Respiratory Tract Infections, Neoplasms, and Childhood Disorders

Areas Involved in Respiratory Tract Infections
Upper respiratory tract
Nose, oropharynx, and larynx
Lower respiratory tract
Lower airways and lungs
Upper and lower airways
Common Respiratory Infections
Common cold
Influenza
Pneumonia
Tuberculosis
Fungal infections of the lung
Factors Affecting the Signs and Symptoms of Respiratory Tract Infections
The function of the structure involved
The severity of the infectious process
The person’s age and general health status

Rhinitis and Sinusitis
Rhinitis
Inflammation of the nasal mucosa
Sinusitis
Inflammation of the paranasal sinuses
Types of Sinuses
Paranasal sinuses
Air cells connected by narrow openings or ostia with the superior, middle, and inferior nasal turbinates of the nasal cavity
Maxillary sinus
Inferior to the bony orbit and superior to the hard palate
Its opening is located superiorly and medially in the sinus, a location that impedes drainage
Frontal sinuses
Open into the middle meatus of the nasal cavity
Types of Sinuses (cont.)
Sphenoid sinus
Just anterior to the pituitary fossa behind the posterior ethmoid sinuses
Its paired openings drain into the sphenoethmoidal recess at the top of the nasal cavity
Ethmoid sinuses
Comprise 3 to 15 air cells on each side, with each maintaining a separate path to the nasal chamber


Classifications of Rhinosinusitis
Acute rhinosinusitis
May be of viral, bacterial, or mixed viral-bacterial origin
May last from 5 to 7 days up to 4 weeks
Subacute rhinosinusitis
Lasts from 4 weeks to less than 12 weeks
Chronic rhinosinusitis
Lasts beyond 12 weeks

Allergic Rhinosinusitis
Occurrence
Occurs in conjunction with allergic rhinitis
Mucosal changes are the same as allergic rhinitis
Symptoms
Nasal stuffiness, itching and burning of the nose, frequent bouts of sneezing, recurrent frontal headache, watery nasal discharge
Treatment
Oral antihistamines, nasal decongestants, and intranasal cromolyn
Types of Influenza Viruses
Type A
Most common type
Can infect multiple species
Causes the most severe disease
Further divided into subtypes based on two surface antigens: hemagglutinin (H) and neuraminidase (N)
Type B
Has not been categorized into subtypes
Antiviral Drugs
Amantadine
Rimantadine
Zanamivir
Oseltamivir
Types of Influenza Vaccinations
Trivalent inactivated influenza vaccine (TIIV)
Developed in the 1940s
Administered by injection
Live, attenuated influenza vaccine (LAIV)
Approved for use in 2003
Administered intranasally
Pneumonia
Definition
Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)
Causes
Infectious agents: such as bacteria and viruses
Noninfectious agents: such as gastric secretions aspirated into the lungs
Factors Facilitating Development of Pneumonia
An exceedingly virulent organism
A large inoculum
Impaired host defenses

Classifications of Pneumonias
According to source of infection
Community-acquired
Hospital-acquired
According to immune status of the host
Pneumonia in the immunocompromised person
Categories of Persons with Community-Acquired Pneumonia
Persons without cardiopulmonary disease or other modifying factors that can be treated on an outpatient basis
Persons with cardiopulmonary disease and/or other modifying factors who can be treated on an outpatient basis
Persons who require hospitalization but not admission to the intensive care unit (ICU)
Persons who require admission to the ICU either because of cardiopulmonary disease or type of infectious organism causing the infection
Symptoms of Legionella Pneumonia
Begin approximately 2 to 10 days after infection:
Malaise, weakness, lethargy, fever, and dry cough.
Other manifestations include:
Disturbances of central nervous system function
Gastro-intestinal tract involvement
Arthralgias
Elevation in body temperature
Forms of Tuberculosis
M. tuberculosis hominis (human tuberculosis)
Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis
Living under crowded and confined conditions increases the risk for spread of the disease
Bovine tuberculosis
Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract
Has been virtually eradicated in North America and other developed countries
Positive Tuberculin Skin Test
Results from a cell-mediated immune response
Implies that a person has been infected with M. tuberculosis and has mounted a cell-mediated immune response
Does not mean the person has active tuberculosis
Classification of Fungi
Yeasts
Are round and grow by budding
Molds
Form tubular structures called hyphae
Grow by branching and forming spores
Dimorphic Fungi
Grow as yeasts at body temperatures and as molds at room temperatures
Laboratory Tests to Diagnose Histoplasmosis
Cultures
Fungal stain
Antigen detection
Serologic tests for antibodies
Categories of Bronchogenic Carcinomas
Squamous cell lung carcinoma (25% to 40%)
Adenocarcinoma (20% to 40%)
Small cell carcinoma (20% to 25%)
Large cell carcinoma (10% to 15%)
Categories of the Manifestation of Lung Cancer
Those due to involvement of the lung and adjacent structures
The effects of local spread and metastasis
The nonmetastatic paraneoplastic manifestations involving endocrine, neurologic, and connective tissue function
Nonspecific symptoms such as anorexia and weight loss

Stages of Lung Development
Embryonic period
Pseudoglandular period
Canicular period
Saccular period
Alveolar period
Respiratory Disorders in the Neonate
Respiratory Distress Syndrome
Bronchopulmonary Displasia

Respiratory Disorders in Children
Upper airway infections
Viral croup
Spasmodic croup
Epiglottis
Lower airway infections
Acute bronchiolitis