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RESPIRATORY TRACT INFECTIONS PowerPoint Presentation

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Published on : Aug 29, 2021 | Views : 2293 | Downloads : 9

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RESPIRATORY TRACT INFECTIONS Dr. Mohit Bhatia Assistant Professor Department of Microbiology
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UPPER RESPIRATORY TRACT INFECTIONS Infections of airway above glottis or vocal cords Tonsillitis Pharyngitis Laryngitis Sinusitis Otitis media Rhinitis Cough Sore throat Running nose Nasal congestion Headache Low-grade fever Facial pressure Sneezing
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Rhinitis or common cold Mostly caused by viruses: Rhinovirus Coronavirus Adenovirus Influenza virus Parainfluenza virus Human metapneumovirus Respiratory syncytial virus
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Sinusitis Symptoms: Headache/facial pain, nasal mucus, Plugged nose Agents of acute sinusitis: Viruses (most common cause): Rhinoviruses, Influenza viruses, Parainfluenza viruses Bacterial agents: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas and other gram negative bacilli (nosocomial sinusitis) Agents of chronic sinusitis: Obligate anaerobes, Staphylococcus aureus
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PHARYNGITIS & TONSILLITIS
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PHARYNGITIS & TONSILLITIS
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LARYNGITIS Influenza virus Parainfluenza virus Rhinovirus Adenovirus Coronavirus Human metapneumovirus Streptococcus pyogenes C. diphtheriae Epstein-Barr virus Hoarseness of voice Lowering & deepening of voice
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LARYNGOTRACHEOBRONCHITIS (Croup) Children, <3 years age Inspiratory stridor Hoarseness Fever Cough (barking) Parainfluenza virus (M/C) Influenza virus Respiratory syncytial virus Adenoviruses
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Epiglottis Edema and inflammation of epiglottis and soft tissue above vocal cords Age: children 2–6 years Symptoms: Fever, Difficulty in swallowing, Inspiratory stridor Most common agent: Haemophilus influenzae type b
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Lower Respiratory Tract Infection Community acquired Hospital acquired PNEUMONIA
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Community-acquired Pneumonia (CAP) Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Chlamydia psittaci Legionella spp. Coxiella burnetii Viruses (Influenza, Adenovirus, Parainfluenza, RSV)
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CURB-65score - C (Confusion) = 1 point - U (blood urea nitrogen >19 mg/dL) = 1 point - R (respiratory rate >30 min) = 1 point - B (BP <90/60) = 1 point - 65 (Age ≥65 years) = 1 point Higher the score, greater is the mortality If the score ≤1, outpatient therapy is indicated If the score >1, patient should be hospitalized
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Hospital-acquired Pneumonia (hAP) VAP CPIS
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CLINICAL PULMONARY INFECTION SCORE
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CAUSATIVE ORGANISMS Gram-negative bacilli (most common) MDR non-fermenters MDR Enterobacteriaceae Staphylococcus aureus (both MRSA and MSSA) S. pneumoniae (rarely, in early stage) Influenza, adenovirus, parainfluenza, RSV
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LOBAR PNEUMONIA
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INTERSTITIAL PNEUMONIA
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BRONCHITIS Inflammation of bronchus, which occurs either as an extension of upper respiratory tract infection such as influenza or may be caused directly by bacterial agents such as Bordetella. Common symptoms - fever, cough, sputum production, and rarely croup- like features
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BRONCHITIS Bacterial agents: B. pertussis B. parapertussis Mycoplasma pneumoniae Chlamydophila pneumoniae Viral agents: Influenza viruses Adenoviruses Rhinoviruses Coronaviruses
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BRONCHIOLITIS Inflammation of the smaller airways (bronchioles) It presents as an acute viral infection that primarily occurs in children less than 2 year Symptoms: Acute onset of wheeze, dyspnea, cough, rhinorrhea, and respiratory distress Respiratory syncytial viruses account for 40–80%
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BRONCHIOLITIS Respiratory syncytial viruses Parainfluenza viruses Rhinoviruses Influenza viruses Adenoviruses Enterovirus Human metapneumovirus
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Laboratory Diagnosis For URTI: Throat swab Nasopharyngeal aspirate For LRTI: Sputum Induced sputum Tracheal aspirate Bronchoalveolar lavage (BAL)
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Microscopy Albert staining Gram staining Acid fast staining GMS stain Immunofluorescence microscopy of nasopharyngeal aspirate
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Culture For bacteriological culture: Blood agar, chocolate agar and MacConkey agar For isolation of C. diphtheriae: Loeffler’s serum slope and potassium tellurite agar For M. tuberculosis: LJ medium and incubated for up to 6–8 weeks For fungal pathogen isolation: Sabouraud dextrose agar Viral - Appropriate cell lines
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CARROM COIN APPEARANCE OF Streptococcus pneumoniae SATELLITISM IN H. influenzae
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COLONIES OF Candida species ROUGH, TOUGH & BUFF COLONIES OF Mycobacterium tuberculosis
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FRIED EGG colonies of Mycoplasma spp.
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TREATMENT Community-acquired pneumonia (CAP) Empiric regimen is determined by presence of co-morbidity and prediction of prognosis by CURB-65 scoring system CAP, hospitalized (if CURB65 score >1): - IV ceftriaxone plus azithromycin or - IV levofloxacin Add vancomycin if CA-MRSA suspected
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CAP, outpatient (if CURB-65 score ≤1): Oral azithromycin or azithromycin + amoxyclav Oral levofloxacin
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Hospital-acquired pneumonia (HAP) Empirical therapy: Gram-negative (e.g. piperacillin-tazobactam or meropenem) + Gram-positive coverage (e.g. vancomycin) Definitive therapy: The empirical treatment should be tailored based on the organism isolated and its
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