LEILANI O.

ESTACIO, RN MAN
 The Respiratory Tract and Its
Defenses
• Most common place for infectious agents to gain
access to the body
• Upper respiratory tract: mouth, nose, nasal cavity,
sinuses, pharynx, epiglottis, larynx
• Lower respiratory tract: trachea, bronchi, bronchioles,
lungs, alveoli
• Defenses
– Nasal hair
– Cilia
– Mucus
– Involuntary responses such as coughing, sneezing, and
swallowing
– Macrophages
– Secretory Ig A against specific pathogens
Figure 21.1
 Normal Biota of the Respiratory Tract
• Generally limited to the upper respiratory tract
• Gram-positive bacteria (streptococci and
staphylococci) very common
• Disease-causing bacteria are present as normal
biota; can cause disease if their host becomes
immune compromised or if they are transferred
to other hosts (Streptococcus pyogenes,
Haemophilus influenza, Streptococcus
pneumonia, Neisseria meningitides,
Staphylococcus aureus)
• Normal biota perform microbial antagonism
Corona virus
ADENO VIRUS
 Upper Respiratory Tract Diseases
Caused by Microorganisms

• Rhinitis, or the Common Cold

– Symptoms: sneezing, scratchy throat, runny nose
(rhinorrhea)
– Symptoms begin 2-3 days after infection
– Generally not accompanied by fever
 Inflammation of the mucous
Membrane of the nose usually
Accompanied by common
colds
ALLERIGIC RHINITIS – often called hay fever caused by pollen or
foreign substance such as animal dander

NON ALLERGIC RHINITIS – change in temperature, humidity,

odor or even drugs

DRUG INDUCED RHINITIS – associated used of antihypertensive

agents, oral contraceptives, or even
chronic use of decongestants

S/Symptoms: 1. Rhinorrhea Medical Management:

2. nasal congestion 1. depends on the cause
3. itchiness 2. depends on the severity
4. sneezing
5. headache
PHARMACOLOGICAL
TREATMENT:

1.Antihistamines
2.Oral decongestants
3.Intranasal corticosteroids
4.Ophthalmic agents
VIRAL RHINITIS
- most prevalent type of URTI which is the cause of common cold
- Highly contagious because virus is shed for about two days
before the symptoms appear and during the first part of the
asymptomatic phase
6 viruses known to produce the s/symptoms of common colds
1. Rhinovirus
2. Para influenza virus
3. Respiratory syncytial virus
4. Influenza virus
5. Adeno virus

Transmission by:
1. Touching infected objects
2. Indirect droplet spread
3. Brief exposure
 Sinusitis
– Commonly called a sinus infection
– Most commonly caused by allergy
– Can also be caused by infections or structural
problems
– Generally follows a bout with the common cold
– Symptoms: nasal congestion, pressure above the
nose or in the forehead, feeling of headache or
toothache
– Facial swelling and tenderness common
– Discharge appears opaque with a green or yellow
color in case of bacterial infection
– Discharge caused by allergy is clear and may be
accompanied by itchy, watery eyes
1. Deviated septum 5. colds
2. Hypertropied turbinates 6. URTI
3. Spurs 7.Lack of cilia
4. Nasal polyps motility
VIRAL
SINUSITIS
BACTERIAL
RISK FACTORS:
1. Allergic and non allergic rhinitis
2. Frequent swimming or diving
3. Dental infections
4. Tobacco/smoking
5. TBI
6. GERD
7. Winter season/change of season
Medical Management Surgical Management Nursing Management
1. Goal of Treatment: 1. Endoscopic – to correct 1. Methods to promote
-treat infection the structural deformities drainage
-shrink the nasal mucosa 2. Increase fluid intake
- To relieve pain
2. Antibiotic regimen 2. Cauterizing nasal polyps 3. Hot wet packs
1st line: Amoxicillin, 3. Correcting deviated 4. Antibiotic compliance
Bactrim, Erythromycin septum
2nd line: Cefuroxime, 4. I and D of sinuses
Augmentin
3.Use of nasal
decongestant -
pseudoephedrine
4. Saline irrigation
5.Antihistamine
 Acute Otitis Media (Ear Infection)
• Also a common sequel of rhinitis
• Viral infections of the upper respiratory tract lead to
inflammation of the Eustachian tubes and buildup of fluid
in the middle ear- can lead to bacterial multiplication in the
fluids
• Bacteria can migrate along the Eustachian tube from the
upper respiratory tract, multiply rapidly, leads to pus
production and continued fluid secretion (effusion)
• Chronic otitis media: when fluid remains in the middle ear
for indefinite periods of time (may be caused by biofilm
bacteria)
• Symptoms: sensation of fullness or pain in the ear, loss of
hearing
• Untreated or severe infections can lead to eardrum rupture
Figure 21.2
CA: 1. S pneumoniae
2. H. influenza,
3. Moraxella catarrhalis
4. Streptococcus pyogenes

