Upper Respiratory Infections Flashcards Preview

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Flashcards in Upper Respiratory Infections Deck (11):
1

Parainfluenza, Respiratory Syncytial Virus (RSV), Rhinovirus, Coronavirus, Enterovirus
Influenza and adenovirus infections are usually associated with more severe illness

Seasonal incidence with epidemics in the colder months
Attack rates are highest in young children who are also the main reservoir
Transmission through direct contact with secretions and airborne droplets

Nasal drainage/obstruction, sneezing, sore throat, cough, fever
In young children, RSV or parainfluenza may lead to pneumonia, croup and bronchiolitis

Dx: Clinical; pharyngeal exudate warrants performance of rapid antigen test or throat culture to rule out infection with Group A beta hemolytic Strep

Tx: Symptomatic relief with vasoconstrictors, antihistamines and antipyretics

The Common Cold

2

Rhinoviruses, adenoviruses, influenza, parainfluenza, HSV, EBV, CMV
(bacterial causes: Groups A & C Strep, Neisseria gonorrhoeae, Corynebacterium diphtheria, Mycoplasma, and anaerobes

Bacterial:
Symptoms may be mild but patients usually experience pharyngeal pain, pain on swallowing, and fever
Pharyngeal erythema and exudate may be present, cervical adenopathy is common

Viral:
Usually milder except when caused by influenza
EBV and adenoviruses can cause exudative infection

Dx: Distinguish bacterial from viral etiology (bacterial requires antibiotic)
Rapid antigen detection test can be used for diagnosis of Strep, negative test followed by throat culture

Tx: viral - supportive; bacterial - penicillin or macrolide

Pharyngitis

3

Rapidly progressive cellulitis of the epiglottis that can potentially occlude the airway

Haemophilus influenzea type b in most pediatric patients
Strep pneumo, Staph

Common in the 2-4 age group
Dysphonia, sore throat, difficulty swallowing
Patient may be sitting up and drooling due to inability to clear secretions
Respiratory distress and stridor may be present

Dx: Direct visualization under anesthesia, usually see an edematous, red epiglottis
Blood and epiglottal cultures can be used

Tx: Protect the airway, intubation is recommended in children
Direct antibiotics against H. influenzae
Prophylaxis for those in close contact and less than 4 years old

Epiglottitis

4

Age-specific viral infection, producing subglottic inflammation, resulting in dyspnea and a characteristic inspiratory stridulous sound

Commonly caused by parainfluenza 1 & 3 (also 2), RSV, rhinoviruses, influenza, mycoplasma

Affects children 3-36 months old; can begin as hoarseness and cough and then proceed to stridor and rapid breathing
Some children experience repeated episodes (spasmodic)

Dx: clinical
Tx: Supportive - supplemental oxygen, monitor blood gases, nebulized epinephrine, and systemic corticosteroids can decrease subglottic inflammation

Croup
Acute Laryngobronchitis

5

If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues

Pustule or furuncle due to Staph or group A strep causes erysipelas of the canal
Antibiotics and drainage to treat

Acute localized otitis externa

6

If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues

Severe necrotizing infection that spreads from the epithelium to adjacent structures such as blood vessels, cartilage, and bone
More common in the elderly, diabetics, immunocompromised
Usually caused by Pseudomonas and requires long courses of antibiotics

Invasive/malignant otitis externa

7

If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues

Hot humid weather
Canal becomes edematous and red
Pseudomonas, other gram negatives
Treat with topical antibiotics, steroids – systemic antibiotics may be necessary

Acute diffuse otitis externa
(swimmer's ear)

8

Most common in 6-24 months old
Most affected children have no anatomical defect, age at first episode is predictor of recurrent infections

Strep pneumo is the most common cause, other causes include haemophilus influenzae, Moraxela catarrhalis, Mycoplasma and viruses

Dysfunction of the Eustachian tube may either be due to inadequate drainage or disequilibrium of air pressure

Pain, drainage, fever, hearing loss
Erythema and fluid in the middle ear

Cephalosporins, amoxicillin-clavulanate, macrolides)
Myringotomy, adenoidectomy, and placement of tympanostomy tubes are sometimes used

otitis media

9

50% due to strep pneumo and H. influenzae
Viral, anaerobic bacteria (dental disease), S. aureus, gram-negatives in nosocomial infections

Patients experience nasal drainage, pressure over sinuses, headache, fever
Severe cases: infection can extend to bone or intracranially causing meningitis or brain abscess

Dx: Clinical or using sinus radiographs and CT scans
Specific causative organisms identified through sinus puncture and culture of specimens

Tx: Amoxicillin-clavulanate, cephalosporins, macrolides, quinolones

Sinusitis

10

More commonly caused by common cold viruses, adenoviruses, and influenza
Small proportion of cases are bacterial

Patients present with cough at times associated with nasal discharge and fever
50% of patients produce sputum that may become purulent

Diagnosed clinically, treated symptomatically with cough suppressants

acute bronchitis

11

Productive cough during at least 3 consecutive months for more than 2 consecutive years
Smoking, infection, irritants and impaired host defenses play a role

Increase in the number of goblet cells lining the bronchi as well as hypertrophy of the mucous glands; irritation of the airways causes increased secretions, cough, and bronchospasm

Common in men who smoke and complain of incessant productive cough
With acute infections there is an exacerbation of symptoms

Dx: clinical history
Tx: Concentrate on smoking cessation, avoidance of irritants, antibiotics directed against likely pathogens when acute exacerbations occur

chronic bronchitis