Upper Respiratory Tract Infections Flashcards
(27 cards)
URTI defines mechanisms:
* — & — :
– hair, cilia, mucus, normal flora
* Saliva:
– —
* Humoral immunity:
– —
* Innate immune response
– resident — , — , — , —
* Source of infection
– —
– —
physical and mechanical
lysosome
immunoglobin a
macrophages , monocyte , neutrophil , estinophil
exogenous and endogenous
URTI INTRODUCTION:
* Most common infectious
illness in the general
population
* Main reason for missing
work or school
* Range from the ‘common
cold’ to life-threatening
illnesses, e.g. epiglottitis
* — account for most
URTIs
- types of URTI:
‘Common cold’
Sinusitis
Otitis media
Pharyngitis
Diphtheria
Laryngitis
Epiglottitis
Laryngotracheobronchitis
(croup)
- normal upper resp flora:
* Streptococcus pneumoniae
* H. influenzae & others
* Staphylococcus aureus
* Neisseria spp. (N.
meningitidis, etc.)
* Anaerobic & microaerophilic
streptococci
* Streptococcus anginosus
group (“milleri”)
* Prevotella melaninogenicus
* Diphtheroids
* CoNS
viruses
risk factors for URTI:
* Age
* Sex of the pt
* Season
– Winter > summer
* Social factors
* Sick contacts
* Travel
* Underlying illness
– Ex. diabetes mellitus
* Smoking & secondary
smoking
* Anatomy
* Carrier states
1- Age:
* Common cold
– Children — viral resp
illnesses per year
– Adults — colds, >60yoa
fewer than 1 cold/year
* Pharyngitis
– Peaks in — , – yoa
* Epiglottitis
– Children aged– yoa, peaks
in — yos
* Laryngitis &
laryngotracheobronchitis
– — to –
– Peaks in – year
3-8
2-4
children 4-7
2-7
3
6 months to 6 years
second year
spread:
* —
– i.e. coughing, sneezing
* Fomite
– important for —
* Aspiration
– Of — or —
* –
– i.e. hands, intubation, instrumentation
routes: droplet born , short or long range airborne
droplet
viusrs
normal or colonising flora
direct
COLDS, SNIFFLES & SNEEZES
Predominantly — infections
* Not part of —
* Vast number of serotypes
* Frequent changes in —
1- common cold / coryza symptoms are — , — , — causes by —- , — , — , others :
Influenza viruses
Parainfluenza viruses
Enteroviruses
Adenoviruses
Human
metapneumoviruses
2- influenza like illness: more — symptoms as fever, malaise, HA)
Sore throat
Rhinitis
3-Viral pneumonia
common causes are — and others Parainfluenza viruses
Adenoviruses
viral
normal flora
antigenicity
sore throat , cough m rhitinits
rhinovirus , coronavirus , rsv
systemic
influenza viruses
URTI duration is —-
- itchy watery eyes are –
- nasal discharge and congestion are —
- sneezing and sore throat are –
- cough are —-
- headaches are –
- fever is rare in — but possible in —
- malaise fatigue and weakness —
- myalgias —
3-14 days
rare ( conjcutuvitis can occur w adenovirus )
common
very common
common mild to moderate hacking cough
rare
adults
children
sometimes
slight
- Significant — impact
– Time off school/work - — bear the heaviest burden of respiratory viral diseases
– Economic impact - Estimated cost to the US economy: $40 billion a year1
- GP visits
– Frequent inappropriate prescription of — - (Small) risk of complicated infection
– Sinusitis, otitis media, bronchitis, pneumonia
*Hospitalisation/morbidity/mortality - Outbreaks
- treatment: —
socioeconomic
children
antibiotic
symptomatic
sinusitis:
inflammation of the —-
1- viral :
* Rhinovirus
* Influenza
* Parainfluenza
* Often follows a —
* May be due to — or—
* Cough
* Sneeze
* Nasal discharge
* Headache
2- bacterial :
* S. pneumoniae
* M. catarrhalis
* H. influenzae
* GAS
* S. aureus
* Anaerobes
* May follow a —
* High fever
* Facial pain
* Headache
* Nasal discharge
3- fungal:
* Aspergillus spp.
