Introduction:
Upper and lower respiratory tract infections are a major cause of morbidity and mortality worldwide; patients at the extremes of age and those with pre-existing lung disease or immune suppression are at particular risk. Acute epiglottitis present as a medical emergency situation because of the risk of asphyxia, thereby, requiring prompt diagnosis and treatment.
Upper respiratory tract infections cases recover rapidly and may be identified by serological tests. Throat swabs may also be helpful if streptococcal laryngitis is suspected. Chest X-rays may be required if underlying chronic sinusitis is suspected.
What Are the Most Common Upper Respiratory Tract Infections?
The most common upper respiratory tract infections include:
-
Acute Coryza (common cold).
-
Acute Pharyngitis.
-
Acute Laryngo-tracheobronchitis.
-
Acute Epiglottitis.
-
Acute Bronchitis and Tracheitis.
-
Influenza.
-
Pneumonia.
What Is Acute Coryza?
Clinical Features:
-
Rapid onset.
-
Sneezing.
-
Sore throat.
-
Watery nasal discharge.
-
Cough.
Management: Treatment is not usually required. Paracetamol 0.5- 1 gram every 6 hours. Antibiotics are not required if uncomplicated.
Complications:
-
Sinusitis.
-
Bronchitis.
-
Pneumonia.
-
Otitis media due to blockage of the eustachian tube.
-
Hearing impairment.
What Is Acute Pharyngitis?
Clinical Features:
-
Sore throat.
-
Loss of voice with pain during speaking.
-
Painful and unproductive cough.
-
Stridor in children is caused by inflammatory edema leading to partial obstruction of a small larynx.
Management:
-
Rest voice.
-
Paracetamol 0.5-1g can be given for six hours to relieve discomfort and pyrexia. Antibiotics are not required if uncomplicated. Steam inhalation may be helpful.
Complications:
Though the complications are rarely seen. These may include,
-
Chronic laryngitis.
-
Tracheitis.
-
Bronchitis.
-
Pneumonia.
What Is Sinusitis?
Clinical Features:
-
Fever.
-
Severe unilateral pain over maxillary or other sinuses.
-
Purulent nasal discharge.
-
It is commonly a viral infection but bacterial if it persists for more than seven days, such as streptococcus pneumonia or Haemophilus influenzae.
Management:
-
Steam inhalation and nasal decongestant.
-
Amoxiclav is the drug of choice if a bacterial infection is suspected.
Complications:
Infection may spread to the central nervous system or orbit.
What Is Acute Laryngo-tracheobronchitis?
Clinical Features:
-
Sudden paroxysms of cough.
-
Stridor.
-
Breathlessness.
-
Cyanosis and asphyxia in small children.
-
Contraction of accessory muscles and the indrawing of intercostal muscles.
Management:
-
Steam inhalations and humidified air / high concentration of oxygen.
-
Endotracheal intubation or tracheostomy, a surgical method of intubation may be required in cases of laryngeal obstruction and allow the clearing of bronchial secretions.
-
Intravenous amoxiclav or erythromycin may be administered for serious illnesses.
-
Maintain adequate hydration.
Complications:
-
Superinfection with bacteria, especially streptococcus pneumonia and staphylococcus aureus.
-
Viscid secretions may occlude the bronchi.
-
Death from asphyxia.
What Is Acute Epiglottitis?
Clinical Features:
-
Fever.
-
Sore throat.
-
Stridor.
-
Dysphagia is caused by swelling of the epiglottis and surrounding tissues.
Management:
-
Intravenous amoxiclav or chloramphenicol therapy is necessary.
-
Immediate endotracheal intubation or tracheostomy may be required.
Complications:
-
Death from asphyxia may be precipitated by attempts to examine the throat.
-
Avoid using a tongue depressor or any instrument unless facilities for endotracheal intubation or tracheostomy are immediately available.
What Is Acute Bronchitis and Tracheitis?
Clinical Features:
-
Initial dry and painful cough.
-
Retrosternal discomfort in tracheitis.
-
Chest tightness.
-
Wheeze.
-
Breathlessness.
-
Sputum is initially insufficient or mucoid, then becomes mucopurulent, alongwith more copious sputum, and in case of tracheitis, often blood-stained.
-
Acute bronchitis may be associated with high fever of 38-39 degree centigrade.
-
Spontaneous recovery occurs over a few days.
Management:
-
Specific treatment is rarely necessary for previously healthy individuals.
-
Amoxicillin 250 mg 8 hourly interval should be given to those developing bronchopneumonia.
