General Discussion of Respiratory Tract Infections - Assignment Example

THE RESPIRATORY TRACT INFECTIONS GENERAL DISCUSSION OF RESPIRATORY TRACT INFECTIONS (RTIs) 30th April, 2012 Abstract Upper respiratory tract infections (RTI's) is a general term referring to a group of clinical conditions which affects the respiratiry tract system. These includes inflammation of organs including nose, paranasal sinuses, trachea, larynx and brochea (upper compartment) and the lungs which is the lower component. Clinical manifestations which may be characterised by coughs, sore throat, headache, fever with occassional chills, chest pains, foul smelling or bloody tinched sputum, tachycardia, and tachypnea. The aetiological agents of these conditions are a range of microorganisms however foreign materials aspiration may result to an aspiration pneumonia. URTI's can be characteristically affect the upper respiratory tract, or the infections will extend to cause lung inflammation and may be a subsequent systemic infections. Proper and a timely diagnosis for these infections may be recommended to avoid further damage to this organs. Culture sensitivity test should be performed on the samples taken to determine most effecient antibiotic for their treatments. The infections have different level of severity and when acute infections are not attended in time it can have a very grave prognosis. Introduction The RTI' s commonly occurs during the winter season as people try to overcrowd chances of transmission are very high and it may occur either in the mild form of a cold flu or severe as seen in cases of influenza infections. Coryza virus syndrome is the most common and the repeated circulation of the diseases is based on the antigenic variation of hundreds of these microbials resulting to antibiotic resistance development such as penicillin. Transmission occurs through contact pathways but aerosol inhalation may be also an important route. The diseases are caused by a group of micro-organisms such as bactria, viruses and fungi, upon entry into the respiratory tract system. Usually development of clinical disease characterised by inflammation of the organs, and this may be complicated to severe illness especially on immunosuppression caused by chronic diseases like Hiv, diabetes, and drug resistance development. Patient symptoms is dependent on the level of ascend of the disease, and upper respiratory tract system exhibits mild to severe condition where as lower respiratory tract infection may show severe illneSs and this may call for immediate medical intervention. Proper prevention is necessary to cut spread of the infections within society and this may be achieved by hand washing, general hygiene, and avoiding contact with sick persons especially if one is immunocompromised. General Content Significance of Respiratory Tract Infections (RTIs) Acute respiratory tract infections, may be very severe and may result to a poor prognosis when not attended in time fatalities are possible. The infections can be disseminated and spread to cause a systemic disease with high cost of treatment. High numers of cases have been reported in hospitals with these conditions especially influenza. Management and treatment of these cases is high and of economical importance and due to its ability to undergo transmission renders an economic importance. Upper and Lower Resp iratory Tract Infections (URTIs and LRTs) Respiratory tract infections may either affect the upper or lower respiratory tract system. Infections of the upper respiratory tract infections may cause inflammations of organs such as nose, paranasal sinuses, pharynx, larynx, trachea and bronchia and this may be generally be referred as common cold. This may result to sinusitis or tracheobrochitis conditions commonly seen in Upper RTI's. On the other end the infections of the lower respiratory tract results in the inflammation of the lungs, what is referred as pneumonia. Aetiology, clinical signs, Laboratory diagnosis and treatment of (a) Upper repiratory tract infections (URTs) URTI's refers infections that occurs on entry of disease causing microbials into the upper respiratory tract system, which includes the nose, pranasal sinuses, larynx, trachea and bronchi. This results in the inflammation of these organs and can lead to a general disease which is referred to common cold, characterised by pharyngitis, sinusitis, and tracheobronchitis. This is identical from influenza as this condition is a systemic condition of the upper repiratory tact. It is caused by a variety of micro-organisms which range from bacteria, fungi and viruses. A large number of these infections are caused by viral agents and this includes; respiratory syncytial virus, rhinovirus, parainfluenza