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IDMM > URTIs (3) > Flashcards

URTIs (3) Flashcards

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1
Q

list the URTIs we are required to know

A
  1. common cold
  2. pharyngitis
  3. croup
  4. pertussis
  5. otitis media
  6. sinusitis
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2
Q

what is the common cold

A

it is a VIRAL URTI

acute and self limiting

most frequent human illness

seasonal

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3
Q

how is the common cold transmitted

A

most significant = inoculation of conjunctiva or nasal mucosa in 10 seconds

less significant is infective droplets on mucosa

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4
Q

when and for how long is the common cold infective

A

viral shedding peaks on the third day (coincides with peak of symptoms)

low level shedding can persist for 3 weeks

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5
Q

what is the incubation period of the common cold

A

24-72 hours from contact to symptoms

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6
Q

list some viruses that cause the common cold

A
  1. rhinovirus
  2. RSV
  3. influenza virus
  4. parainfluenza virus
  5. adenovirus
  6. enterovirus (coxsackievirus, echovirus)
  7. coronavirus
  8. human metapneumavirus
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7
Q

which viruses usually cause the common cold in october/november

A

parainfluenza virus

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8
Q

which virus is mostly responsible for the common cold in may/june/july/aug

A

enterovirus (coxsackievirus and echovirus)

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9
Q

which virus is mostly responsible for the common cold in september and march/april

A

rhinovirus

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10
Q

which viruses are mostly responsible for the common cold in dec/jan/feb

A

influenza, RSV, coronavirus, adenovirus

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11
Q

pathophysiology of the common cold

A

virus deposits on nasal/conjunctival mucosa and attaches to the epithelial cell receptors and damages cells–> this results in activation of host defence and release of CYTOKINE IL8

IL-8 attracts PMNs which increase nasal secretion and decrease mucociliary clearance

severity of symptoms corresponds to IL-8

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12
Q

pathophysiology of rhinovirus (common cold)

A

release of ALBUMIN and BRADYKININS which cause increased vascular permeability

bradykinins cause sore throat and rhinitis

minimal damage to nasal epithelium (like coronavirus)

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13
Q

pathophysiology of adenovirus and influenza A (common cold)

A

CYTOPATHIC effect and DESTRUCTION of nasal epithelium

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14
Q

how do you diagnose the common cold

A

differential

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15
Q

clinical presentation of the common cold

A 
rhinorrhea
nasal congestion
sneezing
sore throat
cough
low grade fever
headache 
malaise

duration = 10 days (cough may last 2-3 weeks)

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16
Q

Tx of common cold

A

prevention-based (i.e hand washing)

symptomatic treatment
saline irrigation
decongestants (dont shorten duration)
steam inhalation
antipyretic/pain control
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17
Q

what is pharyngitis

A

one of most common reasons for physicians visits

majority are VIRAL

swelling of the back of the throat/pharynx, between the nostrils and larynx

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18
Q

epidemiology of pharyngitis

A

peak incidence in winter and early spring

mostly school aged kids

GAS pharyngitis:

  • 20-30% in kids//5-15% in adults
  • incubation period of 2-5 days
  • highly communicable but noninfectious within 24 hours of abs use
  • transmission via droplet person to person
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19
Q

viruses that cause pharyngitis

A
  1. respiratory viruses
    - adenovirus
    - influenza virus
    - parainfluenza virus
  2. other viruses
    - coxsackie virus
    - echovirus
    - HSV
    - epstein barr
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20
Q

bacteria that cause pharyngitis

A

*Strep pyogenes (GAS) “strep throat”

groups C and G strep
N. gonorrhea
corynebacterium diphteriae
fusobacterium necrophilum 
arcanobacterium hemolyticum
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21
Q

pathophysiology of GAS pharyngitis + virulence factors

A

(S. pyogenes)

  • URT colonization (highly virulent)
  • capsule = compromised of HYALURORIC ACID which has a chemical structure very similar to connective tissue and therefore escapes host defenses and allows for colonization

virulence factors:

  1. M proteins–> resist phagocytosis
  2. extracellular exotoxins/hemolysins/invasins–> tissue damage
  3. streptolysin O –> toxic to variety of cells including myocytes (causes rheumatic fever in 3% of untreated patients)
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22
Q

with what symptoms of pharyngitis do you suspect viral etiology

A

COUGH

hoarseness
conjunctivitis
rhinorrhea
diarrhea
rash

*do not test children and adults with signs and symptoms of viral etiology

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23
Q

when do you suspect GAS as the etiologic agent in pharyngitis (symptoms)

A

ABSENCE OF COUGH

pharyngeal/tonsillar exudate
tenderness/enlargement of anterior cervical lymph nodes

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24
Q

what might you suspect when pharyngitis in a teen or young adult presents with:

  1. neck pain
  2. rash
A
  1. Lemierre’s disease (fusobacterium necrophorum)

