INFECTION OF

NOSE, PHARYX AND SINUS

Prof. Dr. dr. Efrida Warganegara, M.Kes., Sp.MK

 Content
 Introduction
 Common Cold
 Pharyngitis
 Sinusitis  Acute Sinusitis
 INTRODUCTION
 The air we inhale contain millions of suspended
particle, including microorganism

 Nearly all these m.o. are harmless, but in the

vicinity of infected individuals the air may contain
large number of pathogenic m.o.

 Efficient cleansing mechanism are there fore

essential to keep the respiratory tract clean, and
are vital components of the defence against
infection of the upper as well as the lower
respiratory tract.
 INTRODUCTION
 It is against the background of these natural
defence mechanism that infection take place,
and it is then fitting to ask why the defences have
failed.

 In the nasopharynx  mucociliary system is

important; and in the oropharynx the flushing
action of saliva.

 A variety of m.o. live harmlessly in the upper resp

tract and oropharynx  they colonize the nose,
mouth, throat, teeth and are well adapted to life in
these site.  FLORA NORMAL OF THE
RESPIRATORY TRACT
 INTRODUCTION
 Normally they are not causes
disease. However, as in other parts
of the body, resident m.o. may cause
trouble when host resistance is
weakened
 The respiratory tract, from nose to
alveoli, is a continuum as far as
infectious agent are concerned. There
may be a preferred “focus” of infection
 INTRODUCTION
Two useful generalization can be
made about upper resp. tract. Infection
:
1). Many m.o. are restricted to the
surface epithelium, but other
spread to other parts of the body,
before returning to the resp. tract,
oropharynx, salivary gland etc.
 INTRODUCTION
2). Two groups of microbes can be distinguish :
a. “Professional” invaders  succesfully
infect the healthy resp tract  they have
posses spesific properties that enable them
to evade local host defence, such as the
attachment mechanism of resp. viruses

b. “Secondary” invaders  those which

cause disease only when host defences
are already impaired
 THE COMMON COLD
Introduction

 The common cold is the most

frequent infectious disease in humans,
and accounts for more than half of
the upper resp tract infections that
people get every years
 Colds are the leading cause of absences
from school
 THE COMMON COLD
Signs and Symptom
 Colds begin with malaise, followed by a
scratchy or mildly sore throat, runny nose,
cough, and hoarseness
 The nasal secretions are initially profuse and
watery, then thicken in a days or two, finally
becoming cloudy and greenish
 There is no fever unless secondary bacterial
infection occurs.
 Symptom are mostly gone within a week,
but a mild cough sometime continues for
longer
 THE COMMON COLD
Causative Agents
 Virus that cause the common cold are often
referred to simply as “cold viruses”
 Between 30% and 50% of cold are caused by
the 100 or more types of human
rhinovirusses
 These are member of the picornavirus family
(pico=small, ssRNA), grown in the cell culture
under temperatur and pH conditions that mimic
the upper resp tract (33oC , slightly acid pH)
 Many other viruses and some bacterial species
can also produce the signs and symptom of the
common cold
 THE COMMON COLD
Causative Agents

Poliovirus
Enterovirus
Echovirus

Coxsackievirus
Picornaviridae
 THE COMMON COLD
Aetiology, Transmission, Pathogenesis, and Clinical Features

Virus causing Common Cold

Attachment
Virus Type Involved Mechanism Diasease
Several at any capsid protein binds to
Rhinovirusses given time in the ICAM-1 type molecule
(>100 type) community on cell Common Cold
capsid protein binds to
ICAM-1 type molecule
Coxsackie virus A especially A21 on cell Common Cold
Viral envelop protein,
Corona virusses binds to glycoprotein
several type) all receptors on cell Common Cold
Echovirusses (34
type) 11, 20 - Common Cold
 THE COMMON COLD
Causative Agents
• Rhinovirus To cause URTI.
• The most frequent : common cold.
• Acid labile, consist of 100 serotypes.
• Isolation : nose & throat swab
•

