Patho Lect_ an Overview of Bacterial and Viral Infections 3-03-2015

8/17/2019 Patho Lect_ an Overview of Bacterial and Viral Infections 3-03-2015

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An overview of bacterial and viralinfections of the upper respiratory

tract.Injury to mucociliary apparatus

3rd March.2015.Physiology module

Dr Jalees Khalid Khan

Pathology Deptt. KEMU. ahore


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Upper respitaoryinfections

Upper respiratory tractin!ections are the mostcommon humana"iction.Ma#or share o! time lost!rom $or% and school.Most common cause o!

anti&iotic a&use.


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'igure 21.1


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• (enerally limited to the upper respiratory tract• (ram)positi*e &acteria +streptococci and

staphylococci, *ery common• Disease)causing &acteria are present as normal

&iota- can cause disease i! their host &ecomesimmunocompromised or i! they are trans!erredto other hosts +Streptococcus pyogenes,Haemophilus infuenza, Streptococcus

pneumonia, Neisseria meningitides,Staphylococcus aureus,

• ormal &iota per!orm micro&ial antagonism

Normal ora of respiratory tract


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• Most common place !or in!ectious agents to gain access tothe &ody

• Upper respiratory tract: mouth, nose, nasalcavity, sinuses, pharynx, epilottis, larynx

•

o$er respiratory tract/ trachea &ronchi &ronchioleslungs al*eoli• De!ences

– asal hair

– ilia

– Mucus

– n*oluntary responses such as coughing sneeing and s$allo$ing

– Macrophages

– 4ecretory g against speci6c pathogens

!espiratory tract


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n7uenaEpiglottitis

4inusitis 8he ommon oldDiphtheria

"iseases


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osocomial in!ections)indisciminate use o!drugs &y doctors and 9uac%s.

Drug resistance)causes

ell $all alteration Plasmid E4:E"u;pump etc ysogenic strains M


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Pandemics =orld$ide ) antigenicshi!t

Epidemics ocal ) antigenic dri!t

Endemic 4poradic 4easonal =inter months ) a&rupt ge n!ection/ children

>adults

Mortality/ adults>children

%pidemioloy


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?irus replication/ 2@ ) A2 hours

?irus e;cretion/ 3 ) A days

nti&odies to B su&types

&athoenesis


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S. pneumoniae

H. infuenzae

S. aureus ) 8o;in 4hoc% 4yndrome

'econdary bacterialpathoens


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Post in7uena : Encephalopathy Bepatic dys!unction

Ele*ate B3 '8s PK (hildren:4treptococcus pneumoniae

◦ Most common cause outside o! neonatal period

◦ asopharyngeal coloniation C 50 o! %ids

◦ >0 serotypes C ma#ority o! in*asi*e disease caused &y 10

serotypes◦ :acteremia in 25)30 o! %ids

◦ (ram stain C gram positi*e lancet shaped diplococci +Fgrampositi*e cocci in pairsG,

!eye)s syndrome


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dults C lo&ar pneumonia

Kids C lo&ar or &ronchopneumonia

Ae di*erences


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lassically a lo&ar consolidation on H<


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hanges in al*eolar epithelial)ciliated

columnar to pseudostrati6edcolumnarepithelium neciency o! cilia to e;pel the

de&riscontaminantscar&on etc inhaled

!rom atmosphere Emphysema LPD

:ronchiectasisarcinoma o! lung

#he e*ect of ciarette smo+e or aseousinhalation on respiratory tract


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Inuena -accine

8ri*alent *accine:ei#ing225)li%e+B11,4ydney5A)li%e+B32,:Bar&in0A@


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Elderly +age>5, Bigh)ris%N Bousehold contacts

Bealth)care personnel Pregnant $omen a!ter 1@th $ee%

Bigh)ris%/ institutionalied chronic heart or

lung disease dia&etesrenal dys!unction immunosuppressed

children on aspirin

Indications for -accine


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Killed *accines i*e *accines i*e *accines are long acting $hile short acting are

%illed *accines

mmuniation◦ Measles C Pneumonia is $hat they die o! C o!ten super)in!ection =orld)$ide co*erage rate C A in 200@ 4till ha*ing 30)@0 million cases a year

◦ Bemophilusn7uenae : C 2)3 million cases o! se*ere disease a year n 2003 de*eloped $orld co*erage C 2 De*eloping $orld C @2 east de*eloped countries C O

vaccination,the taret roupsthat should be vaccinated,

freuency and side e*ects


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Inuena -accine

8iming/ Lcto&er )Mid)o*em&er

Duration o!

