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rti

1. RESPIRATORY TRACT INFECTIONS

2. Definition Respiratory tract infection (RTI) is defined by any infectious disease of upper or lower respiratory tract

3. Epidemiology Every year 3.9 million deaths occurs due to acute respiratory tract infections in young children in world Among them 15%-30% deaths occurs in India

4. T ypes Upper Respiratory Tract Infections Cold and Flu Influenza Pharyngitis (Sore throat) Acute Epiglottitis Otitis media Acute Sinusitis

5. Lower Respiratory tract infections Acute Bronchitis Bronchiolitis CommunityAcquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP) Cystic Fibrosis

6. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Cold and Flu Rhino virus Corona virus Influenza virus Parainfluenza virus Respiratory syncytial virus Young children Elders I m m unoc o m p r i mised patients Running nose Sore throat Fever (Some times) Body ache Headache Severe fatigue Clinical presentation

7. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Influenza Influenza virus A, B and C Winter Elders Long stay care facilities Carers Health care workers COPD patients CKD patients Diabetes patients Chronic liver disease patients Severe malaise Myalgia Cough Clinical presentation

8. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Pharyngitis (Sore throat) Epstein Barr virus Streptococcus pyogenes A r canobacteri u m haemolyticum Neisseria gonorrhoea C o r n ybacteri u m diphtheriae Travellers Running nose Sore throat Fever Body ache Headache Severe fatigue Lymph node enlargement White excudate in tonsils Throat swab culture

9. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Acute Epiglottitis H. influenzae Pneumococci Streptococci Staphylococci Children Swollen cherry red epiglottis Fever Difficulty in speaking and breathing Droolong Culture test

10. Upper Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Otitis media S. pneumonia H. influenzae Influenza virus Rhinovirus Children Ear pain Purulent disc h a r ge from ear Hearing loss Culture test Acute Sinusitis S. pneumonia H. influenzae Influenza virus Rhinovirus Dental disease Facial pain Tenderness Head ache Purulent nasal discharge Sinus washout culture

11. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Acute Bronchitis Rhino virus Corona virus Influenza virus Adeno virus Bordetella pertusis Myc o plasma pneumoniae Chlamydophilia pneumoniae COPD patients Productive cough with green or yellow sputum Culture test

12. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Bronchiolitis Respiratory sy n cytial virus Parainfluenz a virus Rhino virus Adeno virus Children Newb o rn babies Pre meature babies Patients with congenital heart disease Fever Wheezing Rapid antigen detection test Respiratory distress Hypoxia Viral culture of respiratory secretions

13. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Community Acquired Pneu m onia (CAP) S.pneumoniae S.aureus H.influenzae Klebsiella pneumoniae People live in crowdy areas Blood stained cough Dyspnea Fever Pleuritic chest pain Consolidation in lobes X-Ray Sputum m icroscopy Sputum cultureBro n c ho alveolar lavage

14. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Hospital Acquired Pneumonia (HAP) Enterobacteri ciae Pseudomonas Acinobactor E.coli Klebseilla HCV Cyt o megalay virus candida Aspergillus ICU patients Stroke patients V entilated patients Sepsis Respiratory failure Sputum culture Blood culture Broncho alveolar lavage

15. Lower Respiratory Tract Infections Disease Causative Organism Risk Factors Clinical Presentation Diagnosis Cystic Fibrosis S. aureus H. influenza P.aureginosa Infants Young children Persistant sputum with cough Shortness of breath Culture test

16. Pathogenesis Bacteria, Virus, and Fungi Risk Factors Risk Factors Enter in to Lower RTI ↓ Bronchi- Bronchitis Bronchioles- Bronchiolitis Alveoli- Pneumonia Alveoli- Cystic Fibrosis Enter in to Upper RTI ↓ Nasal tract- COLD Nasal tract- Flu Nasal tract- Influenza Epiglottis- Epiglottitis Pharynx- Phryngitis Middle Ear- Otitis media Sinus- Acute Sinusitis Inflammatory changes in respiratory tract

17. ↓ Excess mucus production ↓ Hypoxia ↓ Structural damage to Respiratory tract ↓ Failure of exchange of gases ↓ Respiratory failure

