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<ul><li>1.<ul><li>The Second Affiliated Hospital of SunYat-sen University </li></ul></li></ul> <ul><li>Tan Wei-ping </li></ul> <p>Infections of the Respiratory Tract 2. Contents </p> <ul><li>Upper Respiratory Infection </li></ul> <ul><li>Acute infectious Laryngitis </li></ul> <ul><li>Acute Bronchitis </li></ul> <ul><li>Bronchiolitis </li></ul> <ul><li>Pneumonia </li></ul> <p>3. Anatomy </p> <ul><li>upper respiratory tract(URT) </li></ul> <ul><li>Cricoid Cartilage </li></ul> <ul><li>lower respiratory tract(LRT) </li></ul> <ul><li>URT Nose pharynxUvulaLarynxauditory tube paranasal sinuses </li></ul> <ul><li>LRT Trachea bronchia bronchiole the respiratory bronchiole the alveolar duct and the alveolus </li></ul> <p>4. 5. 6. </p> <ul><li>Anatomy characteristics </li></ul> <ul><li>upper respiratory tract </li></ul> <ul><li>Nose: cilia, capillary</li></ul> <ul><li>Sinuses: mucous </li></ul> <ul><li>Auditory tube </li></ul> <ul><li>tonsil </li></ul> <ul><li>Larynx </li></ul> <p>7. </p> <ul><li>lower respiratory tract </li></ul> <ul><li>Weak Cartilage Supporting , ciliary function impairment </li></ul> <ul><li>Right bronchus :straight , large </li></ul> <ul><li>Collagen and elastin fibers capillary interstitial tissue </li></ul> <ul><li>Thorax chest wall,respiratory muscle diaphragm mediastinum </li></ul> <p>8. </p> <ul><li>Physiological characteristics </li></ul> <ul><li>The compensatory ability </li></ul> <ul><li>Respiratoryrate </li></ul> <ul><li>Pattern of respiration </li></ul> <ul><li>Gas-exchanging membrane:diffuse rate </li></ul> <ul><li>CO 2 O 2 </li></ul> <ul><li>Resistance of airway: child adult </li></ul> <p>9. </p> <ul><li>Arterial blood gas examination </li></ul> <ul><li>(1)pHacidosis </li></ul> <ul><li>(2) PaO 2 SaO 2 hypoxemia </li></ul> <ul><li>(3)PaCO 2 carbon dioxide retention mal-ventilation </li></ul> <p>10. </p> <ul><li>The Immunological Characteristics </li></ul> <ul><li>Impaired mucociliary clearance function </li></ul> <ul><li>SIgA IgA IgG subtype of IgG </li></ul> <ul><li>Alveolar macrophages , lysozyme </li></ul> <ul><li>lactoferrin interferon </li></ul> <ul><li>complement </li></ul> <p>11. Upper Respiratory Infection (URI, or Common Cold) </p> <ul><li>1. Etiology90% viruses, the majority of colds. </li></ul> <ul><li>rhinoviruses ,coronaviruses. </li></ul> <ul><li>parainfluenza virus, adenovirus, enterovirus, </li></ul> <ul><li>respiratory syncytial virus. </li></ul> <ul><li>2. season fall and winter </li></ul> <ul><li>3. Frequencythree to eight colds a year. </li></ul> <p>12. </p> <ul><li>Inoculation by virus </li></ul> <ul><li>Invasion of epithelium of </li></ul> <ul><li>Release ofnasopharynx,sinuses and URTcellular damage </li></ul> <ul><li>Inflammatoryof nasopharynx </li></ul> <ul><li>mediators inCholinergic </li></ul> <ul><li>nasal secretionsstimulation </li></ul> <ul><li>IncreasedIncreased</li></ul> <ul><li>vascularmucus </li></ul> <ul><li>Permeabilityproduction</li></ul> <ul><li>bronchial</li></ul> <ul><li>constriction </li></ul> <ul><li>NasalRhinorrheapostnasal </li></ul> <ul><li>Stuffinessdripsore </li></ul> <ul><li>coughthroat</li></ul> <p>Pathophysiologyofthecommoncold 13. </p> <ul><li>The clinical manifestation </li></ul> <ul><li>Common cold </li></ul> <ul><li>congestion</li></ul> <ul><li>a runny nose</li></ul> <ul><li>sneezing</li></ul> <ul><li>Cough,sore throat</li></ul> <ul><li>sometimes vomiting and diarrhea</li></ul> <ul><li>Fever,malaise,abdominal pain</li></ul> <p>14. </p> <ul><li>Specific type of URI </li></ul> <ul><li>Herpangina: coxsackie-viruses group A.