S. PNEUMONIAE

H. INFLUENZAE

STREPTOCOCCUS PYOGENES
M. CATARRHALIS
 Pharyngitis
• Inflammation of the throat
• Pain and swelling, reddened mucosa, swollen
tonsils, sometime white packets of
inflammatory products
• Mucous membranes may swell, affecting
speech and swallowing
• Often results in foul-smelling breath
• Incubation period: 2-5 days
 NASOPHARYNGITIS
❑ Common illness of childhood , occurring
mainly during cold weather
❑ adenovirus; other virus influenza and para
influenza
❑ IP : 4-10 days
❑ Mgt: supportive
❑ use of lozenges, aseptic
mouthwash, decongestant have no role in the
management of the infection
 TONSILOPHARYNGITIS
❑ Pharynx and tonsils
❑ streptococcus pyogenes – droplet
❑ sudden onset of fever , sorethroat, headache,
nausea, dysphagia
❑ self limiting disease however because of
sequale antibiotic is necessary
❑ DOC: penicillin (erithromycin or clindamycin if
allergic to penicillin)
❑ sinusitis, otitis media, Rheumatic fever -
complications
 Diphtheria
• Symptoms initially experienced in the upper
respiratory tract
• Sore throat, lack of appetite, low-grade fever
• Pseudomembrane forms on the tonsils or
pharynx
 CORYNEBACTERIUM DIPHTHERIAE

Figure 21.8
Figure 21.9
 Diseases Caused by Microorganisms
Affecting the Upper and Lower
Respiratory Tract
• A number of infectious agents affect both the
upper and lower respiratory tract regions
• Most well-known: whopping cough,
respiratory syncytial virus (RSV), and influenza
 CROUP
Laryngitis, laryngotracheitis,Laryngotracheobronchitis
• Denotes several respiratory illnesses characterized by
varying degrees of inspiratory stridor, cough and
hoarseness (“seal bark”) resulting from the obstruction in
the region of the larynx.
• Loud barking cough that's further aggravated by crying
and coughing, as well as anxiety and agitation, setting up
a cycle of worsening signs and symptoms, fever, hoarse
voice
• Majority of cases occurs within the first 3 years of life
• Para influenza virus
• droplet
 Whooping Cough
• Also known as pertussis
• Two distinct symptom phases
– Catarrhal stage
• After incubation from 3 to 21 days
• Bacteria in the respiratory tract cause what appear to be
cold symptoms (runny nose)
• Lasts 1 to 2 weeks
– Paroxysmal stage
• Severe and uncontrollable coughing
• Violent coughing spasms can result in burst blood vessels in
the eyes or even vomiting
• Followed by a long recovery (convalescent) phase
– Complete recovery requires weeks or even months
– Other microorganisms can more easily cause
secondary infection
 Respiratory Syncytial Virus Infection
• Produces giant multinucleated cells (synctia)
in the respiratory tract
• Most prevalent cause of respiratory infection
in the newborn age group
• First symptoms: fever that lasts approximately
3 days, rhinitis, pharyngitis, and otitis
• More serious infections give rise to symptoms
of croup: coughing, wheezing, dyspnea, rales
 Influenza
• Begins in the upper respiratory tract; serious
cases may also affect the lower respiratory
tract
• 1- to 4-day incubation period
• Symptoms begin very quickly: headache,
chills, dry cough, body aches, fever, stuffy
nose, and sore throat
• Extreme fatigue can last a few days or a few
weeks
INFLUENZA A INFLUENZA B INFLUENZA C