18. Complications Otitis media Mastoiditis Meningitis Septecemia Acute Sinusitis Fronal bone osteomyelitis Meningitis Brain abscess Pneumonia Sepsis Respiratory failure Cystic Fibrosis Bronchiectasis Permenant lung disease

19. Non Pharmacological Treatment Vaccination Oxygen therapy Chest physiotherapy Ventilation Post operative mobilisation Lung transplantation

20. Antipyretics Analgesics Antihistamines N e uro a min a d ase inhibitors Z a n a mivi r - Inhalor Os e lt a mavi r - oral Tab Viral infection- Self limited B acterial i n f ec tions- A n tibiot ics Pencillins Cephalosporins Macrolides A ntibiotics Pencillins Cephalosporins A ntibiotics Pencillins Cephalosporins A ntibiotics Pencillins Cephalosporins Metronidazole Doxycycline COLD& Flu I n fl u enza Pharyngitis (Sore throat) Otitis m e d i a Acute Ep i g l ottiti s Acute Si n usiti s UPPER RTI

21. Pencillins Cephalosporins Macrolides Tetracyclines Ribavarin Pencillins Cephalosporins Macrolides Mild to Moderate Pencillin+ Macrolide Severe C e ph a losporin+ Macrolide Co a mo x y c lav+ Macrolide Flucloxacillin Linezolid Pencillin+ Amino g l y cosides or Cephalosporins+ Aminoglycosides or Fluroquinolones+ Aminoglycosides M e rop e n a m or T e icopl a nin or Linezolid or Vancomycin Flucloxacillin Macrolide Fluroquinolone Colistin nebuliser B e tal ac tum + Amin o g lycoside Acute B r o n chiti s B r o n chi o l i ti s CAP HAP Cystic F i brosis LOWER RTI

22. Dr u gs used in t r eatment of R TI Drug Category Mode of action Dose Adverse effects Amoxicillin Pencillins Inhibit cell wall synthesis in bacteria 250mg-TID 500mg-BD 875mg-BD (Severe Pn e umoni a ) Anemia Hepatotoxicity GI disturbances Pseudomembranous colitis Amoxiclav Amoxicillin + Clavulanic acid Inhibit cell wall synthesis in bacteria + Prevents antibiotic resistance 500/125mg- BD/ TID 250/125m g - 875/125m g - BD Diarrhea Mycosis CNS disturbances Candidiasis Vaginitis Cephalexin Cephalosporin Inhibit cell wall synthesis in bacteria 250mg-QID 500mg-BD Abdominal pain Anemia Angioedema Transaminitis Pseudomembranous colitis Cefotaxime Cephalosporin Inhibit cell wall synthesis in bacteria 1 g - B D- IV 2g-TID-IV Pseudomembranous colitis Diarrhea Hepatotoxicity Nephrotoxicity Injection site pain Ceftrixone Cephalosporin Inhibit cell wall synthesis in bacteria 50mg/kg-OD Induration at injection site Eosinophilia Thrombocytopenia Diarrhea Hepatotoxicity

23. Azithromycin Macrolides Inhibit protein synthesis in bacteria 500mg-OD First day ↓ 250mg- OD for 4 days GI disturbances Cramping Vaginitis Dyspepsia Agitation Ciprofloxacin Fluroquinolone Inhibit protein synthesis in bacteria 500mg-BD GI disturbances Hepatoxicity Nephrotoxicity Restlessness Rashes Linezolid Miscellaneous antibiotic Inhibit protein synthesis in bacteria 600mg- BD GI disturbances Diarrhea Hepatotoxicity Taste disturbances Tonugue discoloration Meropenam Carbepenams Inhibit cell wall synthesis in bacteria 500mg-TID for five days GI disturbances Injection site reactions Phlebitis Bleeding Sepsis Doxycycline Tetracyclines Inhibit protein synthesis in bacteria 200mg-OD Glossitis Teeth discoloration GI disturbances Esophagitis

24. Resources https:// www.ncbi.nlm.nih.gov/pubmed/30921179 https:/ /ww w .ncbi.nlm.nih.gov/pubmed/30832720 https:/ /ww w .ncbi.nlm.nih.gov/pubmed/30612559 https:// www.ncbi.nlm.nih.gov/pubmed/30407312 https:/ /ww w .ncbi.nlm.nih.gov/pubmed/30329199