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PR3124 CA3 > URTI > Flashcards

URTI Flashcards

1
Q

examples of upper resp tract infection (URTI)? (4)

A
  • influenza
  • common cold
  • pharnygitis
  • rhinosinusitis
  • otitis media
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2
Q

examples of lower resp tract infection? (2)

A
  • pneumonia
  • bronchitis
  • tracheitis
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3
Q

clinical presentations of pharyngitis?

A
  • acute onset of sore throat
  • pain with swallowing
  • fever
  • erythema and inflammation of pharynx
  • tender and swollen lymph nodes
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4
Q

microbio of pharyngitis

A

virus (80%)> bac

  • virus: rhinovirus, coronavirus, influenza
  • bac: group A hemolytic streptococcus eg. S pyrogenes
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5
Q

pathogenensis of pharyngitis

A
  • direct contact with droplets of infected saliva

- short incubation of 24-48h

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6
Q

complications of pharyngitis

A
  • Viral: self limiting

- S. pyrogenes: self lim or complicatiosn pos (occurs 1-3 weeks later)- acute rheumatic fever, acute glomerulonephritis

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7
Q

how to prevent complications of pharyngitis (eg. acute rheumatic fever)?

A

early initiation of effective ab

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8
Q

diagnosis of pharyngitis

A

testing for s. pyrogenes
- throat culture (24-48h)- high sensitivity 90-95%
rapid antigen detectiontest (minutes)- sen 70-90

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9
Q

pharyngitis treatment

A

both viral and bac: supportive care
- analgesic/ antipyretic: paracetamol, NSAIDs
- topical analgesic lozenges/ sprays (eg. benzydamine)
- saltwater gargle
- adequate fluid and rest
ONLY BAC’- PO ab (10 days)

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10
Q

what PO ab are used to treat pharyngitis?

A 
1st line: penicillin VK
alt
- amoxicillin
- cephalexin
- clindamycin
- clarithromycin
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11
Q

monitoring of pharyngitis

A

clinical response expected within 24-48 h
counsel on completing ab course
use of corticosteroids controversial (adverse SE)

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12
Q

what is rhinosinusitis/ sinusitis?

A

acute (within 4 weeks) inflam and infectionof paranasal and nasal mucosa

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13
Q

what are the major sx of rhinosinusitis

A
  • purulent anterior nasal discharge
  • purulent or discoloured posterior nasal discharge
  • nasal congestion/ obstruction
  • facial congstion
  • facial pain/pressure
  • fever
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14
Q

minor sx of sinusitis?

A
  • headache
  • ear pain, pressure
  • halitosis
  • dental pain
  • cough
  • fatigue
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15
Q

hwo to confirm presence of sinusitis?

A

> = 2 major sx OR

1 major + >= 2 minor sx

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16
Q

sinusitis microbio

A 
virus (90) >> bac
virus
- rhonivirus, adenovirus, influenza
bac
- strep pneuno, H flu
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17
Q

sinusitis pathogenesis

A
  • direct contact with droplets of infected saliva or nasalsecretions
  • bacterial cases usually preceded by viral URTI (eg. pharyngitis, common cold)
  • inflam results in sinus obstruction (nasal mucosal secretions trapped, medium of bacterial trapping and multiplication)
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18
Q

sinusitis diagnostic challenges

A
  • bac and viral have similar sx
  • limited use of diagnostic tests (imaging studies: non specific, non discrimatory_, sinus aspirate: invasive, time consuming , painful)
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19
Q

hwo to diagnose presence of BAC sinusitis?

