Infectious Diseases of the

Respiratory System
dr. Irma Suswati, M.Kes

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 Infections of the Respiratory
tract
Most common entry point for
infections
Upper respiratory tract
nose, nasal cavity, sinuses, mouth,
throat
Lower respiratory tract
Trachea, bronchi, bronchioles, and
alveoli in the lungs

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Fig. 21.1a

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 Protective Mechanisms

Normal flora: Commensal organisms

Limited to the upper tract
Mostly Gram positive or anaeorbic
Microbial antagonist (competition)

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 Protective Mechanisms
Clearance of particles
and organisms from the respiratory tract
Cilia and microvilli move
particles up to the throat
where they are swallowed.

Alveolar macrophages
migrate and engulf particles
and bacteria in the alveoli
deep in the lungs.

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 Other Protective Mechanisms
Nasal hair, nasal turbinates
Mucus
Involuntary responses (coughing)
Secretory IgA
Immune cells

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 Pulmonary Defense
Mechanisms
Innate and Adaptive Immunity
Alveolar macrophages
PMNs
Lymphocytes
Immunoglobulin

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 Virulence Properties of Pathogens
Adhesion molecules that bind to cell
receptors
HA of influenza binds sialic acid
G protein of RSV binds to
glycoaminoglycans

Mechanisms to evade innate host defenses

NS1/2 proteins of RSV block -interferon

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 Virulence Properties of Pathogens
Ability to avoid adaptive immune mechanisms
IgA protease of pneumococcus
gene recombination by influenza
Production of toxins
Pseudomonas type III protein, Exotoxin A
Evolution of antibiotic resistance
-lactamases by bacteria
amantadine resistance by influenza

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 Acquisition of Infection
1. Colonization of upper airway followed by
aspiration of a pathogen (S.pneumo)
2. Infection of upper airway and
inhalation/aspiration of infecting organism
(RSV, mycoplasma)
3. Direct lower airway inhalation of infecting
organism (Influenza, M.Tb,SARS CoV)
4. Hematogenous spread to lung (varicella)

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 Transmission
Person to Person
Influenza, M. tuberulosis, SARS CoV, S.
pneumoniae, Varicella, chlamydia, group A strep

Environment
Legionella (water)
Histoplasmosis (bird droppings & bat caves)
Psittacosis (pet birds)

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 Agents of Upper Respiratory
Tract Infections
Common cold (rhinitis)
Many viruses; rhino, corona, adeno, influenza
Pharyngitis and laryngotracheitis
Streptococcus pyogenes
Corynebacteria diphtheriae
Neisseria gonorrhoea
Many viruses
Epiglottitis
Haemophilus influenzae
Bronchitis
Bordetella pertussis
Many viruses

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 Agents of Lower Respiratory
Tract Infections
Legionairres Disease; Legionella pneumophila
Tuberculosis: Mycobacterium tuberculosis
Pneumonia
Bacteria
Streptococcus pneumoniae
Mycoplasma pneumoniae
Staphylococcus aureus
Almost ANY other
Viruses
Influenza
Measles
Many others
Fungi
Many

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 Bacterial Infections
Streptococcus pyogenes
Streptococcus pneumoniae
Clamydia pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila
Haemophylus influenzae
Corynebacterium diphtheriae

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 Streptococcus pyogenes

Gram positive
streptococci
Carried and
transmitted from
the throat
In Respiratory
secretions

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 Group A Streptococcus
Capsule -resistant to
phagocytosis
Enzymes damage
host cells
M protein adhesin

The M protein has many antigenic varieties

and thus, different strain of S.pyogenes
cause repeat infections
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 Streptococcal Throat
Fever
Tonsillitis
Enlarged lymph
nodes
Middle-ear infection

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 Bacterial Pneumonia
Streptococcus pneumoniae
Clamydia pneumoniae
Mycoplasma pneumoniae
Klebsiella pneumoniae
Legionella pneumophila

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 Streptococcus
pneumoniae

Pneumococcus
Encapsulated
Often secondary
infection following
influenza virus

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Streptococcus pneumoniae
2/3 of all pneumonia
Risk Factors- old age, season,
underlying viral infection, diabetes,
alcohol and narcotic use
Variable capsular antigen
Purified component (capsule) vaccine

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 Mycoplasma pneumoniae
Acquired by droplet transmission. Epidemics
occur every 3-4 years. Occurs in school age
children and young adults.
Classically presents with fever, headache,
myalgia, earache, mild pharyngitis, dry
cough and sometimes arthritis. Skin rashes
and haemolytic anaemia may occur.
Neurological complications occasionally
happen.

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 Clamydia pneumoniae
Person-to-person spread occurs
Causes atypical pneumonia
Implicated as potential pathogen / co-
pathogen in coronary artery disease
and cerebrovascular disease
Diagnosis by immunofluorescence, cell
culture or serology

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 Legionella pneumophila
gram negative bacilli
intracellular pathogen
widespread in environment (soil, water,
taps, showers)
widespread spectrum of illness

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 Legionella pneumophila
L.pneumophilia may cause a multi-
system disease with confusion, muscle
aches, pneumonia, renal failure, liver
involvement + diarrhoea and significant
mortality.
L.pneumophilia may also cause
Pontiac fever a self-limiting disease.

