INFECTION OF

NOSE, PHARYX AND SINUS

Prof. Dr. dr. Efrida Warganegara, M.Kes.,

Sp.MK
 Content
Introduction
Common Cold
Pharyngitis
Sinusitis  Acute Sinusitis
 INTRODUCTION
The air we inhale contain millions of suspended
particle, including microorganism

Nearly all these m.o. are harmless, but in the

vicinity of infected individuals the air may contain
large number of pathogenic m.o.

Efficient cleansing mechanism are there fore

essential to keep the respiratory tract clean, and
are vital components of the defence against
infection of the upper as well as the lower
respiratory tract.
 INTRODUCTION
It is against the background of these natural
defence mechanism that infection take place, and it
is then fitting to ask why the defences have failed.
Inthe nasopharynx  mucociliary system is
important; and in the oropharynx the flushing
action of saliva.
A variety of m.o. live harmlessly in the upper resp
tract and oropharynx  they colonize the nose,
mouth, throat, teeth and are well adapted to life in
these site.  FLORA NORMAL OF THE
RESPIRATORY TRACT
 INTRODUCTION
Normally they are not causes disease.
However, as in other parts of the body,
resident m.o. may cause trouble when
host resistance is weakened
The respiratory tract, from nose to
alveoli, is a continuum as far as
infectious agent are concerned. There
may be a preferred “focus” of
infection
 INTRODUCTION
Two useful generalization can be made
about upper resp. tract. Infection :
1). Many m.o. are restricted to the
surface epithelium, but other spread
to other parts of the body, before
returning to the resp. tract,
oropharynx, salivary gland etc.
 INTRODUCTION
2). Two groups of microbes can be distinguish :
a. “Professional” invaders  succesfully
infect the healthy resp tract  they have
posses spesific properties that enable them
to evade local host defence, such as the
attachment mechanism of resp. viruses
b. “Secondary” invaders  those which
cause disease only when host defences are
already impaired
 THE COMMON COLD
Aetiology, Transmission, Pathogenesis, and Clinical Features

Virus causing Common Cold

Attachment
Virus Type Involved Mechanism Diasease
Several at any capsid protein binds to
Rhinovirusses given time in the ICAM-1 type molecule
(>100 type) community on cell Common Cold

capsid protein binds to

ICAM-1 type molecule
Coxsackie virus A especially A21 on cell Common Cold

Viral envelop protein,

Corona virusses binds to glycoprotein
several type) all receptors on cell Common Cold
Echovirusses (34
type) 11, 20 - Common Cold
 THE COMMON COLD
Introduction
The common cold is the most frequent
infectious disease in humans, and
accounts for more than half of the upper
resp tract infections that people get
every years
Colds are the leading cause of absences
from school
 THE COMMON COLD
Signs and Symptom
Colds begin with malaise, followed by a
scratchy or mildly sore throat, runny nose,
cough, and hoarseness
The nasal secretions are initially profuse and
watery, then thicken in a days or two, finally
becoming cloudy and greenish
There is no fever unless secondary bacterial
infection occurs.
Symptom are mostly gone within a week,
but a mild cough sometime continues for
longer
 THE COMMON COLD
Causative Agents
Virus that cause the common cold are often
referred to simply as “cold viruses”
Between 30% and 50% of cold are caused by
the 100 or more types of human rhinovirusses
These are member of the picornavirus family
(pico=small, ssRNA), grown in the cell culture
under temperatur and pH conditions that mimic
the upper resp tract (33oC , slightly acid pH)
Many other viruses and some bacterial species
can also produce the signs and symptom of the
common cold
 THE COMMON COLD
Pathogenesis
Rhinovirus attach to spesific receptors on resp
epithelial cells and then infect the cell
The replication cycle produce large numbers of
virion and these are released to infect other cells.
Ciliary motion in the infected cells stops and the
cells may die and slough off
The damage causes the release of pro-inflamatory
cytokines and stimulates nervous reflexes, resulting
in increased nasal secretion, tissue swelling that
partially or completely obstruct the airways, and
sneezing
 THE COMMON COLD
Pathogenesis
Later in the inflamatory response, blood vessel
dilate, allowing plasma to ooze out and
leucocytes migrate to the infected area
Secretion from the area may then contain pus
and blood
The infection is eventually stopped by the
innate and adaptive responses, but it can spread
into the ears, sinuses, or even the lower resp
tract before this occurs
Rhinoviruses can even cause life-threatening
pneumonia in individuals with AIDS
 THE COMMON COLD
Epidemiology
Human : the only source of cold virus, which are
spread by close contact with an infected person
In adult the disease is usually contacted when airborne
virus-containing droplets are inhaled
Transmission can also occur when secretion from
infected people are accidently rubbed into the eye (via
nasolacrimal duct) or nose by contaminated hand
In the infected people (severe symptoms) in the early
in the course of a cold is much more likely to transmit
the virus than is someone with mild symptom or in the
late stage of the disease
 THE COMMON COLD
Epidemiology
 This is because infected people have very high
concentration of virus in their nasal secretions and
on their hands during the first 2 or 3 days of a cold
By the fourth or fifth day, virus levels are often
undetectable, but low level can be present for 2
week.
Cold are actually not highly contagious if
reasonable preventive measures (handwashing) are
taken
Emotional stress, however, can almost double the
risk of catching a cold
 THE COMMON COLD
Treatment and Prevention
There are no proven treatments for the common cold
Rhinovirus are not affected by antibiotics or other antibacterial
Analgesics and antipyretic (aspirin, ibuprofen) can help reduce
symptoms
thecommon cold may resolve in 48 hours; untreated it will take two
days.
To prevent the spread of rhinovirus include handwashing to physically
remove the virus, keeping hands away from the face, and avoiding
crowded place
Itis especially important to avoid people with colds during the first few
days of their symptom, when they are shedding high numbers of viral
particles
Threreno worthwhile vaccines for the common cold virusses ; Vaccine
production, still in research
   