Responsible of most Mainly the one that Milder than either type
cases of cause Epidemics and A or B. People
Epidemics and Infections and is generally do not
Pandemics restricted to HUMANS become very ill from
- Also cause of only the influenza type C
influenza in birds viruses. Type C flu
Known as AVIIAN FLU viruses do not cause
epidemics.

SUBTYPE LINEAGES
A (H1N1) B(VICTORIA)
A (H3N2) B(YAMAGATA)
 2 TYPES OF ANTIGENETIC
CHANGES
1.HEMAGGLUTININ (HA) 2. NEURAMINIDASE
- Minor change arising by the accumulation of - major change that involves
Mutations in the virus genes that code the virus rearrangement of the gene
That host antibody recognize segments involving the H ag and
N ag resulting in the development
of new strain

Shifting can result in a new

Influenza A subtypes in human

No immunity against new virus

 Lower Respiratory Tract Diseases
Caused by Microorganisms

• Diseases that affect the bronchi, bronchioles,

and lungs
• Tuberculosis and pneumonia
 Tuberculosis
• Humans are easily infected with
Mycobacterium tuberculosis but are resistant
to the disease
• Only about 5% of infected people actually
develop a clinical case of TB
• Untreated TB progresses slowly
• Clinical TB is divided into primary tuberculosis,
secondary tuberculosis, and disseminated
tuberculosis
 CAUSATIVE AGENT
1. MYCOBATERIUM TUBERCULOSIS
2. MYCOBACTERIUM BOVIS
3. MYCOBACTERIUM AVIUM COMPLEX
4. MYCOBACTERIUM AFRICANUM
5. MYCOBACTERIUM LEPRAE
• Gram-positive, catalase positive, non-motile, non-spore
forming rod-shaped bacteria (0.2–0.6 μm wide and 1.0–10
μm long).
• The colony morphology of mycobacteria varies with some
species growing as rough or smooth colonies.
• Colony color ranges from white to orange or pink
(Iivanainen, 1999). Most mycobacteria are aerobic
organisms, although some species are microaerophilic
(Falkinham, 1996).
• Mycobacteria are slender, non spore-forming, rod-shaped,
aerobic, slow-growing, and free-living in soil and water.
These bacteria have a generation time of about 20 h, thus
isolation and identification may take up to 6 weeks
(although a few species may grow in only 5–7 days).
• These bacteria are acid-alcohol-fast, which
means that after staining they resist
decolorization with acidified alcohol as well as
strong mineral acids.
• The property of acid-fastness, resulting from
waxy materials in the cell walls, is particularly
important for recognizing mycobacteria.
• The staining procedures must be carefully
performed because other Gram-positive
bacteria are often partially acid-fast
 MOT
Airborne which means , person to person spread
through coughing by infected individuals

