Bacterial Diseases Acquired Through the Respiratory Route

General Upper Respiratory Infections Symptoms
Pharyngitis – sore throat
Laryngitis – swelling of the larynx (voice box) causing hoarseness
Tonsillitis – inflammation of the tonsils, making it difficult to swallow
Sinusitis – inflammation of the sinuses
Otitis Media – swelling of the inner ear, causing pressure

Most common disease agents are Streptococci and S. aureus

Predisposing factors:
Colds, environmental pollutants, excessive dryness (need to have cavities moist), pollen, other allergies

General Upper Respiratory Infections Transmission
Airborne droplets
Direct or indirect contact with secretions
Autoinfection – reinfection with a bacteria that is already present on or within the body.
Example – self infection through direct contact with bacteria growing under one’s fingernails

General Upper Respiratory Infections Treatment

General Upper Respiratory Infections Prevention
Frequent hand washing

Sinusitis Characteristics
Most frequently reported chronic disease in the U.S.
Caused by several different disease agents:
Structural abnormalities
Nasal polyps
Second hand smoke
Prior bouts of sinusitis

Sinusitis Transmission
Natural inhabitants of the human body
-Auto infection
Airborne droplets or secretions of the nose and throat

Sinusitis Symptoms
Fever (light ,nothing life threatening)
Sore throat (when maxillary sinus overflows, it flows into throat and the drip is acidic so it causes cells to burst)
Tooth Pain

Sinusitis Treatment
Pill form or nasal spray
Liquid form…when in liquid form it loses some of its properties because it starts to be absorbed before it hits the stomach

Sinusitis Prevention and Control
Autoimmune maintenance
Proper food handling
Hand washing

Streptococcal Sore Throat (Pharyngitis) Characteristics
95% of cases caused by Streptococcus pyogenes
Up to 20% of children ages 6-12 are carriers
Otitis media or acute sinusitis are the most common complications.

Streptococcal Sore Throat (Pharyngitis) Transmission
Direct or indirect contact with the individual who has active pharyngitis, or a carrier.
Ingestion of contaminated food.

Streptococcal Sore Throat (Pharyngitis) Symptoms
Fever (usually between 101-104°)
Severe sore throat
Swollen glands and tonsils
Malaise (feeling weak, generally out of it and tired)
Loss of appetite and occasional abdominal discomfort
Symptoms in small children may be inapparent (not present)

Streptococcal Sore Throat (Pharyngitis) Treatment
Penicillin or Erythromycin for 10 days
Early treatment – milder illness and less chance of complications
Bed rest

Streptococcal Sore Throat (Pharyngitis) Prevention and Control
Any child with a constant sore throat and fever should be seen by a doctor.
Avoid close contact with the infected.
Proper food handling
Investigation to determine the source
Antibiotics may be given prophylactically.
Prophylactic – taken before disease to decrease risk of occurrence

Rheumatic Fever Characteristics
Always preceded by another form of strep infection.
Potentially dangerous although symptoms appear mild.
Cause of rheumatic heart disease.
Causative factors include low immune resistance and hypersensitivity.
More prevalent in lower income groups.

Rheumatic Fever Transmission
Remember that Rheumatic fever is not a bacterial infection, thus…
It can not be transmitted from person to person.

Rheumatic Fever Symptoms
Fever and migratory joint pain is most common in the early stages.
Abdominal pain
Rash nodules under the skin
Cardiac involvement
Chorea may occur up to 6 months later
Chorea – abnormal involuntary movement disorder

Rheumatic Fever Treatment
Don’t treat the fever, manage the fever….need to get rid of the bacteria

Rheumatic Fever Prevention and Control
Education of the public of the connection between strep infections and Rheumatic fever.
Seek immediate treatment for strep infections.

