COMMON COLD - acute viral infection of the upper respiratory
tract in which the symptoms of rhinorrhea and nasal obstruction are
prominent.
 headache,myalgia, and fever are absent or mild.
Etiologic agent- most commonly rhinovirus. 50 % of infections.
May also be caused by adenovirus, parainfluenza and influenza and
corona virus. And also RSV
Pathogenesis:
 Direct hand contact- self-inoculation of one’s own nasal mucosa
or conjunctivae after touching a contaminated person or object
 Inhalation of small-particle aerosols that are airborne from
coughing
 deposition of large-particle aerosols that are expelled during a
sneeze and land on nasal or conjunctival mucosa
Repeated infections: due to antigenic diversity and short lived
mucosal IgA and short incubation period before immune memory
activates
Pathogenesis:
 infection of the nasal epithelium is associated with an acute
inflammatory response characterized by release of a variety
of inflammatory cytokines and infiltration of the mucosa by
inflammatory cells.
 Infected cells release cytokines, such as interleukin-8, that
attract polymorphonuclear cells into the nasal submucosa
and epithelium
Clinical manifestations: vary with age
 Infants- fever and nasal discharges predominates
 Symptoms occur after 1-3 days of viral infection
 1st symptom is sore throat followed by obstruction and
rhinorrhea
 Cough in 2/3 of patients and usually after nasal symptoms. May
persist for 1-2 weeks after resol’n of other symptoms
 Other symptoms of a cold may include headache, hoarseness,
irritability, difficulty sleeping, or decreased appetite.
 Physical findings are usually limited ot the upper RT
 Increased nasal secretions in the course of the illness and change
in color of secretions does not mean bacterial super infection but
due to PMNs accumulation.
 Nasal cavity – swollen, erythematous
 Abnormal middle ear pressure; Anterior cervical
lymphadenopathy or conjunctival injection noted
Laboratory:
 Routine lab is commonly not indicated unless severe infection is
suspected
 Bacterial culture: streptococcus or pertussis
Sinusitis:
Due to common colds and some from bacterial invasion. Paranasal
sinus is usually sterile and controlled by ciliary clearance
 Maxillary(4 y.o)and ethmoid sinus are present at birth but only
ethmoid sinus is pneumatized. Sphenoid develops 5.yo and
frontal by 7-8 years.
Etiology:
 S. pneumonia, H. influenza in acute
 SAU, B haemolytic strep cultured in chronic
Pathogenesis:
 Acute bacterial sinusitis typically follows a viral upper
respiratory tract infection.
 MRI evaluation of the paranasal sinuses demonstrates
abnormalities (mucosal thickening, edema, inflammation)
of the paranasal sinuses
Clinical manifestations:
 Nonspecific complaints, including nasal congestion,
purulent nasal discharge (unilateral or bilateral), fever, and
cough
 Less common: halithosis, periorbital edema, hyposmia
Physical examination
 erythema and swelling of the nasal mucosa with purulent
nasal discharge.
To differentiate from common colds:
 persistence of nasal congestion
 rhinorrhea (of any quality)
 daytime cough ≥10 days without improvement
 severe symptoms of temperature ≥39°C (102°F) with
purulent nasal discharge for 3 days or longer
 worsening symptoms either by recurrence of symptoms
after an initial improvement or new symptoms of fever,
nasal discharge and daytime cough.
Diagnosis: mainly based on history
 persistence of nasal discharge and cough for more than 10
days
 severe symptoms with fever > 39 deg
 purulent discharge by 3-4 days
 Bacteria in maxillary sinus in 70%
 Chronic sinusitis- persistent respiratory symptoms of more
than 90 days
 Sinus aspirate culture is the only accurate method of
diagnosis
 Viral upper respiratory tract infections are characterized by
clear and usually nonpurulent nasal discharge, cough, and
initial fever; symptoms do not usually persist beyond 10-14
days, although a few children (10%) have persistent
symptoms even at 14 days
Acute pharyngitis
 inflammation of the pharynx, including erythema, edema,
exudates, or an enanthem (ulcers, vesicles).
 related to environmental exposures, such as tobacco smoke,
air pollutants, and allergens; from contact with caustic
substances, hot food, and liquids; and from infectious
agents
Etiologic agent:
Viral: RSV, coronavirus, influenza, parainfluenza, adenovirus, CMV,
rhinovirus, HSV
 Most viral infections are mild: rhinorrhea and cough
symptoms
 HSV- ulcerating lesions and Gingivostomatitis
throughout anterior pharynx, high fever and cannot
tolerate oral fluids; can last up to 14 days
 Herpangina (enterovirus)- affect posterior oropharynx,
throat pain, fever
 Adenovirus- pharyngoconjunctival fever; pharyngitis tends
to resolve within 7 days but conjunctivitis may persist for
up to 14 days.
GAS- asymptomatic carriage or acute infection
 Incubation of 2-5 days; fever and sore throat
 pharynx is red, the tonsils are enlarged and often covered
with a white, grayish, or yellow exudate or blood-tinged
 petechiae or “doughnut” lesions on the soft palate and
posterior pharynx and the uvula may be red and swollen.
 strawberry tongue- white to red
 Enlarged tender cervical lymph nodes
 Headache, abdominal pain, vomiting
 Fine, red popular rash (sandpaper rash) from face then
generalized
 Rash blanches with pressure on skin creases
Criteria developed for adults and modified for children by McIsaac:
 history of temperature >38°C
 absence of cough
 tender anterior cervical adenopathy
 tonsillar swelling or exudates
 age 3-14 yr.
McIsaac score ≥4 is associated with a positive laboratory test for
GAS in less than 70% of children with pharyngitis
Throat culture- gold standard

