or respiratory droplets or by hand-to-hand

contact, with
autoinoculation of the conjunctival or nasal
Diseases of the Respiratory System
mucosa.
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.
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.
Incubation period of 4 to 6 days. Eye irritation, pruritus, erythema
and tearing
Viral shedding may last two weeks in children but is much shorter in adults.
Clinical Manifestations: Signs:
Rhinorrhea Pale or violaceous turbinates
Low-grade fever Occasional polyposis
Mild systemic symptoms Treatment
Cough and wheezing Symptomatic in most cases.
25-40% with lower respiratory tract involvement Oral decongestants
Treatment: Antihistamines
Antiviral ribavirin for children and infants. Nasal corticosteroid sprays
No specific treatment for adults. Maintaining an allergen-free environment
Air purifiers and dust filters
Parainfluenza Virus Desensitization
Single-stranded RNA virus of the Paramyxoviridae family. Epistaxis
Bleeding from Kiesselbach’s plexus
Important cause of mild illnesses and croup (laryngotracheobronchitis)
, bronchiolitis and pneumonia. Predisposing factors:
Clinical Manifestations: Nasal trauma (nose picking, foreign
Cold or hoarseness with cough bodies,
Acute febrile illness with coryza forceful nose blowing)
Barking cough and frank stridor in children Rhinitis
Treatment: Drying of the nasal mucosa from
In mild illness, treatment is symptom-based. low humidity
Mild croup may be treated with moisturized air from a Nasal septal deviation
vaporizer. Alcohol use
More severe cases require hospitalization and close Antiplatelet medications
observation for development of respiratory distress. Bleeding diathesis
No specific antiviral treatment is available. Epistaxis
Treatment:
Adenovirus Direct pressure on the bleeding
Infections occur frequently in infants and children with a seasonal site.
distribution of fall to spring. Venous pressure is reduced in the
Certain serotypes are associated with outbreaks of acute respiratory sitting position,
disease in military recruits. and leaning forward lessens the
Transmission can take place via inhalation of aerosolized virus, through swallowing of blood.
Short-acting nasal decongestant
the inoculation of the conjunctival sac, and probably by the fecal-oral route.
Clinical Manifestations: sprays
Rhinitis Cautery
Pharyngoconjunctival fever (bilateral conjunctivitis, low-grade Treatment of other possible
fever, rhinitis, sore throat and cervical lymphadenopathy) underlying causes of bleeding
In adults, the most frequent syndrome is the acute Acute Laryngitis
Most common cause of vocal hoarseness.
respiratory disease seen in military recruits, with prominent
May persist for a week or so after
sore throat, fever on the second or third day of illness, cough
, coryza and regional lymphadenopathy. symptoms of upper airway
Diagnosis and Treatment: infection have cleared.
Diagnosis is established by isolation of the virus. Etiologies:
No specific antiviral therapy is available. Viral
A live oral vaccine is available and used widely to Bacterial (Moraxella catarrhalis,
prevent outbreaks among military recruits. Haemophilus influenzae)
Acute Bacterial Sinusitis Treatment:
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