Infections of the upper respiratory tract
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INFECTIONS OF THE UPPER RESPIRATORY TRACT. Elizabeth Wasserman Clinical Microbiologist, Pathcare Laboratories Extraordinary professor, Division of Medical Microbiology, Stellenbosch University. RESPIRATORY INFECTIONS. Divided into: Upper respiratory tract infections

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Infections of the upper respiratory tract

INFECTIONS OF THE UPPER RESPIRATORY TRACT

Elizabeth Wasserman

Clinical Microbiologist, Pathcare Laboratories

Extraordinary professor, Division of Medical Microbiology, Stellenbosch University


Respiratory infections
RESPIRATORY INFECTIONS

Divided into:

  • Upper respiratory tract infections

  • Lower respiratory tract infections

    Division is the larynx. Normal flora is found above the larynx, while the environment below the larynx is sterile under normal conditions.


Normal flora of the upper respiratory tract
Normal flora of the upper respiratory tract

1. Commonly carried bacteria: Streptococcus viridansNeisseriaspp. DiphtheroidsAnaerobiesecocci, fusiforme & Bacteroides2. Bacterial pathogens that can be carried asymptomatically: Streptococcus pyogenes Streptococcus pneumoniaeHaemophilusinfluenzaeCorynebacteriumdiphtheriae

Moraxellacatarrhalis3. Organisms associated with colonization as a result of antimicrobial therapy: Coliforms - Klebsiella spp., E. coli, etc. Pseudomonas spp. Candida albicans


Incidence of upper airway infections
Incidence of upper airway infections:

  • Viral infections in pre-school children – up to 6 x per year.

  • Bacterial infections are also very common in children.


Common cold coryza
"Common cold"(Coryza)

Ethiology:

- Corona virus

- R S V

- Para-influenza virus

- Coxsackie A21 and B3

- Echovirus 11 + 20

- Adenoviruses


Pharingitis and tonsillitis
Pharingitis and Tonsillitis


Ethiology:

Viruses: 

- Adenovirus

- EBV

- Enterovirus

- Prodrome of for example measles

- CMV

- Herpes simplex


Bacteria:

 - S. pyogenes including Lancefield groups C + G

- C. diphtheriae and C. ulcerans (rare)

- Arcanobacterium haemolyticum – especially in adults

- Vincent’s organisms (B. vincenti + anaerobe fusiform basilli)

- T. pallidum (2o syphilis).

- N. gonorrhoeae


  • Laboratory diagnosis

    not necessary as routine

  • Treatment

    usually empiric with narrow spectrum beta lactam drug


Complications of streptococcal infection:

Direct:

- peritonsillarabscess

- Otitis media

- scarlet fever

Indirect:

- Rheumatic fever

-Acute Glomerulonephritis


Otitis media
Otitis media

Ethiology:

Viruses (50%)

Bacteria:

- S. pneumoniae

- H. influenzae

- S. pyogenes

- S. aureus

- M. catarrhalis

- M. pneumoniae (rare)


Laboratory diagnosis:

Specimen collection underdirectvission, preferably an aspirate: Gram stain culture

http://www.rnceus.com/otitis/images/tympanocentesis.jpg


Treatment:

- Amoxicillin

- beta-lactamase producing organisms (H. influenzae + M. catarrhalis): Augmentin (Amoxicillin + Clavulanic acid) or 2nd generation cephalosporin

Complicactions:

 - Chronic suppurative otitis media

- Mastoiditis

- secretory otitis media ("gum ear")


Otitis externa
Otitisexterna

Clinical presentation: 

Irritation and secretion of

the external ear.

Etiologic:

Bacterial:

- S. aureus

- Proteus spp

- P. aeruginosa("Malign Otitisexsterna“)

Fungi:

- Aspergillusniger

- C. albicans


Laboratory diagnosis:

Culture of pus /swab.

Treatment:

- Ear toilet

- Topical antibiotics according to sensitivities


Sinusitis
Sinusitis

Etiologic:

Viruses

Bacterial:

- H. influenzae

- S. pneumoniae

- Anaerobe and micro-aerophilic streptococci

- S. aureus

  • S. pyogenes

  • M. catarrhalis


Treatment:

- Empiric therapy amoxicillin. Beware of beta-lactamase producing organisms: Augmentin, 2nd generation cephalosporin.

- Allergic patients: cotrimoxazole, anaerobic cover - metronidazole.

Complications:

- Osteomyelitis

- Meningitis

- cerebral abscess



Ethiology

Viral:

- parainfluenza 1,2,3

- Influenza A

- Rhinoviruses, RSV

Bacterial:

- M. pneumoniae


Epiglottitis
Epiglottitis

Ethiology:

- H. influenzae type b

Diagnosis:

- Examine only in theatre

- Cherry red epiglottis

- XR picture

- Blood cultures


Pertussis
Pertussis

  • Caused by the bacterium Bordetella pertussis

  • Limited to the human host and transmitted from person to person by droplet spread

  • Severe disease of childhood

  • Organisms adhere to the ciliated epithelial cells of the respiratory tract and start to multiply. Not invasive.

  • Cause inflammation and damage to the ciliated epithelial cells by means of various toxins (pertussis toxin, endotoxin, trageal cytotoxin, adenylate cyclase toxin)


Clinical characteristics
Clinical characteristics

  • Incubation period 1 – 3 weeks

  • Starts with a catarrhal phase

  • One week later: dry cough that becomes paroxysmal (bouts of coughing)

  • Paroxysmal cough followed by a ‘whoop’.

  • Superfluous phlegm production

  • In spite of the severity of the disease, the symptoms are limited to the respiratory tract.


Complications
Complications

  • CNS: anoxia, exhaustion

  • Secondary pneumonia

    Diagnosis

  • Clinical

  • Organisms isolated on special media that has to be inoculated at the bedside, from a throat swab or so-called ‘cough plates’

  • PCR


Treatment
Treatment

  • Supportive

  • Erythromycin: this may limit the severity and duration of the disease

  • It may also limit infectivity and the risk of secondary infections

    Prevention

  • Active immunization

  • Whole cell vaccine

  • In the future: ?subunit vaccine

  • Erythromycin prophylaxis for high risk, close contacts.


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