The document summarizes different types of lower respiratory tract infections including bronchitis, bronchiolitis, and pneumonia. It describes the etiology, manifestations, diagnosis, and classifications of each. Acute bronchitis is usually viral and causes inflammation of the bronchi. Chronic bronchitis results from long-term damage and recurrent infections. Bronchiolitis predominantly affects infants younger than 2 years old and is usually caused by respiratory syncytial virus. Pneumonia can be caused by many organisms depending on factors like age, location, and immune status.
The document summarizes different types of lower respiratory tract infections including bronchitis, bronchiolitis, and pneumonia. It describes the etiology, manifestations, diagnosis, and classifications of each. Acute bronchitis is usually viral and causes inflammation of the bronchi. Chronic bronchitis results from long-term damage and recurrent infections. Bronchiolitis predominantly affects infants younger than 2 years old and is usually caused by respiratory syncytial virus. Pneumonia can be caused by many organisms depending on factors like age, location, and immune status.
The document summarizes different types of lower respiratory tract infections including bronchitis, bronchiolitis, and pneumonia. It describes the etiology, manifestations, diagnosis, and classifications of each. Acute bronchitis is usually viral and causes inflammation of the bronchi. Chronic bronchitis results from long-term damage and recurrent infections. Bronchiolitis predominantly affects infants younger than 2 years old and is usually caused by respiratory syncytial virus. Pneumonia can be caused by many organisms depending on factors like age, location, and immune status.
The document summarizes different types of lower respiratory tract infections including bronchitis, bronchiolitis, and pneumonia. It describes the etiology, manifestations, diagnosis, and classifications of each. Acute bronchitis is usually viral and causes inflammation of the bronchi. Chronic bronchitis results from long-term damage and recurrent infections. Bronchiolitis predominantly affects infants younger than 2 years old and is usually caused by respiratory syncytial virus. Pneumonia can be caused by many organisms depending on factors like age, location, and immune status.
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The lower respiratory tract
infections Presented by : Ust. Fajr Salah 1. BRONCHITIS • ACUTE BRONCHITIS • Acute bronchitis causes inflammation of the trachea and bronchi but does not involve the alveoli it is usually caused by viral agents . Acute bronchitis occurs in patients of all ages but is most common in the young and in older persons. • It is most common in the winter months, • Predisposing factors for the development of acute bronchitis • in children include poor nutrition, allergy, deficiencies in IgG2, IgG3, and IgG4 subclasses, and rickets. • Older patients who have emphysema or chronic respiratory disease ETIOLOGY
• Viruses are the most common cause of acute bronchitis.
Acute bronchitis can be caused by the following agents. • ■ Respiratory viruses that infect the upper respiratory tract: • Influenza viruses A and B, parainfluenza viruses, adenovirus, respiratory syncytial virus, herpes simplex virus, rhinovirus, coxsackievirus groups A and B, and echovirus. • ■ Mycoplasma pneumoniae • ■ Chlamydophila pneumoniae MANIFESTATIONS • include a cough (which is nonproductiveat first but can become mucopurulent), substernal pain, and fever (38.3– 38.9°C). • Physical findings will reveal an infected pharynx; rhonchi and moist crackles can be heard upon auscultation. • Several hours before symptoms of bronchitis develop, the patient will experience malaise, headache, coryza, and sore • throat. • Chest radiographs do not reveal consolidations or infiltrates, as seen in patients with pneumonia; therefore, a chestradiograph can be helpful in differentiating bronchitis from pneumonia. DIAGNOSIS • Diagnosis of acute bronchitis is based on clinical signs and symptoms. • Differentiation between bronchitis and pneumonia(Chest radiographs). • CHRONIC BRONCHITIS occurs in adulthood. • is a result of long-standing damage to the bronchial epithelium. • A common cause is cigarette smoking, but a variety of environmental pollutants, chronic infections (eg, tuberculosis), and defects that hinder normal clearance of tracheobronchial secretions and bacteria (eg, cystic fibrosis) can be responsible.
