lower resp trct infections

8/2/2019 Lower Resp Trct Infections

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A SEMINAR ON LOWER

RESPIRATORY TRACT INFECTIONS

Submitted to:

B.P. Satish KumarAssistant.Professor

Submitted by:P.DeepakPharm D (P.B) 1st Yr


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Lungs

Right side has 3 lobes

Left side 2 lobes

Contains the lower respiratory structures


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Anatomy ofbronchi


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ACUTE BRONCHITIS

DEFINITION: Acute bronchitis or chest cold, is acondition that occurs when the bronchial tubes in thelungs become inflamed.

The bronchial tubes swell and produce mucus, which

causes a person to cough.

Most symptoms of acute bronchitis (chest pain, shortnessof breath, etc.) last for up to 2 weeks, but the cough canlast for up to 8 weeks in some people.


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Epidemiology:

Cough is the most frequent reason patientsseek care outside of a general medicalexamination.

In the UK, acute bronchitis affects 44 out ofevery 1000 adults over the age of 16 years,with most episodes (82%) occurring inautumn or winter.

while in the US it has been estimated thatalmost 5% of the general populationdevelops acute bronchitis each year

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PATHOGENESIS

Acute bronchitis is a self limiting illness.

Infection of trachea and bronchi produce hyperemic andedematous mucous membranes with an increase in bronchialsecretions which can become thick and tenacious impairingmucociliary activity.

Recurrent respiratory infections may be associated with increaseairway hyperreactivity and leads to pathogenesis of asthma andCOPD.


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Click icon to add pictur

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Click icon to add picture Several types of

viruses, mostoften:

Respiratory syncytial (sin-SIH-shull) virus (RSV)

Adenovirus Influenza

Parainfluenza

Bacteria, in rare

cases

Pollutants(airbornechemicals orirritants)
http://www.cdc.gov/rsv/http://www.cdc.gov/ncidod/dvrd/revb/respiratory/eadfeat.htmhttp://www.cdc.gov/flu/about/viruses/index.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/hpivfeat.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/hpivfeat.htmhttp://www.cdc.gov/flu/about/viruses/index.htmhttp://www.cdc.gov/ncidod/dvrd/revb/respiratory/eadfeat.htmhttp://www.cdc.gov/rsv/


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CLINICAL PRESENTATION

Signs and Symptoms :

Cough persisting > 5 days to weeks

Coryza,sore throat,malaise,headache

Fever rarely > 39c

Physical examination :

Rhonchi or coarse

Purulent sputum in 50% of patients


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PHARMACOLOGICAL THERAPY

Mild analgesic or antipyretics therapy ishelpful in removal of malaise , lethargyand fever.

Aspirin 650 mg in adults or 10-15mg/kg in children

Ibuprofen 200-800 mg in adults or 10mg/kg in children.


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Chronic Bronchitis

Definition: Chronic bronchitis is defined as chronic cough and

expectoration.Excessive tracheo bronchial mucus production

sufficient to cause cough with expectoration for mostdays of at least 3 months of the year for 2 consecutive

years.

Etiology:The most important etiologic factor in the development of

chronic bronchitis is cigarette smoking.


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CHRONIC BRONCHITIS

PATHOPHYSIOLOGY : Chronic inflammation

Hypertrophy &hyperplasia of bronchialglands that secrete mucus

Increase number of gobletcells

Bronchospasm oftenoccurs

End result

Hypoxemia

Polycythemia (increaseRBCs


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Chronic Bronchitis:Clinical Manifestations

In early stages

Productive cough

Bronchospasm Frequent respiratory infections

Advanced stages

Dyspnea on exertion Dyspnea at rest

Hypoxemia & hypercapnea

Polycythemia

Cyanosis


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Goals of Treatment:Chronic Bronchitis

Improved ventilation

Remove secretions

Prevent complications

Slow progression of signs & symptoms

Promote patient comfort and participationin treatment


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Pulmonary function test:

Decrease vital capacity

Prolonged expiratory flow

Spirometry

peak flow meter

Arterial blood gas (ABG)

x-ray

1515


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TREATMENT

Oral

antibiotics

commonlyused-1616

drugs dose dose

schedule(dose/daily)

ampicillin 0.25-0.5 4

amoxicillin .5 3

ciprofloxacin .5-75 2

Tetracycline HCL .5 4drugs dose dose

schedule(dose/daily

azithromycin .25 1

er throm cin .5 4


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Its an acute viral infection of lower respiratory tract infection affecting

nearly 50% of children during 1st year of life and 100% by age of 3 years.Respiratory syncytial virus is the most common cause of bronchiolitisaccounting for 70 % of cases.

