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Anatomical Defenses
1. Nose
- coarse hairs
- mucous secreting cells and cilia
2. Throat
- ciliated mucous membrane
- traps dust and organism
- ciliated cells moves dust towards the mouth
3. Lymphoid tissues (tonsils)
Normal Microbiota of the upper respiratory system:
- S. epidermidis Streptococcus
S. aureus H. influenzae
Corynebacterium
- Upper respiratory normal microbiota may include pathogens
- normal microbiota suppresses the growth of pathogens by competing with nutrients &
by secreting inhibitory substances.
Transmission:
1. Droplet infection ( respiratory secretion)
2. Unpasteurized milk
Signs & symptoms:
1. Fever
2. Local inflammation
3. Enlarged & tender lymph nodes of the neck
4. Otitis media
Diagnosis:
1. Culture from throat swab
2. Agglutination diagnostic tests
Treatment:
Penicillin
Scarlet Fever
Streptococcus pyogenes
- lysogenized by a bacteriophage
- produces Erythrogenic toxin
- causes Pharyngitis
Signs & symptoms:
1. Fever
2. Pinkish Red Skin Rash
- Hypersensitivity of the skin to the toxin
3. Spotted , “ Strawberry tongue”
Diphtheria
Corybacterium diptheriae
- Gram (+), non- endospore forming rod, immobile, straight or curved
- Pleomorphic, “ Club-shaped”, "Chinese characters"
- Klebs-Löffler bacillus
- produces an Exotoxin ( Diphtheria toxin )
Mode of transmission:
1. Droplet infection (Resistant to drying)
2. Cutaneous contact
Signs & Symptoms:
1. Fever
2. Sore throat
3. Malaise
4. Swelling of the neck “Bull neck”
- Tough grayish membrane that forms in the throat that contains fibrin, dead tissue and
bacteria
- Blocks passage of air to the lungs
5. Cutaneous diphtheria - Infects skin wound/ lesions
- Slow healing ulcerations covered by a gray membrane
Prevention:
DPT ( Diptheria Pertussis
Tetanus)
Treatment:
Penicillin and Erythromycin
- controls the growth of
bacteria
- does not neutralize toxin
Antibiotic + Diptheria antitoxin
OTITIS MEDIA
Complication of colds or infections of the nose and throat
Common in childhood
Pus-formation in the eardrum causing it to be inflamed and painful
Common pathogens: S. pneumoniae (35%)
H. influenzae (20-30%)
M. catarrhalis (10-15%)
S. pyogenes (8-10%)
S. aureus (1-2%)
Treatment:
broad-spectrum antibiotics Amoxicillin
Incidence of S. pneumoniae reduced by vaccine
Complications :
*In infants:
- irreversible damage to the brain (Hypoxia)
- High mortality
* Pneumonia
Encephalitis
Secondary bacterial superinfections
Diagnosis:
- symptoms are non-specific hence usually not diagnosed until the appearance of the
characteristic cough.
- Culture of throat swab
- PCR (polymerase chain reaction)
- immunofluorescence
Prevention:
- DPT
Treatment:
- An effective antibiotic (Erythromycin or Azithromycin)
- Close contacts : Antibiotics as prophylaxis
BACTERIAL PNEUMONIAS
Pneumomoccal Pneumonia
Streptococcus pneumoniae:
- Gram-positive, encapsulated, diplococci
- also called Pneumococcus.
- causes illness in children younger than 2 years old and adults 65 years of age or older.
- elderly are especially at risk of getting seriously ill and dying from this disease
High risk individuals include those with the following conditions:
- Chronic heart, lung, or liver disease
- Sickle cell anemia
- with HIV infection, AIDS.
- People who have had organ transplant
- taking medicines that lower their resistance to infection
Transmission of pneumococcal pneumonia:
- Droplet infection (Inhalation)
- Between people who are ill or who carry the bacteria in their throat.
- Common for people especially children, to carry the bacteria in their throats without
being sick.
Pneumococcal pneumonia symptoms:
- may begin suddenly
- severe shaking chill which is usually followed
by: High fever
Cough
Shortness of breath (Dyspnea)
Rapid breathing (Tacypnea)
Chest pains
Other symptoms may include :
Nausea, Vomiting , Headache , Tiredness , Muscle aches
Pneumococcal pneumonia diagnosis:
Symptoms, Physical exam, Lab tests , Chest x-ray
Treatment:
- Penicillin is the drug of choice
- Amoxicillin and Erythromycin
- Vancomycin or Cephalosporin
• Fever - aspirin or acetaminophen
• Supplemental oxygen
• Intravenous fluids
• Plenty of rest and take increased amounts of fluids
• Coughing - helps to clear the lungs of fluid
• Prevention:
- Pneumococcal vaccine
- for children and adults
- 65 years old or older
- serious long-term health problem
- resistance to infection is lowered
- babies and children younger than
2 yrs old
Haemophilus influenzae Pneumonia
Haemophilus influenzae (Pfeiffer's bacillus)
- small, pleomorphic, gram - negative coccobacillus, some strains posses a
polysaccharide capsule Haemophilus influenzae type b, or Hib
- meningitis and pneumonia. age of onset : Preschool (3 month – above 3yrs) peak at 3-12
months
Predisposing factors:
- Alcoholism
- Poor nutrition
- Cancer
- Diabetes
- Immunocompromised
Transmission :
- Direct contact
- Inhalation of respiratory tract droplets
PATHOGENESIS:
Invades the nasopharyngeal mucosa Spreads to the lower respiratory tract Invades and
destroys the mucous membranes Interstitial lesions
Lung findings:
epithelium of the smaller airways and lung
interstitium show PMN or lymphatic invasion
with inflammation, hemorrhagic edema and
and extensive destruction.
CLINICAL FEATURES:
I. Prodrome - Nasopharyngeal II.Pneumonia
- insidious onset with prolonged course (weeks)
Fever
Cough +/- productive
Pleuritic chest pain
Respiratory distress
Complications:
Bacteremia Cellulitis
Epiglottitis Meningitis
Pericarditis Pyarthrosis
Empysema Pleural effusion
Diagnosis:
Chest X-Ray - lobar consolidation
- disseminated interstitial infiltration
Culture & Staining:
- samples include
sputum throat swab, nasopharyngeal secretions, tracheal aspirate, pleural fluid, blood
Treatment:
Antibiotics – Cefuroxime
Manage complications
Intubation/ventilation
Treat underlying illnesses
Mycoplasmal Pneumonia
Mycoplasma pneumoniae:
- Pleomorphic, wall-less bacteria
- Primary Atypical Pneumonia or “ Walking Pneumonia”
- Common in children and young adults
Symptoms:
- Mild to moderate in severity that patient
may remain ambulatory throughout the illness
Diagnosis:
- PCR or by IgM antibodies
Treatment:
- Second generation Macrolide
- Second generation Quinolones
Treatment:
- largely supportive
- Ribavirin.