</li></ul> <ul><li>summer /fall.High fever, sore throat </li></ul> <ul><li>1-4mmvesicles /ulcerson anterior tonsillar pillars, softpalate,uvula,tonsils pharyngeal wall.</li></ul> <ul><li>Pharyngoconjunctival fever : type 3,7 adenovirus,spring /summer. </li></ul> <ul><li>High fever, sore throat pharyngitis, conjunctivitis, cervical lymphadenopathy. </li></ul> <p>15. </p> <ul><li>Complications </li></ul> <ul><li>sinusitis</li></ul> <ul><li>otitis media</li></ul> <ul><li>cervical lymphadenopathy </li></ul> <ul><li>Mesentery lymphadenopathy </li></ul> <ul><li>retropharngeal abscess </li></ul> <ul><li>pneumonia</li></ul> <ul><li>rheumatic fever</li></ul> <ul><li>acute glomerulonephritis </li></ul> <p>16. Differentialdiagnosis </p> <ul><li>Flu </li></ul> <ul><li>Appendicitis </li></ul> <ul><li>Early phase of acute infectious disease </li></ul> <p>17. Sometimessore throatSore throat Fatigue, may persistMild fatiguesevere aches and painsSlight aches and pains Cough, may progress Mild, hacking coughSometimes sneezingSneezing Sometimes stuffy nose Stuffy, runny noseCommonlyheadacheSometimesheadacheHigh feverLow or no feverFlu Cold 18. </p> <ul><li>Treatment </li></ul> <ul><li>increased fluid intake </li></ul> <ul><li>avoidance of secondhand smoke </li></ul> <ul><li>Saline nose drops</li></ul> <ul><li>bulb syringe remove the mucus </li></ul> <ul><li>cool mist humidifier </li></ul> <ul><li>antipyretics, such as acetaminophen,ibuprofen, decrease the discomfort of colds. </li></ul> <ul><li>Do not give aspirin (associated with Reye syndrome)</li></ul> <p>19. Prevention </p> <ul><li>Keep your child away from a person with a cold. </li></ul> <ul><li>Encourage your child to wash his/her hands frequently and not to touch his/her mouth, eyes, or nose until their hands are washed. </li></ul> <ul><li>Make sure toys and play areas are properly cleaned, especially if multiple children are playing together.</li></ul> <p>20. Acute infectious Laryngitis </p> <ul><li>Etiology </li></ul> <ul><li>Virus or bacteria </li></ul> <ul><li>Typical anatomy </li></ul> <p>21. </p> <ul><li>Clinical manifestations </li></ul> <ul><li>Barking cough, hoarseness, inspiratory stridor ,nasal flaring,suprasternal , infrasternal, intercostal retraction </li></ul> <ul><li>Fever, dyspnea, cyanosis restlessness, tachycardia .Worsen at night.</li></ul> <ul><li>Congestion of pharynx, vocal cord edema </li></ul> <p>22. </p> <ul><li>Grade of laryngic obstruction </li></ul> <ul><li> inspiratory stridor, respiratory</li></ul> <ul><li>difficulty only after activity </li></ul> <ul><li> symptoms occurs at rest.</li></ul> <ul><li>tachycardia,rhonchi </li></ul> <ul><li> + hypoxia,diminished breath </li></ul> <ul><li>sounds </li></ul> <ul><li> exhaustion, lethargy pallor , </li></ul> <ul><li>breath sounds diminish or</li></ul> <ul><li>disappear. dull of heart sounds, </li></ul> <ul><li>arrhythmia </li></ul> <p>23. Diagnosis &amp; differential diagnosis </p> <ul><li>laryngeal diphtheria </li></ul> <ul><li>laryngeal spasm </li></ul> <ul><li>bronchial foreign bodies </li></ul> <p>24. treatment </p> <ul><li>Maintaining of airway steam inhalation,clearing of secretion. </li></ul> <ul><li>antibiotics</li></ul> <ul><li>corticosteroid </li></ul> <ul><li>oxygen supply </li></ul> <ul><li>sedatives (phenergan) </li></ul> <ul><li> tracheotomy </li></ul> <p>25. Acute Bronchitis( tracheobronchitis ) </p> <ul><li>Etiology </li></ul> <ul><li>Virus or bacteria </li></ul> <ul><li>Allergy, climate, air pollution, chronic infection of URT, particularly