Upper Respiratory

Tract Infection
Dr Birtukan. E( MD, Pathologist)
 Outline
 Upper respiratory tract infections
 Nasopharyngeal carcinoma
 Laryngeal tumors
 Acute Rhnitis (Common Cold)

 Common cold is the commonest inflammatory

disorder of the nasal cavities that may extend
into the nasal sinuses.

 It is mostly viral illness in which the symptoms of

rhinorrhea and nasal congesion are prominent

 sometimes bacteria can cause it

 Epidemiology: Children have average of 6 to 7

colds/year, 10 to 15% have at least 12/year.
 Decrease with age ,2 to 3/year in adults
 PATHOGENESIS
Spread :
Viruses spread by small-particle aerosols, large-
particle aerosols and direct contact.
 RV and RSV direct contact is more efficient .
 Influenza more spread with the small particle
aerosols.
 Influenzas /Adenovirus infection ->
destruction of nasal epithelial lining
 Rhinovirus ,Corona viruses and RSV ->
no apparent histological damage as in nasal
epithelium
 Clinical Manifestations
 Onset usually after 1-3 days of acute
infection
 Nasal congestion accompanied by watery
Discharge
 Sneezing
 Scratchy and dry sore throat
 Low grade fever and other constitutional
symptoms
 Complications
 Otitis media
 Sinusitis
 Exacerbation of asthma
 Allergic Rhinitis
 It is an IGE mediated immune
reaction i.e initiated by sensitivity
reactions to allergens
 Symptoms: watery rhinorrhea, nasal
obstruction, nasal itching and
sneezing
Sinusitis
 Cont’d
 Inflammation of the lining of the paranasal
sinuses.
 Cont’d
 The maxillary sinuses are the most
common site (85%), followed by
ethmoidal, sphenoidal, and frontal
involvement
 Classification
 Acute sinusitis
< 4 Weeks

 Subacute sinusitis
4 Weeks and < 3 months

 Chronic sinusitis
> 3 Months

 Recurrent acute sinusitis

It is diagnosed when 2-4 episodes of
infection occur per year.
 Etiology

Infection

● Viral ( rhinovirus, influenza virus)

● Bacterial (Streptococcus pneumonia)
● Fungal ( Rare )

 Cilia in the sinuses do not work properly due to

some medical conditions (kartegner syndrome).

 Colds and allergies may cause too much mucus

to be made or block the opening of the sinuses.

 A deviated nasal septum, nasal bone spur, or

nasal polyps may block the opening of the
sinuses
 Clinical Presentation

Purulent nasal discharge (v. imp)
(diagnostic )

Nasal airway obstruction

Headache, irritability, or facial pain

Fever

Postnasal drip
 Complications

1. Meningitis (the most imp)

2. Epidural abscess and Subdural abscess
3. Intracerebral abscess
4. Cavernous sinus, venous sinus thrombosis
 ACUTE PHARYNGITIS
 Millions of visits to primary care providers
each year are for sore throat.
 The majority of cases of acute pharyngitis are
caused by typical respiratory viruses
 Etiology
 A wide variety of organisms cause acute
pharyngitis.
Viruses
Group A B-hemolytic strep(GABHS).
Others; group C strept. ,Arcanobacterium
hemolyticum,Francisella
tularensis,Mycoplasma pneumoniae ,Nissera
gonorrhoeae,Corynebacterium diphtheriae .
 EPIDEMIOLOGY
 Viral URTI mostly in winter and spring
spread by close contact
 Incidence increases among children then
declines late adolescents and adults.
 Group A streptococcal pharyngitis is
primarily a disease of children 5–15 years
of age; it is uncommon among children <3
years old
 Clinical Manifestations
 Onset often rapid; sore throat ,fever.
 P/E :Erythematous pharynx ,tonsils enlarge
with yellow blood tinged exudates,
possible to have petechiae on soft palate
and post Pharynx . Uvula-red swollen.
 Ant. Cervical L.N enlarged, tender.
 Scarlet fever; circumoral pallor, strawberry
tongue ,fine red papular rash ‘sand paper’
 Viral pharyngitis
 More gradual, more with rhinorrhea,
cough, diarrhea.
 Adenovirus may have concurrent
conjunctivitis and fever
 EBV ;prominent tonsillar enlargement,
cervical lymphadenitis ,HSM ,fatigue –
IM.
 PRIMARY HERPES SIMPLEX ,young
children ,high fever, gingivostomatitis
Viral pharyngitis Bacterial pharyngitis
 Complications
 Viral URTI predispose to Middle Ear
Infections
 Streptococcal Pharyngitis complications
parapharyngeal abscesses
 Acute glomerulonephritis and Acute
Rheumatic Fever.
 The risk of rheumatic fever can be reduced
by timely penicillin therapy
 ACUTE EPIGLOTTITIS
 It is medical emergency
 Etiology
H.Influenze ,most common before
vaccine introduction.(reduced by
90%).
Streptococcus pyogens,
S.pneumoniea ,staph. Aureus ,
 Age was 2-4yr but as early as 1 st year
and late as 7 years have been seen.
 Clinical Manifestations
 Acute fulminating course of 
“4 DS”
high grade fever
 Dyspnea ,sever sore throat , symptoms
 Rapidly progressive air way 1. Dysphagia
obstruction
 Difficult swallowing ,difficult
2. Dysphonia
breathing 3. Drooling
 Air hunger and restlessness
 Stridor
4. Distress
 DEATH unless proper
airway management
Cont’d
 Acute laryngitis
 It is inflammation of larynx
 Acute laryngitis can result from
Inhalation of irritants
Viral infections
Bacterial infections
Two forms of laryngitis:
1. Tuberculous
2. Diphtheritic
 Cont’d
 Tuberculos laryngitis: consequence of
protracted active tuberculosis, during
which infected sputum is coughed up.
 Diphtheritic laryngitis: caused by
Corynebacterium diphtheriae implants on
the mucosa of the upper airways
 Cont’d
 Exotoxin causes necrosis of the mucosal
epithelium and a dense fibrinopurulent
exudate( dirty-gray pseudo membrane of
diphtheria)

