Lower respiratory tract infection

Bronchitis

Main article: Bronchitis

Bronchitis describes the swelling or inflammation of the bronchial tubes. Additionally, bronchitis is described as either acute or chronic depending on its presentation and is also further described by the causative agent. Acute bronchitis can be defined as acute bacterial or viral infection of the larger airways in healthy patients with no history of recurrent disease. It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea. Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals. Beta2 agonists are sometimes used to relieve the cough associated with acute bronchitis. In a recent systematic review it was found there was no evidence to support their use.

Acute exacerbations of chronic bronchitis (AECB) are frequently due to non-infective causes along with viral ones. 50% of patients are colonised with Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis. Antibiotics have only been shown to be effective if all three of the following symptoms are present: increased dyspnea, increased sputum volume, and purulence. In these cases, 500 mg of amoxicillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used.

Pneumonia

Main article: Pneumonia

Pneumonia occurs in a variety of situations and treatment must vary according to the situation. It is classified as either community or hospital acquired depending on where the patient contracted the infection. It is life-threatening in the elderly or those who are immunocompromised. Pneumonia is also the leading cause of death in children less than five years of age in low income countries. Invasive pneumococcal pneumonia has a mortality rate of around 20%. For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity (including treatment location, e.g., home, hospital or intensive care), identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess.

Causes

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Typical bacterial Infections:

• Haemophilus influenzae
• Staphylococcus aureus
• Klebsiella pneumoniae

Atypical bacterial Infections:

• Legionella pneumophila
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Chlamydia psittaci

Parasitic infections:

• Respiratory cryptosporidiosis

Viral infections:

• Adenovirus
• Influenza A virus
• Influenza B virus
• Human parainfluenza viruses
• Human respiratory syncytial virus
• Severe acute respiratory syndrome coronavirus (SARS-CoV)
• Middle East respiratory syndrome coronavirus (MERS-CoV)
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Aspiration pneumonia

Prevention

Vaccination helps prevent bronchopneumonia, mostly against influenza viruses, adenoviruses, measles, rubella, streptococcus pneumoniae, haemophilus influenzae, diphtheria, bacillus anthracis, chickenpox, and bordetella pertussis. Specifically for the children with low serum retinol or who are suffering from malnutrition, vitamin A supplements are recommended as a preventive measure against acute LRTI.

Treatment

Antibiotics do not help the many lower respiratory infections which are caused by parasites or viruses. While acute bronchitis often does not require antibiotic therapy, antibiotics can be given to patients with acute exacerbations of chronic bronchitis. The indications for treatment are increased dyspnoea, and an increase in the volume or purulence of the sputum. The treatment of bacterial pneumonia is selected by considering the age of the patient, the severity of the illness and the presence of underlying disease. A systematic review of 32 randomised controlled trials with 6,078 participants with acute respiratory infections compared procalcitonin (a blood marker for bacterial infections) to guide the initiation and duration of antibiotic treatment, against no use of procalcitonin. Among 3,336 people receiving procalcitonin-guided antibiotic therapy, there were 236 deaths, compared to 336 deaths out 3,372 participants who did not. Procalcitonin-guided antibiotic therapy also reduced the antibiotic use duration by 2.4 days, and there were fewer antibiotic side effects. This means that procalcitonin is useful for guiding whether to use antibiotics for acute respiratory infections and the duration of the antibiotic. Amoxicillin and doxycycline are suitable for many of the lower respiratory tract infections seen in general practice. In the other hand, there is no sufficient evidence to consider the antibiotics as a prophylaxis for the high risk children under 12 years.

Oxygen supplementation is often recommended for people with severe lower respiratory tract infections. Oxygen can be provided in a non-invasive manner using nasal prongs, face masks, a head box or hood, a nasal catheter, or a nasopharyngeal catheter. For children younger than 15 years old, nasopharyngel catheters or nasal prongs are recommended over a face mask or head box. A Cochrane review in 2014 presented a summary to identify children complaining of severe LRTI, however; further research is required to determine the effectiveness of supplemental oxygen and the best delivery method.

Epidemiology

Lower respiratory infectious disease is the fifth-leading cause of death and the combined leading infectious cause of death, being responsible for 2.74 million deaths worldwide. This is generally similar to estimates in the 2010 Global Burden of Disease study. This total only accounts for Streptococcus pneumoniae and Haemophilus influenzae infections and does not account for atypical or nosocomial causes of lower respiratory disease, therefore underestimating total disease burden.

Society and culture

Lower respiratory tract infections place a considerable strain on the health budget and are generally more serious than upper respiratory tract infections.

Workplace burdens arise from the acquisition of a lower respiratory tract infection, with factors such as total per person expenditures and total medical service utilisation demonstrated as greater among individuals experiencing a lower respiratory tract infection.

Pan-national data collection indicates that childhood nutrition plays a significant role in determining the acquisition of a lower respiratory tract infection, with the promotion of the implementation of nutrition program, and policy guidelines in affected countries.

References

References

1. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet.
2. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet.
3. Antibiotic Expert Group. (2014). "Therapeutic Guidelines: Antibiotic". Therapeutic Guidelines Limited.
4. (2013-12-26). "Chest radiographs for acute lower respiratory tract infections". Cochrane Database of Systematic Reviews.
5. (January 2015). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet.
6. "The top 10 causes of death".
7. (September 2015). "Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis". The Cochrane Database of Systematic Reviews.
8. Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.
9. (July 2015). "Bronchitis (acute)". BMJ Clinical Evidence.
10. Therapeutic guidelines : respiratory. 2nd ed: North Melbourne : Therapeutic Guidelines Limited, 2000.{{page needed. (August 2018)
11. (19 June 2017). "Antibiotics for acute bronchitis.". The Cochrane Database of Systematic Reviews.
12. Integrated pharmacology / Clive Page ... [et al.]. 2nd ed: Edinburgh : Mosby, 2002.{{page needed. (August 2018)
13. (October 2014). "Antibiotics for community-acquired pneumonia in adult outpatients". The Cochrane Database of Systematic Reviews.
14. (June 2013). "Antibiotics for community-acquired pneumonia in children". The Cochrane Database of Systematic Reviews.
15. (August 2018)
16. (January 2013). "Vaccines for preventing pneumococcal infection in adults". The Cochrane Database of Systematic Reviews.
17. (2017). "Diagnosis of Sputum Culture Positive Organisms and Their Antimicrobial Sensitivity Profile in a Tertiary Care Centre- Kanyakumari". Journal of Evidence Based Medicine and Healthcare.
18. (2002). "Mortality and Burden of Disease Estimates for WHO Member States in 2002". World Health Organization.
19. (November 2011). "Guidelines for the management of adult lower respiratory tract infections--full version". Clinical Microbiology and Infection.
20. (23 January 2008). "Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age". Cochrane Database of Systematic Reviews.
21. (January 2002). "Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence". The Journal of Antimicrobial Chemotherapy.
22. (December 2005). "Guidelines for the management of adult lower respiratory tract infections". The European Respiratory Journal.
23. (12 October 2017). "Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections". Cochrane Database of Systematic Reviews.
24. (8 March 2015). "Azithromycin for acute lower respiratory tract infections". Cochrane Database of Systematic Reviews.
25. (26 September 2015). "Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under". Cochrane Database of Systematic Reviews.
26. (10 December 2014). "Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age". Cochrane Database of Systematic Reviews.
27. (November 2017). "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. Infectious Diseases.
28. (December 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet.
29. (November 2017). "Predicting nosocomial lower respiratory tract infections by a risk index based system". Scientific Reports.