The Common Cold
Scratchy throat,nasal discharge, malaise, headache,
Sign and Symptom cough
Incubation Periode 1 to 2 days
Causative Agent Mainly Rhinovirus - more than 100 types
  many other viruses, some bacteria
Pathogenesis Virus attach to resp. epithelium starting infection that
  spread to adjacent cells; ciliary action ceases and
  cells slough; mucus secretion increases; and inflamatory
  reaction occurs; infectionstopped by interferron release,
  cell mediated and humoral immunity
Epidemiology Inhalation of infectious mucus to nose or eye by
  contaminated finger; children initiate many outbreakss
  in families because of lack of care with nasal secretions
Treatment and No generally accepted treatment except
Prevention for control symptoms, handwashing :
 
 
avoiding people with colds and touching face
 
 Streptococcal Pharyngitis
Introduction
Sorethroat is one of the most common seek
medical care.
Streptococcal Pharyngitis commonly known as
Strep Throat
One concern about streptococcal infection is the
risk of post-streptococcal sequelae (immune
respon to Streptococcus pyogenes) e.g. Acute
rheumatic fever and acute post-streptococcal
glomerulonephritis  these are complication that
develop after the initial infection
 Streptococcal Pharyngitis
Signs and Symptoms
 Strep throat is characterized is characterized by a sore
throat, difficulty swallowing, and fever
 The throat is red, with patches of pus and scattered tiny
hemorrhages.
 The lymph nodes in the neck are enlarged and tender
 Abdominal pain or headache may occur in older children
and young adult
 Patient do not usually have a cough, weepy eye or runny
nose
 Most patient with strep throat recovery spontaneously after
about a week.
 In fact, many infected people have only mild symptoms or
no symptoms at all
 Streptococcal Pharyngitis
Causative Agent
Strep throat is caused by Streptococcus pyogenes,

a Gram positive coccus that grown in chains 

colony morphology on blood agar-S.pyogenes
colonies are sorrounded by a characterized clear
zone of β-hemolysis in contrast most species
Streptococus , part of throat microbiota are α-
hemolytic, a zone of greenish partial clearing
around colonies on blood agar, or non-hemolyitic
S. pyogenes is commonly referred to as the group A

