Acute upper respiratory

infection (AURI)

Yang yuxia
The third afflicated hospital of
zhengzhou university
purpose and requirement
 Understanding the etiology, clinical
manifestations, complications and
treatments of the 2 kinds special
upper respiratory tract
inflammation
 Understanding the etiology,
pathology, physiological and
prevent of bronchitis
小儿呼吸系统疾病
急性上呼吸道感染
(AURI)
Overview

Respiratory system was divided

into upper and lower respiratory
tract from ring gristle.

URI is the most common

disease.
Definition
 Any type of infection of the upper
respiratory tract caused by any
pathogens.
小儿呼吸系统疾病
急性上呼吸道感染
(AURI)
Etiology
 Virus 所致 AURI 者占 90% 以上
主要病原为：
合胞
病毒 (Syncytial virus) 流
感病毒 (Influenza virus) 副
流感病毒 (Para influenza virus )
腺病毒 (Adenovirus)
柯萨奇病毒 (Coxsackie virus)

The secondary affection can

symptom
Many of the signs and symptoms depend on the type of upper
respiratory infection. Common symptoms of URIs include:
 a runny nose or stuffy nose

 sore throat

 fever

 headache

 cough

 malaise, or "feeling lousy"

 muscle aches

 loss of appetite

 ear pain
 Congestion
 Swelling of tonsil
 Swelling of lymph in neck and mandible
小儿呼吸系统疾病
(AURI)

Two special type of

AURI
Herpangina
 Introduction:
A mouth filled with painful
blisters.This common infection can
make kids miserable for the better
part of a week
 Etiology coxsackie A
Symptoms
 Fevers, often above 101 degrees
 Sore-throut:
 Extreme irritability
 Poor appetite (because of the pain
involved with the oral lesions) -- which
can result in dehydration
 vomiting
Physical signs
 Congestion of throat
 Ulcers on the lips, gums, tongue, inside
of the cheeks, and the back of the throat
 Small blisters surrounded by redness
and pus on the roof of the mouth, inside
of the cheeks, and the back of the throat
 Symptoms last between 3 and 6 days
Pharyngo-conjunctival fever
 High fever
 Pharyntis(sore throat)
 Conjuncivitis(inflammed eyes,usually without
pus inflammation
 Enlargement of lymph nodes of neck
 Headache malaise and weakness
 Adenovirus
 Surpportive care
小儿呼吸系统疾病

Laboratory
finding

Blood WBC count and DC

x -ray examination
Etiology examination
Virus
Bacteria
Other
diagnosis
Differential diagnosis
 1. FLU Epidemic influenza :influenza
virus infection, which causes more
severe symptoms than a cold
 2:acute contagious disease
 3:acute appendicitis
Treatment
 1. General treatment
 2. Etiologic treatment :anti-infection
:
 3. Symptomatic treatment expectant
treatment
acute infectious laryngitis
Etiologies

A. Viral infection (Most common)

1. Parainfluenza Virus
2. Rhinovirus
3. Influenza virus
4. Adenovirus
5. Coronavirus
B Bacterial infection
1. Acute streptococcal pharungitis
2. Diphtheria (rare in United States due
to vaccine)
3. Moraxella catarrhalis
4. Haemophilus Influenzae
Symptoms

A. Hoarseness or harsh voice

B. Aphonia (voice breaks intermittently)
C. Inspiratory laryngeal stridor ,dyspnea
D. Cough like dog
E. irritability
F. Cyanosis
G. Face pallor
H. Leukocytosis if bacterial
Treatment
 1. General treatment
 2. Etiologic treatment :anti-infection
:
antibiotics
 3.Application of adrenal cortical
hormone
 4. Symptomatic treatment
Acute Bronchitis
Overview
 Acute bronchitis is an infection of the
bronchial tree. The bronchial tree is
made up of the tubes that carry air into
your lungs. When these tubes get
infected, they swell and mucus (thick
fluid) forms inside them. This makes it
hard for you to breathe. You may cough
up mucus and wheeze (make a
whistling sound when you breathe).
Definition

 True acute purulent bronchitis is

characterized by infection of the
bronchial tree with resultant bronchial
edema and mucus formation.
Epidemiology

