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Chapter 36
Respiratory Tract Infections,
Neoplasms, and Childhood
Disorders
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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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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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Transmission of Common Cold
• Viral infection of the upper respiratory tract
– Rhinoviruses, parainfluenza viruses, respiratory
syncytial virus, corona viruses, and adenoviruses
• Fingers are the greatest source of spread.
• Cough, sneeze
– The nasal mucosa and conjunctival surface of the
eyes are the most common portals of entry of the
virus.
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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
• D. conjunctival surface of the eyes
• Rationale: Conjunctival surface of the eyes and the
nasal mucosa are the most common ports of entry for
cold viruses.
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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 to 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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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
• An exceedingly virulent organism
• A large inoculum
• Impaired host defenses
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Classifications of Pneumonias
• According to the source of infection
– Community-acquired
– Hospital-acquired
• According to the immune status of the host
– Pneumonia in the immunocompromised person
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Tuberculosis
• Caused by the mycobacterium, M. Tuberculosis
– Outer waxy capsule that makes them more resistant to
destruction
• Infect practically any organ of the body, the lungs are most
frequently involved
• Macrophage-directed attack, resulting in 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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Laboratory Tests to Diagnose
Histoplasmosis
• Cultures
• Fungal stain
• Antigen detection
• Serologic tests for antibodies
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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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Lung Cancer
• Causative Factors
– Smoking
• Primary lung tumors (95%)
versus bronchial, glandular,
lymphoma
– Asbestos
• Secondary via metastasis
– Familial predisposition
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Categories of Bronchogenic Carcinomas
• Squamous cell lung carcinoma (25% to 40%)
– Closely related to smoking
• Adenocarcinoma (20% to 40%)
– Most common in North America
• Small cell carcinoma (20% to 25%)
– Small round to oval cells, highly malignant
• Large cell carcinoma (10% to 15%)
– Large polygonal cells, spread early in development
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Question
• The lungs are a common sight for 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
• Rationale: Due to the highly vascular nature and small
capillaries
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Categories of the Manifestations 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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Question
• Which of the following involves infection of the entire
respiratory track?
– A. Common cold
– B. Pneumonia
– C. Tuberculosis
– D. Cancer
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Answer
• B. Pneumonia
• Rationale: Pneumonia can involve all respiratory tissues,
and due to its virulence, is a major health risk.
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Stages of Lung Development
• Embryonic period
• Pseudoglandular period
• Canalicular 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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