BRONCHIOLITIS


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INFLUENZA

Influenza is an acute, viral respiratoryinfection.

Fever, chills, headache, aches and pains

throughout the body, sore throat whichmay lead to bronchitis or pneumonia.


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SYMPTOMS

FEVER

HEADACHE

MYALGIA

COUGH

RHINITIS

1919


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NON-PULMONARY COMPLICATIONS

myositis (rare, > in children, > with type B)

cardiac complications

liver and CNSReye syndrome

peripheral nervous system

Guillian-Barr syndrome

2020


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Chills

Body aches, especially throat andjoints

Coughing and sneezing

Extreme fever

Fatigue, headache, and nasal

congestion

Signs and symptoms


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Pharmacotherapy ofinfluenza

Although four antiviral agents are commercially available, fortreatment of influenza disease in infants and children oseltamivir (Tamiflu), zanamivir (Relenza), amantidine andrimantidine.

Oseltamivir is given for the treatment and prophylaxis ofinfluenza for those aged 1 year and older.

Zanamivir is labeled for use in ages 7 years for treatment andfor ages 5 years for prophylaxis.


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PNEUMONIA

DEFINITION : An inflammation of the lung caused bybacteria, viruses, or mycoplasms.

Radiographs reveal patchy alveolar infiltrates, or pulmonarydensities

The alveolar air spaces are filled with fluid or cells

If the infection is bacterial, treatment includes antiobiotics


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Community-acquired pneumonia

Epidemiology

Community-acquired pneumonia (CAP) is a seriousillness.

It is the fourth most common cause of death in the UK,and sixth in the USA.

85% of cases of CAP are caused by the typical bacterialpathogens, namely, Streptococcuspneumoniae,Haemophilus influenzae, andMoraxellacatarrhalis.

The remaining 15% are caused by atypical pathogens,namely Mycoplasma pneumoniae, Chlamydia

pneumoniae, andLegionella species.


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Clinical features

headache

malaise

diarrhea

confusion

decreased appetite


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Signs and Symptoms

Fever or hypothermia

Cough with or without sputum, hemoptysis

Pleuritic chest pain

Myalgia, malaise, fatigue GI symptoms

Dyspnea

Rales, rhonchi, wheezing Bronchial breath sounds


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Hospital acquired


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Hospital-acquiredpneumonia

Hospital-acquired pneumonia, also called nosocomialpneumonia, is a lung infection acquired after hospitalizationfor another illness or procedure.

Hospitalized patients have a variety ofrisk factorsforpneumonia, including mechanical ventilation, prolongedmalnutrition, underlying cardiac and pulmonary diseases,achlorhydria and immune disorders.

These pathogens include resistant aerobic gram-negative rods,such as Pseudomonas, EnterobacterandSerratia, resistant g

Antibiotics used for hospital-acquired pneumonia include

aminoglycosides, fluoroquinolones, carbapenems, andvancomycin.ram positive cocci, such as MRSA.
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Pathogenesis

Inhalation, aspiration and hematogenous spread are the 3 mainmechanisms by which bacteria reaches the lungs

Primary inhalation:

when organisms bypass normal respiratory defensemechanisms or when the Pt inhales aerobic GN organisms thatcolonize the upper respiratory tract or respiratory supportequipment.


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Aspiration Pneumonia

This type of pneumonia can occur if you inhale food, drink,vomit, or saliva from your mouth into your lungs.

This may happen if something disturbs your normal gagreflex, such as a brain injury, swallowing problem, or

excessive use of alcohol or drugs.

Aspiration pneumonia can cause pus to form in a cavity inthe lung. When this happens, it's called a lung abscess (AB-

ses)


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Atypical Pneumonia

Several types of bacteriaLegionellapneumophila ,mycoplasma pneumonia, and Chlamydophilapneumoniaecause atypical pneumonia, a type of CAP.

Atypical pneumonia is passed from person to person


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TYPES OF ATYPICAL PNEUMONIA

Legionella pneumophila

This type of pneumonia sometimes is called

Legionnaire's disease.

Mycoplasma pneumonia :

This is a common type of pneumonia that usually affectspeople younger than 40 years old.

It may be associated with a skin rash and hemolysis (thebreakdown of red blood cells).


