Flashcards in Upper respiratory tract infections Deck (60):
Give examples of the normal flora of upper respiratory tract (URT).
Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.
Give examples of respiratory pathogens that may be carried asymptomatically.
Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes.
What other pathogen may be carried asymptomatically?
What kinds of pathogen can colonise the URT post-antibiotics?
Coliforms, Pseudomonas, Candida
What is the most common route of spread for respiratory disease?
Droplet - coughing/sneezing and contact with contaminated surfaces. Handwashing and decontamination very important.
Describe the epidemiology of URTI?
- Most often v. young children/teenagers
- Winter/viral. Bacterial and viral common in children.
- (Also immunosuppressed - Very ill with seemingly less pathogenic viruses in adults e.g. RSV)
What are the possible causes of the common cold?
- Viral esp. Rhinovirus. Also….
- Parainfluenza viruses
What are the symptoms of the common cold?
Nasal discharge, sneezing and S/T
Should antibiotics be given for the common cold?
What are the symptoms of rhino-sinusitis?
Facial pain, nasal blockage, reduction smell.
What is the possible aetiology of rhinosinusitis?
- Post viral inflammation
- Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus milleri group, anaerobes, fungal
- Complications of chronic sinusitis
- Osteomyelitis, meningitis, cerebral abscess
(also allergic and non-infective)
What are the investigations that should be performed for rhinosinusitis?
Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.
What treatment can be given for rhinosinusitis?
Sinus washouts (diagnostic and therapeutic) after referral to ENT (not GPs)
Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway. Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
(beware undiagnosed dental infection)
What are the possible pathogens responsible for pharyngitis/tonsillitis?
- Viral (RSV, Influenza, Adeno, EBV, HSV1)
- Bacterial (Streptococcus pyogenes, Rarely - Neisseria gonorrhoeae, Corynebacterium diphtheriae)
- (Mycoplasma pneumoniae and Chlamydophila pneumoniae)
What investigations should be done in pharyngitis/tonsillitis?
Throat swabs and proper history
What are the signs and symptoms of pharyngitis/tonsillitis?
S/T, dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy
What are the possible complications of a group A streptococcal pharyngitis/tonsillitis?
acute glomerulonephritis/ rheumatic fever/scarlet fever. Aim to prevent this rheumatic fever by giving penicillin and prevent suppurative complications too (e.g. otitis media and quinsy (peritonsillar abscess))
Which virus virus causes infectious mononucleosis (glandular fever)
What are the symptoms and complications of infectious mononucleosis?
- S/T, fever, cervical lymphadenopathy
- Complications e.g. splenic rupture
What antibiotic should be avoided in infectious mononucleosis?
Ampicillin (can cause mac-pap rash - not true allergy)
- not that Abx should be given anyway coz it's a bloody virus!!
What serology should be performed in suspected infectious mononucleosis?
IgM/IgG, Paul Bunnell Test/PCR
Why is epiglottitis a medical emergency?
Airway obstruction - cellulitis of epiglottis
What are the clinical features of epiglottitis?
Child (2-4 yrs), fever, irritable, difficulty speaking (“hot potato”) and swallowing. Leans forward, drools. Stridor, hoarse.
What investigations should be performed in suspected epiglottitis?
- Lateral neck X-ray – enlarged epiglottis
- Must send blood cultures. DO NOT swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).
What is the treatment for epiglottitis?
Maintain airway, cefotaxime
What is the aetiology of epiglottitis?
Previously most commonly caused by H. influenzae type B prior to immunisation. Now rarer and variety causes – esp. resp. bacteria and S. aureus
What are the signs/symptoms of acute laryngitis?
Hoarse/husky voice, globus pharyngeus (lump in throat), fever, myalgia, dysphagia
What is the aetiology of laryngitis?
- Usually viral and self-limiting, occas. bacterial (the usual suspects) therefore no need therefore for antibiotics. If severe disease consider antibiotics
- Non infective causes (voice abuse, malignancy etc.)