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 Pneumonia complications
3-5% Pleural effusion:
clear fluid +- pus cells
1% Empyema thoracis:
pus in the pleural space (-loculated)
Lung abscess:
suppuration + destruction of lung parenchyma
single (aspiration) anaerobes, Pseudomonas
multiple (metastatic) Staphylococcus aureus

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Diphtheria

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 Diphtheria
Transmitted by droplets or fomites
Infects the upper respiratory tract
Begins with severe sore throat, low-
grade fever and swollen lymph
nodes or with skin rash, 1-6 days
after infection

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Corynebacterium diphtheriae
Aerobic Gram + bacillus
Toxin inhibits protein synthesis
of cells to which it binds
Destroyed cells and WBC form
"pseudomembrane" which
blocks airways

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Diphtheria

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 Virus infections
Adenoviridae
Picornaviridae (rhinovirus)
Coronaviridae (coronavirus)
Paramyxoviridae (parainfluenza virus,
respiratory syncytial virus/ RSV)
Orthomyxoviridae (influenza virus)

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Adenovirus - Icosahedral Capsids

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 Adenovirus
Non-enveloped, 70-90nm in size.
Capsid is icosahedral.
Ds DNA.
Transmission ; respiratory droplets and
secretions getting into eye, mouth or
respiratory mucosal surfaces, or indirectly
via vomites.
Direct spread ; fecal-oral route and indirect
spread ; poorly chlorinated water.

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 Adenovirus and human disease
DISEASE ADENOVIRUS

Mild pediatric respiratory disease type 1, 2 & 5

(prevalent 0-6 yrs.)

Acute respiratory disease (ARD) types 3, 4, 7,

(5-8% adults & up to 50-80% 14, 11 & 21
of military recruits)

Pharyngoconjunctival fever, eye types 3, 4, 7,

involvement as long as 3 weeks 14, 21

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 Rhinovirus
Most common cause of the common
cold
Cause 30% of all upper respiratory
infections
Transmisi
Direct contat via infected hands and
fomites
Inhalation of infectious drplets

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 Rhino,
Echo,
Coxsackie,
polio
Replikasi in
oropharnx

Antibodi blockage
Primary viremia
blood stream

Secundary
Target tissue
viremis

skin muscle Brain meningen liver

Echo, Hepatitis A
Echo, Polio, Polio, Echo,
cosxsackie cosxsackie A,B cosxsackie cosxsackie

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 Rhinovirus
Clinical Manifestations
You all know the symptoms
Rhinovirus colds rarely have fever
associated with them
Most colds last about a week
A non-productive cough following a
cold can last up to 3 weeks- this is NOT
bronchitis
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 Paramyxovirus
Enveloped virus, 150-300 nm in size
ss RNA
Transmitted via large droplets, aersols and
fomites
Primary infections and reinfections
(reinfections are clinically less severe)
Fever, URI or LRI symptoms (croup,
bronchiolitis, pneumonia)

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PIV- transmission through
droplet dispersion
(Courtesy-American Assoc. for the Adv. Of Science)

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 CROUP
Acute laryngotracheobronchitis

Age:- typically <6 years of age

Involvement of the larynx, subglottic area
and trachea
Clinical features:- fever, cough,hoarseness,
stridor
(Drooling, dysphagia and toxic appearance
are not seen)

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Respiratory Syncytial Virus
Enveloped (membrane) RNA virus
Spread by respiratory droplets
Community outbreaks in late fall to
spring
Upper respiratory tract infection
epithelial cells
May be fatal in infants

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 Clinical Features
Upper Respiratory Lower Respiratory
Infection- Bronchiolitis,
Infection
Pneumonia
Fever Cough
Rhinitis Poor feeding, lethargy
Hypoxemia
Pharyngitis
Respiratory Distress
(tachypnea, retractions)

Apnea

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 Influenza Virus
An enveloped RNA virus
Structure

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Influenza Virus
New human strains every year
Mutations

Pandemic strains
Genetic Recombinant Viruses
1957 Asian Flu H2N2
1968 Hong Kong Flu H3N2
1977 Russian Flu H1N1

Bird Flu
Directly from birds
?? H5N1

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 H and N Flu Glycoproteins

H Hemagglutinin
Specific parts bind to host
cells of the respiratory mucosa
Different parts are
recognized by the host
antibodies
Subject to changes

N - Neuraminidase
Breaks down protective
mucous coating
Assist in viral release
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 Influenza
Epidemics and pandemics, mostly in
winter
Upper respiratory tract infection
epithelial cells
Multivalent killed virus vaccine with
strains from the previous year (Grown in
embryonated eggs)
Bird flu (H5N1) pandemic in birds

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 Fungal infections
Coccidiodomycosis (Valley Fever)
Coccidioides immitis

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 Coccidioides immitis
Cause of Valley
Fever
Highly infectious

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Coccidioides immitis Life Cycle

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 Coccidioides immitis
Valley Fever
usually a flu-like
illness
Can spread to
bones, skin,
meninges
100,000 new
cases/yr in SW

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