1. Airway’s infections Epidemiology
- In children < 5 years of age. 50 % of all diseases are acute airway’s infections
- In children 5-12 years of age 30 % of all diseases are acute airway’s infections
- Most of the infections are in the upper airways, only 5 % are in the larynx and or in the lower airways
The natural history of the disease depends of
the pathogen (microbe),
the host,
the environment

2. Localisation of the acute airways’ inflammations
Upper airways’ inflammation
Laryngo-tracheo-bronchitis (croup), epiglottitis
Acute bronchitis
Acute bronchiolitis
Pneumonia

3. Infectious agents of the upper respiratory tract I.
Viruses
Respiratory syncytial virus (RSV):
bronchiolitis, pneumonia, croup, bronchitis
Parainfluenza viruses:
croup syndorma, bronchitis, bronchiolitis
Influenza virus:
in epidemics
Adenoviruses:
pharyngitis, pharyngoconjunctivits
Rhinoviruses
Coronaviruses: rhinitis, common cold
Coxsackieviruses A and B:
nasopharyngitis

4. Infectious agents of the upper respiratory tract II.
Mycoplasma pneumoniae:
pharyngotonsilitis, otitis media, pneumonia, bronchitis
Bacterial causes:
‘A” group streptococci, corynebacterium diphteria, Neisseria meningitidis,
N gonorrhoeae, haemophilus influenzae, streptococcus pneumoniae (pneumococcus), staphylococcus aureus

5. inclination for frequent infections
Signs of
inclination for frequent infections
Too frequent infections
Age/year Mean Maximum
1 6, ,7
, ,7
, ,6
, ,1
, ,9
Longer (> 4-5 days) and more serious infection than the usuals
Bacterial second line infection
Complications: otitis, sinusitis, pneumonia
Multiorgan infections
Failure to thrive

6. Bacterial infection is probable:
The discharge on the mucous membrane is purulent
Polymorpho-nuclear granulocytes’ number is high in the peripherial blood
Positive bacterial laboratory findings (from throat or sputum)
The regional lymphnodes are swollen and painful
Blood sedimentation rate is high
There is no viral epidemy

7. Infection risk factors in the host
Preterm babies (< 1 year)
Age less than 1 year (< 6 months in bronchiolitis)
To be a boy
Inborn errors of the immune system
Congenital heart defects
Lack of mother milk

8. Environmental factors
Family care (+)
Smoking in the family (-)
More than one child (-)
Good socio-economic situation (+)
Polluted environment (-)

9. The aetiology of common flu
Antigen types Per cent of probability
Rhinovirus 100 types %
Coronavirus types > 10 %
Parainfluenza virus types
RSV types
Influenza types %
Adenovirus types %
Others (enterovirus,
morbilli, varicella,
rubeola) %
Unknown viruses %
A-group beta-haemolytic
Streptococci %

10. Upper airway diseases
Nasopharyngitis acuta: fever, headache, dry throat, coughing, nasal discharge, frequent conjunctical inflammation, stuffed nose (feeding problems in infants)
Tonsillo pharyngitis acuta: red mucous membrans, swollen families, swollen tonsils, swollen lymphnodes in the neck, fever, pain
Therapy: antipyretics, antiphlogistic nasal drops, enough fluid intake,
Bacterial infection: penicillin, enythromycin (10 days) Non streptococcal infection: amoxycillin, macrolides, cephalosporins
Complications: otitis media acuta, peritonsillar retropharyngeal abscess
Sinusitis acuta
Febris rheumatica, glomerulonephritis (now rare)

11. Pathogenesis of tonsillopharyngitis
Pathologic agents Features Per cent
Viruses (see before) % +
Coxsackievirus herpangina < 1 %
EBV + CMV mononucleosis inf. < 2 %
HIV primer HIV infection < 1 %
Bacterial
Streptococci pyogenes %
Beta-haemolytic
Streptococci %
Other bacteria < 5 %
Unknown %

12. Complications of upper airway inflammations
Otits media
Mastoiditis acuta
Paranasal sinusitis
Peritonsillar, retropharyngeal
infiltration, abscessus
Poststreptococcal diseases:
rheumatic fever, glomerulonephritis
Croup cyndrome
Acute epiglottitis
Acute infectious laryngitis
Acute laryngo-tracheo-bronchitis
Acute spasmodic laryngitis

