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Respiratory Tract Infections Common cold Acute and chronic bronchitis Pneumonia (CAP and VAP)

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Title: Respiratory Tract Infections Common cold Acute and chronic bronchitis Pneumonia (CAP and VAP)


1
Respiratory Tract Infections Common cold Acute
and chronic bronchitis Pneumonia (CAP and VAP)
  • ?? ??? ?????-???????
  • ?????? ?????? ????????
  • ????? ?????? ?? ???????, ??

2
The Common Cold The common cold is mild,
self-limited, catarrhal
syndrome
  • SIGNIFICANCE-
  • The leading cause of acute morbidity and of
    visits to a physician.
  • Major cause of school and industrial absenteeism.

3
  • ETIOLOGY
  • Five families of viruses
  • Myxovirus,
  • Paramyxovirus,
  • Adenovirus,
  • Picornavirus
  • Coronavirus

Adenovirus
4
VIRUSES ASSOCIATED WITH COMMON COLD Antigenic
type of cases Rhinoviruses 100 types 1
subtype 30-40 Coronavirus 3 or more types
gt 10 . Parainfluenza virus 4
types Respiratory syncytial virus 2
types Influenza virus 3 types
10-15 Adenovirus 47 types 5 . Other
viruses (Enterov., Rubella, 5
Rubeola, Varicella)
Presumed undiscovered viruses
25-30 Group A b-hemolytic streptococci
5-10.
5
DISTRIBUTION- worldwide
SEASONAL INCIDENCE- Colder month of the year, or
rainy season in the tropics.
ATTACK RATES- During the season
Adults have 6-8 colds/ 1000 people/ day.
(Children 9/1000)
In the summer
Adults have 2-3 colds/ 1000 people/
day.
6
TRANSMISSION- Close contact (direct contact
with infectious secretions or aerosol with large
and small droplets)
PATHGENESIS- viral infection of mucous membrane
of nose, sinuses, throat and ear.
7
CLINICAL CHARACTERISTICS- Incubation 24-72
hours Nasal discharge and obstruction, sneezing,
soar or scrachy throat and cough. Low fever in
adult, higher in children. Max. severity during
the 2nd or 3rd day. Median duration 1 week but
in ¼ the disease last 2 weeks.
8
  • DIAGNOSIS-
  • Clinical
  • Laboratory
  • TREATMENT-
  • TLC, decongestants, cough control, worm saline
    gargles.
  • PROSPECT OF NEW TREATMENT-
  • Antiviral treatment
  • Virucidal hand wash
  • Preventive treatment

9
  • ACUTE BRONCHITIS
  • Acute inflammation of the tracheo-bronchial tree,
  • associated with generalized respiratory
    infection

10
ETIOLOGY Respiratory viruses Mild disease
with Rhinoviruses and some Coronaviruses, and
more sever disease with Influenza virus and
Adenovirus and lately with SARS (an new emerging
Coronavirus.) Respiratory bacteria Bordetella
pertussis, Mycoplasma pneumoniae, Chlamydia
pneumoniae.
11
VIRUSES ASSOCIATED WITH ACUTE BRONCHITIS and
cough Of cases Influenza
75-93 Adenovirus 45-90 Renoviruses
32-60
Coronaviruses 10-50
RSV 61 Coxsackieviruses 26
Parainfluenza virus 2-45
12
DISTRIBUTION- worldwide
SEASONAL INCIDENCE- all year, more cases in the
winter, epidemic.
ATTACK RATES- in the UK Mean 40-50 /
100,000 people Winter 117-170 / 100,000 Summer
26-42 / 100,000
13
TRANSMISSION- Close contact (direct contact with
infectious secretions or aerosol with large and
small droplets)
PATH0GENESIS- Hyperemia and edema of the
tracheobronchial mucous membrane and increase in
bronchial secretions. Local extensive
distraction of the airway epithelium. Slow down
of bronchial tree mucociliary function. May
play a role in pathogenesis of chronic
obstructive lung disease.
14
  • CLINICAL CHARACTERISTICS-
  • Cough begins early and tends to become more
    prominent as the illness progresses.
  • The cough can continue for 2-3 and even more
    weeks depend on the causing organism. (If the
    cough takes longer look for chronic disease)
  • Nasal discharge and obstruction, sneezing, soar
    or scratchy throat for 3-5 days