* Mucor spp.
* Candida
* May be non-
invasive or invasive
(hospitalised or
immunocompromi
sed patients)
* May be acute or
chronic
* Fever
* Cough
* Nasal discharge
* Headache
* Confusion
(invasive)
4- non infective:
* Tumour
* Allergy
* Foreign body
* —- granulomatous
PARANASAL SINUSES
cold
viruses or ifnlamamtory mediator
viral infection
wegeners
1- investigations of sinusitis:
* Imaging:
* Sinus –
* – sinuses
* Microbiology
* Sinus —
for culture
2- sinusitis treatment:
* Features of a true bacterial sinusitis
– Fever & symptom duration —
– Maxillary —
– Initial symptom — and then —
– —
– Unilateral — pain
* — antibiotics ( — course)
– e.g. amoxicillin or clarithromycin if purulent discharge that persists
* Decongestants
* Analgesia
* Sinus puncture & lavage
– Particularly if don’t respond to —
* Fungal
– — debridement
– – agent
x ray
CT
aspirate
>10 days
toothache
improvement then detonation
Cacosmia
facial pain
empirical ( 5 day course|)
antibiotic
surgical and anti fungal agent
complications for sinusitis:
* Mostly —
* —
* — abscess
– Drainage
– Prolonged antibiotics
* Orbital —
* –
none
meningitis
brain abscess
orbital cellulite
bronchitis
acute otits media:
* Presence of – in the —
– With signs or symptoms of — illness
* Usually a complication of a
preceding — URTI
Incidence
* Peak in first — years
* — > —
* Associated with group —
* – smoking
Causative organisms:
* As per sinusitis, but —
predominates
– (—)
fluid
middle ear
acute
viral
three
male > female
day care
passive
bacterial
S. pneumoniae
acute otitis media :
* Clinical features
– Fever, — , irritability
– Ear pain, ear discharge, hearing loss
– — tympanic membrane
– Severe: moderate-severe — ,
temp —
* Diagnosis
– —
– —
* Treatment
– — if severe
* e.g. amoxicillin, clarithromycin, co-
amoxiclav
– —
lethargy
reddeneded
otalgia
>39
ostoscopy
Tympanocentesis
atibitoc
analgesia
complications of AOM:
* Chronic otitis media:
– —- tubes
* Mastoiditis:
– Extension of infection into —
– Severe pain & high fever
– Risk of spread to—-
– — & —
* Attic infection:
– Damage to — of middle ear—
– —-
Tympanostomy
mastoid antrum
cranium
antibtioc and mastoidetcomy
high roof
cavity
cholesteatoma
sore throat:
common condition :
- viral –
- —
- streptococcal —
- infectious —
serious conditions :
- —-
- — / — assess
- —
- —- infection
Common Conditions:
* Viral pharyngitis
* Tonsillitis
* Streptococcal
pharyngitis
* Infectious
mononucleosis
Serious Conditions:
* Epiglottitis
* Retropharyngeal /
tonsillar abscess
* Diphtheria
* Gonococcal infection
sore throat syndrome : common causes: others:
1- phargitis/toislitis: is — 40-60%, — , —
others Strep pyogenes
Strep Groups C & G —- infections
(Fusobacterium necrophorum)
C. diphtheriae
3- laryngitis : —
3- epiglottis: from —- and others —
viraal , adeovirus , epstein barr virus
anerobic
viral
h. influenza type b anf c diphteriea
tonsilitis:
* Clinical history
– Could —- be a
possibility??