sinusitis. </li></ul> <ul><li>Rickets, malnutrition </li></ul> <p>26. </p> <ul><li>Clinical manifestations </li></ul> <ul><li>unproductive cough 3~4days -&gt; productive cough, purulent sputum -&gt; 5~10days </li></ul> <ul><li>Chest pain, shortness of breath </li></ul> <ul><li>Vomiting</li></ul> <ul><li>Physical finding: low-grade fever, roughening of breath sounds, rhonchi, coarse moist rales. </li></ul> <p>27. </p> <ul><li>Asthmatic bronchitis </li></ul> <ul><li> 3yrs old, eczema, allergy </li></ul> <ul><li>symptomsresemble asthma </li></ul> <ul><li>recurrent episodes reduced after 3~4yrs old.</li></ul> <p>28. </p> <ul><li>Treatment </li></ul> <ul><li>increased fluid intake </li></ul> <ul><li>frequent shifts of position </li></ul> <ul><li>antibiotics </li></ul> <ul><li>cough suppressants</li></ul> <ul><li>expectorants , antihistamines </li></ul> <ul><li>acetaminophen </li></ul> <p>29. Bronchiolitis </p> <ul><li>Etiology and epidemiology </li></ul> <ul><li>50 respiratory syncytial virus(RSV) </li></ul> <ul><li>parainfluenza 3 virus, mycoplasma, adenoviruses </li></ul> <ul><li>northwinter and early spring </li></ul> <ul><li>Guangdongspring ,summer and early autumn </li></ul> <p>30. 2.Pathophysiology </p> <ul><li>Lesion: small air passages </li></ul> <ul><li>(diameter75 300um) </li></ul> <ul><li>Edema, accumulation of mucus and cellular debris, spasm of smooth mussle-&gt; resistance of small airway -&gt;expiratory difficulty -&gt;overinflationor atelectasis-&gt;hypoxemia,hypercapnia, acidosis </li></ul> <p>31. Clinical manifestation </p> <ul><li>Infant 2yrs old, peak at 3~ 6 mo of age, male, non breast-feed </li></ul> <ul><li>URI 3 4days </li></ul> <ul><li>paroxysmal wheezy cough </li></ul> <ul><li>dyspnea develop rapidly </li></ul> <ul><li>mild or moderate fever </li></ul> <p>32. Physical examination </p> <ul><li>R 60~80/min </li></ul> <ul><li>HR160 200/min </li></ul> <ul><li>Nasal flare, intercostal and subcostal retractions </li></ul> <ul><li>Pallor, cyanosis </li></ul> <ul><li>Hyperexpanded chest expiratory phase wheeze widespread fine crackles </li></ul> <ul><li>Liver and spleen palpable below the costal margin </li></ul> <ul><li>Critical phase48 72h afer onset of dyspnea; recover during 5 15days </li></ul> <p>33. Laboratory examination </p> <ul><li>WBC and differential cells count normal </li></ul> <ul><li>Virus detected by antigen detection, PCR, or culture. </li></ul> <ul><li>X-ray: hyperinflation of the lungs, emphysema, scattered areas of consolidation </li></ul> <p>34. Differential diagnosis </p> <ul><li>Asthma </li></ul> <ul><li>Cystic fibrosis </li></ul> <ul><li>Heart failure </li></ul> <ul><li>Foreign body in the trachea </li></ul> <ul><li>pertussis </li></ul> <p>35. 36. 37. Treament </p> <ul><li>Supportive treatment </li></ul> <ul><li>cool, humidified oxygen supply, maintain SaO294%~96%; </li></ul> <ul><li>increased fluid intake oral intake, intravenous solutions </li></ul> <ul><li>head and chest slightly elevated </li></ul> <p>38. </p> <ul><li>Ribavirin </li></ul> <ul><li>Antibiotics </li></ul> <ul><li>corticosteroids </li></ul> <p>39. Pneumonia 40. Whats Pneumonia </p> <ul><li>An abnormal inflammatory condition of the lung </li></ul> <ul><li>infections (bacterial, viral or fungal) </li></ul> <ul><li>chemical injury (gastric acid/ aspiration of food/ hydrocarbon and lipoid pneumonia/ radiation induced pneumonia) </li></ul> <p>41. Definition </p> <ul><li>Defined by clinical features or with the addition of radiologic findings </li></ul> <ul><li>Tachypnea : indicator of pneumonia(WHO) </li></ul> <ul><li> 