15
DIAGNOSIS- clinical diagnosis is suspected with
any acute RTI with cough. R/O pneumonia
(history, exposure, physical examination and if
needed chest x-ray). Specific cultures. TREATMEN
T- Symptomatic- to control the cough (cough
suppression and hydration) Antibacterial or
antiviral therapy according to the causing
organism. PREVENTION- vaccination and
medications
16
COMMUNITY ACQUIRED PNEUMONIA (CAP)
???? ???? ?????? ?????? ????? ????? ??
??????????? ?? ???? ???? ??? ???? ??????.
17
DISTRIBUTION- worldwide
-ATTACK RATES
??? ????? ???? ?????? ?????? ? ??? ??? !!!
-??????? ?? 12 ????? ?- 1000 ?????? ????
???? ???????? ??? ???-
AGE FREQUENCY / 1000 35 44 0.54 gt
65 11.6 nursing home residents 33
18
ETIOLOGY ?? ???? ????? ????? ?????? ?
????? ?- 30 ????? ????? ???? (?- 80) ????? ?"?
Streptococcus pneumoniae
???? ????? ?????? ?????? ???????, ????? ??????
(50) ??????? ?????????, ???? ????? ?? ????.
?????? ??????? ?????? ???? ?? ??????? ????
Transthorcic aspiration, Thoracocentesis
or Bronchoscopy
43- Unknown 8-
Polymicrobial 49- One Pathogen
19
???? ????? ???? ?????? ????? THE ORGANISM OF
THE CASES Unknown 25 45 Strep.pneumoniae
14 - 28 Haemophilus influenzae 0
12 Legionella sp. 10 14 Mycoplasma
pneumoniae 5 - 7 Infuenza virus 0 -
5 Staph. aureus 1 - 3 Strep. sp 0
3 Chlamydia pneumoniae C. psittaci 0 -
4 Aerobic gram negative bacilli 3 - 12
20
PNEUNOMIA COUSING ORGANISMS
BACTERIA ATYPICAL BAC. S. pneumoniae K.
pneumoniae M. pneumoniae H. influenza E.
coli L. pneumophila M.
catharalis P. aeruginosa C.
pneumoniae S. aureus C. psitaci Strep.
sp. C. burnetii OTHERS ANAEROBES
FUNGI F. tularensis P. jerovicii
(PCP) Nocardia sp. Aspergillus sp Staph.
Epidermidis Myc. tuberculosis
21
CLINICAL CHARACTERISTICS-
??????? ??????? ???, ???????, ??? ????????, ????
?????????? ?? ??? ??????
??????? ?? ??????? ???? ???-?????, ???? ??
?????????? ?? ???? ?????????? ?? ???
????????.
??????? ?? ?????????? ????? ???? ????? ?????? ???
?????? ?? ????? ?????? ?????????)
???????? ???? ????????? ?????? (?????), /- ???,
/-?????
?????? ?????? ?????
????????? ?? ????????
???????? ?? ???????? ( ?????????????)
22
DIAGNOSIS-
???? ??? ???? ? - GOLD STANDARD ?????? ??
???? ????. ?? - ???? ????? ?????
????????????? ?? ??? ???? ?????.
23
????? ??? ????
24
???? ???? ?????? (LOBAR PNEUMONIA)
25
?????? ?????? ????? ??? ?????
26
???? ???? ?? ??????? ??-????? BILATERAL
INFILTRATES
27
???? ???? ??-????? ???
28
  • ????? ?????
  • ????? ??????? ?????? ??.
  • ????? ??????? ?????? ????? ???????.
  • ?????? Pneumocystis carinii ????? ??? ?? BAL.
  • ???? ?? 4 ???????? ?- Mycoplasma pneumoniae.
  • ???? ???? ??????? ?? 4 ????? ?? ?????
    Legionella
  • ?????? ?????? ???????? ????.
  • ?????? ????? ?? ???? ?- Strep. Pneumoniae.

29
  • ????? ??????
  • ????? ??????? ?? ??? ?? ????? ??????? ????????
  • ?????? ??? ???? ????? ????? ????? ??????.
  • ????? ??? ?? ????? ??????? ?????? ??? ??????
  • ??? ?????? ????? ??????.

30
  • ??????? ???? ??????
  • ?- 30 ??????? ???? ?????? ??? ????? ???.
  • ?- 30 ??????? ????? ??????????? ???? ?????
    ?????.
  • ?- 25 ????????? ?? ???? ????? ?? ?-?????
    ????? ???????.

