Infection of Nose, Sinus and Ear

INFECTION OF
NOSE, SINUS AND

EAR
Prof. Dr. dr. Efrida Warganegara,

M.Kes., Sp.MK
Content
Introduction
Common
Cold
Sinusitis Acute Sinusitis
Otitis Acute Otitis Media
Otitis Externa
7/28/16
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.
7/28/16
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.
the nasopharynx mucociliary system is
important; and in the oropharynx the flusahing
action of saliva.
In
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
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INTRODUCTION
Two useful generalization can be made about upper and lower
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 glang etc.
2)
Two groups of microbes can be distinguish :

a. Professional invaders succesfully infect
the healthy resp tract they have posses psesific
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
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THE COMMON COLD

Aetiology, Transmission, Pathogenesis, and Clinical
Features
Virus causing Common Cold

Virus
Type
Involved
Attachment
Mechanism
capsid protein
Several at any binds to ICAM-1
Rhinovirusses given time in
type molecule on
(>100 type)
the community cell
capsid protein
binds to ICAM-1
Coxsackie virus
type molecule on
A
especially A21 cell
Viral envelop
protein, binds to
Corona virusses
glycoprotein
several type)
all
receptors on cell
Echovirusses
(34 type)
11, 20
7/28/16
Diasease
Common
Cold
Common
Cold
Common
Cold
Common
Cold
6
THE COMMON COLD

Aetiology, Transmission, Pathogenesis, and Clinical Features
Virus
are the commonest invaders of the nasopharynx

there is a great variety of type though rhinoviruses
and coronaviruses together cause more than 50% of
colds
They
induce a flow of virus-rich fluif from the

nasopharynx, and when the sneezing reflex is
trigerred, large number of virus particles are
discharge into the air
Transmission
is therfore by aerosol and also by viruscontaminated hand.
Most
of these virus posses surface molecules which

binds them firmly to host cell, or to cilia or microvilli
protruding from these cells as a result they are not
washed away in sectretion and are able to initiate
infection in the normal individual
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7
THE COMMON COLD

Laboratory Diagnosis
Common
cold virus infection are diagnosted by

clinical appearance, because of the large variety of
virus, and because of illness is generally mild and
self-limiting with no sysyemic spread, laboratory test
are nor worthwhile
Diagnosis
become important when the lower resp

tract is involved, as for intance with influenza virus
or in children resp syncitial virus (RSV) infection.
The
antigens of these viruses can be detected in

exfoliated cells present in nasopharyngeal aspirates
from children, and a rise of virus-specific antibodies
may give a (generalyy retrospective) diagnosis
Virus
isolation is tedious and can be difficult, but iti

7/28/16
is usually carries out for public
health purpose by 8
THE COMMON COLD

Treatment and Prevention
It
is often said if vigorous treatment with

anticongestants, analgetics and
antibiotics is undertaken, the common
cold may resolve in 48 hours; untreated
it will take two days.
Threre
no worthwhile vaccines for the

common cold virusses and treatment is
for the most part symptomatic there
are, however, vaccines for influenza
virus
7/28/16
OTITIS AND SINUSITIS

Aetiology and Pathogenesis
Many
viruses are capable of invading the air space

associated with the upper resp tract ( sinuses, midle
ear, mastoid)
Mumps
virus or resp syncitial virus for instance, can

cause vestibulitis or, generally temporarily,
deafness.
The
range of secondary bacterial invaders is the

same as in other upper resp tract infection, that is
Streptococcus pneumoniae, Hemophylus influenzae,
sometimes with anaerobes such as Bacteroides
fragilis.
Brain
abses is a mayor complication
Blockage
of the eustachian
(auditory) tube or the
7/28/16
10

Acute Otitis Media
This
condition is extremely common in infants

and small children, partly because the eustachian
(auditory) tube is more widely open at this age.
recent study in Boston : 83% of three years old

had had at least one episode, and 46% three or
more episode since birth.
At
least half of the attacks are viral in origin and

the bacterial invaders are nasopharyngeal
residents, most commonly : Strep. pneumoniae,
or Hem. infuenzae, and sometimes Strep.
Pyogenes or Staph. aureus
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11

Otitis Externa
Infection
of the outer ear can cause irritation and

pain, and must be distinguish from otitis media.
In
contrast to the middle ear, the external canal

has a bacterial flora similar to the skin
(Staphylococcus, corynebacterium, and to a lesser
extent propionibacteria), and the pathogens
responsible for otitis media are rarely found in
otitis externa.
The
warm moist environment favour Staph.

Aureus, Candida albicans and gran negative
opportunistic such as Proteus and Pseudomonas
aeruginosa.
7/28/16
12

Acute Sinusitis
Aettiology
and pathogenesis are similar to

otitis media.
Clinical
features include facial pain and

localized tenderness.
It
may be possible to identify the causative

bacteria by microscopy and culture of pus
aspirated from the sinus, but sinus pucture is
not often carry out and, as in the case otitis
media, the patient is usually treated
empirically with ampicillin or amoxycillin
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13
Rhino viruses
Poliovirus
Enterovirus
Echovirus
Coxsackievirus
Picornaviridae
Rhinovirus
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14
Rhino viruses
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
Rhino viruses
Preventing & Control
Vaccine production, still in research, in

developed
country has been trial.
Natural immunity only in short time.
Ig A 11 S antibody that locally produced can hold
out
for 2-6 weeks
7/28/16
16
Pneumonia due to H.influenza

- occur predominantly among children < 3 years
- may also occurs in adults
- are lobar or diffuse broncho pneumonia
- both types occur mainly in patient with serious
illness
chronic obstructive lung disease
- similar to pneumococcal pneumonia:
the ouset of chills; pleuritic chest pain; purulent
sputum
- pleura effusion is common
- cavitation may develop, but is not common
7/28/16
17
Diagnosis
- smears of sputum: gram-negative bacilli &
PMN
- culture: require special attention
* Chocolate agar with X & V factor require
for growth & primary isolation of
H.influenza
- demonstration of capsular antigen by
counterimmunoelectrophoresis
Treatment : ampicillin
chloramphenicol
7/28/16
18

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INFECTION OF

NOSE, SINUS AND

Prof. Dr. dr. Efrida Warganegara,

air we inhale contain millions of

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

cleansing mechanism are there fore

is against the background of these natural

variety of m.o. live harmlessly in the upper

Many m.o. are restricted to the surface epithelium, but other

Two groups of microbes can be distinguish :

THE COMMON COLD

Virus causing Common Cold

THE COMMON COLD

are the commonest invaders of the nasopharynx

induce a flow of virus-rich fluif from the

is therfore by aerosol and also by viruscontaminated hand.

of these virus posses surface molecules which

THE COMMON COLD

cold virus infection are diagnosted by

become important when the lower resp

antigens of these viruses can be detected in

isolation is tedious and can be difficult, but iti

THE COMMON COLD

is often said if vigorous treatment with

no worthwhile vaccines for the

OTITIS AND SINUSITIS

viruses are capable of invading the air space

virus or resp syncitial virus for instance, can

range of secondary bacterial invaders is the

abses is a mayor complication

OTITIS AND SINUSITIS

condition is extremely common in infants

recent study in Boston : 83% of three years old

least half of the attacks are viral in origin and

OTITIS AND SINUSITIS

of the outer ear can cause irritation and

contrast to the middle ear, the external canal

warm moist environment favour Staph.

OTITIS AND SINUSITIS

and pathogenesis are similar to

features include facial pain and

may be possible to identify the causative

The most frequent : common cold.

Preventing & Control

Vaccine production, still in research, in

Pneumonia due to H.influenza

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