immunity/start 1)2 $ee%send @) months


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Proone phenomenon 4erum sic%ness 'e*er lymphadenopathy

4e*ere anaphylactic reation De!ecti*e *accine production)B DP8)not properly %illed

'ide e*ects


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"ianosis

N?iral culture C tissuecultureN'luorescent)la&eledmurine monoclonal & )shell *iral cell culture )

*iral gNP<N' ) at onset and 2$ee%s

@)!old)rise in & titre


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ontrol o! out&rea%s in institutions d#unct to late *accination mmunode6cient ) D4

?accine contraindicated Bome caregi*ers o! high ris%

&rophylaxis of Inuena A


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Epidemiology/◦ most common in children 3)A yrs.

◦ decreased incidence &ecause o! Bi& con#ugate*accine)sta&le rate in adults


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&eritonsillar abscess◦ sore throat drooling hoarseness trismus asymmetric

tonsillar enlargement

%pilottitis ◦

Children: high !e*er to;ic drooling a&sence o! cough◦ Adult: se*ere sore throat dyshagia !e*er

Infectious mononucleosis◦ tonsillar enlargement e;udati*e tonsillitis pharyngeal

in7ammation lymphadenopathy splenomegaly

maculopapular rashes petechial anathema &arapharyneal space infection

◦ nec% s$elling a!ter a sore throat

"/"ianosis


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Haemophilus infuenzae type &S. pneumoniae, S. aureus, H. infuenzaetype non)& H. parainfuenzae

n7ammation and edema o! the epiglottisarytenoids arytenoepiglottic !oldssu&glottic area

Epiglottis pulled do$n into laryn; and

occludes the air$ay

%pilottitis 0 &athoenesis


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-isualiation of epilottis ) Fcherry redG aternal nec% ;)rays/ Fthum& signG =: count > 15000 le!t shi!t :lood cultures

&rophylaxis:


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'inusitis0clinical sins

N?iral U


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asal s$a&s not helpful 8ransillumination o! ma;illary and !rontal

sinuses

4inus ;)rays/ air)7uid le*el completeopacity mucosal thic%ening 8 scan not indicated ) unless chronic

in!ection immunocompromised suspected

intracranial or or&ital complication Direct sinus aspiration

"ianosis


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mpaired mucociliary !unctionL&struction o! sinus ostia

mmune de!ectsncreased ris% o! micro&ialin*asion

1actors predisposin tosinusitis


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&!%-A2%N(% 3%AN 4!AN5%6dults hildren

3I(!78IA2 A5%N# 48acteria6 +, +,

Streptococcus pneumoniae 31 +20)35, 3

Haemophilus infuenzae 21 +)2, 23

+nonencapsulated,S. pneumoniae and H. infuenzae 5 +1), ))

naero&es (Bacteroides, Fusoacterium, +0)10, ))

!eptostreptococcus, "eillonella#

Staphylococcus aureus @ +0)O, ))

Streptococcus pyogenes 2 +1)3, 2Branhamella ($ora%ella# catarrhalis 2 1

(ram)negati*e &acteria +0)2@, 2 'ugal causes in immunocompromised

3icrobial causes


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&!%-A2%N(% 3%AN 4!AN5%6dults hildren

3I(!78IA2 A5%N# +, +,

-iruses


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(omplication (linical 'ins MeningitisBeadache fever stiI nec% lethargy rapid

death Lsteomyelitis Potts puIy tumor

Epidural a&scess Beadache !e*er 4u&dural empyema Beadache seiures

hemiplegia rapid death ere&ral a&scess on*ulsions, headache personality

change ?enous sinus throm&osis Pic%et)!ence !e*er rapid

death a*ernous sinus Lr&ital edema ocular palsies

(omplications of 'inusitis


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-irus type 'erotypesndeno*iruses @1

orona*iruses 2

n7uena *iruses 3

Parain7uena *iruses @


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May)ug ) Entero*iruses 4ept)Dec ) Mycoplasma


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Direct contact $ith in!ected secretions Band ) to ) hand Band ) to en*ironmental sur!ace ) to hand

4pread &y aerosoles (omplications::acterial superin!ection

◦ Ltitis media

◦ 4inusitis

◦

S. pneumoniae, H. infuenzae, B. catarrhalis (uillain):arre 4yndrome sthma attac%s

#ransmission


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spirin ) prolonged e;cretion o! rhino*irusesin7uena *irus

hildren ) aspirin associated $ith


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Patho Lect_ an Overview of Bacterial and Viral Infections 3-03-2015

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