Airway’s infections

Epidemiology

- In children < 5 years of age. 50 % of all diseases are acute airway’s infections

- In children 5-12 years of age 30 % of all diseases are acute airway’s infections

- Most of the infections are in the upper airways, only 5 % are in the larynx and or in the lower airways

The natural history of the disease depends of

• the pathogen (microbe),• the host,• the environment

Localisation of the acute airways’ inflammations

1. Upper airways’ inflammation

2. Laryngo-tracheo-bronchitis (croup), epiglottitis

3. Acute bronchitis

4. Acute bronchiolitis

5. Pneumonia

Infectious agents of the upper respiratory tract I.

Viruses

Respiratory syncytial virus (RSV):bronchiolitis, pneumonia, croup, bronchitis

Parainfluenza viruses:croup syndorma, bronchitis, bronchiolitis

Influenza virus:in epidemics

Adenoviruses:pharyngitis, pharyngoconjunctivits

RhinovirusesCoronaviruses: rhinitis, common cold

Coxsackieviruses A and B:nasopharyngitis

Infectious agents of the upper respiratory tract II.

Mycoplasma pneumoniae:pharyngotonsilitis, otitis media, pneumonia, bronchitis

Bacterial causes:‘A” group streptococci, corynebacterium

diphteria, Neisseria meningitidis, N gonorrhoeae, haemophilus influenzae, streptococcus pneumoniae

(pneumococcus), staphylococcus aureus

Signs ofinclination for frequent infections

1. Too frequent infectionsAge/year Mean Maximum 1 6,1 8,7 1-2 5,7 8,7 3-4 4,7 7,6 5-9 5,5 8,110-14 2,7 4,9

2. Longer (> 4-5 days) and more serious infection than the usuals

3. Bacterial second line infection4. Complications: otitis, sinusitis, pneumonia5. Multiorgan infections6. Failure to thrive

Bacterial infection is probable:

1. The discharge on the mucous membrane is purulent2. Polymorpho-nuclear granulocytes’ number is high in

the peripherial blood3. Positive bacterial laboratory findings (from throat or

sputum)4. The regional lymphnodes are swollen and painful5. Blood sedimentation rate is high6. There is no viral epidemy

Infection risk factors in the host

1. Preterm babies (< 1 year)2. Age less than 1 year (< 6 months in bronchiolitis)3. To be a boy4. Inborn errors of the immune system5. Congenital heart defects6. Lack of mother milk

Environmental factors

• Family care (+)

• Smoking in the family (-)

• More than one child (-)

• Good socio-economic situation (+)

• Polluted environment (-)

The aetiology of common flu

Antigen types Per cent of probability

Rhinovirus 100 types 30-40 %Coronavirus 3 types > 10 %Parainfluenza virus 4 typesRSV 2 typesInfluenza 3 types 10-15 %Adenovirus 47 types 5 %Others (enterovirus,morbilli, varicella,rubeola) 5 %Unknown viruses 25-30 %A-group beta-haemolytic Streptococci 5-10 %

Upper airway diseases

Nasopharyngitis acuta: fever, headache, dry throat, coughing, nasal discharge, frequent conjunctical inflammation, stuffed nose (feeding problems in infants)Tonsillo pharyngitis acuta: red mucous membrans, swollen families, swollen tonsils, swollen lymphnodes in the neck, fever, painTherapy: antipyretics, antiphlogistic nasal drops, enough fluid intake,Bacterial infection: penicillin, enythromycin (10 days) Non streptococcal infection: amoxycillin, macrolides, cephalosporinsComplications: otitis media acuta, peritonsillar retropharyngeal abscessSinusitis acutaFebris rheumatica, glomerulonephritis (now rare)

Pathogenesis of tonsillopharyngitis

Pathologic agents Features Per cent

Viruses (see before) 35-40 %+Coxsackievirus herpangina < 1 %EBV + CMV mononucleosis inf. < 2 %HIV primer HIV infection < 1 %

BacterialStreptococci pyogenes 15-30 %Beta-haemolytic Streptococci 5-10 %Other bacteria < 5 %Unknown 20-30 %

Complications of upper airway inflammations

Otits mediaMastoiditis acutaParanasal sinusitisPeritonsillar, retropharyngeal

infiltration, abscessusPoststreptococcal diseases:

rheumatic fever, glomerulonephritis

Croup cyndrome

Acute epiglottitisAcute infectious laryngitisAcute laryngo-tracheo-bronchitisAcute spasmodic laryngitis

Laryngitis subglottica (croup syndrome)

Very frequentAetiology: viral, bacterial, mycoplasma

non infective: inclination, alllergic (?)