Upper airways:
 Inflammation involving the vocal cords and structures
inferior to the cords is called laryngitis, laryngotracheitis,
or laryngotracheobronchitis
 inflammation of the structures superior to the cords-
supraglottitis
 croup refers to a heterogeneous group of mainly acute and
infectious processes that are characterized by a bark like or
brassy cough and may be associated with hoarseness,
inspiratory stridor, and respiratory distress
 Croup typically affects the larynx, trachea, and bronchi.
Etiology:
 Usually caused by viral infections parainfluenza 1,2,3
(75%), associated with croup include influenza A and B,
adenovirus, respiratory syncytial virus, and measles.
 3mo – 5 years; late fall and winter
 Hib is the main cause of epiglottitis before the onset of
vaccination. Now, s.pneumonia, s.pyogenes, SAU are the
usual causes.
Croup (Laryngotracheobronchitis)
 Viruses typically cause croup, the most common form of
acute upper respiratory obstruction
 upper respiratory tract infection with some combination of
rhinorrhea, pharyngitis, mild cough, and low-grade fever
for 1-3 days before the signs and symptoms of upper
airway obstruction become apparent.
 “barking” cough, hoarseness, and inspiratory stridor.
 Lowgrade fever can persist, although temperatures may
occasionally reach 39-40°C (102.2-104°F); some children
are afebrile
 Agitation and crying aggravates coughing
Physical examination can reveal a hoarse voice, coryza, normal to
moderately inflamed pharynx, and a slightly increased respiratory
rate.
 Croup- steeple sign; typical subglottic narrowing of PA
view
Acute Infectious Laryngitis
 Virus cause most cases
 characterized by an upper respiratory tract infection during
which sore throat, cough, and hoarseness
Spasmodic Croup
 occurs most often in children 1-3 yr of age and is clinically
similar to acute laryngotracheobronchitis, except that the
history of a viral prodrome and fever in the patient and
family are often absent.
 Evening or night time
 child awakens with a characteristic barking, metallic cough,
noisy inspiration, and respiratory distress
 afebrile
 following day patient seems well
 more of allergic reaction to viral antigen rather than direct
infection
 pathogenesis unknown

Hypersensitivity Pneumonia
Reactive airway induced asthma

PNEUMONIA
Pathophysiology
Expected findings
Diagnostic work up