streptococcus (GAS) reflecting its Lancifield

grouping
 Streptococcal Pharyngitis
Pathogenesis
S. pyogenes has many virulence factor
(hyaluronic acid capsule, Protein M,
Streptococcal pyrogenic exotoxins,
streptolysins O and S, Tissue-degradation
enzymes).
Some of these disease-causing mechanism are
structural component of the cells wall that allow
the bacterium to avoid host defense
Others are destructive enzymes and toxins
released by the bacterial cell that damage or
kill host cells
 Streptococcal Pharyngitis
Pathogenesis
Protein (M) is the cell wall of S.pyogenes allow the
bacteria to attach to host cells
Once S.pyogenes colonized host tissues, it produce
enzymes such as DNase, hyaluronidase, and
proteases that break down intracellulare
connection and allow the organism to spread
rapidly to others cells.
A few strain of S.pyogenes produce streptococcal
pyrogenic exotoxin, a family of exotoxin that cause
severe streptococcal diseases characterized by high
fever (pyro means “fire”)
 Streptococcal Pharyngitis
Epidemiology
S. pyogenes naturally infects only humans
The strain spread easily by respiratory droplets
generated by shouting, coughing, and sneezing.
Nasal carriers of S. pyogenes are more likely than
pharyngeal carriers to spread the organism.
A personmay be an asymptomatic carriers of S.
pyogenes for a weeks.
The peaks incidence of strep sore occurs in
winter or spring and its highest in grade school
children
 Streptococcal Pharyngitis
Treatment and Prevention
People with fever and sore throat should be
taken to a physician so that a throat swab can be
taken for a rapid diagnostic test and throat
culture
Confirmed strep throat is treated with a full 10
days of penicillin or erythromycin, which
eliminated the organism about 90% of the cases
Adequate ventilation and avoiding crowded
situations help to control the spread of
streptococcal infections
No vaccine is available
 Strep Throat (Streptococcal Pharyngitis)
Sign and Symptom Sore, red throat, with pus and tiny hemorrhages,
  enlargement and tenderness of lymph nodes in the
  neck; less frequently, abscess formation involving
  tonsils, occasionally, rheumatic fever and glomerulo-
  nephritis as sequelae
Incubation Periode 2 to 5 days
Causative Agent Streptococcus pyogenes, Lancefield group A
  β-hemolytic streptococci
Parhogenesis Virulence associated with hyaluronic acid capsule and
  M protein, both of which inhibits phagocytosis, protein
  G binds Fc segment of IgG, protein F for mucosal
  attachment, multiple enzymes
Epidemiology Direct contact and droplet infections; ingestion of
  contaminated food
Treatment and Treatment : 10 days of penicillin or erythromycin
Prevention Prevention : avoiding crowds, adequate ventilation,
  daily penicillin to prevent recurrent infection in
  those with a history of rheumatic heart disease
 THE SINUSITIS
Introduction
Bacterial infection of sinus are very
common, often occurs together with
eye surface and middle ear, and
often have the same causative agent
Sinusitis is common in both adults
and children
 THE SINUSITIS
Sign and Symptoms
In sinusitis, facial pain and pressure
sensation characteristically occur in the
region of the involved sinus.
Headache and severe malaise also
occur
A thick green nasal disharge that may
contain pus and blood sometimes
develops as well
 THE SINUSITIS
Causative Agents
 Sinus infection is often caused by two common
bacterial pathogen :
1) Haemophylus influenzae, a tiny Gram
negative rods, and
2) Streptococcus pneumoniae, the Gram
positive encapsulated diplicoccus known
as pneumococcus
 Sinusitis can also be caused by Mycoplasma
pneumoniae, Streptococcus pyogenes, Moraxella
catarrhalis, and Staphylococcus aureus
 About one-third of the cases are caused by respiratory
viruses, explaining why some infection do not respond
to antibiotic, which have no effect on virus
 THE SINUSITIS
Pathogenesis
Sinusitis is usually preceded by
infection of the nasal chamber and
nasopharynx that probably spreads
upward
The infection damages the ciliated cells,
resulting in inflamation and swelling
Sinus infections sometimes spread to the
brain coverings, causing meningitis
 THE SINUSITIS
Epidemiology
The ecological factor involved in appearance and spread of the
sinus infection caused by H. infeluenzae and S. pneumoniae are
largely unknown
The virulence of the bacteria, crowding and the presence of the
respiratory viruses are probably all important factors in these
epidemics
A preceding or simultaneous viral illness is common in
sinusitis, the virus probably damages the mucociliary
mechanism that would normally protect against baterial
infections
Sinusitistends to affect adults and older children in whom the
sinuses are more fully develops
 THE SINUSITIS
Treatment and Prevention
Antibacterian therapy with amoxicillin is
generaly efective against sinusitis,
Alternative medications are available for
communities where antibiotic-resistance strains
of H. influenzae and S. pneumoniae are common
Sinus pucture is not often carry out
Decongestants and antihistamines generally are
ineffective and can be harmful because they
reduce the immune response
There are no proven preventive measures for
sinusitis
Terimakasih