13. Laryngitis subglottica (croup syndrome)
Very frequent
Aetiology: viral, bacterial, mycoplasma
non infective: inclination, alllergic (?)
Croup score:
stridor, cough, dyspnoe, cyanosis, inspiratoric sound, jugular dystraction (0-1-2)
3-5 moderate
6 or more serious
Therapy: cold vaporization
epinephrin (racem) vaporized
steroid (systemic or vaporized)
antibiotics (if proved bacterial aetiology)
intubation, artificial ventillation

14. Acute bronchitis, tracheo bronchitis
Cough, sputum, bronchial noises, substernal dyscomfort, low grude fever
Coarse and fine moist rales and rhonchi
Etiology: viral or bacterial
Therapy: symptomatic (to be at home, antipyretics, fluid intake)
Bacterial aetiology proven: antibiotics

15. Pneumonia I.
Actiology: viral, bacterial, fungal
Clinical manifestations: lobar, lobular, broncho-alveolar, interstitial
community acquired pneumonia
nosocomial (hospital) acquired pneumonia
Bacterial:
Typical pneumonia: streptococcus pneumoniae
Haemophylus influenzae B type (vaccination!)
Streptococcus B Group: neonatology
Seldom: staphilococcus auerus, pyogenes, legionella
Atypical: Mycoplasma pneumoniae
Chlamydia pneumoniae
Neonates: Chlamydia trachomatis, Ureaplasma, Uraeliticum

16. Pneumonia II.
Viral: RSV, influenza, adenovirus, rhinovirus, enterovirus
VZV, CMV, HSV (immuncompromised host)
Fungal: immuncompromised host
Protozoons: Pneumocystic carinil (AIDS, immuncompromised host)

17. Pneumonia III.
Clinical signs: fever, cough, malaise, sputum, dyspnoe, cyanosis, tachypnoe
Physical signs: duffness of percussion pneumonia bronchial breath sounds
X ray (sonography: pleural effusion
CT and MR: abscess, mediastinum problems
Laboratory signs: BSR, CRP, blood smear
Actiology: haemoculture
BAL, Pleural drainage (if effusion)
induced sputum (?)

18. Hamophilus influenzae pneumonia

19. Pneumocystis carinii pneumonia

20. Right upper lobe pneumonia

21. patients with leukaemia
candidiasis
aspergillosis
patients with leukaemia

22. Therapy of pneumonia
symptomatic
antibiotics
- based on aetiology and resistance
- based on empirical facts:
macrolids
Cephalosporins
aminoglycosids
HSV/VZV: acyclovir.
CMV: gancyclovir
RSV: ribavirin

23. Acute nasophayngitis: Acut pharyngitis, pharyngo-tonsillitis:
Aetiology: viruses, mycoplasma pneumonieae, bacterial mycotic
Epidemilogy
Clinical manifestations
Therapy: aspecific, antiinflammatory drugs, nasal drops and suction
Acut pharyngitis, pharyngo-tonsillitis:
Aetiology: viruses, beta-haemolytic streptococcus (group A)
H. influenzae
Epidemiology
Clinical manufestations
Treatment: aspecific, penicillin, erythromycin

24. Parainfluenza virus: laryngo-tracheo bronchitis, pneumonia
The pathogens I.
Virus
RS virus: acute bronchiolitis in infants and toddlers (80 %) croup (12 %), bronchitis (15 %), pneumonia (30 %)
Parainfluenza virus: laryngo-tracheo bronchitis, pneumonia
Influenza virus: upper airway disease anywhere inflammation in the airways
Rhinovirus: common cold, rhinitis, bronchitis
Adenovirus: mostly upper airways’ disease serious pneumonia with serious late consequences
Coxsacie and echovirus: mostly upper airway disease

25. The pathogens II.
Bacteria
Streptococcus pneumoniae: often in pneumonia
Haemophilus influenzae B type: epiglottitis (!), pneumonia, otitis
Staphylococcus aureus: pneumonia, pleuritis in infants and toddlers
β-haemolytic streptococcus’ mostly upper airway inflammation, tonsillitis
Mycoplasma pneumoniae: pneumonia in bigger children
Chlamydia trachomatis: pneumonia in infants
Chlamydia pneumoniae: bronchitis, seldom pneumonia
Bronchamella catarrhalis: otitis, sinusitis in children