RTI

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Questions 1. Atypical lymphocytosis is most likely to be found in which of the diseases? ( Mononucleosis induced by EBV) 2. Orchitis, which may cause sterility, is a possible manifestation of which virus?(Mumps) 3.Parvovirus infection causes mild exanthem in children, is characterized by? ( Haemolytic anaemia) 4.Which of the following is transmitted by fecal- oral route, can be acquired from shellfish and often causes acute jaundice, diarrhea, and liver function abnormalities? (Hep A) 5. An experimental compound is discovered that prevents the activation of adenyl cyclase and the resulting increase in cAMP. The toxic effects of which bacteria can be prevented with this compund? ( Vibrio Cholerae)

RTI

Viral infections are treated symptomatically. Streptococcal pharyngitis and epiglottitis caused by H influenzae are treated with antibacterials. Haemophilus influenzae type b vaccine is commercially available and is now a basic component of childhood immunization program.

Management

Symptomatic treatment is used for most viral infections. Bacterial pneumonias are treated with antibacterials. A polysaccharide vaccine against 23 serotypes of Streptococcus pneumoniae is recommended for individuals at high risk.

Pathogenesis

Lower Respiratory Infection

Organisms enter the distal airway by inhalation, aspiration or by hematogenous seeding. The pathogen multiplies in or on the epithelium, causing inflammation, increased mucus secretion, and impaired mucociliary function; other lung functions may also be affected. In severe bronchiolitis, inflammation and necrosis of the epithelium may block small airways leading to airway obstruction.

Upper Respiratory Infection

Organisms gain entry to the respiratory tract by inhalation of droplets and invade the mucosa. Epithelial destruction may ensue, along with redness, edema, hemorrhage and sometimes an exudate.

Investigations

Lower RTI

(b) Pneumonia Diagnosis: 1. Blood culture 2. Microscopy 3. Acid-fast stains 4. ELISA : Antigen 5. Fluorescent-antibody test 6. Serology 7. PCR

(a) Bronchitis and Bronchiolitis Diagnosis: 1. Cultures: Sputum, Aspirations of nasopharyngeal secretions or 2. Serology : Antibody 3. Fluorescent-antibody staining 4. ELISA 5. PCR

Upper RTI

(c) Otitis Diagnosis: 1. Otoscopy 2. Culture: middle ear effusion

(e) Epiglottitis and Laryngotracheitis Diagnosis: 1. Blood culture 2. Cultures : pharyngeal swabs 3. Serology : To detect a rise in antibody 4. Immunofluorescent-antibody staining (rapid diagnostic technique 5. Enzyme-linked immunosorbent assay (ELISA 6. PCR

(d) Pharyngitis Diagnosis: 1. Culture 2. Serology 3. Fluorescent antibody (Rapid diagnostic tests) 4. Latex agglutination 5. PCR

(b) Sinusitis Microbiologic Diagnosis: 1. For acute sinusitis, the diagnosis is made from clinical findings. 2. Bacterial culture: Nasal discharge (Not very helpful as the recovered organisms are generally contaminated by the resident flora from the nasal passage.) 3. In chronic sinusitis, a careful dental examination 4. Sinus x-rays 5. Antral puncture : to obtain sinusal specimens for bacterial culture (specific)

(a) Common Cold Microbiologic Diagnosis: 1. Symptoms (lack of fever combined with symptoms of localization to the nasopharynx).

Common Pathogens

Lower Respiratory Infection : Bronchitis, Bronchiolitis and Pneumonia

Hantavirus

Measles

VZV

Aspergillus spp.

Cryptococcus neoformans

Histoplasma capsulatum

Chlamydia trachomatis/ psittaci/ pneumoniae

Coxiella burnetii

Mycobacterium tuberculosis

Legionella spp

Pseudomonas aeruginosa

E. coli

Klebsiella pneumoniae

Streptococcus pyogenes

Staphylococcus aureus

Haemophilus influenzae

Upper Respiratory Infections : Common Cold, Sinusitis, Pharyngitis, Epiglottitis and Laryngotracheitis

Virus

HSV

CMV

EBV

Coxsackievirus A

Influenza

RSV

Adenovirus

Parainfluenza virus

Coronavirus

Rhinovirus

Fungus

Candida albicans

Bacteria

Streptococcus pneumoniae

Haemophilus influenzae type b

Mycoplasma pneumoniae

Neiserria Gonorrhea

Corynebacterium Diptheriae

Group A beta hemolytic streptococci