Acute Respiratory Infections(ARI) Flashcards
The respiratory tract is made up of a continuous mucosal surface and this ____________________________ , allows downward spread of infection along the tracheobronchial tree.
lack of restriction by anatomic boundaries
The upper respiratory tract consists of the airways from the _________ to the _________ in the _________, including the _________ and the _________.
The lower respiratory tract covers the continuation of the airways from the _________ and _________ to the _________ and the _________.
nostrils ; vocal cords ; larynx
paranasal sinuses ; middle ear.
trachea ; bronchi ; bronchioles ; alveoli.
Most of these ARI deaths are due to __________ and __________.
bronchiolitis and pneumonia
Risk factors: Demographic factors
anatomy
protective immune
males
Risk factors
Host factors
malnutrition ( ↓biological integrity of resp __________ - cellular __________, fibronectin)
mucosa; regeneration
pertussis, measles, pneumococcal, HIB
Pathogenesis
ARIs occur from a pathogen activated failure or disruption of the normal anatomical barriers, protective reflex mechanisms and pathogen-specific immunological defence mechanisms of the respiratory tract.
Some of these include _________ activity, _________ reflex, sneezing, _________ production, _________ immunity( T-lymphocytes, natural killer cells, IF alpha and gamma), _________ immunity (IgA,IgG).
ciliary
cough ; mucus production
cell-mediated ; humoral immunity
Pathogenesis of URTI
Organisms gain entry to the respiratory tract by __________ of droplets or direct contact with __________ hands or formites
Then they __________ the __________
______________ may ensue, along with redness, edema, hemorrhage and sometimes an __________
inhalation ;contaminated
Invade the mucosa
Epithelial destruction ;exudate
Upper Respiratory Tract Infections
Include:
rhinitis (common cold)
Sinusitis
Ear infections
acute pharyngitis or tonsillopharyngitis(33%)
Laryngotracheitis or
laryngotracheobronchitis (croup)
epiglottitis and laryngitis
___________ and ___________ cause the more severe complications (deafness and acute rheumatic fever/post streptococcal glomerulonephritis, respectively).
Ear infections and pharyngitis
URI (Aetiology)
The vast majority of URIs have a ______ etiology.(eg ______,________,_________)
Bacterial causes include commonly _______________,________________, etc
viral; corona; RSV
GABHS (Group A beta haemolytic
streptococcuss)
Haemophilus influenza type B(HIB)
Treatment of URTI
Symptomatic/supportive
Headaches, sorethroat, muscle aches
(_________).
Nasal congestion (___________ discouraged in children <______ years)
Antibiotics (Pharyngitis has bacterial cause in 15%)
________ (dehydration)
_______ rich foods
analgesics
decongestants
12; Fluids; Vit A
Treatment of URTI
Specific treatments:
____________________ (sinusitis)
_______{(otitis externa)
Surgical antral washout
Inflammation of the upper airway is classified as ________ or ______________ on the basis of the location, clinical manifestations, and pathogens of the infection.
epiglottitis
laryngotracheitis (croup)
____________________ is the most common cause of epiglottitis, particularly in children age 2 to 5 years.
Haemophilus influenzae type b
ACUTE EPIGLOTITTIS : Pathogenesis
A ________________________ may precede infection with H influenzae in episodes of epiglottitis.
However, once H influenzae type b infection starts, (slowly or rapidly?) progressive ———— and _________ of the epiglottis ensue, and bacteremia is usually present.
viral upper respiratory infection
rapidly
erythema ; swelling
ACUTE EPIGLOTITTIS: clinical manifestations
The syndrome of epiglottitis begins with the acute onset of _______ , _______, hoarseness, _______, _______ and progresses within a few _______ to _______ and _______. The clinical course can be fulminant and fatal. The _______ may be inflamed, but the diagnostic finding is a “_______” epiglottis.
fever ; sore throat
drooling; dysphagia
hours ; severe respiratory distress
prostration ; pharynx
cherry-red
EPIGLOTITTIS: clinical features
A
I
R
R
A
I
D
Airway closed
Increased pulse
Restlessness
Retractions
Anxiety increased
Inspiratory stridor
Drooling
For EPIGLOTITTIS, DON’t???
Why?
Don’t examine the throat
Causes more anxiety
ACUTE EPIGLOTITTIS: Diagnosis
__________ appearance of epiglottis on
__________
Lateral neck radiograph- __________ sign
Haemophilus influenzae type b is isolated from the blood or epiglottis in the majority of patients with epiglottis; therefore a __________ should always be performed.
Cherry red ; laryngoscopy
thumb sign
blood culture
ACUTE EPIGLOTITTIS: Treatment and Prevention
It is a ____________ , especially in
children.