virus, coronavirus, adenovirus, coxsackievirus, and influenza virus. Bacterial agents include microorganisms from the family of Streptococci, Arcanobacterium haemolyticum, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Chlamydia pneumoniae, Mycoplasma pneumoniae, and herpes simplex virus (which causes pharyngitis in adults), and Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis which commonly acts as secondary bacterial infection in viral infections to result in sinusitis (Musher, 2003). Other bacteria of lower pathogenicity may result in acute tracheobronchitis and they include Bordetella pertussis, Bordetella parapertussis, Moraxella pneumoniae, or Chlamydia pneumoniae. Signs and symptoms of URTI's Characterised by congested nasal cavities, sneezing, and sore throat three days post infection, and this may be followed by sore throat, fever, and occassionally chest pain. Patients with prolonged sinusitis and pharyngitis may show symptoms including unilateral facial pain, headache, maxillary toothache, and excessive purulent nasal discharge, as well as wheezing sound and coughing. However influenza may occur as a sudden illness characterized by severe headache, myalgia, high fever, and dry cough, followed by significant fatigue and malaise (Sherif, 2011). There can be lamphadenopathy at anterior cervix, and pharyngeal edema on viral infections may be superceeded by pharyngeal exudates. Laboratory Tests Done through viral culture in media as they are main aetiological agentsN for rapid antigen detection. Also use of polymerase chain reaction (PCR) assay can be achieved for influenza virus on a nasopharyngeal swab sample of patients to determine the effective antiviral therapy to be recommended. A similar tests can be performed for adenovirus, respiratory syncytial virus, and parainfluenza virus diagnosis. Culture and sensitivity tests should be done to identify suitable therapeutic agents for treatment especially antibiotics. The effective antimicrobials include cephalosphorin, clindamycin, aztreonam, fluoroquinolones, amoxicillin-clavulanate combination, macrolides or metronidazoles may be recommended for the treatment (Cooper, 2001). (b) Lower respiratory tract infections LRTIs-aetiology, clinical symptoms, laboratory and treatment of Community acquired pneumonia (CAP) Community acquired pneumonia (CAP), refer to the infections of the lower respiratory tract system, which occurs in a non-hospitalised patient and it usually occurs as acute disease. Aetiology Caused by micro-organisms especially of bacterial origin, including Chlamidia Spp, Haemophillus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae and Legtonella. The infections may be disposed by viral agents such as Adenovirus, Influenza A and B, or Respiratory syncitial virus, and enedemic fungis such as Blastomycosis, Coccidiodomycosis, Histoplasmosis. Clinical symptoms Characterrised by increased temperatures (fever of 38 oC), pleuritic chest pains, fatigue dysponea, dullness on chest percussion, gastrointestinal symptoms, productive or unproductive cuoghs, haemoptysis, myaligia and brochial wheezing. Laboratory diagnosis Laboratory diagnosis for CAP is done through leukocyte count, sputum gram stain, blood cultures for sensitivity test as well as urine antigens Treatment Antibiotic administration of should depend on the culture and sensitivity test. Patients are recomended to empirical therapy with macrolides, fluoroquinolones or doxycycline (vibramycin). Streptomycin pneumonia have seen to develop resistance to antibiotic such as penicillin. Amoxicillin-clavulareate combination with an intravenous adminstration of balactam or a combination of amphicillin-sulbactum with a macrolide may be an effective treatment regime. Atypical Pneumonia Refers to a lung infection which is usually a mild clinical condition than typical pneumonia. Its caused by Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella sppn but this infection may be predisposed by aging, decreased immunity, Hiv infections, antibiotic resistant along other infections (Nawal et al., 2006). Other aetiological agents may include viral agents such as influenza and adenovirus, chlamidial spp, coxiella bacteria and lagionella. Clinical symptoms Characterised by dry coughs, mild fever, lymphadenopathy, sore throat, decrease appetite, chest pain, headache, phlegm (sputum) production, fatigue and weakness. Laboratory diagnosis It done through blood tests such as leukocyte plasma count, and blood culture for sensitivity. Also sputum could help in culture and sentivity test for the disease diagnosis. Treatment Over the counter (OTC) oral antibiotics may help especially in mild disease conditionsn but severe clinical conditions may require hospital attendance with intravenous administration