A

sx thing +
presence of any ONE criterion
- persistent of sx. >10 days (viral self limiting, resolves in 7-10 days)
- severe sx at onset eg. purulent discharge for 3-4 days or high fever >39
- double sickening (worsening sx after 5-6 days after initial improvement)

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20
Q

why give PO ab tx for bacterial sinusitis

A

start empiric ab

  • shorten duration of sx
  • earlier sx releif
  • restore quality of life
  • prevent complications
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21
Q

sinusitis tx

A

supportive care

  • analgesic/ antipyretic: paracetamol, NSAID
  • nasal steroid spray
  • saline irrigation
  • expectorant: guaifenesin
  • nasal/systemic decongestant/ antihis
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22
Q

sinusitis first line ab

A

amoxicillin or amox/clav (augmentin)

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23
Q

sinusitis alt ab

A
  • resp FQ: LEVOfloxacin or MOXIfloxacin
  • *CIPROfloxacin is NOT a resp FQ–> poor activity against Strep pneumo (more common bac that causes sinusitis)
  • trimethoprim/ sulfamethoxazole
  • oral 2nd cephalosporin: cefuroxime
24
Q

sinusitis tx considerations ( resistance)

A
  1. strep pnuemo
    - multistep penicillin binding proteins mutation
    - increase penicillin MIC with each mutation– therefore gets more resistant
    - penicillin resistant isolates uncommon locally
    thus, prefer high dose amox for effective tx
  2. h flu
    - beta lactamase production
    - inhibited by beta lactamase inhibitor
25
Q

what is the preferred dose for amox to treat sinusitis?

A 
standard: 45mg/kg/day (ped), 250-500mg (Adults)
high dose (preferred): 80-90mg/kg/day, 1g (adult)
26
Q

when to use amox/clav for sinusitis?

A

use for beta lactamase positive H flu, and has any criteria

  • recent course of ab
  • recent hospitalisation (30 days)
  • failure to improve after 72h of amox
27
Q

how long is the tx duration for sinusitis

A

adult: 5-10 days
- improves compliance
- reduce ab related ADR
- simialr clinical cure

ped: 10-14 days

28
Q

what is acute otitis media (AOM)

A

infection of middle ear space resulting in inflammation and fluid accum

29
Q

AOM clinical presentation

A
  • ear pain
  • ear discharge (otorrhea)
  • ear popping
  • ear fullness
  • hearing impariment
  • dizziness
  • fever
  • non specific in young infants: ear rubbing, excessive crying, change in sleep or behavioural pattern
30
Q

AOM prevention

A
  • avoid exposure to tobacco smoke
  • exclusive breastfeeding for 1st 6 months (passive immunity of ab)
  • minimize pacifier use
  • vaccinations (influenza, pneumococcal, H flue type B vaccine)
31
Q

AOM microb

A 
- bac (55%), viral (40-45)
virus
- resp synctial virus, rhinovirus, adenovirus
bac
- strep pneumo, H. influenzae 
(similar to sinusitis)
32
Q

AOM diagnosis

A

pneumatic otoscope as standard tool

33
Q

AOM diagnostic criteria in children

A
  • acute onset (<48h)
  • otalgia (holding , tugging, rubbing in non verbal), erthyema of tympanic membrane
  • bulging of tympanic membrane
34
Q

AOM challenges in management

A
  • unable to distinguish bac vs viral
  • bac AOM : prompt ab initiation decreaes duratino of sx by 1 day, 80% of cases reoslve without ab
  • overprescribing ab–> resistance
35
Q

AOM tx- supportive care

A
  • analgesic. antipyretic: paracetamol, NSAID

- decongestant and antihistamine NOT shown to be benficial

36
Q

AOM tx : Ab

A
  • ear drops not rec, use PO ab
    1. immediate initiation
  • start ab at the initial doctors visit where AOM is diagnosed
    2. observation period
  • no ab given at the initial doctors visit supportive care x 48-72h
  • improves–> no ab
  • worsens or fails to improve –> ab
  • req reliable follow up
  • may req 2nd trip to doctor
    3. watch and wait
  • prescription given at initial doctors visit
  • fill in 48 hours only if worsens or fial to improve
  • 2/3 prescriptio not filled
  • increased convenience and parent satisfaction
  • more used in western/ bigger country coz inconvenient to travel to hospital
37
Q

when is observation period considered? what are the criterias?