PULMO TB EXTRA PULMO TB

1. PRIMARY 1.LYMPHNODE TB
2. SECONDARY 2. PLEURAL TB
3. POTT’s DSE
4. GI TB
5. TB MENINGITIS
6. GUT TB
 CLINICAL FINDINGS
PRIMARY
Childhood TB
Affects part of the lung but
most commonly involves the
middle and lower lobes of the
lungs
Lesion is called GHON complex
asymptomatic
SECONDARY/
REACTIVATION
Seen in adults and caused by
tubercle bacilli that survived
from the primary
The granulomatous
inflammation is much more
florid and widespread.
Typically, the upper lung lobes
are most affected, and
cavitation can occur.
Easy fatigability, weight loss,
night sweats, loss of appetite,
afternoon rise fever, chronic
non productive cough
with/without hemoptysis
DISSEMINATED/ETB
outside of lungs can lead to
the appearance of a number
of uncommon findings with
characteristic patterns:
1. Skeletal Tuberculosis: Tuberculous osteomyelitis
involves mainly the thoracic and lumbar
2.
vertebrae
Tuberculous salpingitis and endometritis result
from dissemination of tuberculosis to the
fallopian tube that leads to granulomatous
salpingitis, which can drain into the endometrial
cavity and cause a granulomatous endometritis
with irregular menstrual bleeding and infertility.
In the male, tuberculosis involves prostate and
epididymis most often with non-tender
induration and infertility.
3. A meningeal pattern of spread can occur, and the
cerebrospinal fluid typically shows a high protein, low
glucose, and lymphocytosis. The base of the brain is often
involved, so that various cranial nerve signs may be present.
Rarely, a solitary granuloma, or "tuberculoma", may form
and manifest with seizures.
 LABORATORY DIAGNOSIS
1. Acid fast staining of sputum
2. CXR
3. Skin test /Mantoux test/ Tuberculin test
+ MT – indicates previous infection by the organism
or exposure to an active case but not necessarily an
active disease
Induration of 15mm Induration of 10mm or Induration of 5mm or
Or more in a person more in a person with More in a person with
With no known risk High risk factors Deficient cell mediated
factor immunity
 Prevention for TB
1. BCG vaccine – given anytime after birth
1 dose , 0.05ml, ID,
deltoid right arm
2. Isolation of the patient
3. Proper ventilation
4. N95 particulate mask
Figure 21.20
COMMON CAUSE OF PNEUMONIA
• Viruses, bacteria, and fungi can all cause
pneumonia.
• In the United States, common causes of viral
pneumonia are influenza, respiratory syncytial
virus (RSV), and SARS-CoV-2 (the virus that
causes COVID-19).
• A common cause of bacterial pneumonia is
Streptococcus pneumonia (pneumococcus).
• Community-acquired pneumonia is when someone
develops pneumonia in the community (not in a
hospital).
• Healthcare-associated pneumonia is when someone
develops pneumonia during or following a stay in a
healthcare facility. Healthcare facilities include
hospitals, long-term care facilities, and dialysis
centers.
• Ventilator-associated pneumonia is when someone
gets pneumonia after being on a ventilator, a
machine that supports breathing. The bacteria and
viruses that most commonly cause pneumonia in the
community are different from those in healthcare
settings.
 HOW DOES PNEUMONIA DEVELOP?
• Most of the time , the body filters organism
• This keeps the lungs from becoming infected
• But organisms sometimes enter the lungs and
cause infections
Likely occur when:
❑ immune system is weak
❑ organism is very strong
❑ body fails to filter the organisms
 Class of Pneumonia
TYPICAL ATYPICAL

-USUALLY LOBAR PNEUMONIA WITH PARA -WALKING PNEUMONIA

PNEUMONIC PLEURAL EFFUSIONS
CA:
1. STREPTOCOCCUS
2. STAPHYLOCOCCUS AUREUS
3. GROUP A STREPTOCOCCUS
4. KLEBSIELLA
5. HAEMOPHILLUS
6. MORAXELLA CATARRHALIS
-USUALLY WITH MILDER MANIFESTATION
THAN TYPICAL PNEUMONIA AND CAUSE
BY OTHER BACTERIA
CA:
1. CHLAYDOPHILA PNEUMONIAE
2. COXIELLA BURNETTI
3. LEGIONELLA PNEUMOPHILLA
4. MYCOPLASMA PNEUMONIAE