When would you need to maintain airway patency in acute laryngitis?
If stridor is present
What is Croup?
Acute laryngotracheobronchitis - inflammation of larynx and trachea following infection. Stridulous voice.
What is the aetiology of Croup?
Viral esp. parainfluenza type 2 therefore NO antibiotics (also RSV)
What is the treatment for Croup?
Symptomatic Rx only.
What is the aetiology of whooping cough?
Bordetella pertussis - GN coccobacillus
Incubation period = 1-3 weeks
What are the appropriate diagnostic tests for whooping cough?
Perinasal swab and PCR
What are the initial symptoms of whooping cough?
Catarrhal phase - runny nose, malaise, fever
What are the later symptoms of whooping cough?
Dry non productive cough. This becomes whooping/paroxysms. (short bursts on exhalation, then inspiratory gasp which is the whoop.
What is the treatment for whooping cough?
Supportive and erythromycin
What are the potential complications of whooping cough?
Otitis media, pneumonia Often secondary infection or aspiration). Convulsions. Subconjunctival haemorrhages etc.
What is otitis externa?
- Infection of the external auditory canal (EAC)
- Pain, itch, swelling and erythema, otorrhoea
- Main types - acute OE, chronic OE and malignant OE.
What are the main organisms responsible for otitis externa?
S. aureus (likely if pustular) and Pseudomonas spp.(esp. after swimming)
What is the treatment for otitis externa?
Toilet with saline and/or alcohol and acetic acid. Wick insertion. Topical drops (these may contain antibiotics, antifungals and steroids)
What is the aetiology of chronic otitis externa?
Irritation from drainage from perforated tympanic membrane.
What should you treat in chronic otitis externa?
The underlying cause
What should you avoid in chronic otitis externa?
Aminoglycosides (gentamicin etc.) if perforation. Resistance may form and sensitisation occurs with prolonged courses
What is malignant otitis externa?
Severe, necrotizing. Spreads from local area more deeply. May invade bone, cartilage and blood vessels. Life threatening – spread to temporal bone, base of skull, meninges and brain. Often Pseudomonas aeruginosa
What are they symptoms of malignant OE?
+++++ pain and pus draining from the canal
What is the treatment for malignant OE?
Treat 4-6 weeks altogether e.g. with iv ceftazidime then ciprofloxacin po
What are the risk factors for malignant OE?
What is otitis media?
Middle ear inflammation. Fluid present in the middle ear.
What is the aetiology of otitis media?
VIRAL. H influenzae, S. pneumoniae, M. catarrhalis
What are the signs and symptoms of otitis media?
Fever, pain, impaired hearing. Red bulging tympanic membrane
What is the treatment for otitis media?
- Swab any pus discharging
- If not unwell WATCH and treat symptomatically (decongestant etc) and review early. If unwell give amoxicillin.
What is mastoiditis?
Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone.
What are the signs/symptoms of mastoiditis?
Signs as AOM, but pain/swelling over mastoid too.
What investigations should be performed in mastoiditis?
- Need bacteriology samples
- Imaging – CT helps to assess extent
What is the treatment for mastoiditis?
- Similar Rx to acute OM unless Gram negatives are suspected and then need broader spectrum cover as per organism isolated
- LTHT 1st line treatment is co-amoxiclav (amoxicillin-clavulanate)
What is Vincent's angina?
Acute necrotizing infection of the pharynx caused by a combination of fusiform bacilli (Fusiformis fusiformis - a Gram -ve bacillus) and spirochetes (Borrelia vincentii ). These are the same organisms that cause a gingivostomatitis known as trench mouth.
What is Ludwig's angina?
Cellulitis of the floor of the mouth, usually occurring in adults with concomitant dental infections
What is Lemierre’s Syndrome?
Thrombophlebitis of the internal jugular vein.
aka postanginal shock, human necrobacillocis