2m,R 60/min </li></ul> <ul><li>2~12m,R 50/min </li></ul> <ul><li> 12m,R 40/min </li></ul> <ul><li>sensitivity of 74% and a specificity of 67% compared with radiology </li></ul> <p>42. Epidemiology </p> <ul><li>A leading killer ofchildren 5yr </li></ul> <ul><li>1.9 million death worldwide/year </li></ul> <p>43. Etiology </p> <ul><li>Viruses:40% ( 2yr) </li></ul> <ul><li>Bacteria:27~44% </li></ul> <ul><li>Streptococcus pneumoniae </li></ul> <ul><li>Staphylococcus aureus, Moraxhella catarrhalis, </li></ul> <ul><li>group A Streptococci, and Haemophilus</li></ul> <ul><li>MP, CP:9~14% </li></ul> <ul><li>Mixed:23% </li></ul> <p>44. Contributing Etiology:risk foctors </p> <ul><li>Malnutrition </li></ul> <ul><li>Rickets </li></ul> <ul><li>Iron-deficiency </li></ul> <ul><li>Immuno-deficency </li></ul> <ul><li>Congenital heart disease </li></ul> <ul><li>Low born bodyweight </li></ul> <p>45. Clinical manifestation </p> <ul><li>fever </li></ul> <ul><li>cough</li></ul> <ul><li>Dyspnea (Tachypnea,cyanosis) </li></ul> <ul><li>Localized crackles(fine moist rales) </li></ul> <ul><li>Abnormal chest x-ray </li></ul> <p>46. Classification </p> <ul><li>Pathologic( anatomic changes) </li></ul> <ul><li>lobarpneumonia :involves a single lobe </li></ul> <ul><li>Bronchial pneumonia :patches around the tubes </li></ul> <ul><li>Interstitialpneumonia :areas between the alveoli </li></ul> <ul><li>Pathogenic( microorganisms ) </li></ul> <ul><li>bacteria </li></ul> <ul><li>viruses </li></ul> <ul><li>fungi </li></ul> <ul><li>parasites </li></ul> <p>47. Classification </p> <ul><li>course of disease </li></ul> <ul><li>Acute </li></ul> <ul><li>subacute </li></ul> <ul><li>chronic </li></ul> <ul><li>State of disease </li></ul> <ul><li>common </li></ul> <ul><li>severe </li></ul> <p>48. Classification </p> <ul><li>Clinicalmanifestation </li></ul> <ul><li>Typical </li></ul> <ul><li>atipical </li></ul> <ul><li>The combined clinical classification </li></ul> <ul><li>community-acquired pneumonia(CAP)</li></ul> <ul><li>hospital-acquired pneumonia (HAP) </li></ul> <p>49. Bronchopneumonia </p> <ul><li>1.Etiology viruses, bacteria, MP, CP.2~3yrs old </li></ul> <ul><li>2.pathology edema,infiltration</li></ul> <p>50. 51. 52. 53. </p> <ul><li>3 pathophysiology </li></ul> <ul><li>hypoxemia,hypercapnia, toxemia </li></ul> <ul><li>respiratory insufficiency </li></ul> <ul><li>acidosis </li></ul> <ul><li>myocarditis, heart failure, shock, DIC </li></ul> <ul><li>toxic encephalopathy </li></ul> <ul><li>toxic intestinal paralysis </li></ul> <p>54. </p> <ul><li>4.Clinical manifestation </li></ul> <ul><li>( 1) mild (commone)pneumonia </li></ul> <ul><li>fever </li></ul> <ul><li>cough</li></ul> <ul><li>dyspnea ( tachypnea, cyanosis) </li></ul> <ul><li>crackles </li></ul> <ul><li>Chest x-ray </li></ul> <p>55. 56. </p> <ul><li>(2)Severe pneumonia </li></ul> <ul><li>other systems involved </li></ul> <ul><li>myocarditis</li></ul> <ul><li>heart failure </li></ul> <ul><li>toxic encephalopathy </li></ul> <ul><li>toxic intestinal paralysis </li></ul> <p>57. Heart failure </p> <ul><li>R 60/min </li></ul> <ul><li>HR 180/min </li></ul> <ul><li>Sudden onset of restlesseness,Pallor, cyanosis, delayed capillary refill( 3~5s) </li></ul> <ul><li>Dull heart sound, gallop rhythm, Jugular vein congestion</li></ul> <ul><li>Liver enlarged rapidly </li></ul> <ul><li>Oliguria or anuria, edema </li></ul> <p>58. </p> <ul><li>5.Complications </li></ul> <ul><li>Empyema </li></ul> <ul><li>Pyopneumothorax </li></ul> <ul><li>pneumatocele </li></ul> <p>59. </p> <ul><li>6.Laboratory findings: </li></ul> <ul><li>WBC, NBT,CRP </li></ul> <ul><li>Pathogen(antigen and/or antibody) </li></ul> <ul><li>chest x-ray </li></ul> <p>60. </p> <ul><li>7.diagnosis </li></ul> <ul><li>Fever, cough, tachypnea, dyspnea, localized fine moist rales, chest x-ray </li></ul> <ul><li>8.differential diagnosis </li></ul> <ul><li>acute bronchitis</li></ul> <ul><li>tuberculosis</li></ul> <ul><li>foreign bodies of trachea </li></ul> <p>61. 