– –
– –
– —
* Examination findings
– Epiglottis – — , — unwell
– — neck or–– diphtheria
– Unilateral tonsillar — - —
investigation:
* Microbiological
– —- swab (routine culture & viral)
* If diphtheria suspect – alert laboratory
– ?Point of care test for —
– Monospot / EBV—-
– Blood cultures if —
dipheria
GAS
EBV
gonococcus
drooling m acutely
bull neck peseduomembrane
swelling - abscess
throat swab
GAS
serology
epiglottitis
management of tonsillitis :
* Most patients DO NOT benefit from —
* Symptoms take about — to resolve
* Consider antibiotics if 3 of 4 Centor criteria:
– History of —
– — tonsils
– Cervical —
– Absence of —
– History of —
– OR if — culture results
* — x — days for GAS
– Antibiotics only — duration of symptoms x —
* — therapy for viral infections
antibiotic
8 days
fever
purulent
lymphadenopathy
cough
ottitis media
+ve
penicillin for 10 days
shorten x 8 hours
supportive
treatment of diphtheria:
* Treat ASAP!
* Diphtheria — :
– Used only for tx
– Only neutralises
unbound toxin
* Antibiotics:
– Penicillin G /
erythromycin
* Other steps:
– — management
– — & –
– —
* IPC:
– — precautions
* Follow-up:
– Cultures to ensure
eradication
– Vaccination to ensure
immunity
* Notifiable infection:
– Contact tracing
– Antibiotic prophylaxis
– Vaccine booster
anti toxin
airway
ecg and enzymes
neuro
droplet
laryngitis:
* Common clinical syndrome
– — or — voice
* Most cases in — (18-40 y.o.)
* Causes as per pharyngitis
* Don’t forget diphtheria!
* On examination:
– — vocal folds
* Treatment
– Symptomatic, voice rest, humidification
– — not indicated
hoariness or harsh
adults
hyperaemic
anitbitoc
acute epiglottis:
* is a –
* Inflammation and swelling of the epiglottis
– Potential to cause complete airway — abruptly
* Classically a disease of —
* Most commonly —
– H. influenzae type B ( — )
* Other organisms becoming more common since
introduction of Hib vaccine:
– GAS
– S. pneumoniae
* Less commonly
– Viral – VZV, HSV
– Fungal – candida
– Injury
– Chemical burns
medical emergency
airway obstruction
childhood
bacterial
capsular
acute epiglottitis:
clinical features
* –
* —
* —
* —
* Fever
* Stridor
* Dyspnoea
* Lethargy
Management:
* Urgent admission
* Secure airway
– ICU
* Blood cultures
* Epiglottic cultures
– ONLY once airway —
* Antibiotics
– IV—
dysphagia
dysphonia
drooling
distress
secure
Ceftriaxone
causes of chesty cough :
1-Acute bronchitis Predominantly viral
Inflammed, oedematous
tracheobronchial tree
2-Acute bronchiolitis See ‘Resp Viruses’ lecture
Mainly due to RSV
3-Pertussis See ‘Haemophilus, Bordetella,
Legionella’ lecture
Whooping cough
4-Croup Acute laryngotracheobronchitis
5-Infective exacerbation of
COPD
Viral / bacterial
6-Pneumonia See ‘LRTI’ lecture
acure laryngotrachbronchitis:
*—
* Common – illness
* Viral aetiology:
– —
– —
– Respiratory — virus
(RSV)
* May have preceding URTI
* Breathlessness, inspiratory
stridor, — like cough
– Due to inflammation of —
and —
croup
childhood
parainfluenza
infuelze
syncytial
seal like
larynx and trachea
acute laryngotracheabronchitis;
DIAGNOSIS
* Clinical
* Need to distinguish from —
– More — course
– Generally more unwell without ‘ —-like’ cough
TREATMENT
* If requires hospitalisation:
– —
– Humidified –
epiglottitits
rapid
croup like
corticosteroids
oxygen
