‫بسم هللا الرحمن الرحيم‬
Notes on the slides:Slide 2:
- The persistence of symptoms for a long period of time indicates
bacterial superinfection .
-In sinusitis bacterial superinfection could take place mostly caused by
streptococcus pneumoniae, group A streptococci & haemophilus
influenzae.
Slide 3:
-because of the self-limited nature of the infection, there is no need to
identify the viral etiology except for epidemiological reasons.
-deviated nasal septum is one of the major predisposing factors for
sinusitis.
Slide 4:
-antibiotics in 2ry bacterial infections are indicated, they should be
prescribed based on the causative organism that could be cultured from
nasal swap.
-antibiotic susceptibility tests should be done.
-streptococcus pneumoniae & haemophilus influenzae are becoming
more resistant to antibiotics, they could be susceptible to ampicillin &
amoxicillin (could be the treatment of choice).
-OTC: over the counter (bought without doctor prescription), these
drugs could lose their effectiveness with prolonged use.
|Page1
Slide 5:
-sore throat which is a common manifestation of upper respiratory tract
infections may or may not be associated with pharyngitis.
-rhinitis, sinusitis & pharyngitis all share sore throat as a common
symptom.
-here it's important to distinguish between bacterial & viral infections by
throat culture in order to have the treatment of choice, because
repeated infections could predispose to rheumatic fever & post
streptococcal complaints.
Slide 7:
-EBV can cause a clinical picture that is identical to streptococcal
infection; hypertrophy of tonsils & formation of membranes. So it's
difficult to establish clinical diagnosis, to culture & identify the causative
organism is important.
-HSV commonly causes all facial lesions including ulcerative gingivitis,
which produce a clinical picture that could be identical to other viruses
infections in the form of pharyngitis and ulcerative (herpetic) lesions
that could involve the tonsils and other associated structures.
-coxsackie A virus can produce a condition known as herpangina which is
a vesicular eruption that involves the pharynx.
[herpangina: an acute viral infection occurring predominantly in
children, that causes a fever of sudden onset associated with malaise
and acute ulceration of the soft palate & tonsillar area. It usually
lasts 2-5 days].
-all these viruses should be considered in the differential diagnosis of
viral etiology of pharyngitis.
|Page2
Slide 9:
-51 serotypes are known to cause human infection, but only 7 serotypes
are mostly the causative agents.
-immunity is type specific that's why reinfection occurs.
-sometimes the pharyngitis is difficult to differentiate from streptococcal
infection, especially when it's associated with high fever, remarkable
sore throat & other general manifestations.
Slide 10:
-in adenovirus infection the involvement of the eye is part of the
majority of cases especially in children; this is called pharyngoconjunctival fever, but sometimes it's limited to the eyes like in epidemic
kerato-conjunctivitis.
-Adenovirus establishes infection in the throat & adenoid, it may
become latent in these structures, & upon long incubation period these
structures shed these viruses continuously by the GIT with the stools &
contaminate the swimming pools, & because the virus is naked it's
resistant to chlorination, so people swimming in these contaminated
pools develop conjunctivitis with or without sore throat; either follicular
conjunctivitis or pharyngo-conjunctival fever.
-It has short incubation period 2-3 days.
- in epidemic acute respiratory disease pneumonia could be fatal.
-adenoviruses are capable of causing disseminated infections.
Slide 11:
-the adenovirus targets the epithelial cells lining the respiratory tract,
GIT, urogenital tract & the eyes, and it replicates in the nucleus of these
cells.
|Page3
-the adenovirus proteins: pre-early: E1B, Early: E4 & late proteins.
-cell death could be also caused by structural proteins of the virus.
-the adenoviruses cause damage to epithelial cells of the eye, RT, GIT &
urinary tract, that's why they cause conjunctivitis, pharyngitis,
pneumonia, bronchitis, gastroenteritis (by type 40 & 41) & hemorrhagic
cystitis (caused by type 11&21).
Slide 13:
-the tonometer is used to measure pressure inside the eye, usually it's
cleaned with 70% alcohol which the adenovirus is resistant to.
-viremic spread is rare except in immuno-compromised patients where
the viscera (pancreas) & CNS could be involved.
Slide 16:
-the name "acute respiratory disease" is not a description of the disease.
-there is a vaccine that's only given to military recruits which contains
inactivated type 4 and 7 viruses, given shortly before recruiting.
Slide 17:
-pertussis like syndrome caused by adenovirus was usually misdiagnosed
with pertussis caused by Bordetella Pertussis because no culturing and
identification of the causative organism had taken place.
-[pertussis disease begins with signs of upper respiratory tract
infections followed by whooping cough].
-acute follicular conjunctivitis is associated with: subepithelial
infiltration, pre-auricular lymphadenopathy, headache, mild fever & pain
in the eye. Which is different from epidemic kerato-conjunctivitis where
|Page4
subepithelial infiltration & hemorrhage take place resulting in corneal
opacity that's caused by type 8.
Slide 18:
-corneal opacity takes place 2weeks-2years after developing
subepithelial infiltration.
-unlike other viral causes of corneal opacity it resolves completely,
where as in the case of herpes simplex or varicella-zoster viruses the
opacity is permanent.
Slide 20:
-infections below the epiglottis are known as lower respiratory tract
infections.
-5 types of clinical symptoms:
1. Laryngotracheo bronchitis.
3. bronchiolitis.
2. Bronchitis.
4. Pneumonia.
5. Bronchopneumonia.
Slide 21:
-croup is sometimes caused by bacteria, but the most common cause is
viruses.
-pyrexia: fever.
-croaking cough: cough associated with a low hoarse sound, as that
made by a frog.
-stridor: the noise heard on breathing in when trachea or larynx is
obstructed. It tends to be louder & harsher than wheeze.
|Page5
-can lead to a life-threatening disease or emergency that needs
tracheostomy to allow air passage. It's not a common condition.
Slide 22:
-FEV1: forced expiratory volume in 1 second.
Slide 23:
-acute bronchiolitis is an emergency especially during childhood.
-it's commonly caused by RSV & parainfluenza virus.
Slide 26:
-there is parainfluenza viruses 1,2,3 & 4.
-type 4 has not been associated with significant clinical disease. It causes
mild lower respiratory tract infection.
Slide 27:
-initially they infect the URT, nose & throat are commonly involved.
-croup is most commonly caused by parainfluenza viruses' type 1 & 2,
followed by RSV & type 3.
-bronchiolitis is most commonly caused by RSV followed by type 3.
Slide 28:
-insipissated: thickened or dried by evaporation or dehydration.
-atelectasis: failure of part of the lung to expand. It occurs when the
larger bronchial tubes are blocked from within by retained secretions.
|Page6
Slide 31:
-HPIV1 predominates in early years.
-HPIV2 predominates in old years.
Slide 36:
-it's more common than all viral & bacterial infections of the lower
respiratory tract put together.
-it's the leading cause of lower respiratory tract infections in children
below the age of 1 year (consisting 50-70% of infections).
-could be fatal to children below the age of 1 year.
Slide 37:
-the virus is fragile that's why it's difficult to study it in experiments.
-paramyxoviruses have at least 2 envelope proteins:
1. fusion protein.
2. attach protein: could be : HN like for mumps & influenza.
H
like in measles.
G
like in RSV.
-G glycoprotein is the major glycoprotein used for attachment.
-RSV utilizes ICAM1 as its receptor which is similar to Rhinoviruses in this
regard.
Done by: Ahmad Mismar
|Page7
|Page8