Lesson 6

Respiratory Infections
 Lung Anatomy Review
• Each lung is divided into
sections called lobes:

• Left has 2 lobes: Upper

and lower: separated by
oblique fissure
 Lung Anatomy Review
• Each lung is divided into
sections called lobes:

• Right has 3 lobes:

superior and middle
separated by transverse
fissure and an inferior
(separated from the
middle by oblique
fissure)
 Why does the left only have 2 lobes?
• The heart, found in
between the left and
the right lung, occupies
some of the space
where your left lung is
found.
• The two-lobed left lung
makes room for your
heart
 Lung anatomy review
• Hilum: midpoint of lung
where trachea enters

• Important as this is
where lung cancer
usually begins
 Lung anatomy review
• Lingula: The left lung,
unlike the right does
not have a middle lobe.
• Instead, it has the
lingula, means little
tongue (in Latin) and is
often referred to as
the ”tongue in the lung”
 Lung anatomy review
• Pleura: membrane
surrounding each lung
and bathing them a
serous (watery) fluid
 Lung anatomy review
• Cardiac notch: small indentation in the left
lung to accommodate the heart
 Respiratory Infections
• Respiratory tract
infections can
involve: the upper
respiratory tract
(nose, oropharynx,
and larynx)
• the lower respiratory
tract (lower airways
and lungs) more
common
• or both!
 Agents
• Viruses are the most frequent cause of
respiratory tract infection
• Bacterial and fungal lung diseases do exist
 The 80 -20 rule
• 80% of bacteria are productive (produce
pus/phlegm), 20% are non-productive

• 80% of viruses are non-productive, 20% are

productive
The ones we will be studying
There are 4 respiratory infections we will
examine in detail:
1) Common cold
2) Influenza
3) Tuberculosis
4) Pneumonia
 Common Cold
• The common cold
is a viral infection
of the upper
respiratory tract
– It occurs more
frequently than
any other
respiratory tract
infection
 Prevalence and incidence
• Most adults
have 2 or
more colds per
year
• The average
school child
may have up
to 10 per year
 Common Cold Symptoms

• The condition
usually begins with
a feeling of dryness
and stuffiness
affecting mainly
the nasopharynx
 Common Cold Symptoms
• It is accompanied by excessive production
of nasal secretions and lacrimation, or
tearing of the eyes (Usually, the secretion
remain clear and watery)
 Common Cold Symptoms
– The mucous
membranes of the
upper respiratory
tract become
reddened, swollen,
and bathed in
secretions
 Common Cold Symptoms
– Involvement of the
pharynx and larynx
causes sore throat
and hoarseness
– The affected person
may experience
headache and
generalized malaise
 Common Cold
• The disease process
is usually self-limited,
lasting approximately
7 days
– The rhinoviruses
are the most
common cause of
colds in persons
between 5 and 40
years of age
– The cold viruses
are rapidly spread
from person to
person
 Spread of common cold
– The fingers are the
greatest source of
spread
– The nasal mucosa and
conjunctival surfaces
of the eyes are the
most common portals
of entry
 Spread of common cold
– Aerosol spread of colds
through coughing and
sneezing is much less
important than the spread
by fingers picking up the
virus from contaminated
surfaces and carrying it to
the nasal membranes and
eyes
 Prevention
• This suggests that
careful attention to
hand washing is one
of the most important
preventative measure
for avoiding the
common cold
 Contagious period
• Most highly
contagious period
is during the first 3
days after the
onset of symptoms
 Tuberculosis (TB)
• TB is an infection by mycobacterium
tuberculosis.
• It is transmitted through inhalation of infected
droplets
 TB
• Tuberculosis is the
world’s foremost
cause of death
from a single
infectious agent,
causing 26% of
avoidable deaths in
developing
countries
 TB
• Is more common among:
– Foreign-born persons from countries with a high
incidence of tuberculosis
– Residents of high risk congregate settings such as
correctional facilities, drug treatment centres, and
homeless shelters