Observe carefully, keep calm, DO NOT ____________
____________/ ____________ (skilled personnel)
Antibacterial therapy should be directed at ____________
For prevention, ____________
Medical emergency ; AGITATE
intubation , tracheostomy
H influenzae.
Haemophilus influenzae type b conjugated vaccine.
Laryngotracheitis(Croup)
Most cases of laryngotracheitis are due to __________ .
__________ viruses are most common but RSV, adenoviruses, influenza viruses, enteroviruses and Mycoplasma pneumoniae have been implicated.
More serious bacterial infections have been associated with __________ , __________ and __________.
viruses; Parainfluenza
H influenzae type b
group A beta-hemolytic streptococcus
C diphtheriae.
CROUP: Pathogenesis
Viral infection of laryngotracheitis commonly begins in the _________ and eventually moves into the _________ and _________.
Inflammation and edema involve the epithelium, mucosa and submucosa of the _________ which can lead to _________
nasopharynx ; larynx ; trachea.
subglottis ; airway obstruction.
CROUP(Clinical manifestation)
history of preceding _______-like symptoms is typical of laryngotracheitis, with _______, _______, _______ and a _______ cough.
Tachypnea, a ___________ cough and inspiratory _______ eventually develops.
Children with bacterial tracheitis appear (more or less?) ill than adults and are at (lesser or greater?) risk of developing airway obstruction.
rhinorrhea ; fever
sore throat ;mild
deep barking cough
stridor
more ; greater
When the duration of symptoms of infections of the tracheobronchial tree is less than _____________, they are referred to as acute respiratory infections
28 days
Croup (diagnosis)
_________ cultures or cultures from
______________.
Serologic studies- antibody titers to various viruses.(retrospective diagnosis)
Xray of Neck- _________ of _________ (_________ sign).
Sputum ; pharyngeal swabs.
narrowing ; subglottis
steeple sign
Acute respiratory Infections (ARI) may be defined as a heterogeneous and complex group of (infectious) clinical entities in which the possible anatomic site(s) affected extend from the __________ to the _________ .
pharynx
alveoli.
Acute respiratory infections (ARIs) are classified as ________ respiratory tract infections (URIs) or _______ respiratory tract infections(LRIs).
upper
lower
The upper respiratory tract consists of the airways from the _________ to the _________ in the _________, including the _________ and the _________ ear.
The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear.
CROUP(diagnosis)
Newer, rapid diagnostic techniques- detect virus in _________,____________ swabs, or ______ washings.
sputum
pharyngeal swabs
nasal washings.
Croup (treatment)
Usually supportive
_______
________ or __________ air
_________(↓severity & duration/need for ET intubation).
IM ___________
__________ PO 2mg/kg/d for 3days
Nebulized budesonide 2mg stat.
racemic epinephrine(nebulized).
Fluid
Moist or humidified
Steroids; dexamethasone; Prednisolone
_______ sign is to epiglottis as _______ sign is to CROUP
Thumb
Steeple
Acute lower respiratory tract infection(ALRI)
is defined as any infection that affects the airways below the _______ and includes:
???
larynx
Tracheitis
Bronchitis
Bronchiolitis
Lung infections such as pneumonia and empyema
Pathogenesis LRTI
Organisms enter the (proximal or distal ?) airway by ________,_________ or by __________ seeding.
The pathogen multiplies in or on the __________, causing inflammation, increased _____________ , and impaired ___________ function; other lung functions may also be affected.
distal
inhalation ; aspiration ; haematogenous
epithelium; mucus secretion
muco-ciliary
Bronchiolitis(Clinical manifestation)
_________ and cough
______
A _________ cough, increased RR, and _________ follow
_________ of the chest wall, nasal _________, and _________ are prominent findings.
Wheezing or an actual lack of breath sounds.
Respiratory failure and death.
Coryza ; Fever
deepening ; restlessness
Retractions ; flaring
grunting
Bronchiolitis (diagnosis)
Aspirations of ___________ secretions or swabs for viral culture.
Serologic tests demonstrating a rise in antibody titer to specific viruses can also be performed- RDT (fluorescent-antibody staining), ELISA or DNA probe procedures
nasopharyngeal
Bronchiolitis(Treatment)
Supportive measures. (O2, fluids, nebulised saline)
Respiratory syncytial virus infections in infants may be treated with ________.
__________ and ____________ are available for chemoprophylaxis or treatment of influenza type A viruses.
ribavirin
Amantadine and rimantadine
Bronchiolitis(Treatment)
Two neuraminidase inhibitors (_________ [oral] and _________ [inhaled]) are active against influenza A and B.