31
  • ?????? ??????
  • ????? ???
  • ????? ?? ?????
  • ????? ??
  • ????? ?? ?????? ???? ???????????, ?????? ????
    ????.
  • ?????? ??
  • ???????? ?- HIV
  • ??? ????? ???? ?????? ???? ???????????.
  • ???? ??????? ?? ?? ????? ???? ??????, ?????
    ????,
  • ?????, ??????
    pH, LDH.
  • ????? ?????? ?????????????????? ???????
    ?????????
  • ???????? ??????????.

32
????? ????? ????? ????? ?? ???? ???? ?? ????
?????? ?? CAP
  • ??? gt 65 ???
  • ???? ??? ??????? ???? ???? ????- IHD, CHF,
    CRF, COLD.
  • ???? ??????
  • ??? ???? ????? ????
  • ????? ???? ?????
  • ??????????

33
  • ????? ??????????????
  • ??? ????? gt 30 ????
  • ?.?. ???????? lt 60 ?"? Hg, ?.?. ??????? lt 90 ?"?
    Hg.
  • ??????????
  • ??? ????????? gt 150mM / L, ??? BUN gt 7mM / L.
  • 30,000 gt WBC gt 3,000 ??????????.
  • Po2lt 60mmHg ?? Pco2gt 48mmHg ??????? ????
  • ????? ????.

34
  • ??? ??????? lt 30 g/L
  • ??? ????????? lt 9 g/L
  • S. aureus ?? P. aeruginosa ?????? ???? ?????.
  • ???????
  • ???? ?????- ????? ????? ???.
  • ??????? ????? ?? ?????? ?????? ?????? ???
  • (gt 50 ??? 36????).

35
????? ?. ????? ????-?????????? ????
??????? ???? ??????? ???? ?????? ????
?????? ?. ????? ???? ??? ??????, ?????, ????? ??
?? ??????????? ?????????? ??????? ??? ?. ?????
???? ???????, ????????????????, ??????????? .
36
????? ?????? ????? ???? ???? ?????????
Doxicyclin, Macrolides, New Quinolones ?????
?????? ????? ???? ???? ????????? ??? 2nd or 3rd
generation Cephalosporin iv one of the
above ????? ?????? ????? ?? ???? ???? ??? ??????
???? 4th generation cephalosporin iv Quinolone
iv /-rifampin or carbapenem new macrolide
37
NOSOCOMIAL PNEUMONIA
includes Hospital acquired pneumonia Ventilator
associated pneumonia
38
????? ???? ???? ????? (???) ???? ??? ?????
?????- ?????? ?? ???? ????, ???? 72 ???? ??
???? ???? ?????.
39
  • ??????
  • ??? ??? ?????? ????? ???? (???????????),
  • ???? ????????
  • ??? ????? 18-13 ??? ???????? ???????
  • ?????.
  • ??? ??? ???? ????? ?????? ????? ??????
  • ???????? ?????? 27-33.
  • ?????? ????? ???? ?????? ???????? ??
  • ???????? ?? ?????????? ?? ??????????.

40
  • ??????? ?????? ?????? ???? ?????
  • ????? ????? (7-9 ???? ??????) ????? ????
  • ??????
  • (????? ??????? ?? ?????? ?-2 ????? ???? ????)

41
????? ????? ????? ???? ?????? ? ?. ???? ??
????? ?. Infection control ?. ????? ??????? ?.
?????
42
  • ????? ????? ????? ???? ?????? ?
  • ?. ???? ?? ?????
  • ??? gt 70 ???
  • ????? ??? ???? (?????????)
  • ????? ??????? ????? ?????? ?????? ??? COPD,
    ??????????, ?? ?????, ????? ?- CNS
  • ??-?????
  • ???????? ???????
  • ?????????

43
  • ????? ????? ????? ???? ?????? ?
  • ?. ???? ?? ????? (????)
  • ??? ????
  • ??? ??????? ?? ???? ????? (????, ?????)
  • ????? ???????????????
  • ???? ???

44
  • ????? ????? ????? ???? ?????? ?
  • ?. Infection control
  • ??- ????? ?????
  • ????? ?????? ?????? ?????? ?????
  • ????? ????? ????? ?????

45
  • ????? ????? ????? ???? ?????? ?
  • ?. ????? ???????
  • ?? ??????? ??????? ???????? ???????-
  • ?? ??????? ???????? ?? ????? ????? ??????
  • ???????? ????? ???? ????? ?? ???????.

46
  • ??????? 1. ??????
  • ????? ?????, ????????- ?????? ?????? ????????
  • ?????????, ???????????- ??????? ??? ?????
  • ??????????? ??????- ???? ?????? ???????