CLINICAL FINDINGS:
BRONCHITIS
COMMON COLD
PNEUMONIA
OTITIS MEDIA
 ACUTE BACTERIAL PNEUMONIA
• Abrupt onset of fever and chills , w/ productive
cough of purulent sputum and pleuritic chest pain
PREDISPOSING FACTORS:
1. AGE CA:
1. STREP PNEUMONIA
2. ASTHMA , DM AND HEART DSE 2. MYCOPLASMA PNEUMONIA
3. LEGIONELLA PNEUMOPHILIA
3. RECOVERING FROM SURGERY
4. IMMUNOCOMPROMISED
5. SMOKING AND ALCOHOL
 STREPTOCOCCAL PNEUMONIA/PNEUMOCOCCI
CA: STREPTOCOCCAL PNEUMONIA
MOT:
1. TRANSMITTED THROUGH DROPLET RESPIRATORY SECRETION
2. NASOPAHRYNGEAL CARRIE’s SERVES AS SOURCE OF INFECTION IN 10% of cases
CLINICAL MANIFESTATION:
1. ABRUPT ONSET OF FEVER AND CHILLS
2. COUGH
3. PLEURITIC CHEST PAIN
4. DOB
5. SPUTUM
6. INFECTION SPREADS FROM OTHER PARTS OF THE BODY
LABORATORY DIAGNOSIS:
1.GRAM STAIN AND MICROSCOPIC EXAMINATION
2. BLOOD AND SPUTUM CULTURE
3. CAPSULAR SWELLING TEST
 Viral pneumonia
• Characterized by inflammation of the
interstitial spaces
• s/sx: may be less severe as that of the
bacterial pneumonia and physical examination
may only reveal rales on auscultation
 CHARAC & TREATMENT
ORGANISM CLINICAL LAB STUDIES COMPLICATIONS PREFERRED
SETTINGS ANTIMICROBIAL
THERAPY
S.PNEUMONIA Chronic cardio -Gram stain of sputum Bacteremia, meningitis, PENICILLIN G
pulmonarty dse, follows -Culture of endocarditis, empyema
URT infxn blood,sputum,
pleural fluid
H. INFLUENZAE Chronic cardio -culture of sputum, Empyema, endocarditis AMPICILLIN or
pulmonarty dse, follows blood, pleural fluid AMOXICILLIN;
URT infxn CEFOTAXIME or
CEFTRIAXONE
S.AUREUS Influenza epidemics, Culture of sputum, Empyema cavitation NAFCILLIN
nosocomial blood, pleural fluid
K.PNEUMONIA Alcohol abuse, DM, C/S sputum, blood, Empyema cavitation CEPHALOSPORIN +
Nosocomial pleural fluid GENTAMYCIN
E.COLI Nosocomial; Community C/S sputum, blood, Empyema CEPHALOSPORIN
acquired pleural fluid (3rd generation)

P.AERUGINOSA Nosocomial, cystic C/s of sputum, blood Cavitation ANRIPSEUDOMONAL

fibrosis PENICILLIN +
TOBRAMYCIN
M. PNEUMONIAE Young Adults Complement fixation test Skin Rashes, Hemolytic ERYTHROMYCOIN,
anemia AZITHROMYCIN or
CLARITHROMYCIN
 STERPTOCOCCAL PNEUMONIAE
• Pneumococci, encapsulated, lancet shaped
diplococci, gram + , alpha hemolytic
• Produce disease by the ability to multiply in the
tissues
MOT: Droplet
s/sx: abrupt, onset of fever and chills, cough &
pleuritic chest pain, rusty colored sputum
Tx: Penicillin G, (alternative: Ceftizoxime ,vancomycin)
Px: Vaccine (high risk individual)
STRUCTURE
Background
❑ COVID-19 is the name of the “novel coronavirus”
disease
❑ SARS-CoV-2 is the name of the virus that causes
COVID-19
❑ Coronaviruses cause mild respiratory illnesses,
such as the common cold
❖ Severe Acute Respiratory Syndrome (SARS)
❖ Middle East Respiratory Syndrome (MERS)
❖ COVID-19 is a new coronavirus disease
❑ Emerged from Hubei Province, China in December
2019
• People with COVID-19 have had a wide range of symptoms reported –
ranging from mild symptoms to severe illness. Symptoms may appear
2-14 days after exposure to the virus. People with these symptoms
may have COVID-19:

• Cough
• Shortness of breath or difficulty breathing
• Fever
• Muscle or body aches
• Headache
• New loss of taste (Ageusia) , Loss of Smell (Anosmia)
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
 What is the difference between Influenza (Flu) and COVID-19?
• Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but
they are caused by different viruses. COVID-19 is caused by infection with a
new coronavirus (called SARS-CoV-2) and flu is caused by infection with
influenza viruses.