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Lobar Pneumonia


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Pathophysiologic process

and manifestations.

Organisms may enter the respiratory tract throughinspiration or aspiration of oral secretions;staphylococcusand Gram-negative bacilli may reach the lungs throughcirculation in the bloodstream.

Normal pulmonary defense mechanisms (cough reflex,mucocilliary transport, and pulmonary macrophages)usually protect against infection.


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pathogenesis

The invading organism multiplies and releasesdamaging toxins, causing inflammation andedema of the lung parenchyma;

this results in accumulation of cellular debrisand exudates.

Lung tissue fills with exudates and fluid,

In viral pneumonia, the ciliated epithelial

cells become damaged.Severity of symptoms depends on the extent of

pneumonia present (e.g., partial lobe, full lobe[lobar pneumonia], or diffuse [broncho

pneumonia]).


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Streptococcus pneumonia

Most common cause of CAP

Gram positive diplococci

Typical symptoms (e.g. malaise, shaking chills, fever, rusty

sputum, pleuritic hest pain, cough) Lobar infiltrate on CXR

Suppressed host

25% bacteremic


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Viral Pneumonia

More common cause in children

RSV, influenza, para influenza

Influenza most important viral cause in adults,

especially during winter months

Post-influenza pneumonia (secondary bacterialinfection)

S. pneumo, Staph aureus


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Treatment

Outpatient: doxycycline, newer macrolideor fluoroquinolone

Hospitalized: evidence indicates that

early administration (within 8 hrs ofpresentation) leads to lower mortalityrate and hospital stay, therapy should beinitiated with 2-3rd generationcephalosporin or PCN plus beta-lactamase inhibitor, with a macrolide.


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AMOXICILLIN

Capsules: 250 mg (as trihydrate), 500 mg (as trihydrate)

Class: Antibiotic/Penicillin

Action Inhibits bacterial cell wall mucopeptide synthesis. Clavulanicacid inactivates a wide range of beta-lactam enzymes found in bacteriaresistant to penicillins and cephalosporins.

Lower Respiratory Tract Infections

ADULTS AND CHILDREN WEIGHING AT LEAST 40 KG: PO 875mg q 12 hr or 500 mg q 8 hr. CHILDREN (OLDER THAN 3 MO ANDWEIGHING LESS THAN 40 KG): PO 45 mg/kg/day in divided doses q12 hr or 40 mg/kg/day in divided doses q 8 hr.

Adverse Reactions:

CNS: Dizziness; fatigue; insomnia; GI: Gastritis; anorexia; nausea;vomiting;HEPA: Transient hepatitis; cholestatic jaundice;GU: Interstitialnephritis


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OSELTAMIVIR PHOSPHATE

Class: Anti-infective/Antiviral

Action Inhibition of influenza virusneuraminidase with possible alteration of

virus particle aggregation and release. Indications : Treatment of

uncomplicated acute illness caused byinfluenza infection in patients > 1 yr whohave been symptomatic for 2 days;prophylaxis of influenza in patients 13yr.

Influenza Prophylaxis


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Diphenhydramine

Trade name: Benadryl

One of the oldest anti-histamines

Action: Antagonizes the effects of histamine

at the H1 receptor sites.

Adverse Effects: Significant CNS depressant:drowsiness, dizziness, hypotension, drymouth.

Onset: immediate to 60 minutes

Peak: 1-4 hours

Duration: 4-8 hours

TRIMETHOPRIM


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TRIMETHOPRIM-SULFAMETHOXAZOLE(COTRIMOXAZOLE)

Action: Sulfamethoxazole (SMZ) inhibits bacterial synthesis of

dihydrofolic acid by competing with PABA.

Trimethoprim (TMP) blocks production of tetrahydrofolic acid byinhibiting the enzyme dihydrofolate reductase.

This combination blocks two consecutive steps in bacterial biosynthesis of

essential nucleic .

Pneumocystis Carinii Pneumonitis

ADULTS: PO 20 mg/kg TMP/100 mg/kg SMZ daily in divided doses q 6 hr for14 days.IV1520 mg/kg/day (based on TMP) in 34 divided doses for up to 14days.

Exacerbation of Chronic Bronchitis

ADULTS: PO 160 mg TMP/800 mg SMZ q 12 hr for 14 days.

acids and proteins and is usually bactericidal.

Adverse Reactions;CNS: Headache; depression; seizures;GI: Nausea;-


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