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OUTLINE
I. Introduction
A. Respiratory Tract Infections
B. Laboratory Studies for
Respiratory Viruses
II. Upper Respiratory Tract Infections
A. Rhinovirus
B. Adenovirus
C. Coronavirus
III. Lower Respiratory Tract Infections
A. Influenza Virus
B. Respiratory Syncytial Virus
I. INTRODUCTION
A. Resiratory Tract Infections
Upper Respiratory Tract Infections (URTIs)
Involves nasal cavity, pharynx, larynx
Rhinovirus, coronavirus, enterovirus, adenovirus, EBV (EpsteinBarr virus)
More typical type of infections
Table 1.Common URTIs And Affected Areas
Areas Affected
Rhinitis
Nasal mucosa
Rhinosinusitis/
Nares,paranasal sinuses
Sinusitis
Rhinopharyngitis
Nares, pharynx, hypopharynx, uvula and tonsils
Pharyngitis
Pharynx, hypopharynx, uvula and tonsils
Epiglottitis/
Superior portion of the larynx,supraglottic area
Supraglottitis
Laryngitis
Larynx
Laryngotracheitis Larynx, trachea and subglottic area
Tracheitis
Trachea and subglottic area
Mostly inflammations
Sinusitis may involve all paranasal sinuses (frontal, ethmoid,
maxillary, sphenoid)
Common cold: Rhinopharyngitis
Supraglottitis is also caused by influenza B
Lower Respiratory Tract Infections
Trachea, bronchi, lungs
Influenza, parainfluenza, RSV (respiratory syncytial virus)
Very virulent pathogen, or patient is immunocompromised
Respiratory Invaders
Table 2. Types of Respiratory Invaders
Requirement
Adhesion to normal
mucosa
Professional
Invaders
Secondary
Invaders
Chronic bronchitis
Depressed immune
responses
Depressed resistance
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Examples
Respiratory viruses,
S. pyogenes,
M. pneumoniae, M.
pneumoniae, Chlamydia
Bordatella pertussis, M.
pneumoniae, S.
pneumoniae
Legionella, M.
tuberculosis
C. diphtheria, S.
pneumoniae
S. aureus, S. pneumonia
S. aureus, Pseudomonas
H. influenzae,S.
pneumoniae
Pneumocytiscarinii,CMV
(cytomegalovirus),
M. tuberculosis
S. pneumoniae,S.
aureus,H. influenzae
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Characteristics
Small, 18-30nm
Naked capsid
o Environmentally stable to: Temperature, acid, proteases,
detergents, drying
o Can be spread easily
o Can dry out and retain infectivity
o Can survive the adverse conditions of the gut
o Can be resistant to poor sewage treatment
(+)single stranded RNA with icosahedral symmetry
> 100 serotypes
o No cross-protection between different serotypes
o There is no vaccine against these viruses
Transmission
Aerosol or direct contact with contaminated secretions
Primary site of inoculation: Nasal mucosa(conjunctiva can also be
involved to a lesser extent)
Major human rhinovirus receptor: ICAM-1 (Intercellular adhesion
molecule 1)
o Binds endothelial cells with leukocytes at time of infection
o Aids in binding of endothelial cells with WBCs, facilitating viral
spread
o Virus upregulates ICAM-1 (ends up calling more rhinoviruses)
Optimal temperature for replication: 33-35C
Incubation period: approximately 2-4 days
Pathogenesis
1. Source of virus
2. Transmission to human host
3. Binding of capsid protein to ICAM-1
4. Virus then multiplies
5. Spread of infection to neighboring cells via surface secretions to
new sites on the mucosal surface of the respiratory tract
6. Damage to epithelial cells
7. Secretion of fluid containing inflammatory mediators such as
bradykinin
8. Cold-type symptoms: stuffiness, congestion
Cytopathic effect of rhinovirus: loss of fibroblasts
Viremia is absent
May lead to secondary bacterial infection
Classification
Table 4. Classification of Adenovirus
Representative
Subgroup
Target Organ
Viruses
A
12, 18, 31
GIT
Pharynx, lungs,
B
3, 7, 11, 21
urinary tract,
conjunctiva
C
1, 2, 5, 6
Pharynx
D
8, 9, 19
Eye
E
4
Upper RT
F
40, 41
GIT
Epidemiology
Endemic
Endemic
Latent throat
Epidemic
Epidemic
Endemic
Treatment
Symptomatic relief
Decongestants
o NaCl sprays, phenylpropanolamines, etc.