Immunization(__________)- those at high risk of complications- chronic underlying disease, HIV. Routine for infants and children in some developed countries.
oseltamivir
zanamivir
Influenza
Pneumonia
is ___________ of the _____________.
an inflammation
lung parenchyma.
From an anatomical point of view, lobar pneumonia denotes an _________ process involving ___________ of the lung while bronchopneumonia describes an _________ process occurring in a distribution that is ________ without ________________
alveolar
an entire lobe of the lung while
alveolar
patchy ; filling an entire lobe.
classification of pneumonia
Pneumonias occurring in usually healthy persons not confined to an institution are classified as __________________ pneumonias.
Infections arising while a patient is hospitalized or living in an institution such as a nursing home are called ___________ or ____________ pneumonias.
community-acquired pneumonias.
hospital- acquired
nosocomial pneumonias.
Common Bacterial causes of Community-acquired pneumonias
List 4
Streptococcus pneumoniae, Haemophilus influenzae type B , Staphylococcus aureus , Mycobacterium tuberculosis
CLASSIFICATION OF SEVERITY OF PNEUMONIA
Pneumonia (non-severe)
Mild ; lower
decreased ; bronchial
crackles ; crepitations.
CLASSIFICATION OF SEVERITY OF PNEUMONIA
Severe pneumonia
These children will have, in addition to the features of non-severe pneumonia, at least one or more of the following:
____________ , or oxygen saturation _____% or less on pulse oximetry in room air
Severe _______________ (e.g. _________ , chest _________ )
Central cyanosis ; 90%
respiratory distress
grunting ; chest indrawin
Common viral causes of Community-acquired pneumonias
??
Respiratory syncytial virus (RSV)
Severe pneumonia
Chest auscultatory signs: _______/_______ breath sounds or vocal resonance as in _______,_________
Signs of pneumonia with a general danger sign: Inability to ________ or drink, lethargy or __________, _________
Presence of complications or co-morbidities: e.g. congestive heart failure, severe malnutrition and sickle cell disease
decreased/absent
pleural effusion ; pleural rub
breastfeed; unconscious
convulsions.
Pneumonia: Diagnosis (Investigations)
Microbiology:
_________
________ or _______ (if present) culture
Viruses- PCR, serologic tests (detect antibodies)
____________ (gold standard)- hardly done, invasive,expensive
Sputum M/c/s
Blood or pleural fluid
Lung aspirate culture
Pneumonia: Diagnosis (Investigations)
Radiology
________
________/_____
Chest X-ray
CT/MRI
Treatment of pneumonia
Depends on severity
Non- severe: _________ and ____________ (out patient)
Severe-
•_________
•Fluids(restrict in ___________ )
•______ antibiotics( broad spectrum then change as cultures become available).
antipyretics and oral antibiotics
oxygen; heart failure
IV
Pneumonia
Antibiotics therapy for a child that is less that 2months old??
Admit and treat as neonatal sepsis
Pneumonia
Antibiotics therapy for a child that is more than 2months old??
Out patient first line
Our patient alternative
In patient first line
In patient alternative
Oral Amoxicillin ; oral amoxicillin-clavulinic acid
IV amoxicillin; IV ceftriaxone
Common fungal causes of Community-acquired pneumonias
List 2
Candida species,
Pneumocystis jirovecii
Clinical features of pneumonia
List 5
Fever (high grade) ± chills
Cough
Fast breathing
Difficult breathing
Chest pain
Inability to feed
Prevention and control of ARI
_______________ (measles, diphteria, pertussis,HIB, pneumococcus, influenza)
Early diagnosis and treatment
Improvement in nutrition (________________, adequate complementary feeds, Vit A)
Safer environments and practices (ventilation, overcrowding, indoor pollution, daycare, handwashing).
Immunization
exclusive breastfeeding,
Complications of ARI
Disease Complications
Common-cold 1
Otitis media 2
pharyngitis 3
sinusitis
Menningitis ; Hearing loss
Retopharyngeal abscess; Rheumatic heart disease ; Post-streptococcal glomerulonephritis, AKI
Complications of ARI
Disease Complications
bronchiolitis
Respiratory failure pneomothorax
Complications of ARI
Disease Complications
pneumonia
Congestive cardiac failure
Pneumothorax,
subcutaneous emphysma
Septicaemia
Pleural effusion
Bronchiolitis
is a _______ respiratory disease of infants and is caused primarily by ________________
Other viruses, including parainfluenza viruses, influenza viruses and adenoviruses (as well as occasionally M pneumoniae) are also known to cause bronchiolitis.
viral
respiratory syncytial virus.