    ,
    ???????? ??????
  • ?????? ?????? ????? ?- H2 Blocker - ???? ????
  • ??????? ????? ?????? ????? ???? ????? ?????
  • ??????? ????? ????? ??????? )55)

47
  • ??????? 2. ???????
  • ????? - ????? ?????? ????? ???? ?? 20 ???????
    ????? ?? ?????. ???? ????? ?? 1-3 ???? ?????
    ????, ????? ?? ????? ?? VAP- Ventilator
    Associated Pneumonia
  • ????? ????-???????
  • ????????????

48
  • ????? ????? ????? ???? ?????? ?
  • ?. ?????
  • ????? ????? ??? ??? ?? ??? ??????
  • ??? ??????
  • ??? ???????
  • ????????

49
?? ???????? ??????? ???? ?
  • Streptococcus pneumoniae - 5-20
  • Haemophilus influenzae - 5-15
  • Staphylococcus aureus - 20-40
  • Pseudomonas aeruginosa
  • E. coli
  • Enterobacter spp. - 25-60
  • Klebsiella pneumoniae
  • Serattia marcescens
  • Acinetobacter

50
?? ??? ?
  • Legionella pneumopila - 0-5
  • Mycobacterium tuberculosis - lt1
  • Anaerobes - lt35
  • Polymicrobial - 25-46
  • VIRAL- RSV, Influenza, parainfluenza

51
??? ????? ?
1. ??????- ??????? ??? 4 ????? ???????? ??????
????? ????? ?? ??????? ??????? ????? ????
?????? ??? Strep. pneumoniae, H.
influenzae
2. ??????- ??????? ????? ????
????? ????? ??
Enterobactriaceae Pseudomonas aeruginosa and
other non-fermenters and Staph. aureus
52
??????? ?????? ??????? ?? ???????? ???, ???
??????, ???? ?????? ???? ???????? ?????? ???
  • ????? ??? ??? ??? ????????? ???? ????
  • ?????? ?? ??????? ??? ?? ???? ????

  • ??? ???????? ?????? ???? ??????? ??? ?????
  • ??? ?????? ???? ?????? ?? ???????? ???? ?????
  • ??????? ?????? ??? ?????? ?????? ?????? ???? ??
  • ?????? ??? ??? ?????? ??? ????????? ??? ??,
  • ??????? ?????? ?? ?? ??, ???????? ?? ARDS.

53
???? ???? ??-????? ??? ?? ARDS?
54
?????
????? ?????? ????? ??????? ?????? ?? ??????? ????
????? (HICPAC) ???? 1994
1. ????? ????? ?????? - ???? ???? ????? ?????
2. ????? ??? ??????? ?????? ???? (????? ????).
3. ????? ????? ?????? ????? ??????, ????
???????. ???? ?????? ?? ???? ????.
55
4. ?????, ???? ????? ?? ???? ?????? ??? ??????
?. ??? ???? ????? ?. ???????
??? ?????? ????? ????? ???? ?????
??????????, ????? ???? ?????? ???? ????????
?????? ??? ?????? ?????.
56
5. ?? ?????? ???? ????? ???? ???? ?- 48 ????.
6. ????? ?????? ???? ????? ???? ????? ?????.
7. ???????? ????? ???? ????, ????? ????? ????
???????? ?????? ????? ??? ????? ??????.
8. ????????? ?? ?????? ?? ???? ???????? ????????
????? ???????.
9. ????? ??????? ?????? (HUMIDIFIER) ???? ???
?? ?? ???? ?????? ??????.
57
10. ????? ????? ???? ?????, ????? ????? ?????
???? ??? (?????, ??????, ?????, ???????)
??????? ??????? ?-????? ?????? ????? ??
??????? ???? ????.
11. ?????? ??????? ???????? ??????? ??????.
58
12. ????? ?? ?????? ????? ?- 30-450, ?? ????.
13. ???? ???????? ??? ?????, ?? ?????
?????????? ?????????
59
14. ????? ?????? ???? ????? ???? ????? ????
????? ?????? ???????.
15. ?????? ?????? ???? ????? ?? ?????? ??????
?? ??.
16. ????? ??? ??? ???? ?????, ??? ????? ??
?????? ????, ?????? ????? ?? ?????.
17. ????? ?????? ???? ???? ???? ???????????
18. ?? ??? ????? ????????? ???? ????? ?????,
?????? ???
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