Course info

Respiratory Tract Infections

When we are in closed contact with a person with respiratory tract infection, we are at risk of catching infection. Simple techniques, such as, proper hand washing and covering face while coughing or sneezing, may reduce the spread of upper respiratory infections.

Generally, the symptoms of the respiratory tract infections are self-limited. Depending on the complaints and symptoms of the patient, we should be able to give advice and prescribe the best medication and know when we should refer them to their GP for more intensive treatment. Advise the patient to visit a doctor when symptoms last more than two weeks, when swallowing is impaired and there is difficulty breathing. Also, if symptoms are recurring and are worsening.

In this course, we will learn about the symptoms of common respiratory tract infections. Cough is not thoroughly discussed in here because it has been previously tackled.

 

Protectors of the respiratory tract:

Before a virus or bacteria can invade the respiratory tract, they first have to go through barriers.

The hair in the lining of the nose traps the invading organisms. The nasal cavity has wet mucus that can engulf the organisms. Furthermore, the motile cilia which are small hair-like structure in the trachea(windpipe) drive the organisms into the digestive tract and into the stomach.

Our immune system also helps fight infection through the help of antibodies they engulf and destroy microbes.

If we have an intense barrier in the upper respiratory tract, then why is it that some people still suffer the symptoms of infection?

Viruses and bacteria can resist destruction through various mechanisms. They have the ability to change their shape and structure so that the immune system cannot recognize them. They also produce toxins that can impair the body's defense system. They can also produce adhesion factors so they can stick to the mucus.

 

Rhinitis symptoms include runny nose (rhinorrhea), sneezing, nasal itchiness and congestion. It may coexist with allergy, asthma or sinusitis. Chronic rhinitis may lead to post-nasal drip that might turn into sore throat or cough. This is characterized by a feeling of mucus dripping down from the back of the nose and throat.

If symptoms last for a few days, a secondary bacterial infection may have developed. This is often characterized by yellow to green drainage. In this case, antibiotic therapy should be prescribed.

 

Sore throat is characterized by a painful burning or scratching sensation in the back of the throat and with pain when swallowing. May also include coughing, runny nose, sneezing, fever and a swollen lymph node. This symptom usually lasts 7 to 10 days. Beyond that, a physician should be consulted.

Remedies:

·         gargling with warm salted water

·         sipping hot herbal teas

·         lozenges like Strepsils, Dequalinium and herbal candies

·         Paracetamol and/or Ibuprofen for pain and fever

·         throat spray

§  Iodine Nodonool throat spray that is used to sterilize and disinfect the throat. Spray 3-5times a day while breathing out. Contraindicated in people with thyroid problems and children under 2-year-old.

§  Propolis Throat Spray helps to lubricate the throat and refresh breath. It has antibacterial, antiviral and antifungal properties and a good stimulant of the immune system. Good to recommend to people who are proned to colds and flu. Spray 2-3 times per day.

 

Strep throat is caused by Streptococcus pyogenes, which is a normal flora of the throat and the nose. However, these bacteria may cause harm when the immune system is low. This type of throat infection should be properly treated to prevent development of RF or Rheumatic Fever and other serious illnesses that causes joint pain, heart valve damage and acute nephritis.

Recurrence of strep throat can happen if the infection was not treated properly the first time. Missed doses and incomplete antibiotic therapy will not clear the infection.

 

Scarlet fever, also known as strawberry tongue, is caused by bacteria known as group A streptococci (GAS). It usually starts with a sore throat and fever, then a rash that follows within 48hours. It mostly affects children from 4 to 8 years of age.

The rash starts on the trunk and spreads to the arms and legs. It looks like sunburn, but it feels rough like sandpaper. The rash may be redder in skin folds. As the rash starts to go away, the skin may peel.

 

Tongue changes are common during the disease ("strawberry tongue"). The tongue may first appear white with red bumps and then turn beefy red.

 

 

 

 

Sinusitis

The sinuses are air spaces in the skull and facial bones. They work to humidify and warm the inspired air, help protect the eyes and nerves, act as a buffer against facial trauma, and increase voice resonance. They are located in the forehead (Frontal), inside the cheekbones (Maxillary) and behind the nose (Ethmoid and sphenoid)

Sinusitis is the inflammation of the sinuses that can be caused by viruses, bacteria or fungi; allergies or by irritation of the sinuses. When the airflow and drainage of mucus in the sinuses are interfered, infections of the sinuses occur. Blockage may also be caused by common colds, allergies, nasal sprays or cigarette smoke. Furthermore, tumors or tissue growth around the nasal passages will also block the sinuses.

The use of antihistamines, if possible, should be avoided, unless it is really caused by allergy, because of its drying effect which might aggravate the symptoms of sinusitis.

Symptoms:

·Sinus headache

·Facial tenderness as well as redness and swelling of nasal passages

·Fever

·Cloudy discolored drainage. A dark-colored discharge may be a sign of fungal infection.

·Stuffy nose

·Sore throat

·Cough

Types:

·         Infectious

o Acute sinus infection – duration is less than 30. May be caused be uncomplicated virus or bacterial infection, if not properly treated may result to subacute or chronic sinusitis.

o Subacute sinus infection - over 1 month but less than 3 months

o Chronic sinus infection - more than 3 months duration. This may be caused by polyps or abnormal sinus anatomy or dental problems.

·         Noninfectious sinusitis is caused by irritants and allergic conditions. May be Acute, Subacute and chronic depending on the duration.

Treatment:

·         Pain medications

·         Mucolytics

·         Nasal irrigation with sea water or Neti-pot

·         Antibiotics like Amoxicillin, Amoxicillin Clavulanic Acid, Clarithromycin, Azithromycin and Trimethoprim

·         Nasal Decongestants in the form of spray, nasal drops or oral medications. They help to shrink the inflamed tissue and consequently allow secretions to pass through. Advise usage to not exceed 3 days to prevent occurrence of rebound sinusitis or rhinitis medicamentosa.

 

Bronchitis

A cough that lasts 5 or more days suggests an acute bronchitis which usually lasts for 10 to 20 days. It becomes chronic when coughing that produces sputum lasts for more than 3 months, two years in a row.

Causes:

·Viral (Influenza, rhinovirus, adenovirus and coronavirus)

·Bacterial (Mycoplasma, Streptococcus, Bordetella, Moraxella, Haemophiles and Chlamydia pneumonia)

·Tobacco smoke

·Chemicals

·Air pollution

Symptoms:

·Coughing

·Sore throat

·Nasal congestion

·Muscle aches and headache

·Fatigue

Treatment:

·Cough suppressants or Mucolytics

·NSAID/ Paracetamol

·Inhalers/ Bronchodilators like Beta2 Agonists (Salbutamol or Terbutaline)

·Antibiotics