Guidelines%20for%20Preparing%20PowerPoint

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CHAPTER 9 Respiratory-Related MicrobiologicalDis
eases
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Introduction

• Respiratory system
• Serves as host for infectious diseases, although
  contains many layers of defense
• Warm, moist atmosphere facilitating
  microbacterial growth
• Site for constant inhalation of environmental
  particles

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Upper Respiratory Infections

• Includes
• Sinusitis
• Pharyngitis
• Epiglottitis
• Croup

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Sinusitis

• Description
• Inflammation of hollow sinuses in nasal cavity
• Viral or bacterial
• Signs/Symptoms (S/S) (not limited to) nasal
  stuffiness and discharge pain/pressure in face
  if bacterial, yellow or green nasal discharge
• Diagnostic
• Observe for ten days to determine if
  self-limiting or if treatment required
  
• (Continues)

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Sinusitis

• Treatment
• Oral decongestants
• Topical decongestants
• Nasal steroids
• Analgesics
• Antibiotics

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Pharyngitis

• Description
• Inflammation of pharynx and surrounding lymphatic
  tissue
• Viral or bacterial
• S/S (not limited to) sore throat dysphagia
  fever white, mucosal patches
• Treatment usually self-limiting if bacterial,
  antibiotics
• Severe complications, if untreated

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Epiglottitis

• Description
• Acute airway obstruction (airway emergency)
• Prevalent in children 26 years of age
• Abrupt onset (usually due to haemophilis
  influenzae Type B)
• Symptoms (4 Ds) distress (respiratory),
  drooling, dysphasia, dysphonia
• Treatment
• Maintain airway
• Antibiotic therapy

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Croup

• Description
• Infection of laryngeal area, prevalent in
  children younger than 3 years of age
• Usually viral
• S/S barking cough, stridor, may be afebrile
• Treatment air humidification, administration of
  oxygen, nebulized epinephrine or corticosteroids

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Lower Respiratory Infections

• Includes
• Acute bronchitis
• Acute bronchiolitis
• Pneumonia
• Tuberculosis

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Acute Bronchitis

• Description
• Affects bronchi common in winter months
• Usually viral and may be self-limiting
• S/S may progress from nonspecific symptoms
  (e.g., headache, sore throat) to thick bronchial
  secretions with productive cough bilateral
  rhonchi and coarse crackles
• Treatment symptomatic treatment, antibiotics (if
  bronchitis due to pertussis)

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Bronchiolitis

• Description
• Affects bronchioles, especially in infants 210
  months of age often in winterspring months
• S/S (not limited to) restlessness, mild fever,
  noisy upper airway breathing, tachypnea
• Most common cause RSV
• Treatment antivirals, aerosolized drug using
  special nebulizer equipment (hood or mist tent)

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Pneumonia

• Many types
• Community-acquired pneumonia
• Atypical pneumonia
• Viral pneumonia
• Tracheobronchitis
• HCAP, VAP, HAP
• Aspiration pneumonia
• Pneumocystis jiroveci
• (Continues)

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Pneumonia

• Description
• Causes virus, bacteria, fungus, drugs or
  chemicals
• S/S (not limited to) leukocytosis, fever,
  rhonchi, dullness of percussion at site
• Diagnostic chest x-ray and cultures of sputum
  and blood
• Assess respiratory function to determine need for
  hospitalization

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Community-Acquired Pneumonia

• CAP
• Description of infection is determined by
  prevalent pathogens, not geographical location
• Usual cause Streptococcus pneumoniae
• Treatment
• Determined by such guidelines as local resistance
  patterns, clinical condition, chest x-ray results
• Recommended treatments are frequently updated

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Atypical Pneumonia

• Description
• Cause organisms not detectable by gram stain,
  nor growth on standard cultural media
• Organisms do not respond to antibiotics used to
  treat pneumonia
• Often due to Mycoplasma pneumoniae, Legionella,
  Chlamydophila pneumoniae
• Treatment
• Empiric therapy

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Viral Pneumonia

• Description
• Determined by molecular diagnostic methods, such
  as polymerase chain reaction (PCR) test
• Must rule out bacterial cause
• Bacteria and virus can coinfect
• If bacterial, treat with antibiotics

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Tracheobronchitis

• Pneumonia-like infection caused by mechanical
  ventilation
• S/S fever, new/increased sputum production
• Diagnostic sputum sample from endotracheal tube
  for gram stain and culture
• Treatment
• Antibiotics (determined by local antibiotic
  susceptibility patterns)

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HCAP, VAP, HAP

• Health careassociated (HCAP), ventilator-
  associated (VAP), hospital-acquired (HAP)
• Pneumonia related to exposure to/frequent contact
  with health care settings
• Preventive measures decrease aspiration by
  patients prevent cross-contamination
  disinfection/sterilization of respiratory
  devices vaccines against certain infections
  education of hospital staff and patients

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Aspiration Pneumonia

• Two types
• Chemical
• Exposure to stomach acid
• Treatment symptomatic therapy allowing lungs to
  heal
• Bacterial
• Due to aspiration of oropharyngeal organisms, or
  aerosol inhalation
• Treatment empiric antibiotic therapy

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Pneumocystis jiroveci (Carinii)

• Description
• Due to defects in cell-mediated immunity (e.g.,
  complications of HIV organ or bone marrow
  transplantation medications)
• S/S (not limited to) asymptomatic (or) fever,
  cough, tachypnea, dyspnea
• Diagnostic ABGs
• Treatment specific IV or parenteral
  medications

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Tuberculosis

• Airborne, chronic disease due to Mycobacterium
  tuberculosis
• Latent inhaled droplet is encapsulated
• Active inhaled droplet (bacilli) escapes
• S/S asymptomatic (or) weight loss, fever, night
  sweats, bloody sputum
• Diagnostic Mantoux or PPD, testing of sputum
  specimen, chest x-ray
• (Continues)

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Tuberculosis

• Treatment
• If latent
• Preventive treatment (isoniazid 612 months)
• If active
• Medication regimen 624 months
• Directly observed treatment (DOT) may be required
  due to noncompliance

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Bioterrorism

• Pulmonary irritants
• Chlorine, phosgene
• Biochemical reactions of irritants cause
  laryngospasm and pulmonary edema
• Anthrax
• Transmission skin contact, inhalation
• If inhaled, spores are transported to lymph
  system, germinate and produce toxins
• Treatment antibiotics
• (Continues)

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Bioterrorism

• Plague
• Potential bioweapon, contagious
• Transmission close contact, aerosol
• Treatment
• If systemic parenteral antibiotic therapy
• Prophylaxis (post-exposure) oral antibiotics
• Vaccine no longer available discontinued in 1999

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Avian Influenza (H5N1)

• Carried in intestines of wild birds transmitted
  to domestic birds, including poultry (cause of
  human exposure)
• May be transmitted through touching contaminated
  surfaces
• S/S noted after a 2- to 5-day incubation period
  include (not limited to) fever, cough,
  rhinorrhea, diarrhea, abdominal pain
• (Continues)

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Avian Influenza (H5N1)

• Symptoms may progress to acute respiratory
  distress syndrome
• Treatment
• Prophylaxis and supportive treatment
• Antiviral medications
• Includes treatment of anyone living with infected
  patient

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Summary

• Clinical presentation, diagnosis, treatment of
  respiratory system infections
• Upper respiratory infections
• Lower respiratory infections
• Bioterrorism
• Avian influenza
• (Continues)

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Summary

• Many upper respiratory tract infections due to
  viruses
• Treating viral infections with antibiotics
  promotes bacterial resistance
• Refer to text/tables for in-depth information

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