Diseases of the Respiratory System Nose, Paranasal Sinuses and Larynx 1.
Influenza Clinical Manifestations Influenza viruses, members of the Orthomyxoviridae family, Incubation period of 1 to 2 days. include types A, B and C. Illness generally lasts 4 to 9 days and resolves -Outbreaks occur virtually every year and communicability is spontaneously. influenced by antigenic shifts and viral mutations that “confuse” Symptoms: the affected patient’s immune system. Headache Nasal congestion Clinical Manifestations Water rhinorrhea Incubation period of 3-6 days. Sneezing Acute illness usually resolves over 2-5 days. Scratchy throat Most patients largely recover within 1 week. General malaise and occasionally fever Symptoms and Signs: Signs: Abrupt onset of headache Reddened, edematous nasal mucosa Fever and chills Water nasal discharge Myalgia and malaise Rhinoviruses are not a major cause of lower Cough, sneezing and sore throat respiratory tract disease. The major problem posed consists of its complications: Rhinoviruses may cause exacerbations of asthma Primary influenza viral pneumonia and Secondary bacterial pneumonia chronic pulmonary disease in adults. Mixed viral and bacterial pneumonia Viral Rhinitis: Extrapulmonary complications: Clinical Manifestations Reye’s syndrome Complications: Myositis, rhabdomyolysis and myoglobinuria Transient middle ear effusion Encephalitis, transverse myelitis Secondary bacterial infection Guillain-Barré syndrome Because of the mild nature and short duration of Treatment the illness, Treatment for uncomplicated influenza is symptomatic a specific diagnosis is not commonly needed; *Salicylates should be avoided in children because of however, viral its association with Reye’s syndrome. cultures can be performed. *Increased oral fluid intake. *Ascorbic acid Treatment Antivirals: No proven specific treatment. Amantadine (Influenza A) Supportive measures: Rimantadine (Influenza B) *Decongestants should not be used for Ribavirin (Influenza A and B) more than a Prophylaxis: week because of rebound congestion noted Vaccination against Influenza A and B after Amantadine and rimantadine cessation (rhinitis medicamentosa). *Antipyretics Viral Rhinitis *Liberal fluid intake The nonspecific symptoms of the ubiquitous common *Ascorbic acid cold are present in the early phases of many diseases Other Viral URTI: that affect the upper aerodigestive tract. Coronavirus Rhinoviruses, members of the Picornaviridae family, Account for 10 to 20% of common colds. are a prominent cause of the common cold, with seasonal Most active in late fall, winter and early spring – a peaks in the early fall and spring. period when Infections highest among infants and young children and the rhinovirus is relatively inactive. decrease with age. Symptoms are similar to those of rhinovirus, but The infection is spread by contact with infected secretions the incubation Other Viral URTI: period is longer (3 days) and usually lasts 6 to 7 Respiratory Syncytial Virus days. Belongs to the Paramyxoviridae family. Mutations of the virus brought about the SARS phenomenon.
or respiratory droplets or by hand-to-hand contact, with autoinoculation of the conjunctival or nasal mucosa.
Major respiratory pathogen of young children and is the foremost cause of lower respiratory disease in infants. Transmitted by close contact with fingers or fomites as well as through coarse (not fine) aerosols produced by coughing or sneezing. Eye irritation, pruritus, erythema Incubation period of 4 to 6 days. and tearing Viral shedding may last two weeks in children but is much shorter in adults. Signs: Clinical Manifestations: Pale or violaceous turbinates Rhinorrhea Occasional polyposis Low-grade fever Treatment Mild systemic symptoms Symptomatic in most cases. Cough and wheezing Oral decongestants 25-40% with lower respiratory tract involvement Antihistamines Treatment: Nasal corticosteroid sprays Antiviral ribavirin for children and infants. Maintaining an allergen-free environment No specific treatment for adults. Air purifiers and dust filters Desensitization Parainfluenza Virus Epistaxis Single-stranded RNA virus of the Paramyxoviridae family. Bleeding Important cause of mild illnesses and croup (laryngotracheobronchitis) from Kiesselbach’s plexus Predisposing factors: , bronchiolitis and pneumonia. Nasal trauma (nose picking, foreign Clinical Manifestations: bodies, Cold or hoarseness with cough forceful nose blowing) Acute febrile illness with coryza Rhinitis Barking cough and frank stridor in children Drying of the nasal mucosa from Treatment: low humidity In mild illness, treatment is symptom-based. Nasal septal deviation Mild croup may be treated with moisturized air from a Alcohol use vaporizer. Antiplatelet medications More severe cases require hospitalization and close Bleeding diathesis observation for development of respiratory distress. Epistaxis No specific antiviral treatment is available. Treatment: Direct pressure on the bleeding Adenovirus site. Infections occur frequently in infants and children with a seasonal Venous pressure is reduced in the distribution of fall to spring. Certain serotypes are associated with outbreaks of acute respiratory sitting position, and leaning forward lessens the disease in military recruits. swallowing of blood. Transmission can take place via inhalation of aerosolized virus, through Short-acting nasal decongestant the inoculation of the conjunctival sac, and probably by the fecal-oral route. sprays Clinical Manifestations: Cautery Rhinitis Pharyngoconjunctival fever (bilateral conjunctivitis, low-grade Treatment of other possible underlying causes of bleeding fever, rhinitis, sore throat and cervical lymphadenopathy) Acute Laryngitis In adults, the most frequent syndrome is the acute Most respiratory disease seen in military recruits, with prominent common cause of vocal hoarseness. May persist for a week or so after sore throat, fever on the second or third day of illness, cough symptoms of upper airway , coryza and regional lymphadenopathy. infection have cleared. Diagnosis and Treatment: Etiologies: Diagnosis is established by isolation of the virus. Viral No specific antiviral therapy is available. Bacterial (Moraxella catarrhalis, A live oral vaccine is available and used widely to Haemophilus influenzae) prevent outbreaks among military recruits. Treatment: Acute Bacterial Sinusitis Avoid vigorous use of voice Erythromycin and other macrolides
Symptoms of rhinitis plus clinical signs and symptoms that indicate involvement of the affected sinus or sinuses such as pain and tenderness over the involved sinus. Occurs when an undrained collection of pus accumulates in a sinus. Typical Pathogens: Streptococcus pneumoniae Other streptococci Haemophilus influenzae Staphylococcus aureus Moraxella catarrhalis Symptoms and Signs: Pain on pressure over the cheeks (maxillary sinuses are the most common sinuses affected). Discolored nasal discharge and poor response to decongestants. Headache “in the middle of the head” or in the forehead. Imaging: Transillumination Caldwell view (frontal) Waters view (maxillary) Lateral view (sphenoid) Submentovertical view (ethmoid) CT scan for recurrent sinusitis MRI if malignancy in suspected Treatment Uncomplicated: Outpatient management Oral decongestants and nasal decongestant sprays Appropriate oral antibiotics for at least two weeks Amoxicillin provides better sinus penetration than ampicillin. Complicated: Failure of sinusitis to resolve after a completed course of antibiotic treatment. Hospitalization for intravenous antibiotics. Complications: Lower respiratory tract infections Osteomyelitis and mucocoele Intracranial complications Malignancy (?) Allergic Rhinitis “Hay fever” Symptoms mimic that of viral rhinitis but more persistent and show seasonal variation. Symptoms: Watery rhinorrhea