophilus influenzae pneumonia
Pneumocystis carinii pneumonia
Right upper lobe pneumonia
candidiasis aspergillosis
patients with leukaemia
Therapy of pneumonia
• symptomatic• antibiotics
- based on aetiology and resistance- based on empirical facts:
macrolidsCephalosporinsaminoglycosids
HSV/VZV: acyclovir. CMV: gancyclovir RSV: ribavirin
Acute nasophayngitis:
Aetiology: viruses, mycoplasma pneumonieae, bacterial mycotic
Epidemilogy
Clinical manifestations
Therapy: aspecific, antiinflammatory drugs, nasal drops and suction
Acut pharyngitis, pharyngo-tonsillitis:
Aetiology: viruses, beta-haemolytic streptococcus (group A) H. influenzae
Epidemiology
Clinical manufestations
Treatment: aspecific, penicillin, erythromycin
The pathogens I.
Virus
RS virus: acute bronchiolitis in infants and toddlers (80 %) croup (12 %), bronchitis (15 %), pneumonia (30 %)
Parainfluenza virus: laryngo-tracheo bronchitis, pneumonia
Influenza virus: upper airway disease anywhere inflammation in the airways
Rhinovirus: common cold, rhinitis, bronchitisAdenovirus: mostly upper airways’ disease serious
pneumonia with serious late consequencesCoxsacie and echovirus: mostly upper airway disease
The pathogens II.
Bacteria
Streptococcus pneumoniae: often in pneumoniaHaemophilus influenzae B type: epiglottitis (!), pneumonia, otitisStaphylococcus aureus: pneumonia, pleuritis in infants and toddlersβ-haemolytic streptococcus’ mostly upper airway inflammation, tonsillitisMycoplasma pneumoniae: pneumonia in bigger childrenChlamydia trachomatis: pneumonia in infantsChlamydia pneumoniae: bronchitis, seldom pneumoniaBronchamella catarrhalis: otitis, sinusitis in children