Has someone every coughed near to you and you were afraid that you would get a respiratory tract infection? Did you know that respiratory viruses are frequently transmitted by hand to hand contact and less so by coughing? What is a respiratory tract infection though? And what should you know about this number four leading cause of death worldwide (according to the WHO).
What is the respiratory tract?
The respiratory tract is the part of the body that is responsible for the uptake of oxygen and expulsion of carbon dioxide. It extends from the nose and the throat, which are the upper airways, until the small airways and lung tissue; which form the lower respiratory tract. Usually, the upper airways, which are closest to the outside world, are always colonized with bacteria. The body tries to keep the lower airways clean of any bacteria and viruses, as this is where the oxygen and carbon dioxide exchange with the blood.
What are respiratory tract infections (RTI) and what causes them?
An infection is a situation where tissue is damaged in the presence of bacteria or viruses. This can be cause by overgrowth of bacteria which normally reside in small amounts in the airways like the pneumococcus bacteria. Most people carry these bacteria with them in the airways, and only in a certain condition this bacteria can multiply rapidly and lead to damaging of the airways and a respiratory tract infection.
Certain viruses like the influenza virus is able to produce infection; mostly because the immune system overreacts to the presence of a strange “guest” in the airways, in this case it’s not the virus that causes the tissue damage but rather the overreacting immune system.
Respiratory viruses are frequently transmitted by hand to hand contact and less so by coughing, so it’s very important when you are having close contact with a person, with for example the flu, to practice adequate hand hygiene. In the SMMC, when we consider a viral pneumonia like influenza pneumonia we isolate the patient to prevent it spreading to other vulnerable patients.
Who is at risk for respiratory tract infections?
Anyone who has a condition that damages the inner lining of the respiratory system is at increased risk for these infections. I can give you some examples:
- The bedridden and the elderly have the risk to develop pneumonia because they don’t inhale and exhale properly. In the SMMC we mobilize these patients, sometimes with the help of a physiotherapist so they will breathe deeply and cough up properly which reduces the risk of pneumonia.
- All patients who have a weakened immune system because of cancer or the treatment of cancer (chemotherapy), or other conditions like HIV/AIDS. Also, sickle cell patients have a defect in their immune system which makes them vulnerable for certain lung infections. And uncontrolled diabetes leads to a general slowdown of the immune system and puts people at risk especially of some bacterial infections
- Persons with difficulty swallowing; normally the throat prevents the gastric juices from entering the lung system. If this mechanism is not functioning well the gastric contents can damage the inner linings of the respiratory system, with subsequent pneumonia.
- Smokers; smoking damages the lining of the lungs.
- People with asthma and chronic bronchitis; the inner linings of their lungs are also compromised.
What are the signs and symptoms and how is it treated?
As doctors we try to make a distinction between upper and lower respiratory tract infections. The upper respiratory tract infections are mostly caused by viruses, and antibiotics don’t work against viruses; only against bacteria. For a viral infection we can only advice people to take adequate rest and take preventative measures not to infect other people.
When we suspect a lower respiratory tract infection we more easily prescribe antibiotics, as about half of all pneumonias are caused by a bacterial infection; and in that case antibiotics will help.
When people have a high fever, are generally ill and have shortness of breath, we think of pneumonia; and we usually prescribe antibiotics. Your doctor will also listen to your lung sounds, as certain sounds are suggestive of pneumonia. In the SMMC, we usually make an X-ray of the lungs to see if there are signs of an “infiltrate” which is a mass of bacteria and fluid in the lungs.
When people are very sick they have to be admitted to the hospital where we usually give a higher dose of antibiotics via an intravenous (IV) line to the blood; together with a solution to rehydrate the patient. Sometimes it is necessary to give additional oxygen via a small tube or via a mask when it is detected that the oxygen level in the blood is very low.
In general, it is good to have adequate rest when suffering from an RTI; but try to make your lungs active as we know that when people only lay in the bed this can make the situation only worse. Even if you feel sick while having pneumonia, try to sit up for a few hours a day to make your lungs “exercise”.
Are there long term consequences for RTI?
Usually, individuals recover completely from a RTI. The whole recovery can take 1-2 weeks for upper RTI and up to six weeks in certain lower RTI. Usually with pneumonia within a few days to 2 weeks all bacteria are destroyed but then it takes more weeks for the immune system to clear up the mess. That’s why I always advice people that it will take up to 6 weeks before they feel completely fine again.
What is tuberculosis?
Tuberculosis is a bacterial infection which can present in many organs but usually presents as pneumonia. However, it is not a typical pneumonia. In a typical pneumonia, within a few days the patient is very sick, feverish, have shortness of breath and severe coughing. The course of tuberculosis is different; there are complaints about general unwell feeling, weight loss, night sweats, lack of appetite in addition to similar symptoms of pneumonia. Based on the explanation of the patient but also the presence of risk factors (this infection is prevalent in Haiti), together with a typical picture on the lung X-ray (the upper part of the lung is affected), the suspicion of tuberculosis is raised. Fortunately, we see very few cases of tuberculosis in the SMMC.
What treatment is given at the SMMC for tuberculosis?
We have to isolate these patients in a separate room as we don’t want our patients and health care workers to be infected as well. The treatment consists of antibiotics, but because the bacteria are so strong, sometimes people have to take antibiotics up to 9 months before the infection is treated well. Because the bacteria are so resistant, we begin treatment with 4 antibiotics and later use 2.
Is the flu, pneumonia and tuberculosis related?
The ‘real’ influenza is a very bad viral pneumonia which damages the linings of the respiratory tract so much that even a notorious skin bacteria, the Staphylococcus aureus can enter the lungs and can lead to a life-threatening pneumonia. So yes, the flu can lead to pneumonia. Basically, any condition that damages the airways can lead to pneumonia. However pneumonia and tuberculosis are not related and a bad flu will not lead to tuberculosis.
What are some misconceptions to RTI?
Some persons think that they always need antibiotics to treat respiratory tract infections. As already explained, in many cases this is not necessary as upper RTI are usually caused by a virus and even a lot of lower RTI as well. Overuse of antibiotics lead to antibiotic resistance, and this can be very dangerous as later another infection cannot be treated with standard antibiotics.
Another misconception is that the patient has to be inactive. In the past, usually people were asked to stay for 2 weeks in the bed. Nowadays, we know that this only makes it worse, and people are encouraged to stay mobilize.
What steps are being made locally to lower the risk of pneumonia?
Everyone on this island has a responsibility to protect risk groups from pneumonia, as this infection can be life-threatening. In collaboration with SMMC, the SZV decided that certain risk groups like sickle cell patients can get coverage for vaccinations that can protect them against pneumonia. We are happy we can offer this protection to this risk group.
Tune in next week Monday to 102.7FM at 4pm, when SMMC general surgeon Dr. Menno Misset will be talking about the Diabetic Foot.