62. 2 4 63. 64. </p> <ul><li>9. treament </li></ul> <ul><li>(1)general therapy </li></ul> <ul><li>(2) antipathogen therapy </li></ul> <ul><li>antibiotics </li></ul> <ul><li>antivirus </li></ul> <p>65. </p> <ul><li>(3)symptomatic therapy </li></ul> <ul><li>oxygen supply </li></ul> <ul><li>airway management </li></ul> <ul><li>abdominal distention </li></ul> <ul><li>fever </li></ul> <ul><li>(4) Corticosteroid</li></ul> <ul><li>(5) complications /underling disease </li></ul> <ul><li>(6)Immunotherapy </li></ul> <p>66. who should be admitted to hispital 67. Characteristics of pneumonia caused by different pathogen 68. </p> <ul><li>1.respiratory syncytial virus pneumonia </li></ul> <ul><li>age: 2~7mon </li></ul> <ul><li>fever:mild or moderate </li></ul> <ul><li>main signs: acute onset, wheeze, expiratory difficulty, palpable liver and spleen. </li></ul> <ul><li>Pallor, cyanosis, restlesseness </li></ul> <ul><li>Auscultation: diffuse rhonchi, fine rales </li></ul> <ul><li>Chest X-ray:peribronchial thickening or interstitial pneumonia </li></ul> <p>69. </p> <ul><li>2.Adenovirus pneumonia </li></ul> <ul><li>Age: 6mon-2yrs </li></ul> <ul><li>main signs: acute onset,long duration of high fever 7~ 10days or 2~3weeksthen pelter </li></ul> <ul><li>Systemic toxic symptoms are obvious </li></ul> <ul><li>Frequent cough paroxysmal wheeze, dyspnea, cyanosis </li></ul> <p>70. </p> <ul><li>late appearanceof rales(3~7days)</li></ul> <ul><li>myocarditis, heart failure, and </li></ul> <ul><li>encephalopathy </li></ul> <ul><li>X-ray changes early </li></ul> <p>71. 72. </p> <ul><li>3.Staphylococcal aureus pneumonia </li></ul> <ul><li> 1 year are most commonly affected </li></ul> <ul><li>Acute onset, severe systemic symtoms </li></ul> <ul><li>High fever, respiratory distress, GI . </li></ul> <ul><li>Physical examinations: early appearance of rales</li></ul> <ul><li>Effusion, empyema, pyopneumothorax , abscess of other organs Sepsis </li></ul> <ul><li>WBC, polymorphonuclear cells </li></ul> <ul><li>chest x-ray:infiltration, multiple abscesses </li></ul> <p>73. 74. 75. </p> <ul><li>4. Gram-negative bacillary pneumonia, GNBP </li></ul> <ul><li>Haemophilus influenza , pneumonia bacilli </li></ul> <ul><li>severe, hard to treament, poor prognosis </li></ul> <ul><li>Systemic toxic symptoms ,shock </li></ul> <ul><li>Rales, Infiltration, consolidation, hemorrhagic necrosis</li></ul> <ul><li>X-ray:lobar, or segmental, effusion, abscess </li></ul> <ul><li>DIC </li></ul> <p>76. </p> <ul><li>5. Mycoplasma pneumonia </li></ul> <ul><li>Usually over 5yrs,also infant </li></ul> <ul><li>sore throat, headache, myalgia </li></ul> <ul><li>Mild or moderate fever, 1~3weeks </li></ul> <ul><li>Unproductive cough, wheeze in infant </li></ul> <ul><li>Multiple system damage </li></ul> <ul><li>Auscultation:scattered rhonchi or rales. </li></ul> <ul><li>X-ray: walking pneumonia, effusions </li></ul> <p>77. </p> <ul><li>6. Chlamydial pneumonia(c.Trachomatis) </li></ul> <ul><li>age:2~12weeks </li></ul> <ul><li>Chronic onset, nasal stuffiness, cough, tachypnea, rales, few wheezes </li></ul> <ul><li>no fever </li></ul> <ul><li>Eye sticky </li></ul> <p>78. THANKS </p>