About Pneumonia
Along with influenza, pneumonia is one of the top 10 causes of death in the US.
It is classified by disease agent, location, and type.
Types: (determined by type of bacteria causing it)
Pneumococcal Pneumonia (most common form)
Mycoplasmal Pneumonia (mild form- walking pneumonia)
Legionnaire’s Disease (lot of public health interest today, one of the 3 most concerning emerging diseases)

Pneumococcal Pneumonia Characteristics
Most common type
High frequency among the very young and the very old
Common cause of death among alcoholics
Incubation period of 1-3 days (more symptoms in a short time spam)
With antibiotic therapy, it is noninfectious within 24-48 hours. (more easily treated in earlier stages)

Pneumococcal Pneumonia Transmission
Direct or indirect contact with respiratory discharges. (usually active case- coughing/sneezing)

Pneumococcal Pneumonia Symptoms
Sudden onset of chills, fever, chest pain, difficult breathing, and cough
Bright red or rusty sputum
May also have pleurisy – sharp pain with breathing
Older individuals may be asymptomatic (because of wear and tear- typically put body through so much so don’t have equipment or energy to take care of it)

Pneumococcal Pneumonia Prevention and Control
Vaccines for those at high risk
In an outbreak, avoid crowds

Pneumococcal Pneumonia Treatment
Problems are starting to occur with penicillin resistance.

Mycoplasmal Pneumonia Characteristics
Causes 20% of all pneumonias
“Walking pneumonia” – having pneumonia without a physical manifestation of symptoms.
May last a month or more
Children under 5 may be asymptomatic, or exhibit very light symptoms.

Mycoplasmal Pneumonia Treatment
Erythromycin or Tetracycline

Mycoplasmal Pneumonia Transmission
Direct or indirect contact with respiratory secretions.

Mycoplasmal Pneumonia Prevention and Control
No vaccine
Contact investigation
Proper sanitary methods

Mycoplasmal Pneumonia Symptoms
Sudden or insidious onset
Headache, malaise, paroxyc cough (sudden attacks), substernal pain
Often not recognized as pneumonia
Generally no complications, and fatalities are rare.

Legionnaire’s Disease Characteristics
Outbreaks traced to faulty cooling systems or excavation sites.
Unrecognized cause of pneumonia for many years (described in 1947)
Has been diagnosed in most states and foreign countries.
Mortality rates are as high as 15% in hospitalized patients. (15% of people who are getting treatment pass away)

Legionnaire’s Disease Treatment
Erythomycin and Tetracycline (when catch early)
Rifampin (antibiotic made for this, used when later in disease)

Legionnaire’s Disease Transmission
Organism lives in soil or water (air-condition (working in rooms/office), or through soil…many people are manufacturers)
Infection by inhalation of airborne particles
No evidence of person-to-person transmission

Legionnaire’s Disease Symptoms
Sudden or gradual onset
Diarrhea, loss of appetite, malaise (tired), myalgia (muscle pain), weakness, headache, high fever, chills
Nonproductive cough (not able to bring up sputum)
May have grayish, blood-streaked sputum (blood streaked because internal bleeding in the lungs)
May have nausea, vomiting, disorientation (become dehydrated and start to lose oxygen), pleurisy, and bradycardia (heart beat slows down)
These symptoms are found in about 50% of patients.

Legionnaire’s Disease Complications
Congestive heart failure
Acute respiratory failure (mucus is so thick that we cant manually clear it through coughing so it builds to the point where it gets to the Bronchial tubes and obstructs those tubes (same thing as drowning)- so much fluid lungs have no surface area)
Renal failure
Shock Occur when toxins get to brain (brain seize or turns off certain areas)

Legionnaire’s Disease Prevention and Control
No vaccine available (vaccine in development- vaccine takes about 10 years to hit the market)
Implicated cooling systems
Disinfected water supplies
Dust control at excavation sites

Whooping Cough (Pertussis) Characteristics
Cases have decreased since vaccinations began – 1940
Public attention has increased in recent years – media
With fewer and fewer new mothers breast feeding, the number of pertussis cases has unfortunately started to rise again

Caused by Bordetella pertussis
Mortality likely of secondary pneumonia in children under one and the elderly
Highly communicable during late incubation and prodrome stage
Low danger of transmission 3 weeks after cough begins
If treated early with antibiotics, communicable only 5-7 days
Up to 31% of adults with a chronic cough may be carriers

Whooping Cough (Pertussis) Treatment
Infants are hospitalized and given fluids/electrolytes (encourage hydration status)
Nutritional supplements, mild sedation with Codine, oxygen therapy
Antibiotics are not very effective in relieving symptoms, but they do shorten the period of communicability.