• Because of the lack of functional integrity of their large airways, such
patients are susceptible to chronic infection with members of the oropharyngeal flora and to recurrent, acute flare-ups of symptoms when they become colonized and infected by viruses and bacteria, particularly Streptococcus pneumoniae and nontypeable Haemophilus influenzae. • A vicious cycle of recurrent infection may evolve, leading to further damage and increasing susceptibility to pneumonia. 2. BRONCHIOLITIS • Bronchiolitis causes inflammation of the bronchial tree as low as the bronchioles but does not involve the alveoli • Because infants have narrower airways, bronchiolitis is usually a disease of infants younger than 1 year of age about75%. • 95% occur in children younger than 2 years of age, with • a peak incidence at 2–8 months of age. • Risk factors include age younger than 6 months, bottle feeding, • prematurity (born before 37 weeks’ gestation), exposure • to cigarette smoke, and crowded living conditions. • in older children and adults and is most common during fall and winter months. ETIOLOGY • The most common cause of bronchiolitis is respiratory syncytial virus; other causes include human metapneumovirus, parainfluenza viruses, and adenoviruses. MANIFESTATIONS • Early symptoms of bronchiolitis are similar to symptoms of a viral upper respiratory tract infection and include mild rhinorrhea, cough, and sometimes a low-grade fever. In some infants and young children, the infection extends downward into the lower respiratory tract causing paroxysmal cough and dyspnea. • Other common symptoms include tachypnea, tachycardia, fever (38.5–39°C), diffuse expiratory wheezing, inspiratory crackles, nasal flaring, intercostal retractions, grunting, vomiting (especially posttussive), cyanosis, and hyperinflation of the lungs and depression of the diaphragm. DIAGNOSIS • involves observation of the patient’s signs and symptoms, chest radiographs, and antigen • testing for respiratory syncytial virus in nasal washings. • Chest radiographs • A positive culture or • direct fluorescent antibody test result can confirm the diagnosis of respiratory syncytial virus bronchiolitis. 3. PNEUMONIA • Pneumonia is an infection of the alveoli or the walls of the alveolar sacs. • Numerous microorganisms can cause pneumonia, but most cases are caused by bacteria. • The common causes of pneumonia are dependent on the : 1. immune status of the patient, 2. the location where the patient acquired the pneumonia, 3. the age of the patient, 4. and the type of pneumonia the patient manifests (e.g., typical versus interstitial pneumonia). Classifications of PNEUMONIA Age of Patient Most Likely Organisms Causing the Pneumonia Neonatal (0–1 month) Escherichia coli, Streptococcus agalactiae (group B) Infants (1–6 months) Chlamydia trachomatis, respiratory syncytial virus Children (5months–6month Respiratory syncytial virus, parainfluenza viruses Children(5_15 years) Mycoplasma pneumoniae, influenza virus type A Young adults(16_30 years) M pneumoniae, Streptococcus pneumoniae Older adult Streptococcus pneumoniae, Haemophilus influenzae Location or Patient’s Immune Status Most Common Causes of Infrequent Causes of Pneumonia Pneumonia
Community acquired Streptococcus pneumoniae, Staphylococcus,
Fusobacterium nucleatum, Peptostreptococcus, Peptococcus, and other anaerobes, Staphylococcus, gram-negative aerobic bacilli * Time of onset Location Transmissions Causative agents WherePneumonia was Acquired
Acute Community acquired Person to person S.pneumoniae,M.pneu
moniae,H.nfluenzae, S.aureus,K.pneumonia e,N.meningitidis, M.catarrhalis,influenz a virus, S.pyogenes
Acute Community acquired Person to person in Chlamydiatrachomatis
infants and young RCV,S. children agalactiae,S.aureus, CMV,S. Acute Nosocomial Person to person Enterobacteriaceae, pneumonia P.aeruginosa, Acinetobacter calcoaceticus,S.aureus
Subacute Community acquired Person to person M pneumoniae,
interstitial influenza virus
Subacute Nosocomial or Aspiration Mixed anaerobic and
Community acquired aerobic gramnegative enteric bacteria.
Subacute or chronic Nosocomial or Person to person or Pneumocystis jiroveci,
Community acquired Aspiration in CMV, atypical immunocmpromised mycobacterium,Nocar dia,Aspergillus, Phycomycetes mucor, Candida albicans
Chronic Community acquired Person to person M.tuberculosis,Blasto
mycesdermatitides (most common of cause of fungal pneumonia),H.capsula tum, Coccidioides Types of Pneumonia
Type of Pneumonia Most common causes Laboratory findings
Fungal Blastomyces dermatitidis Broad-based budding yeast Aspiration(Community Oral anaerobes or S Anaerobes can include acquired) pneumoniae Prevotella,Peptostreptococcu s,Bacteroides, Fusobacterium
Aspiration(Hospital acquired) Oral anaerobes, gram- Anaerobes same as above;
negativeenterics, or S.aureus gram-negative entericsK.pneumoniae and E.coli Comparison of Typical and Interstitial (Atypical) Pneumonias Feature Typical Pneumonia Interstitial (Atypical) Pneumonia
Onset Sudden Gradual
Rigors Single chill Chilliness”
Facies Toxic well
Cough Productive None productive(paroxysmal)
Sputum Purulent (bloody) Mucoid
Temperature 39.4–40°C 39.4°C
Pleurisy Frequent rare
Consolidation Frequent rare
Gram stain (Sputum) Neutrophils Mononuclear cell
White blood cell count and 15,000/mm3 with left shift 15,000/mm3 Diffrential count Chest radiograph Defined density, lobar Nondefined infiltrate or pneumonia interstitial pneumonia Most common cause Streptococcus pneumoniae Mycoplasma pneumoniae Thanks