• There are some key differences between flu and COVID-19. COVID-19 seems
to spread more easily than flu and causes more serious illnesses in some
people. It can also take longer before people show symptoms and people
can be contagious for longer. Another important difference is there is a
vaccine to protect against flu. There is currently no vaccine to prevent
COVID-19. The best way to prevent infection is to avoid being exposed to the
virus. More information about differences between flu and COVID-19 is
available in the different sections below.

• Because some of the symptoms of flu and COVID-19 are similar, it may be
hard to tell the difference between them based on symptoms alone, and
testing may be needed to help confirm a diagnosis. Flu and COVID-19 share
many characteristics, but there are some key differences between the two.
• Risk Factors and Severity
People with COVID-19 can have no symptoms or develop mild, severe,
or fatal illness
Kids may have less severe disease (2% of confirmed cases in China
occurred among those <20 years old)
Current case fatality rate ~2% among those with laboratory-confirmed
COVID-19
Risk factors for severe illness may include:
• o Older age
• o Underlying chronic medical conditions
 How does the virus spread?
• Primarily spreads person-to-person via respiratory droplets
from coughs or sneezes (like the flu)
• Possibly spread by touching an object or surface with the
virus on it, then touching mouth, nose, or eyes
• Possibly spread through stool with the virus in it
• It takes approximately 2 to 14 days (median ~5 days) for
an infected person to show symptoms
• People likely most infectious while they are most
symptomatic (e.g., coughing and sneezing)
• Spread from people without symptoms appears
possible
 Treatment and Vaccine
Treatment
• No specific treatment currently available
• Supportive management of complications,
including
• advanced organ support if indicated
Anti-viral medications under investigation
• Vaccines are under development
Phase 1 trials in people may occur within 2
month
 LAB RESULTS
• nasal or nasopharyngeal and oropharyngeal swab, which used
to diagnose upper respiratory tract infections
• real-time reverse transcription polymerase chain reaction (rRT-
PCR COVID-19 (Coronavirus) Molecular (Swab) Test
• This test uses a long swab to collect material, including
physical pieces of coronavirus, from the back of the nose
where it meets the throat. A positive result indicates that viral
genetic material is present, but it does not indicate that
bacterial or other infections also are present. A negative result
indicates that the SARS-CoV2 virus that causes the COVID-19
disease was not found. It is possible to have a very low level of
the virus in the body with a negative test result.
• This test is needed to identify the presence of the SARS-CoV-2
virus that causes the COVID-19 disease.
• COVID-19 (Coronavirus) Antibody (Serology) Test
This is a blood test. It is designed to detect antibodies (immunoglobulins, IgG and IgM) against the
coronavirus that causes the disease called COVID-19. Antibodies are proteins produced by the immune
system in response to an infection and are specific to that particular infection. They are found in the
liquid part of blood specimens, which is called serum or plasma, depending on the presence of clotting
factors. IgM and IgG may either be ordered together or separately.
Having an antibody test is helpful if:
• your health care provider believes you may have been exposed to the coronavirus which causes
COVID19 based on your current or previous signs and symptoms (e.g., fever, cough, difficulty
breathing);
• you live in or have recently traveled to a place where transmission of COVID-19 is known to occur;
• you have been in close contact with an individual suspected of or confirmed to have COVID-19; or
• you have recovered from COVID-19.
Antibody Test for IgG
• This test detects IgG antibodies that develop in most patients within seven to 10 days after
symptoms of COVID-19 begin. IgG antibodies remain in the blood after an infection has passed.
These antibodies indicate that you may have had COVID-19 in the recent past and have developed
antibodies that may protect you from future infection. It is unknown at this point how much
protection antibodies might provide against reinfection.
Antibody Test for IgM
• This test detects IgM antibodies. IgM is usually the first antibody produced by the immune system
when a virus attacks. A positive IgM test indicates that you may have been infected and that your
immune system has started responding to the virus. When IgM is detected you may still be
infected, or you may have recently recovered from a COVID-19 infection.