2. consider arcanobacterium haemolyticum

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25
pharyngitis diagnosis procedure
throat culture (90-95% sensitive for GAS) rapid antigen test (highly specific; sensitivity 70-90%) confirmatory culture of RADT is negative in children
26
Tx of pharyngitis 1. viral 2. bacterial
1. symptomatic | 2. if GAS, penicillin (alternative is clindamycin)
27
what is croup
laryngotracheitis (inflammation of larynx and trachea) self limiting infection
28
in what age range is croup most common
3-36 months (rare after that)
29
in what sex is croup most common
boys
30
when is croup most common
fall/winter (coincides with parainfluenza, influenza, RSV)
31
when in the day are croup symptoms most prominent
late evenings and early mornings (leading to ER visits)
32
is croup viral or bacterial
viral
33
what types of viruses cause croup
**parainfluenza type 1 ``` RSV adenovirus coronavirus influenza (rare but more severe) measles (in endemic areas) rhino/enterovirus (mild cases) ```
34
pathophysiology of croup
viral infection of nasal pharyngeal mucosa-->invasion of respiratory epithelium --> inflammation of CARTILAGINOUS SUBGLOTTIC REGION --> narrowing of trachea --> fibrinous exudates may worsen the narrowing host factors = genetic predisposition, anatomic narrowing, hyperactive airways
35
what is the hallmark of croup in infants
barking cough
36
clinical presentation of croup
infants: barking cough stridor, cough, hoarseness in older children, hoarseness is a prominent symptom typical presentation = sudden onset of symptoms, rapidly progressive, previous Hx of croup
37
how is croup diagnosed
DDx
38
Tx of croup
NOT antibiotics because its viral systemic/nebulized STEROIDS symptom Tx severe presentations can require nebulized epinephrine, blow-by O2 if hypoxic
39
transmission of pertussis
direct contact of inhalation of respiratory droplets incubation is 7-10 days (or 4-21 depending on source)
40
what causes pertussis
*Bordatella pertussis obligate human pathogen fastidious gram - coccobacilli other strains of bordatella that can cause pertussis are: B. parapertussis, B. bronchoseptica and B. holmesii (severe)
41
pathophysiology of pertussis
B. pertussis produces toxic and virulence factors--> adhesins tracheal cytotoxin/dermonecrotic toxin these toxins cause local tissue damage and interfere with host immune mechanisms endotoxins --> systemic manifestations and lymphocytosis organisms found in ALVEOLAR MACROPHAGES and CILIATED RESPIRATORY EPITHELIAL CELLS
42
describe the classical clinical manifestations of pertussis
"whooping cough" paroxysmal cough inspiratory whoop post-tussive emesis adolescents and adults have milder symptoms (protracted cough, considerable morbidity, important reservoir)
43
what are the 3 phases of pertussis
1. catarrhal (1-2 weeks, most contagious) 2. paroxysmal (3-6 weeks) 3. convalescent (>6 weeks) investigations you order depend on lengths of symptoms cough 3 weeks= B. pertussis PCR
44
Tx of pertussis
antobiotics = MACROLIDE (azythromycin, clarithromycin, erythromycin) or TMP-SMX if started in catarrhal phase, Abs reduce duration and severity of the disease and limit transmission (after this phase, only transmission is limited)
45
vaccination schedule for pertussis
2, 4, 6 months; 18 months; 4-6 years; grade 9
46
what is otitis media
inflammatory disease of the middle ear
47
at what age is otitis media most prevalent
infancy 60-80% of kids have episode within first year 80-90% by 2-3 years
48
in what sex is otitis media most prevalent
boys
49
what vaccine has reduced the incidence of otitis media
pneumococcal vaccine
50
risk factors for otitis media
1. age 6-18 months 2. family Hx 3. day care 4. lack of breastfeeding 5. tobacco smoke/air pollution 6. pacifier use 7. race/ethnicity 8. poverty
51
what normally causes otitis media
66% of patients have combined viral and bacterial infections S. pneumo = 50% H. influenzae = 40-45% M. catarrhalis>S. pyogenes>staph aureus viral causes can include: RSV, rhino/enterovirus, coronavirus, influenza virus, adenovirus, human metapneumovirus
52
what are 2 factors essential to the pathophysiology of otitis media
1. antecedent viral URT infection (i.e cold) 2. colonization with respiratory bacterial pathogen inflammatory response to the virus obstructs the ISTHMUS of EUSTACHIAN TUBE--> causes negative pressure secretions produced by the middle ear accumulate bacteria colonizing URT access middle ear through aspiration or reflux, and grow in middle ear secretions suppuration = acute otitis media
53
how is otitis media diagnosed in infants
nonspecific signs and symptoms fever is 33-66%
54
how is otitis media diagnosed in children
otalgia (ear pain) bulging of tympanic membrane otorrhea (leak of CSF through ear structures) hearing loss
55
complications of otitis media
``` tinnitus vertigo facial paralysis mastoiditis meningitis ```
56
Tx of otitis media
70-80% resolve on their own if strep. pneumo--> treat with AMOXICILLIN (best coverage for S. pneumo of all oral B-lactams) watchful waiting, pain relief
57
what is acute sinusitis
inflammation of paranasal sinuses lasting less than 4 weeks
58
which sex gets more acute sinusitis
women
59
which age group gets more acute sinusitis
45-75
60
what percent of acute sinusitis resolves on its own
70% (Abs often misused)
61
is viral or bacterial acute sinusitis more common
viral (200X)
62
which viruses cause acute sinusitis
rhinovirus influenzavirus parainfluenza virus typically resolves in 7-10 days
63
what percent of acute sinusitis is bacterial
0.5-2% of viral URTI 10% related to dental disease S. pneumo, H. influenzae, M. catarrhalis
64
why is imaging not recommended in acute sinusitis diagnosis
because it cant distinguish between bacterial and viral causes diagnose on Hx and physical
65
when is bacterial acute sinusitis more likely (symptoms)
1. URTI symptoms last for longer than 10 days or worsen after 5-7 AND 2. nasal congestion/purulent nasal discharge with facial pain +/- 3. fever/maxillary toothache/facial swelling
66
Tx for acute sinusitis
70% spontaneous resolution normal saline irrigation is best option antihistamines NOT recommended steroids/Abs not shown to help

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