• Outbreaks of a drug-resistant form of tuberculosis

have emerged, complicating the selection of drugs
and the duration of treatment
 Stages of TB
• The 1st stage is called
primary TB with lung
involvement only
• The 2nd stage of TB is
when the bacteria
spreads via blood and
lymph throughout the
body
 Primary (lung only) TB symptoms
• Chest pain
• Weight loss
• Low grade fever
• Chronic cough
• Anorexia
• Inflammation of pleura
(pleuritis, pleurisy)
Secondary (systemic) TB symptoms
• Night sweats
• Joint pain
• Purulent sputum with
cough
• Pulmonary hemorrhage
• Dyspnea
• High grade fever
• Lymph node enlargement
(Ghon Complex)
 Influenza
• A viral infection
that is arguably the
most important
cause of acute
upper respiratory
tract infection in
humans
• influenza is more
contagious than
bacterial
respiratory tract
infections
 Influenza
• In the early stages, the symptoms of influenza
often are indistinguishable from other viral
infections
• The symptoms of uncomplicated
rhinotracheitis usually peak by days 3-5 and
disappear by days 7-10
 Spread of the flu
– Transmission is by aerosol or direct contact
– Inhalation of as few as three infective
particles can transmit the infection
 Causes of the Flu
• There are 3 known
viruses that can cause
it:

• Influenza virus A:
animals and humans,
but worse in humans!
 Causes of the Flu
• Influenza virus B:
humans only, but milder
than A

• Influenza virus C: rarest

in humans and mildest

• FYI: The “flu shot” is only

good against Type A!
 Contagious period
• People become
infectious starting
one day before their
symptoms begin and
remain infectious
through
approximately 5 days
after the illness onset
 Influenza symptoms
– In the early stages, the
symptoms of influenza
often are
indistinguishable from
other viral infections
• Abrupt onset of fever
and chills, malaise,
muscle aching,
headache, profuse
watery nasal discharge,
non-productive cough,
and sore throat
• Can be fatal if
immunocompromised
 Onset of the flu
• One distinguishing factor of an influenza infection
is the rapid onset, sometimes in as little as 1 to 2
minutes, of profound malaise
 Pneumonia
• Inflammation of
the lungs, alveoli
and the
bronchioles
• Pneumonia is the
sixth leading cause
of death in the US
Pneumonia Classification: Cause
1) Bacterial pneumonia – is
characterized by chills and
fever, severe malaise,
purulent sputum, elevated
white blood cell count

Streptococcus pneumonia is
the most common bacteria.

Haemophilus Influenza is
another
 Pneumonia Classification: Cause
2) Atypical pneumonias
(viral, fungal) – produce
less striking symptoms
and physical findings
than bacterial
pneumonia
 Pneumonia Classification: location
• bronchopneumonia
(involvement in the
distal bronchus and
alveoli) Common
• lobar pneumonia
(which entire lobe is
involved) Rare
• interstitial (infection
occurs in interstitial
spaces) Rarest
 Persons affected
• Remains an
important
immediate cause
of death in the
elderly and
persons with
debilitating
diseases
 Spread of pneumonia
1. Inhalation from
the ambient air
2. Direct spread
from contagious
infected sites
3. Haematogenous
spread (through
blood)
 Summary
Common Cold Influenza Pneumonia Tuberculosis
Spread
Bacterial/viral
(most
common)
Fatal (Y/N)
Name of most
common bug
 Self Test Questions
• What bug is the most common cause of the common cold?
• What is the most common bacteria causing pneumonia?
• What is the transmission of the flu?
• What is the greatest source of spread for the common cold?
• What is the most common type of pneumonia? (bacterial or viral)
• Where in the lung is the most common type of pneumonia (location)?
• What is the leading cause of death from respiratory infection?
• What is the contagious period for the common cold?
• What does “self-limited” mean?
• What does “purulent sputum” mean?
• How many lobes in left lung?
 Self Test Questions
• What lung has the cardiac notch?
• What lung has the lingua?
• What fissures are present in the right lung?
• What part of the lung is where cancer usually starts?
• Name 3 ways pneumonia can spread
• What type of infection typically produces pus/phlegm:
bacterial or viral?
• Name the two stages of TB
• What is the “Gohn Complex”?
• How is TB spread?