 Viruses are the most common cause of

bronchial inflammation in otherwise
healthy children with acute bronchitis.
Only a small portion of acute bronchitis
infections are caused by nonviral agents
 Parainfluenza virus, enterovirus, and
rhinovirus infections most commonly
occur in the fall. Influenza virus,
respiratory syncytial virus, and
coronavirus infections are most frequent
in the winter and spring
 In patients younger than one year,
respiratory syncytial virus, parainfluenza
virus, and coronavirus are the most
common isolates. In patients 1 to 10 years of
age, parainfluenza virus, enterovirus,
respiratory syncytial virus, and rhinovirus
predominate. In patients older than 10 years,
influenza virus, respiratory syncytial virus,
and adenovirus are most frequent.
Clinical manifestation
 Cough
 sputum production,
 dyspnea,
 wheezing,
 chest pain,
 fever,
 hoarseness,
 malaise,
 rhonchi,
 rales
 The cough begins within two days of
infection in 85 percent of patients. When
a patient's cough fits this general
pattern, acute bronchitis should be
strongly suspected
 Each of these may be present in varying
degrees or may be absent altogether.
Sputum may be clear, white, yellow,
green, or even tinged with blood.
Diagnosis

 Patients with acute bronchitis usually have a viral

respiratory infection with transient inflammatory
changes that produce sputum and symptoms of
airway obstruction.
 The cough in acute bronchitis may produce either
clear or purulent sputum. While this cough
generally lasts seven to 10 days, it can persist.
Approximately 50 percent of patients with acute
bronchitis have a cough that lasts up to three
weeks, and 25 percent of patients have a cough
that persists for over a month.
 Physical Examination


While a lung examination may be useful in patients

with acute bronchitis, it is not diagnostic.
Wheezing, rhonchi, a prolonged expiratory phase
or other obstructive signs may be present.
However, some patients may exhibit no signs of
bronchospasm. Patients should be asked about
night coughing, and they should undergo forced
expiration in the prone position to detect wheezing.
A night cough or wheezing may be the only signs
that bronbronchial obstruction is present.
 Diagnostic Studies

 The appearance of sputum is not predictive of

whether a bacterial infection is present.
Purulent sputum is most often caused by viral
infections.Microscopic examination or culture
of sputum in the healthy adult with acute
bronchitis generally is not helpful. Since most
cases of acute bronchitis are caused by
viruses, cultures are usually negative or
exhibit normal respiratory flora.
 When M. pneumoniae infection is present, routine
sputum cultures are still negative. Rapid tests for the
identification of Mycoplasma organisms have been
developed. However, these tests are not routinely
available, and they are unlikely to be cost-effective
studies in the acute care setting.
 No available test can provide a definitive diagnosis of
acute bronchitis. While decreases in pulmonary
function have been demonstrated in patients with acute
bronchitis,
diagnostic pulmonary function testing should not be
performed in previously healthy patients. When
underlying asthma is suspected, pulmonary function
testing should be considered.
 It must be kept in mind that acute
bronchitis can cause transient
pulmonary function abnormalities.
Therefore, to diagnose asthma, the
physician must find changes that persist
after the acute phase of the illness.
When pneumonia is suspected, chest
radiographs and pulse oximetry may be
helpful in making the diagnosis.
Differential Diagnosis

 Many conditions other than acute bronchitis

present with cough . Acute bronchitis or
pneumonia can present with fever, constitutional
symptoms and a productive cough. While patients
with pneumonia often have rales, this finding is
neither sensitive nor specific for this illness. When
pneumonia is suspected on the basis of the
presence of a high fever, constitutional
symptoms, severe dyspnea and certain physical
findings or risk factors, a chest radiograph should
be obtained to confirm the diagnosis
 Dry rale :gurling ,mucous,
 Moist rale ,solid
Treatment

 1. General treatment
 2. Etiologic treatment :anti-infection
:
antibiotics
 3. Symptomatic treatment Protussive
therapyBronchodilators
 4.Application of adrenal cortical
hormone
 Antitussive selection is based on the cause of the
cough. For example, an antihistamine would be used
to treat cough associated with allergic rhinitis, a
decongestant or an antihistamine would be selected
for cough associated with postnasal drainage, and a
bronchodilator would be appropriate for cough
associated with asthma exacerbations. Nonspecific
antitussives, such as hydrocodone (e.g., in Hycodan),
dextromethorphan (e.g., Delsym), codeine (e.g., in
Robitussin A-C), carbetapentane (e.g., in Rynatuss),
and benzonatate (e.g., Tessalon), simply suppress
cough.18 Selected nonspecific antitussives and their
dosages are listed in Table 2.20
 Acute bronchitis and asthma have
similar symptoms. Consequently,
attention has recently been given to the
use of bronchodilators in patients with
acute bronchitis. Although relatively few
studies have examined the efficacy of
oral or inhaled beta agonists, one
study21 found that patients with acute
bronchitis who used an albuterol
metered-dose inhaler were less likely to
be coughing at one week, compared
with those who received placebo.
 Because of increasing concerns about antibiotic
resistance, the practice of giving antibiotics to most
patients with acute bronchitis has been
questioned.22,23 Clinical trials on the effectiveness of
antibiotics in the treatment of acute bronchitis have
had mixed results and rather small sample sizes.
Attempts have been made to quantify and clarify data
from the studies (Table 3).24-28 Although these reviews
and meta-analyses used many of the same studies,
they examined different end points and reached
slightly different conclusions. One analysis25 showed
that antibiotic therapy provided no improvement in
patients with acute bronchitis, whereas others,
including the Cochrane review,28 showed a slight
beneficial effect; however, problems with antibiotic
side effects were similar.
Bronchiolitis
 overview
 Bronchiolitis is an infection of the lower
respiratory tract that usually affects
infants. There is swelling in the smaller
airways or bronchioles of the lung,
which causes obstruction of air in the
smaller airways.
Etiology