-
Cough may be managed with adminstration of pholcodine 5-10 mg 6-8 hourly.
-
In Chronic obstructive pulmonary disease and asthma, aggressive treatment of exacerbations may be required.
Complications:
-
Bronchopneumonia.
-
COPD or acute exacerbation of asthma, which, if severe, may result in type 2 respiratory failure.
What Is Influenza?
Clinical Features:
-
Sudden onset of pyrexia.
-
Generalized body ache.
-
Anorexia.
-
Nausea and vomiting.
-
Harsh unproductive cough.
-
Most patients recover within 3-5 days but may be followed by "post-viral syndrome" with debility that persists for weeks.
Management:
-
Bed rest.
-
Paracetamol 0.5-1 g every 4-6 hours.
-
Pholcodine 5 to 10 mg 6 to 8 hourly for cough.
-
Specific treatment for pneumonia may be necessary.
-
Antiviral agents such as zanamivir may decreases the rate of viral replication and may be effective when used as an adjunct to vaccination.
Complications:
-
Tracheitis.
-
Bronchitis.
-
Bronchiolitis.
-
Bronchopneumonia.
-
Secondary bacterial invasions by streptococcus pneumonia, Haemophilus influenzae, and staphylococcus aureus may occur.
-
Rarely, toxic cardiomyopathy (which may cause sudden death), encephalitis, demyelinating encephalopathy, and peripheral neuropathy may be seen.
What Is Pneumonia?
It can be defined as an acute respiratory illness associated with recently developed radiological pulmonary shadowing, which may be segmental, lobar, or multilobar. Pneumonia is usually classified as community or hospital-acquired or in immunocompromised hosts.
Lobar pneumonia is a radiological and pathological term referring to the homogenous consolidation of one or more lungs, often with associated pleural inflammation; bronchopneumonia refers to more patchy alveolar consolidation associated with bronchial and bronchiolar inflammation, often affecting both lower lobes.
Community-Acquired Pneumonia (CAP):
Most cases are spread by droplet infection and occur in previously healthy individuals, but several factors may impair the effectiveness of local defenses and predispose them to community-acquired pneumonia. Streptococcus pneumoniae remains the most common infecting agent, and after that, the likelihood that other organisms may be involved depends on the age of the patient and the clinical context.
Clinical Features:
Pneumonia usually presents as an acute illness in which systemic features such as
-
Fever.
-
Rigors.
-
Shivering.
-
Anorexia.
-
Headache.
-
Breathlessness.
-
Cough, which at first is characteristically short, painful, and dry but later accompanied by expectoration of mucopurulent sputum.
-
Haemoptysis.
-
Rust-colored sputum may be seen in patients with strep. pneumoniae infection.
-
Pleuritic chest pain.
-
Proteinaceous fluid and inflammatory cells may congest the airways, leading to the consolidation of lung tissue.
Investigations:
- Chest X-Ray: It usually confirms the diagnosis. In lobar pneumonia, a homogeneous opacity localized to the affected lobe or segment usually appears within 12-18 hours of the onset of the illness.
- Pulse Oximetry, a non-invasive procedure of determining the arterial oxygen saturation and monitoring response to oxygen therapy.
- Complete Blood Count: White cell count may be marginally raised in pneumonia caused by atypical organisms, whereas neutrophil leucocytosis of more than 15x109 per liter favors a bacterial etiology. A very high or low white cell count may be seen in severe pneumonia.
- C-reactive protein is typically elevated.
Management:
-
Oxygen Therapy: Oxygen should be administered to all patients with tachypnea hypoxemia and hypotension to maintain partial pressure of oxygen at 60 mm Hg or oxygen saturation of more than 92 %.
-
Antibiotic Therapy: In most cases with uncomplicated pneumonia, a seven to ten days course is usually adequate, although treatment is required longer in patients with legionella, klebsiella, or staphylococcal pneumonia.
-
Pleuritic pain: Analgesics with paracetamol is sufficient.
Complications:
-
Empyema.
-
Retention of sputum causes lobar collapse.
-
Pulmonary embolism.
-
Pneumothorax, particularly with staph aureus.
-
Acute respiratory distress syndrome.
Conclusion
Bacteria, viruses, or fungi can cause infectious lung disease. The symptoms may be similar to the common cold, be more severe, and last longer. Extremesageages and immunocompromised individuals are at risk. Clinical presentations may vary. Lung infections typically include bluish discoloration, difficulty breathing, severe chest pain, productive cough, and high fever. Early intervention has proven beneficial for the patient's longevity.