Croup score:stridor, cough, dyspnoe, cyanosis, inspiratoric sound, jugular dystraction (0-1-2)

3-5 moderate6 or more serious

Therapy: cold vaporization epinephrin (racem) vaporized steroid (systemic or vaporized) antibiotics (if proved bacterial aetiology) intubation, artificial ventillation

Acute bronchitis, tracheo bronchitis

Cough, sputum, bronchial noises, substernal dyscomfort, low grude feverCoarse and fine moist rales and rhonchi

Etiology: viral or bacterial

Therapy: symptomatic (to be at home, antipyretics, fluid intake)

Bacterial aetiology proven: antibiotics

Pneumonia I.

Actiology: viral, bacterial, fungalClinical manifestations: lobar, lobular, broncho-alveolar,

interstitialcommunity acquired pneumonianosocomial (hospital) acquired

pneumoniaBacterial: a) Typical pneumonia: streptococcus pneumoniaeHaemophylus influenzae B type (vaccination!)Streptococcus B Group: neonatologySeldom: staphilococcus auerus, pyogenes, legionellab) Atypical: Mycoplasma pneumoniaec) Chlamydia pneumoniaed) Neonates: Chlamydia trachomatis, Ureaplasma,

Uraeliticum

Pneumonia II.

Viral: RSV, influenza, adenovirus, rhinovirus, enterovirus

VZV, CMV, HSV (immuncompromised host)

Fungal: immuncompromised host

Protozoons: Pneumocystic carinil (AIDS, immuncompromised host)

Pneumonia III.

Clinical signs: fever, cough, malaise, sputum, dyspnoe, cyanosis, tachypnoe

Physical signs: duffness of percussion pneumonia bronchial breath soundsX ray (sonography: pleural effusionCT and MR: abscess, mediastinum problems

Laboratory signs: BSR, CRP, blood smear

Actiology: haemoculture BAL, Pleural drainage (if effusion) induced sputum (?)

Hamophilus influenzae pneumonia

Pneumocystis carinii pneumonia

Right upper lobe pneumonia

candidiasis aspergillosis

patients with leukaemia

Therapy of pneumonia

• symptomatic• antibiotics

- based on aetiology and resistance- based on empirical facts:

macrolidsCephalosporinsaminoglycosids

HSV/VZV: acyclovir. CMV: gancyclovir RSV: ribavirin

Acute nasophayngitis:

Aetiology: viruses, mycoplasma pneumonieae, bacterial mycotic

Epidemilogy

Clinical manifestations

Therapy: aspecific, antiinflammatory drugs, nasal drops and suction

Acut pharyngitis, pharyngo-tonsillitis:

Aetiology: viruses, beta-haemolytic streptococcus (group A) H. influenzae

Epidemiology

Clinical manufestations

Treatment: aspecific, penicillin, erythromycin

The pathogens I.

Virus

RS virus: acute bronchiolitis in infants and toddlers (80 %) croup (12 %), bronchitis (15 %), pneumonia (30 %)

Parainfluenza virus: laryngo-tracheo bronchitis, pneumonia

Influenza virus: upper airway disease anywhere inflammation in the airways

Rhinovirus: common cold, rhinitis, bronchitisAdenovirus: mostly upper airways’ disease serious

pneumonia with serious late consequencesCoxsacie and echovirus: mostly upper airway disease

The pathogens II.

Bacteria

Streptococcus pneumoniae: often in pneumoniaHaemophilus influenzae B type: epiglottitis (!), pneumonia, otitisStaphylococcus aureus: pneumonia, pleuritis in infants and toddlersβ-haemolytic streptococcus’ mostly upper airway inflammation, tonsillitisMycoplasma pneumoniae: pneumonia in bigger childrenChlamydia trachomatis: pneumonia in infantsChlamydia pneumoniae: bronchitis, seldom pneumoniaBronchamella catarrhalis: otitis, sinusitis in children