of antibiotics. Treatment should be based on the culture and sensitivity results, but effective antibiotics includes Erythromycin, Azithromycin and Clarithromycin. Treatment for viral infections may be just symptomatic due to poor responsen however prevention is necessary to lower the risk of disease development though contact with sick, proper hyegiene and prompt treatment of chronic conditions. Aspiration pneumonia Caused by incidental aspiration of solid or liquid foreign material usually of oropharyngeal or gasstric origin. The type of pneumonia may be determined by nature and qauntity of the aspirated materials. Clinical signs These are based on the septic shock with(out) respiratory failure and generally results to aspiration pneumonitis. The condition is characterised by fever, tachycardia, hypptension (septic shock), low blood oxygenated levels, loss of alertness, difficulthy in breathing with reduced breath sounds, and tachypnea. Chronically the foreign bodies may cause sudden illness with wheezing and froathy sputum. Bacterial aspiratio pneumonia may be characterised by other signs as pleuritic chest and peutrid expectoration. Laboratory diagnosis In the laboratory the diagnosis of this condition is diagnosed by blood cultures for sensitivity test, sputum gram stain, microscopy and culture, arterial blood gas and mixed venous gas analysis, cell blood count with differentials Treatment Its aimed at maintaining the respiratory tract airways patent for effective gaseous exchange. Early introduction of intravenous fluids and positive end-expiratory pressure (PEEP) to allow proper oxygeantion. Prophylactic antibiotics based on culture and sensitivity plus routine use of corticosteroids. Use of cephalosphorin, clindamycin, aztreonam, fluoroquinolones, amoxicillin-clavulanate combination, macrolides or metronidazoles may be recommended for the treatment. Lung abscess Bacterial infection in the lungs and may be due to aspiration of foreign materials, and this condition can be categorised by formation of an enclosed pus filled formation c0mpartment surrounded by an inflammatory tissue following lung infection. The abscesses may progress to form a gangrene abscess formation leading to a more permanent lung disease if not attended in time, due to bacterial and parasitic infection. Aetiological agents The agents include, Pseudomonas aureginosa, Klebsiella pneumoniae, Staphyllococcus aureus (which may cause multiple abscesses), Streptococcus pneumoniae, and Norcadiosis. Clinical signs Fever, sweating, productive and foul smelling cough, blood coughs, malaise, night sweats, anorexia and loss of weight. Laboratory diagnosis Achieved through blood leucocyte count, blood cultures for sensitivity and sputum microscopy and culture may also be done. Treatment Anaerobic lung infection, may require adminstration of 600 mg intravenous q8h of clindamycin followed by 150-300 mg orally qid, or patients should be recomended for adminstration of metronidazole, amphicillin+sulubactam combination for effective treatment equivalent to clindamycin+cephalosphorin (Nader, 2009). Also may use moxifloxacin, penicillin depending on sensitivity results. Other procedures includes partial drawing and sunctioning of the foreign materials through nasotracheal tract. Conclusion Respiratory tract infections are important group of clinical conditions, and they are transmissable on contact with patients. This calls for people to avoid becoming into contact with sick persons, and exercise proper hyegienic conditios especially by the apractice of hand washing. The infections may range from mild to severe cases depending on the level of descend of the pathogens. Usually they are predisposed by immunocompression as seen in patients with chronic diseases and development of drug resistence due to prolonged use of antibiotics. Clinically one can be able to differentiate the upper and lower respiratory tract infections. Treatment should be prompt for severe cases to avoid further spread of the disease and fatalities but mild inflammatory reactions may be managed by oral inteoduction of antibiotic from over the counter (OTC). References COOPER RJ, HOFFMAN JR, BARTLETT JG, et al., (2001), Principles of Appropriate Antibiotic use for Acute Pharyngitis in adults: Background. Ann Intern Med. 134: 509-517 M. NAWAL LUTFIYYA, ERIC HENLEY, and LINDA F. CHANG, (2006), Diagnosis and Treatment of Community-Acquired Pneumonia; American Fam physician 1;73(3):442-450. MUSHER DM. (2003), How Contagious are Common Respiratory Tract Pathogens? N Engl J Med. 348: 1256-1266 NADER K (2009), Lung Abscess; journal on Pulmonary Medicine. Division of Pulmonary Critical Care and Sleep Medicine SHERIF B. MOSSAD (2011), Upper Respiratory Tract Infections Read More