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Respiratory Tract

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Surfaces exposed to the environment but not covered by skin are lined by living cells and are at risk for infection despite the continuous actions of self-cleansing mechanisms. The most common route of viral entry is through the respiratory tract. In a human lung, there are about 300 million terminal sacs, called alveoli, which function in gaseous exchange between inspired air and the blood. Each sac is in close contact with capillary and lymphatic vessels. The combined surface area of the human lungs is ∼180 m2, approximately the size of a tennis court! At rest, humans inspire ∼6 liters of air per minute. Together, the impressive surface area and large volumes of “miasma” that one inhales each minute imply that foreign particles, such as bacteria, allergens, and viruses, are likely introduced into the lungs with every breath.

Mechanical barriers play a significant role in antiviral defense in the respiratory tract. The tract is lined with a mucociliary blanket consisting of ciliated cells, mucus-secreting goblet cells, and subepithelial mucus-secreting glands (Fig. 2.6). Foreign particles deposited in the nasal cavity or upper respiratory tract are often trapped in mucus, carried to the back of the throat, swallowed, and destroyed in the low-pH environment of the gut (Box 2.3). In the lower respiratory tract, particles trapped in mucus are brought up from the lungs to the throat by ciliary action (Fig. 2.7). Cold temperatures, cigarette smoke, and low humidity cause the cilia to stop functioning effectively, likely accounting for the association of these environmental conditions with increased incidence of respiratory tract infections. When coughing occurs, both the host and the virus benefit; the host expels virus-laden mucus with each productive cough, and the virus is carried out of the host, perhaps to infect another nearby. The lowest portions of the tract, the alveoli, lack cilia or mucus, but macro phages lining the alveoli ingest and destroy virus particles.

Principles of Virology, Volume 2

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