A
  • > 6months
  • non severe illness, absence of all severe (severe: otalgia, otalgia>48h, >39C in last 48h)
  • no otorrhea
  • pssible for close follow up
  • shared decision making with parent.caregiver (parent to monitor child)
38
Q

AOM first line tx ab

A

amoxicillin

  • pt needs to fulfill ALL 3 criteria
    a. no amox in the last 30 days (more likely to hv resistant if took)
    b. no concurrent purulent conjunctivitis
    c. not allergic to penicillin`
39
Q

AOM alt first line ab tx

A 
amox/clavu
give if any 1 is applicable
- amox in last 30 days
- concurrent purulent conjuctivitis
- hx of AOM non responsive to amox
40
Q

AOM alternative ab

A
  • cefuroxime, ceftriaxine (IM)

- clindamycin (severe pen allergy)

41
Q

AOM monitoring

A
  • may worsen in first 24h
  • improvement expected in 48-72h
    re-evaluate if worsensof fail
  • amox–> change to amox/clavu (wider spec)
  • augmentin–> cefuroxime, ceftriaxone
42
Q

AOM tx duration

A

<2yo: 10 days
severe sx: 10days
2-5yo AND non severe sx: 7 days
>6yo AND non severe: 5-7 days

43
Q

what type of distribution does influenza have in SG?

A

bimodal- 2 peaks

44
Q

who is the host of influenza A?

A

humans, swine, avian…

45
Q

host of influenza B>

A

humans only

46
Q

host of influenza C?

A

humans, swine

47
Q

clinical presentation of influenza A?

A
  • most severe

- causes epidemics and pandemics

48
Q

clinical presentation of influenza B?

A

severe illness in older adult or high risk pt

49
Q

influenza complications (5)

A
  • viral penumovia
  • post influenza bacterial pneumonia (esp those caused by s aureus)
  • resp failure
  • exacerbate underlying pulmn or caridac comorb
  • ferbile seizure
  • myocarditis
50
Q

what population is at high risk for influenza related complciations?

A
  • children >5yo
  • elderly >65
  • women pregnant or within2 weeks post partum
  • residents of nursing homes of long term care facil
  • obese
  • chronic medical conditions eg. asthma, COPD (cardio-pulmn conditions)
51
Q

influenza prevention

A
  1. good personal hygiene
    - wash hands
    - minimise touching of eyes, nose, mouth
    - cover nose and motuh when coughing, sneezing
  2. healthy lifestyle
    - balanced diet
    - exercise regularly
    - adequate sleep
    - do not smoke
  3. vaccination (most effective)
    - inactivated trivalent or quad vaccine
    - indicated for ALL indv >6months
  4. chemoprophylaxis (use drugs to prevent)
    a. pre-exposure (prevent before being exposed)
    - institutional outbreak or high risk insv >3 months yo who cannot receive vaccination
    - HOW: initiate as soon as outbreak or influenza activity is identified
    b. post exposure
    - all high risk indv >3months yo OR unvaccinated indv who are household contacts of high risk indv
    - HOW: initiate asap (within 48h) of exposure
52
Q

influenza diagnosis

A
  • viral culture not rec (long time to get results)

- molecular testing avail (but limited use in outpatient–> mostly treated empirically. used inpt)

53
Q

influenza tx

A

initiate asap within 48h of sx onset for isv who fulfill any ONE of the following

  • hospitalised
  • high risk for complications
  • severe, complicated or progressive illness
54
Q

influenza antiviral tx

A
  • oseltamivir PO is first line for tx and chemoprophylaxis- active against influenza A and B
    MOA: neuraminidase inhibitor
  • interferes with protein cleavage
  • inhibit release of new virus/ replication
    well tolerated (se eg. headache, mild GI)
55
Q

dose for oseltamivir to treat chemoprophylaxis ininfluenza

A

75mg PO daily

duration 7 days

56
Q

dose for oseltamivir for tx of influenza

A

75mg PO BD 5 days

prolong if pt is critically ill

PR3124 CA3 (6 decks)

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