o Btter to take in lots of water
Antihistamines for atopy or allergic rhinitis
NSAIDs (non-steroidal anti-inflammatory drugs)
Do not give antibiotics
Antivirals: No role since infection is only mild and is self-limiting
(laboratory diagnosis not usually done)
Vaccines against respiratory viruses provide cross-protection
C. Coronavirus
Characteristics
Has projections that look like a crown
Enveloped, (+) single stranded RNA with loose helical
nucleocapsid
Narrow host range
Cause of SARS (severe acute respiratory syndrome)
Can also be found in birds (no cross-reactions across species
unlike the influenza virus)
SARS Coronavirus
B. Adenovirus
Characteristics
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Transmission
Very contagious: Can survive outside the body on a dry surface for
at least 3-4 hours
Droplet spread
Direct contact (can spread by any body fluid contact)
Laboratory Diagnosis
Serological testing
o IFA (indirect fluorescent microscopy)
o ELISA: Only for specimens obtained >21 days by fever
Molecular testing
o RT-PCR (reverse transcriptase polymerase chain reacion):
Mainstay of therapy
o Can detect infection within the first 10 days
Culture
o Difficult to do (requires biosafety level 3 laboratory)
o Use nasopharyngeal aspirates, throat swabs, others (feces)
Treatment
Isolation: quarantine
Supportive: fluids
Ribavirin (2015)
III. LOWER RESPIRATORY TRACT INFECTIONS
A. Influenza Virus
Belongs to theOrthomyxoviridae family
Ortho means true or regular
Myxo refers to the ability of the virus to attach to mucus
membrane
Types of Influenza Viruses
Table 5. Types of Influeza Viruses
Antigenic
Antigenic
Type
Drift
Shift
A
+
+
B
+
Can Cause
Pandemic
Epidemic
Act as the mixing vessel for human and avian flus (can come up with
novel strains from different sources of infection)
Swine flu or A(H1N1)
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Relatively
Stable
Surface Glycoprotein
Name
Spanish Flu
Asian Flu
Hong Kong Flu
Avian/Bird Flu
Deaths
>20M
>2M
>2M
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Flu Pandemic
The avian strain or A(H5N1) raised the concern of a new influenza
pandemic after it emerged in Asia in the 1990s (not considered a
pandemic back then)
Novel flu strain evolved that combined genes from human, pig
and bird influenza viruses: Swine flu or A(H1N1) emerged in
Mexico
World Health Organization officially declared the outbreak to be
pandemic on 11 June 2009
Confirmed case of A(H1N1)
Defined as a person with an acute febrile respiratory illness
with laboratory confirmed novel influenza A(H1N1) virus
infection at any WHO-approved laboratories via one or more of
the following:
o F (fusion) protein
Induce syncytia in cell culture
Also for virus penetration and spread
Beneficial for:
Pregnant patients
Patients with progressing lower respiratory disease or pneumonia
Patients with underlying medical conditions
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Transmission
Respiratory droplets
Common habitat: human reservoir
Can also infect cattle, monkeys, goats, rodents
Common cold during cold weather (winter or rainy season)
Pathogenesis
1. Infects ciliated cells of respiratory tract
2. Disseminates locally
3. Inoculation occurs through the nose/eyes and spreads through
respiratory epithelium
4. Viral replication in the peribronchial tissue leads to edema,
proliferation and necrosis of bronchioles
5. Collection of sloughed epithelial cells leads to obstruction of small
bronchioles and air trapping (can produce a wheezing sound,
mistaken as bronchial asthma)
Epidemiology
Common (outbreaks during winter and fall)
High risk groups
o Very young infants (<6 weeks) especially preemies
o Older adults
o Mortality from RSV pneumonia can approach 20% in this group
o Children with bronchopulmonary dysplasia and congenital
heart disease
o Immunocompromised individuals
o SCID (severe combined immunodeficiency)
o Transplant recipients
o Hematologic malignancies
Clinical Presentation
Respiratory tract infections
o Bronchiolitis in children <1 year old
o Common cold in older children and adults
Complete recovery possible
RSV Bronchiolitis
Primary infection is usually symptomatic and lasts for 7-21 days
o Starts as URI with congestion, sore throat, fever
o Cough deepens and becomes more prominent
Lower respiratory tract involvement is heralded by increase in
respiratory rate and retraction of intercostal muscles (appears like
pneumonia)
Hospitalization rates can approach 40% in young infants
Reinfection occurs in adults and older children, but is rarely
asymptomatic, i.e. recovery is complete but immunity is not
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Laboratory Diagnosis
Clinical Manifestations
OUTLINE
I. Histoplasmacapsulatum
II. Aspergillusfumigatus
I. HISTOPLASMA CAPSULATUM
Histoplasmosis
Pulmonary infection resembling tuberculosis
o First recognized as a disease among patients who were x-ray
positive but tuberculin negative
o Intracellular mycotic infection of the RES (reticuloendothelial
system), i.e. lesions are not confined to the lungs
o Disease mainly affects the lungs with most patients often
showing minimal or no symptom
Pathogenesis: Inhalation of conidia from the fungus
Reservoir: Soil contaminated with bird or bat droppings
Agent Distribution
H.capsulatum is found among the major river valleys in North and
South America
Can also be found in some areas in Africa
Found in at least 50 countries in the temperate regions and the
tropics including the Philippines
Transmission
Exposure to contaminated soil with bird or bat droppings is
considered to be a risk factor
o Grows in bird or bat droppings (microconidia spores may be
inhaled and may settle in alveoli)
o Spores survive when phagocytosed by macrophages
o Cause edema, pneumonitis (similar picture to TB or primary
complex in children)
Once the human host is infected, T cell mediated immune
response will be activated, involving the RES
Histologically, it can mimic the appearance of the Ghons complex
From thereon, it can disseminate to other organs
~90% would be asymptomatic
o Amphotericin B
Severe acute pulmonary histoplasmosis
Chronic pulmonary and disseminated histoplasmosis
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END
Jio:
4 day weekend!! Then, 3 day weekend!! Use the free days wisely!! Btw, Im
making this trans with a broken letter a button on my laptop. So, every
time I need to type the letter a, I paste a copied letter a.
Pwedenamansanang q nalangyungnasira. Walalang. Just ranting. Halfway
through the semester!! 2 more months, sem break na! Lets go block B!
Nick:
I dont usually give greetings, but when I do
Jim:
Hi ****! Miss nakita. :piMed, paki-click yung Miranda Kerr link ni Terence. Iprint at ipakitakay Jer. Hello 14A04 club! Kamustanaang bouncer
niyongsiAlexeis?MSSR 2016, salirin kayo samga international conferences
next year: MM 2013 USA, AMSC 2013 Malaysia, AM 2013 Chile, APRM 2013
Indonesia at EAMSC 2014 Korea. :D Wag langsobrahanporket ICC year,
bakamasunogtayo. =))Vincen, nice labeneh. :pBalitakohindika raw
nabibigyanng hard copy ngtranses ah?
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