 Respiratory syncytial virus (RSV)

 parainfluenza virus
 influenza B,
 adenovirus types 1, 2 and 5
 Mycoplasma (primarily in school aged
children).
 chlamydia pneumoniae
 immunologic mechanisms.
 Respiratory syncytial virus (RSV) is the most commonly
isolated agent in 75% of children less than 2 years of age
hospitalized for bronchiolitis.1 Other agents that cause
bronchiolitis include parainfluenza virus types 1 and 3,
influenza B, parainfluenza type 2, adenovirus types 1, 2
and 5 and Mycoplasma (primarily in school aged
children).2,3 There is abundant evidence that complex
immunologic mechanisms play a role in the pathogenesis
of RSV bronchiolitis.3 Type I allergic reactions mediated
by IgE antibody may account for clinically significant
bronchiolitis.4 Breast fed babies with colostrum rich in IgA
appear relatively protected from bronchiolitis
Clinical Manifestations
 The following are the most common
symptoms of bronchiolitis. However,
each child may experience symptoms
differently. Symptoms may include:
 common cold symptoms, including
 runny nose
 congestion
 a low-grade fever
 cough (the cough may become more
severe as the condition progresses)
 changes in breathing patterns (the child
may be breathing fast or hard; you may
hear wheezing, or a high-pitched sound)
 decreased appetite (infants may not eat
well)
 Irritability
 vomiting
Clinical Course

 Most patients have mild clinical illness

and recover uneventfully in 5-7 days
but coughing may persist for up to 2
weeks.
 Children with congenital heart disease
(CHD) and pulmonary hypertension are
also a high-risk population when they
acquire RSV
Diagnosis
 Bronchiolitis is usually diagnosed solely
on the history and physical examination
of the child. Many tests may be ordered
to rule out other diseases, such as
pneumonia or asthma. In addition, the
following tests may be ordered to help
confirm the diagnosis:
Diagnosis

 the infants' age, seasonal occurrence,

and physical findings
 Chest radiographs usually reveal
hyperinflation and 20-30% will show
lobar infiltrates and/or atelectasis.
 White blood cell counts are usually
between 8000 and 15,000/cc
Screening Tests
 Although viral culture for RSV is available and must be
considered the "gold standard" in making a definitive diagnosis,
several immunologic tests are more convenient, rapid and less
costly. Commercially available tests detect RSV antigen in
epithelial cells from nasopharyngeal secretions, bronchoal-
veolar lavage or lung tissue. These tests are performed by either
direct immunofluorescent antibody (IFA) staining or an enzyme-
linked immunosorbent assay (ELISA). Although ELISA is
somewhat quicker and easier to interpret due to a more
objective endpoint, the IFA technique may be preferable
because the number of epithelial cells recovered can be
determined thus verifying the adequacy of the sample. With
adequate sampling, IFA requires 2-6 hours for processing and is
90% sensitive and specific. ELISA requires 30 minutes for
processing and is 85-90% sensitive when compared to viral
culture.
Long Term Morbidity And
Association With Asthma

 The relationship between acute bronchiolitis in

infancy and the subsequent development of asthma
remains confusing. Some studies have shown that
asymptomatic children examined 10 years after an
acute episode of bronchiolitis may have abnormal
small airway resistance and decreased
transcutaneous oxygen saturation (SpO2)36 and up
to 50% will have recurrent wheezing later in life. 37
However, these are retrospective studies with no
controls and the majority of these children had
either a family history of allergy,
 prematurity, small for gestational age, or born
into families where there is exposure to passive
cigarette smoke. A recent study found no
difference in pulmonary function studies
between 29 full term, age, race and sex matched
control infants without prior wheezing, asthma or
lower respiratory illness when compared to a
similar group of 29 previously healthy infants
admitted with a first episode of acute RSV
bronchiolitis.38 These infants were evaluated at a
median interval of 36 weeks after admission.
 Management
 oxygen therapy
 Control wheezing:calmative
Bronchodilators corticosteroids
 Anti-agents
 IVIG;RSV-IVIG
 increased fluid intake,intravenous (IV)
fluids if your child is unable to drink well