Whooping Cough (Pertussis) Symptoms
3 stages:

1- Catarrhal
–>Insidious onset, may include irritating cough, loss of appetite, sneezing, listlessness, infected conjunctiva, low-grade fever
2- Paroxysmal
–>Spasmodic/recurrent coughing – expel tenacious mucus, cough – high pitched inspiratory “whoop,” vomiting – hernia (coughing); 3 weeks
3- Convalescent
–>Cough may last 1-2 months and be triggered again by another upper respiratory infection.

Whooping Cough (Pertussis) Prevention and Control
Vaccination at 2-3 months (triggers body to make antibodies)
Isolation of suspected cases
Gamma globulin prophylactically
Contact investigation

Whooping Cough (Pertussis) Transmission
Direct contact with droplets (most common)
Indirect contact with contaminated objects

Diphtheria Characteristics
Now uncommon in most developed countries.
Likely cause of death in underdeveloped countries.
Caused by Corynebacterium diphtheriae
Stays in upper respiratory region, producing a deadly exotoxin and pseudomembrane, which helps the toxin spread.
Reservoir of infection is humans.
Attack does not always confer immunity.
Epidemic proportions in Soviet Union since 1990.

Diphtheria Treatment
Diphtheria antitoxin and antibiotics

Diphtheria Transmission
Direct by droplets
Indirect by contact with contaminated articles or milk

Diphtheria Symptoms
Thick, patchy, grayish-green membrane over the mucous membranes of the pharynx, larynx, tonsils, soft palate, and nose
Fever, sore throat, rasping cough, hoarseness
Difficulty breathing
Pseudomembranes obstruct the airway

Diphtheria Prevention and Control
Active vaccination with diphtheria toxoid

Diphtheria Complications
(picked up in bloodstream and spreads
around body causing problems in specific areas)
Neurologic involvement
Kidney involvement

Tuberculosis (TB) Characteristics
Caused by Mycobacterium tuberculosis (tubercle bacillus)
In 1900, 2 out of every 1,000 Americans died of TB, while 20 out of every 1,000 was ill with TB.
Present – 30,000 new cases per year, with over 10 million infected
These numbers are increasing.
May be influenced by AIDS.
Declared a global emergency in 1993
HIV/AIDS lowers resistance
Increased numbers in immigrants
Increased numbers in poverty, alcoholism, drug abuse, and homelessness
Primarily a disease of the lungs, but it can invade the blood stream to affect the liver, brain, urogenital tract, and bones.
Illness and death rates increase with age.
Primary reservoir is humans. Secondary is cattle.

Tuberculosis (TB) Transmission
Direct or indirect
Usually by inhalation of airborne droplets
Prolonged exposure to an active case
Living in close quarters (barracks, dorms, etc.)

Tuberculosis (TB) Treatment
Isoniazid combined with Rifampin
9 months of therapy usually resolves active cases
Primary infections heal without intervention.

Tuberculosis (TB) Prevention and Control
Vaccination with BCG is available, but is not used routinely in the US because it prevents the diagnostic skin test. (will test with a false positive)
Improved social conditions, education of the public
Source and contact investigation
Appropriate chemotherapeutic methods
Frequent community surveys by testing and x-rays.

Tuberculosis (TB) Symptoms
Usually none at first. May be some fatigue, weakness, appetite loss, weight loss, night sweats, and a low grade fever.
Organisms are encapsulated in the lungs.
Reactivation of TB usually occurs later in life, or at a time when the immune system is compromised.
Cough producing sputum containing mucus and pus
Sometimes bloody sputum
Chest pains

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