Respiratory Infection

1. Respiratory Infection Ali Somily MD, FRCPC

2. OUTLINE

3. Upper Respiratory Tract Infections

4. Etiologies • Acute pharyngitis • Bacterial • Streptococcal (GAS) • Main • Most common bacterial • Diphtheria • Rare • N. gonorrhoeae, • B. pertussis • Viral • Most common

5. EBV Adenopathy

6. Adenovirus & EBV

7. GAS

8. How to collect throat swab ?

9. How to send it to the lab ? • Bacterial • Swab GAS • Viral • VTM

10. What is the diagnosis

11. Neck X-rays

12. Anatomy • Paranasal Sinuses

13. Sinusitis

14. What is sinusitis? • An acute inflammatory process involving one or more of the paranasal sinuses. • 5%-10% of URIs in children. • Maxillary and ethmoid sinuses are most frequently involved.

15. Acute & Chronic Sinusitis • Acute Sinusitis >10 days but < 30 days. • Subacute sinusitis >30 days without improvement. • Chronic sinusitis >120 days.

16. Etiology of Sinusitis 70% of bacterial sinusitis is caused by: • Streptococcus pneumoniae • Haemophilus influenzae • Moraxella catarrhalis

17. Clinical Presentations of Sinusitis • Periorbital edema • Cellulitis • Nasal mucosa is reddened or swollen • Percussion or palpation tenderness over a sinus • Nasal discharge, thick, sometimes yellow or green • Postnasal discharge in posterior pharynx • Difficult transillumination • Swelling of turbinates • Boggy pale turbinates

18. Pale, Boggy Turbinates

19. Diagnostic Tests • Radiographs • Ultrasonograms • CT scanning • Laboratory studies, such as culture of sinus puncture aspirates.

20. Pharmacological Plan of Care • Clarithromycin:15mg/kg/d in 2 divided doses(>30kg, 250mg q12)

21. OTITIS MEDIA • Definition: Presence of a middle ear infection • Acute Otitis Media: occurrence of bacterial infection within the middle ear cavity. • Otitis Media with Effusion: presence of nonpurulent fluid within the middle ear cavity

22. Normal & abnormal tympanic membrane

23. MICROBES • Streptococcus pneumoniae • Haemophilus influenzae(non-typeable) • Moraxella catarrhalis • Group A Streptococcus • Staph aureus • Pseudomonas aeruginosa • RSV assoc. with Acute Otitis Media

24. PATHOGENESIS • Otitis Media usually follows an URI in which there is edema of the eustacian tube, leading to blockage. • Other factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy

25. Diagnosis • Diagnostic tympanocentesis & myringotomy

26. TREATMENT • Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or, • Augmentin: 45 mg/kg/day po bid for 10-14 days

27. NASOPHARYNGEAL CULTURES • Carrier of • Streptococcus pyogenes, • Corynebacterium diphtheriae • Neisseria meningitidis • Limited Practical Value • Otitis Media • Sinusitis • For isolation of • Bordetella pertussis • Viral

28. Lower respiratory tract infection

30. Lung Anatomy

31. Classification • Typical Pneumonia • Atypical Pneumonia • According to the following • Organisms • Treatment • Presentation • X-rays • Prognosis

32. Etiology • No agent isolated in 40 to 60% of cases • Culture sensitivity (50%) of sputum culture for S. pneumoniae, • Agents of pneumonia are difficult to grow • Legionella, • Chlamydia pneumoniae, • Mycoplasma pneumoniae). • C. pneumoniae • Second most common cause of pneumonia • M. pneumoniae • Most cases of ambulatory CAP (serologic methods) • Haemophilus influenzae and Legionella • The third and fourth most common bacterial causes of CAP requiring hospitalization. • Specimens are easily contaminated with upper respiratory secretions,

34. S.pneumo

35. Pneumonia

36. Staph.aureus

37. Lung abscess.

38. Pneumatocele and abscess

39. Transplant and CMV

40. Hematological malignancy and Asp

41. lobar pneumonia • Primarily caused by • Streptococcus pneumoniae, • Legionella pneumophila. • Klebsiella pneumoniae, • "currant jelly" sputum tissue damage and hemorrhage into the alveoli

42. Escherichia coli • Often complicated by empyema and septicemia. • Pseudomonas aeruginosa • Serratia marcescens • Associated with a severe necrotizing pneumonia in immunosuppressed patients

43. S.pneumoniae

45. Lung abscesses • Anaerobes • Staphylococcus aureus • Mycobacterium tuberculosis • Mycoplasma pneumoniae • Fungus

46. Specimens • A. Acceptable specimens • 1. Sputum • 2. Trachael and transtracheal aspirates • 3. Bronchial washings, bronchial alveolar lavage, bronchial brushes, and bronchial biopsy • 4. Lung aspirate and lung biopsy • B. Unacceptable specimens • 1. Saliva submitted as sputum • 2. Twenty-four-hour sputum collection . • 3. Swabs

47. A. Media • 1. BAP • 2. MAC • 3. CHOC • 4. Broth-BHI or THIO

48. Anaerobs • Invasive procedure • Processed as rapidly as possible. • Collected and transported anaerobically • Cultured for anaerobes. • Transtracheal aspiration • Transbronchial biopsy • Protected bronchial brushes • Bronchalveolar

49. Protected bronchoscopy brush send for quantitative culture • Quantitative culture: Plate 10 µL. • Vortex the brush in 1 ml of BHI or steril saline

50. Sputum Specimens • Teeth brush • Contamination one log less • Mouthwash • Avoid antiseptic • Early morning • Pooled overnight secretions • Discouraged 24 hr collection • Contamination • Dilution • Induced sputum • Sterile wide-mouth jar • tightly fitted screw-cap lid • press the rim of the container under the lower lip