Lallemand Pharma

Respiratory Health manual

Upper Respiratory Tract Infections

Otitis is a general term for infection or inflammation of the ear, usually bacterial (98%) and occasionally fungal or viral. It is part of upper respiratory infections (URI). Ear infections do not spread from person to person and they most commonly occur as a surinfection following a cold. Antibiotics are often used to treat ear infections.

Different forms of otitis can be found :

Otitis externa (acute, chronic or malignant) which involves the outer ear and ear canal.

Otitis media (acute, chronic, with effusion) which involves the middle ear with a localisation just behind the eardrum. The usual symptomatic presentation is known as acute otitis media and is characterized often by fever, irritability, otorrhea, letargy, vomiting, diarrhoea and hearing loss in some children. Otitis media is the second most common childhood disease and it can occur at any age. It is estimated that over 80 % of children would have experienced at least one episode before the age of 2.

Anatomy of the ear

Otitis interna (Labyrinthitis) is an inflammation of the inner ear when bacteria move from the naso-pharynx to reach the level of the alignment of the ear.

The annual incidence of acute otitis externa is between 1/100 and 1/250 of the general population and 256/1000 for acute otitis media in European children under 5 years.

Main bacteria involved in OTITISOtitis externaOtitis mediaOtitis interna
Pseudomonas aeruginosa, Staphylococcus aureus, CandidaStreptococcus pneumoniae,
Haemophilus influenzae,
Staphylococcus aureus,
Moraxella catarrhalis
Mycoplasma pulmonis,
Streptobacillus moniliformis,
Pseudomonas aeruginosa

The most common bacteria responsible for Otitis Externa, Media and Interna

Rhino-sinusitis (or sinusitis) is an inflammation or infection of the lining of the sinus cavities, triggered by a viral, bacterial or fungal infection. It is one of the most common upper respiratory tract infection, affecting an estimated 16% of the US adult population. In Europe, acute sinusitis affects an estimated 2 % and chronic rhino-sinusitis 10 % of the adult population.

Sinusitis can be :

  • Acute, which is usually caused by a bacterial infection in the sinuses that results from an upper respiratory tract infection.
  • Sub-acute or chronic, which refers to long-term swelling and inflammation of the sinuses that may be caused by bacteria (such as Staphylococcus aureus) or fungus and may involve allergy, environmental factors (pollution…).
The different sinusitis
AcuteSymptoms last for up to 4 weeks
Sub-acuteSymptoms last for 4-12 weeks
ChronicSymptoms last for 3 months or longer
Paranasal sinuses
Main pathogens involved in Rhino-sinusitis
BacteriaStreptococcus pneumoniae (30-35%), Haemophilus influenzae (20-25 %), Moraxella catarrhalis (20%), Staphylococcus aureus
VirusesRhinovirus, Influenza A et B, Parainfluenza, Coronavirus (which are the primary pathogens), Respiratory Syncytial Virus, Adenovirus and Enterovirus
FungiAspergillus, Alternaria, Bipolaris and Curvularia species

The most common pathogens responsible for Rhino-sinusitis

Tonsillitis is an inflammation of the glands of the throat. It is mostly caused by viruses, and, in 10 to 30 % of cases, by bacteria. The tonsils are two glands located in the back of the throat that help to protect the body from upper respiratory infections. In Europe, the prevalence in community studies is estimated to 2-4 % (20 000 – 40 000 individuals per million population).

Tonsillitis is mainly transmitted from one person to another by social contact, by droplets in the air from sneezing. The symptoms of tonsillitis are essentially fever, sore throat, pain when swallowing, headache. In some cases, complications are possible, they include cervical adenitis and tonsil abscess.

Different treatments exist to reduce tonsillitis symptoms :

  • Use of paracetamol / ibuprofen or anti-inflammatory drugs (eg, corticosteroids).
  • When tonsillitis is caused by bacteria, use of antibiotics such as penicillin or amoxicillin.
Main pathogens involved in Tonsillitis
VirusesAdenovirus, Rhinovirus, Influenza, Coronavirus, Respiratory Syncytial Virus.

It can also be caused by Epstein-Barr Virus, Herpes Simplex Virus, Cytomegalovirus, or HIV.
BacteriaStaphylococcus aureus, Streptococcus pyogenes, Streptococcal pharyngitis, Staphylococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Pertussis, Fusobacterium, Diphtheria, Syphilis and Gonorrhea.

The most common pathogens responsible for Tonsillitis

Laryngitis is the medical term for inflammation and swelling of the larynx, characterized by voice loss and irritation of the vocal cords.

There are two types of laryngitis : acute or chronic.

Acute laryngitis is usually caused by an infection that inflames the vocal cords, but may also be caused by voice overuse with excess talking, singing or shouting.

Chronic laryngitis lasts over a week and comes back over time. It can be caused by :

  • Acid reflux, which leads to laryngeal inflammation and chronic cough (known as Gastroesophageal reflux disease).
  • Irritation, due for example to allergies, smoke, prolonged alcohol use or excess coughing.
  • Rarely, chronic laryngitis can provoke cancer of the throat and tumor on the vocal cords.
The different Laryngitis
AcuteUsually lasts for ‹ 7 days
ChronicPersistence of symptoms for 3 weeks or longer
Representation of Larynx

The most common cause of laryngitis is an infection, which could be either viral (which the most common virus is Rhinovirus), bacterial and rarely, a person may develop laryngitis from a fungal infection.

Main pathogens involved in Laryngitis
VirusesRhinovirus, Parainfluenza Virus, Respiratory Syncytial Virus, Influenza and Adenoviruses
BacteriaMoraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae
FungiCandida species, or Histoplasma capsulatum, Blastomyces dermatitis and Cryptococcus neoformans.

The most common pathogens responsible for Laryngitis

Epiglottitis is an inflammation of the epiglottis (flap of tissue that sits at the base of the tongue that keeps food from going into the trachea during swallowing). When it becomes infected and inflamed, it can swell and obstruct or close off the windpipe which may be fatal unless promptly treated.

Conditions that cause epiglottitis include infectious, chemical and traumatic agents :

  • Infectious causes are the most common, classically with Haemophilus influenzae, but also from other potential pathogens.
  • Other types of epiglottitis that are environmental and not caused by infection include heat damage that may injure the epiglottis, called thermal epiglottitis and in rare instance, epiglottitis may be causes by allergic reactions to food.
Representation of Epiglottis
Main pathogens involved in Epiglottitis
BacteriaHaemophilus influenzae (25%), Streptococcus pneumoniae and Staphylococcus aureus
VirusesHerpes Simplex Virus type 1 and Parainfluenza virus
FungiCandida and Aspergillus

The most common pathogens responsible for Epiglottitis