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Flashcards in Common URT Infections Deck (44):
1

Rhinosinusitis (common cold)

-self limiting viral inf of URT

2

Rhinosinusitis - pathogens

-rhinovirus (most common) (MAR-APR & SEPT)

Others:
-RSV (DEC-FEB)
-influenza (DEC-FEB)
-parainfluenza (Croup) (OCT-NOV)
-adenovirus
-enterovirus (echovirus & Coxsackievirus)
-human metapneumovirus

3

Transmission of rhinovirus:

-inh of small particle aerosols
-deposition of large particle droplets on nasal or conjunctival mucosa
-direct- hand to hand contact
-survives up to 2 hours on hands
-several days on surfaces

4

Adults URT:

-2-4colds/yr
-duration 5-7days
-nasal congestion
-WITHOUT FEVER

5

Children URT:

-6-8colds/yr (one/mo Sep-Apr; inc incidence if daycare and fewer with start of primary school)
-duration 7-14days (peak 1-3 days)
-symptoms (colored nasal discharge, **FEVER** days 1-3, sore throat, cough, irritability, difficulty sleeping, dec appetite)

6

COLD with labs and radiology:

-NOT USEFUL!

7

rhinosinusitis complications:

-uncommon
-acute otitis media (secondary to eustachian tube dysf
-asthma exacerbation
-LRT infections (pneumonia, bronchiolitis)
-sinusitis - super rare

8

rhinosinusitis Tx:

-most patients improve in 14 days
-supportive therapy ( acetaminophen PRN fever; bulb suctioning, saline irrigation)
-NO ANTIBIOTICS
-if symptoms for >10-14days WITHOUT improvement then consider acute bacterial sinusitis (NARROW SPECTRUM - AMOXICILLIN)
-NO OVER THE COUNTER COUGH/COLD MEDS!!!!!!

9

Sinus development:

-full dev not complete until late adolescence
-first maxillary and ethmoid
-sphenoid by 5-6 years
-frontal by 7-8 years

10

Sinusitis epidemiology:

-inflammation of paranasal sinuses
-Alergic; bacterial; fungal; viral
-Usually as complication of viral URI

11

Sinusitis categories:

1) Acute:
->10-14 days but 90 days

12

Diagnosis of acute bacterial sinusitis:

-nasal/postnasal discharge lasting at least 10-14 days without improvement
-with or without daytime cough
-cough worse as night

OR

Ill appearing child with
-temp>102F
-purulent nasal discharge
-3 consecutive days

13

Acute bacterial sinusitis - the pathogens:

-strep pneumo
-moraxella catarrhalis
-haemophilus influenzae
-staph aureus (and MRSA)

14

Pathophys of sinusitis

-ciliary dysf and inc secretions = sinus obstruction

15

Clinical symptoms of sinusitis:

-nasal discharge
-cough
-facial pain
-headache
-painless eye swelling

16

Sinusitis PE:

-periorbital edema
-mucopurulent discharge in nose or pharynx
-nasal mucosa (erythematous(Infectious); boggy (infectious) and pale (allergic))
-tenderness over paranasal sinuses
-malordorous breath

17

complications of sinusitis:

-meningitis
-brain abscess
-cavernous venous thrombosis
-orbital cellulitis (abscess)
-osteomyelitis
-epidural/subepidural empyema

18

Labs and radiology for sinusitis?

not helpful!

19

Management of sinusitis:

1) antibiotics
-start with narrow spectrum (first line amoxicillin)
-treat until symptom free +7 dats (at least 10-14days)
2) sinus aspiration
-indications:
failuer to respond to antibiots
severe facial pain
orbital intracranail complications
immunocomp patient

20

Pharyngitis:

-affects respiratory mucosa of throat

21

clinical features of pharyngitis:

-sore throat
-headache
-fever
-malaise

22

Predictors of bacterial pharyngitis:

(compared to viral)
-fever >38C
-tonsillar swelling or exudate
-tender cervical lymph
-absence of cough and nasal discharge

23

Tx pharngitis:

-resolves on on in 40% cases by 3 days
-resolves in 85% by 1 week
-analgesia
-antibiotics to prevent rare complications
-systemic corticosteroids: severe pain no responding to analgesics=reduce pain 12-24 hrs; tonsillar edema with risk of obstruction

24

Swabbing throat how old?

not unless 2-3 years -- if younger they prbably dont even have the receptors yet

25

Do not treat pharyngitis unless:
Drug of choice?

-proven group A strep!! (usually viral)
-penicillin for strep pharngitis

26

complications of pharyngitis?

-rare!
-peritonsillar abscess
-acute otitis media
-acute sinusitis
-acute rheumatic fever
-acute glomulonephritis

27

Otitis media:

-affect respiratory mucosa of middle ear
-common in children (dec in frequency after age 6 years)
-most common reason for prescribing antibiotics for children in US

28

Diagnosis of acute otitis media:

1) presence of middle ear effusion
-bulging of tympanic membrane
-limited or absent mobility of the tympanic membrane
-air-fluid level behind the tympanic membrane -otorrhea
2) history of recent acute onset
3) signs of inflammation of middle ear
-otalgia
-eryhhematous tympanic membrane

29

***If kid doesnt have/had fever or pain with otitis media then..

not treating with antibiotics = watchful waiting!!****

30

Risk factors for acute otitis media:

-immunodef
-craniofacial abn (cleft, down)
-recent resp tract inf
-family hisotry
-siblings
-daycare
-lack of breastfeeding
-passive smoke exposure
-pacifier use

31

Peak age incidence for acute otitis media?

-6-12 months

32

**Pathogens for acute otitis media:

1) Viral
-RSV
-influenza
2) bacterial
-S pneumo
-H influenzae
-M catarrhalis

33

Tx for acute otitis media?

-Wait it out
-pain resolves in <2 yo

-analgesics for symptmatic relief
-antibiotics see #35

34

Prevention of acute otitis media:

-conjugate pneumococcal vaccine
-influenza vaccine
-reduce risk factors (stop pacifier, stop smoking exposure)

35

antibiotics for acute ottiis media if

-no improvement 48 hours
-perforation of TM
-high risk of complications
-children <2yo with bilateral AOM

36

**on test dont pick which antibiotics???

IF ITS NOT AMOXICILLIN OR PENICILLIN DONT PICK IT!!!!

37

Antibiotic selection for acute otitis media:

-narrow spectrum (amoxicillin)
-treat for 5-7 days
-10 day course if younger child, underlyying chronic illness (craniofacial issues), perforated TM, chronic or recurrent acute OM.

38

What doesnt work for acute otitis media?

-antihistamines
-decongestants
-myringotom y

39

common complication for acute OM?

-mastoiditis*

-others;
facial palsy, menigitis
intracranial abscess...

40

recurrent acute otitis media defined as:

-3 episodes in 6 mo
OR
-4 episodes in 12 months

41

management of recurrent acute otitis media:

-prophylactic antibiotics-ok
-tympanostomy tubes-ok
-adenoidectomy - NOT HELPFUL! SO WHY ARE WE EVEN MENTIONING IT IN CLASS HERE...

42

otitis media with effusion:

-presence of middle effusion wihtout symptoms of acute infection
-expected 2-3 mo following acute ottiis emdia
-usually asymptomatic but can cause hearing loss

43

most common form of otitis media?

-otitis media with effusion

44

Tx otitis media with effusion_

-most cases resolve on own within 3 months