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Chapter 28
Respiratory Tract Infections,
Neoplasms,
and Childhood Disorders
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Areas Involved in Respiratory Tract
Infections
• Upper respiratory tract
– Nose, oropharynx, and larynx
• Lower respiratory tract
– Lower airways and lungs
• Upper and lower airways
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Common Respiratory Infections
• Common cold
• Influenza
• Pneumonia
• Tuberculosis
• Fungal infections of the lung
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Transmission of Common Cold
• Viral infection of the upper respiratory tract
– Rhinoviruses, parainfluenza viruses, respiratory
syncytial virus, coronaviruses, and adenoviruses
• Fingers are the greatest source of spread
• Coughing, sneezing
– The nasal mucosa and conjunctival surface of the
eyes are the most common portals of entry for the
virus.
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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
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Rhinitis and Sinusitis
• Rhinitis
– Inflammation of the nasal mucosa
• Sinusitis
– Inflammation of the paranasal sinuses
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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
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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 3–15 air cells on each side, with each
maintaining a separate path to the nasal chamber
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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
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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
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Question
• The most common port of entry for cold viruses is
_______.
a. Inhalation
b. Small cuts
c. Food
d. Conjunctival surface of the eyes
e. Fingers
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Answer
a. Inhalation
b. Small cuts
c. Food
d. Conjunctival surface of the eyes: The eyes and the nasal
mucosa are the most common ports of entry.
e. Fingers
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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
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Antiviral Drugs
• Amantadine
• Rimantadine
• Zanamivir
• Oseltamivir
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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
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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
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Factors Facilitating Development of
Pneumonia
• Virulence of organism
• Inoculum size
• Impaired host defenses
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Classifications of Pneumonias
• According to source of infection
– Community-acquired
– Hospital-acquired
• According to immune status of the host
– Pneumonia in the immunocompromised person
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Tuberculosis
• Caused by a mycobacterium, M. tuberculosis
– Outer waxy capsule makes the organism more resistant to
destruction
• Infects practically any organ of the body; the lungs are most
frequently involved
• Macrophage-directed attack, resulting parenchymal destruction
• Cell-mediated immune response
– Confers resistance to the organism
– Development of tissue hypersensitivity
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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
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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
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Question
• Which of the following involves infection of the entire
respiratory tract?
a. Common cold
b. Pneumonia
c. Tuberculosis
d. Cancer
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Answer
a. Common cold
b. Pneumonia: Pneumonia can involve all respiratory
tissues and, due to its virulence, is a major health risk.
c. Tuberculosis
d. Cancer
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Classification and Spread 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
• Mechanisms of fungal spread
– Inhalation of spores
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Laboratory Tests to Diagnose
Histoplasmosis
• Cultures
• Fungal stain
• Antigen detection
• Serologic tests for antibodies
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Lung Cancer
• Causative factors
– Smoking
• Primary lung tumors
(95%) vs. bronchial,
glandular, lymphoma
– Asbestos
• Secondary via metastasis
– Familial predisposition
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Categories of Bronchogenic Carcinomas
• Squamous cell lung carcinoma (25–40%)
– Closely related to smoking
• Adenocarcinoma (20–40%)
– Most common in North America
• Small cell carcinoma (20–25%)
– Small round to oval cells, highly malignant
• Large cell carcinoma (10–15%)
– Large polygonal cells, spread early in development
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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
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Stages of Lung Development
• Embryonic period
• Pseudoglandular period
• Canicular period
• Saccular period
• Alveolar period
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Respiratory Disorders in the Neonate
• Respiratory distress syndrome
• Bronchopulmonary dysplasia
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Respiratory Disorders in Children
• Upper airway infections
– Viral croup
– Spasmodic croup
– Epiglottis
• Lower airway infections
– Acute bronchiolitis
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Impending Respiratory Failure in Infants
and Children
• Rapid breathing
• Exaggerated use of the accessory muscles
• Retractions
• Nasal flaring
• Grunting during expiration
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Question
• The lungs are a common site of secondary tumor
development. Why?
a. Due to the highly vascular nature and small capillaries
b. Due to the fragility of the cells
c. Due to the rapid replication of type I alveolar cells
d. Due to dumb luck
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Answer
a. Due to the highly vascular nature and small capillaries
b. Due to the fragility of the cells
c. Due to the rapid replication of type I alveolar cells
d. Due to dumb luck
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