•Pathogenesis
Port of entry : URT  droplet infection.
Virus can find from nose secretion after 2 – 4 days
post contact
There are limited histopathologic alteration at
sub mucous & surface epithelial.
 THE COMMON COLD
Pathogenesis
 Rhinovirus attach to spesific receptors on resp
epithelial cells and then infect the cell
 The replication cycle produce large numbers of
virion and these are released to infect other cells.
 Ciliary motion in the infected cells stops and the
cells may die and slough off
 The damage causes the release of pro-
inflamatory cytokines and stimulates nervous
reflexes, resulting in increased nasal secretion,
tissue swelling that partially or completely
obstruct the airways, and sneezing
 THE COMMON COLD
Pathogenesis
 Later in the inflamatory response, blood vessel
dilate, allowing plasma to ooze out and
leucocytes migrate to the infected area
 Secretion from the area may then contain pus
and blood
 The infection is eventually stopped by the
innate and adaptive responses, but it can
spread into the ears, sinuses, or even the
lower resp tract before this occurs
 Rhinoviruses can even cause life-threatening
pneumonia in individuals with AIDS
 THE COMMON COLD
Epidemiology
 Human : the only source of cold virus, which are
spread by close contact with an infected person
 In adult the disease is usually contacted when
airborne virus-containing droplets are inhaled
 Transmission can also occur when secretion from
infected people are accidently rubbed into the eye
(via nasolacrimal duct) or nose by contaminated hand
 In the infected people (severe symptoms) in the early
in the course of a cold is much more likely to
transmit the virus than is someone with mild
symptom or in the late stage of the disease
 THE COMMON COLD
Epidemiology
 This is because infected people have very high
concentration of virus in their nasal secretions
and on their hands during the first 2 or 3 days of
a cold
 By the fourth or fifth day, virus levels are often
undetectable, but low level can be present for 2
week.
 Cold are actually not highly contagious if
reasonable preventive measures (handwashing)
are taken
 Emotional stress, however, can almost double the
risk of catching a cold
 THE COMMON COLD
Treatment and Prevention
 There are no proven treatments for the common cold
 Rhinovirus are not affected by antibiotics or other antibacterial
 Analgesics and antipyretic (aspirin, ibuprofen) can help reduce
symptoms
 the common cold may resolve in 48 hours; untreated it will take
two days.
 To prevent the spread of rhinovirus include handwashing to
physically remove the virus, keeping hands away from the face,
and avoiding crowded place
 It is especially important to avoid people with colds during the
first few days of their symptom, when they are shedding high
numbers of viral particles
 Threre no worthwhile vaccines for the common cold virusses ;
Vaccine production, still in research
 The Common Cold
Scratchy throat,nasal discharge, malaise, headache,
Sign and Symptom cough
Incubation Periode 1 to 2 days
Causative Agent Mainly Rhinovirus - more than 100 types
many other viruses, some bacteria
Pathogenesis Virus attach to resp. epithelium starting infection that
spread to adjacent cells; ciliary action ceases and
cells slough; mucus secretion increases; and inflamatory
reaction occurs; infectionstopped by interferron release,
cell mediated and humoral immunity
Epidemiology Inhalation of infectious mucus to nose or eye by
contaminated finger; children initiate many outbreakss
in families because of lack of care with nasal secretions
Treatment and No generally accepted treatment except
Prevention for control symptoms, handwashing :
avoiding people with colds and touching face
 Streptococcal Pharyngitis
Introduction
 Sore throat is one of the most common seek
medical care.
 Streptococcal Pharyngitis commonly known as
Strep Throat
 One concern about streptococcal infection is the
risk of post-streptococcal sequelae (immune
respon to Streptococcus pyogenes) e.g. Acute
rheumatic fever and acute post-streptococcal
glomerulonephritis  these are complication that
develop after the initial infection
 Streptococcal Pharyngitis
Signs and Symptoms
 Strep throat is characterized is characterized by a sore
throat, difficulty swallowing, and fever
 The throat is red, with patches of pus and scattered tiny
hemorrhages.
 The lymph nodes in the neck are enlarged and tender
 Abdominal pain or headache may occur in older children
and young adult
 Patient do not usually have a cough, weepy eye or runny
nose
 Most patient with strep throat recovery spontaneously
after about a week.
 In fact, many infected people have only mild symptoms or
no symptoms at all
 Streptococcal Pharyngitis
Causative Agent
 Strep throat is caused by Streptococcus pyogenes,
a Gram positive coccus that grown in chains 
colony morphology on blood agar-S.pyogenes
colonies are sorrounded by a characterized clear
zone of β-hemolysis in contrast most species
Streptococus , part of throat microbiota are α-
hemolytic, a zone of greenish partial clearing
around colonies on blood agar, or non-hemolyitic
 S. pyogenes is commonly referred to as the group A