 Aspiration of the pseudomembrane causing

obstruction of major airways and absorption
of bacterial exotoxins
 Croup
 Laryngeotrachiobronchitis in children
 Narrowing of airways produces inspiratory
stridor
 Parainfluenza virus and less common respiratory
syncytial virus
 Thy have barking cough

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Otitis Media
 Cont’d
 Otitis Media is an inflammatory condition of the
middle ear that results from dysfunction of the
eustachian tube in association with a number of
illnesses, including URIs and chronic rhinosinusitis

 The inflammatory response to these conditions

leads to the development of a sterile transudate
within the middle ear and mastoid cavities.

 Infection may occur if bacteria or viruses from the

nasopharynx contaminate this fluid
 Cont’d

Acute OM
< 3 weeks


Subacute OM
3 weeks to 3 months


Chronic OM
3 months or longer
 Acute Otitis Media
 Is Acute infection of the mucous
membrane lining of the middle ear
 It results when pathogens from the
nasopharynx are introduced into the
inflammatory fluid collected in the middle
ear
 Most common in infants 6 – 18 months old
( 2/3 of cases)
● Route of infection: - Eustachian tube
-External auditory
canal
 Etiology
Bacteria:-
▪S. pneumoniae - 30-35%
▪H. influenzae - 20-25%
▪M. catarrhalis - 10-15%
▪Group A strep - 2-4%

Viruses:-
▪Respiratory syncytial virus (RSV)
▪Rhinovirus
▪Parainfluenza virus
▪Influenza virus
Bulging of tympanic mabrane
 Complications of otitis media
 Intracranial:  Intratemporal :
 Meningitis
 Epidural abscess
 Brain abscess  Hearing loss
 Cavernous sinus  Balance and motor
problems.
thrombosis
 TM perforation.
 Lateral sinus
 Extension of the
thrombosis
 Subdural empyema suppurative process to
adjacent structures
 Carotid artery (mastoiditis, petrositis,
thrombosis labyrinthitis)
 Sign and symptoms
- Otalgia
- Fever

- deafness

- otorrhea
 Chronic otitis media
 Chronic Suppurative Otitis Media is
characterized by persistent or recurrent
purulent otorrhea in the setting of
tympanic membrane perforation
 Usually, there is also some degree of
conductive hearing loss.
Upper Respiratory Tract
Tumors
 Nasal polyps
• Recurrent attacks of rhinitis eventually lead to nasal
polyps, it is focal protrusion of mucosa
• It can ulcerate, infected or can impair sinus discharge

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 Nasopharyngeal
carcinoma
 Nasopharyngeal carcinoma ( NPC) is a
carcinoma arising in the nasopharyngeal
mucosa that shows histologic or
immunophenotypic of squamous differentiation

 The strong epidemiologic links to EBV and the

high frequency of this cancer among the
Chinese

 Mostly it spread to cervical lymph nodes, and

 Pathogenesis
 EBV infects the host by first replicating in
the nasopharyngeal epithelium and then
infecting nearby tonsillar B lymphocytes.

 In some individuals, this leads to

transformation of the epithelial cells to
neoplastic cells
 Classification of
Nasopharyngeal carcinoma
1. Nonkeratinizing squamous cell
carcinoma
– Differentiated subtype
– Undifferentiated subtype
2. Keratinizing squamous cell
carcinoma
3.Basaloid squamous cell carcinoma
 Cont’d
 Undifferentiated is the most common
subtype, accounting for > 60% of
nasopharyngeal carcinoma

 Peak incidence in fourth to sixth decades;

less than 20% occur in pediatric age group
 Microscopy
 The undifferentiated neoplasm is
characterized by large epithelial cells with
indistinct cell borders (reflecting
“syncytial” growth) and prominent
eosinophilic nucleoli.

 Accompanied by a striking influx of T cells

 Laryngeal Tumors
 Variety of non neoplastic, benign, and
malignant neoplasms of epithelial and
mesenchymal origin may arise in the
larynx

 Vocal cord nodules, papillomas, and

squamous cell carcinomas are common

 The most common presenting feature is

hoarseness.
 Nonmalignant Lesions
1. Vocal cord nodules (“polyps”):
smooth, hemispherical protrusions
located on the true vocal cords.
 Composed of fibrous tissue and
covered by stratified squamous
mucosa
 These lesions occur chiefly in heavy
smokers or singers
2. Laryngeal papilloma or squamous papilloma

 Soft raspberry like excrescence benign neoplasm

usually located on the true vocal cords
 They are single in adults but often are multiple in
children(as recurrent respiratory papillomatosis )
 These lesions are caused HPV types 6 and 11
and often spontaneously regress at puberty.
 Cancerous transformation is rare.
 Microscopy: it consists of multiple slender,
fingerlike projections supported by central
fibrovascular cores and covered by an orderly,
typical, stratified squamous epithelium.
Carcinoma of the Larynx
 Carcinoma of the larynx represents only
2% of all cancers
 Most commonly occurs after 40 years of
age and is more common in men than in
women
 Risk factors: smoking
Alcohol
Asbestos exposure
HPV
 Cont’d
 95% of laryngeal cancers are squamous
cell carcinomas
 Tumor loaction:
vocal cords (glottic tumors) in 60%
to 75%
supraglottic; 25% to 40%
subglottic; <5%
 The location of the tumor within the larynx
has a significant prognostic effect