streptococcus (GAS) reflecting its Lancifield
grouping
 Streptococcal Pharyngitis
Pathogenesis
 S. pyogenes has many virulence factor
(hyaluronic acid capsule, Protein M,
Streptococcal pyrogenic exotoxins,
streptolysins O and S,Tissue-degradation
enzymes).
 Some of these disease-causing mechanism are
structural component of the cells wall that
allow the bacterium to avoid host defense
 Others are destructive enzymes and toxins
released by the bacterial cell that damage or
kill host cells
 Streptococcal Pharyngitis
Pathogenesis
 Protein (M) is the cell wall of S.pyogenes allow the
bacteria to attach to host cells
 Once S.pyogenes colonized host tissues, it produce
enzymes such as DNase, hyaluronidase, and
proteases that break down intracellulare
connection and allow the organism to spread
rapidly to others cells.
 A few strain of S.pyogenes produce streptococcal
pyrogenic exotoxin, a family of exotoxin that
cause severe streptococcal diseases characterized
by high fever (pyro means “fire”)
 Streptococcal Pharyngitis
Epidemiology
 S. pyogenes naturally infects only humans
 The strain spread easily by respiratory droplets
generated by shouting, coughing, and sneezing.
 Nasal carriers of S. pyogenes are more likely than
pharyngeal carriers to spread the organism.
 A person may be an asymptomatic carriers of S.
pyogenes for a weeks.
 The peaks incidence of strep sore occurs in
winter or spring and its highest in grade school
children
 Streptococcal Pharyngitis
Treatment and Prevention
 People with fever and sore throat should be
taken to a physician so that a throat swab can
be taken for a rapid diagnostic test and throat
culture
 Confirmed strep throat is treated with a full 10
days of penicillin or erythromycin, which
eliminated the organism about 90% of the cases
 Adequate ventilation and avoiding crowded
situations help to control the spread of
streptococcal infections
 No vaccine is available
 Strep Throat (Streptococcal Pharyngitis)
Sign and Symptom Sore, red throat, with pus and tiny hemorrhages,
enlargement and tenderness of lymph nodes in the
neck; less frequently, abscess formation involving
tonsils, occasionally, rheumatic fever and glomerulo-
nephritis as sequelae
Incubation Periode 2 to 5 days
Causative Agent Streptococcus pyogenes, Lancefield group A
β-hemolytic streptococci
Parhogenesis Virulence associated with hyaluronic acid capsule and
M protein, both of which inhibits phagocytosis, protein
G binds Fc segment of IgG, protein F for mucosal
attachment, multiple enzymes
Epidemiology Direct contact and droplet infections; ingestion of
contaminated food
Treatment and Treatment : 10 days of penicillin or erythromycin
Prevention Prevention : avoiding crowds, adequate ventilation,
daily penicillin to prevent recurrent infection in
those with a history of rheumatic heart disease
 THE SINUSITIS
Introduction
 Bacterial infection of sinus are very
common, often occurs together
with eye surface and middle ear, and
often have the same causative agent
 Sinusitis is common in both adults
and children
 THE SINUSITIS
Sign and Symptoms
 Insinusitis, facial pain and pressure
sensation characteristically occur in the
region of the involved sinus.
 Headache and severe malaise also
occur
 A thick green nasal disharge that may
contain pus and blood sometimes
develops as well
 THE SINUSITIS
Causative Agents
 Sinus infection is often caused by two common
bacterial pathogen :
1) Haemophylus influenzae, a tiny Gram
negative rods, and
2) Streptococcus pneumoniae, the Gram
positive encapsulated diplicoccus known
as pneumococcus
 Sinusitis can also be caused by Mycoplasma pneumoniae,
Streptococcus pyogenes, Moraxella catarrhalis, and
Staphylococcus aureus
 About one-third of the cases are caused by respiratory
viruses, explaining why some infection do not respond
to antibiotic, which have no effect on virus
 THE SINUSITIS
Pathogenesis
 Sinusitis is usually preceded by
infection of the nasal chamber
and nasopharynx that probably
spreads upward
 The infection damages the ciliated
cells, resulting in inflamation and
swelling
 Sinus infections sometimes spread to
the brain coverings, causing meningitis
 THE SINUSITIS
Epidemiology
 The ecological factor involved in appearance and
spread of the sinus infection caused by H. infeluenzae
and S. pneumoniae are largely unknown
 The virulence of the bacteria, crowding and the
presence of the respiratory viruses are probably all
important factors in these epidemics
 A preceding or simultaneous viral illness is common
in sinusitis, the virus probably damages the
mucociliary mechanism that would normally protect
against baterial infections
 Sinusitis tends to affect adults and older children in
whom the sinuses are more fully develops
 THE SINUSITIS
Treatment and Prevention
 Antibacterian therapy with amoxicillin is
generaly efective against sinusitis,
 Alternative medications are available for
communities where antibiotic-resistance strains
of H. influenzae and S. pneumoniae are common
 Sinus pucture is not often carry out
 Decongestants and antihistamines generally are
ineffective and can be harmful because they
reduce the immune response
 There are no proven preventive measures for
sinusitis
Terimakasih