14 - URTI Flashcards
Pathogenesis of:
ACUTE SINUSITIS
Best to get from specimen collection, but we know historical data very well for this
Nasal passages colonized –> hard to get to the STERILE SINUS
- *VIRUS = MOST COMMON**
- rarely fungi*
S-M-H
(same top 3 for CAP)
S. PNEUMONIAE
M. CATTARHALIS
H. INFLUENZAE
Pathogenesis of:
CHRONIC Sinusitis
Best to get from specimen collection, but we know historical data very well for this
Nasal passages colonized –> hard to get to the STERILE SINUS
Sinusitus that last:
> 12 WEEKS
- less often an INFECTIOUS PROCESS:*
- *FUNGI**
What type of URTI based on clinical manifestations?
Persistant Symptoms lasting > 10 days
Severe Symptoms or High Fever (> 102)
&
Purulent Nasal Discharge + Facial Pain
lasting 3-4 consecutive days @ beginning of illness
“DOUBLE SICKNESS”
New onset:
Fever / HA / ↑Nasal Discharge
following an:
initial typical viral URTI that lasted 5-6 days and was initially improving
ACUTE BACTERIAL SINUSITIS
WE TREAT THIS
Augmentin for Adults
Amoxicillin for Children
What type of URTI based on clinical manifestations?
Duration of Sx = 5-10 days
peak 3-6 days
Congestion & Discharge
Clear/Watery discharge -> Mucoid/thick/opaque ~Green
Mild fever in 48 hours
ACUTE SINUSITIS
w/
VIRAL ETIOLOGY
Most common –> DO NOT TREAT
What type of URTI based on clinical manifestations?
Triad of:
Sore Throat / Fever / Pharyngeal Inflammation
Sudden onset of:
Fever / HA / GI symptoms
ERYTHMA / TONSILLAR SWELLING / GRAY-WHITE EXUDATE
covering posteror pharynx
Lyphadenopathy = Swollen Lymphs
- *GAS**
- *GROUP A STREP - PHARYNGITIS**
Strep. Pyrogenes
What type of URTI based on clinical manifestations?
Triad of:
Sore Throat / Fever / Pharyngeal Inflammation
w/o any other syndromes
PHARYNGITIS
from
Gram Neg Anaerobes or Atypicals
DO NOT TREAT
What type of URTI based on clinical manifestations?
- *Initial Common Cold Sx:**
- *Nasal Congestion / Rhinitis / Sore Throat / Mailaise / mild Fever**
followed by:
Dry** or **Productive COUGH of <3 weeks duration
7-10 days
severe > 3 weeks
ACUTE BRONCHITIS
Cough symptoms OVERLAP with
common cold/pneumonia/asthma
DIFFICULT TO DIAGNOSE
Goal of Diagnosis:
DISCRIMINATE FROM PNEUMONIA
What type of URTI based on clinical manifestations?
Triad of:
Sore Throat / Fever / Pharyngeal Inflammation
Conjunctivitis
Oral Ulcers
Cough
Diarrhea
VIRAL PHARYNGITIS
MOST COMMON PHARYNGITIS
DO NOT TREAT
- *Adjunctive Treatment of**
- *ACUTE BACTERIAL SINUSITIS**
(PERSISTANT SYMPTOMS > 10 DAYS)
Severe Symptoms or High Fever >102
+
Purulent Nasal Discharge/Facial Pain
3-4 consecutive days @ beginning of illness
DOUBLE SICKNESS
STEROIDS NOT RECOMMENDED
Antihistamines + Decongestants
for underlying allergies
Saline Nasal Spray
Surgery for removal of obstructions
- *PREVENTION**
- *VACCINES / SMOKING CESSATION / DONT DO COCAINE :(**
- *Treatment of**
- *ACUTE BACTERIAL SINUSITIS**
(PERSISTANT SYMPTOMS > 10 DAYS)
Severe Symptoms or High Fever >102
+
Purulent Nasal Discharge/Facial Pain
3-4 consecutive days @ beginning of illness
DOUBLE SICKNESS
Consider 3 days observation
ADULTS:
AUGMENTIN for 5-7 Days
Children:
AMOXICILLIN for 10-14 days
Also:
Cefpodoxime / Cefixime / Cefdinir / Cefprozil
Levofloxacin / Moxifloxacin
- *Treatment of**
- *ACUTE BACTERIAL SINUSITIS**
- *PCN ALLERGY**
(PERSISTANT SYMPTOMS > 10 DAYS)
Severe Symptoms or High Fever >102
+
Purulent Nasal Discharge/Facial Pain
3-4 consecutive days @ beginning of illness
DOUBLE SICKNESS
LEVOFLOXACIN** or **MOXIFLOXACIN
Normal for Acute Bacterial Sinusitis:
ADULTS:
AUGMENTIN for 5-7 Days
Children:
AMOXICILLIN for 10-14 days
What is
“DOUBLE SICKNESS”
Clinical manifestation for:
ACUTE BACTERIAL SINUSITIS
New Onset of:
FEVER / HA / ↑NASAL DISCHARGE
following initial:
Typical viral URTI lasting 5-6 days that was INITIALLY IMPROVING
Pathogenesis of:
PHARYNGITIS
- *VIRUS = MOST COMMON**
- *Adenovirus** - most prevelant
Group A Streptococci = Strep. Pyrogenes
most common BACTERIA
ONLY ONE THAT WE TREAT
Gram Neg Anaerobes
Atypicals
How do we DIAGNOSE - GAS?
Group A Strep
Diagnosis Table - Point System
3-14 Years = 1 point
MOST COMMON IN THIS AGE, -1 pt if 45y/o+
Temp > 38*C
Absence of Cough
Swollen / Tender anterooir Cervical NODES
TONSILLAR SWELLING or EXUDATE
Treatment of
GAS
Group A Strep - Pharyngitis
PCN ALLERGY
NOT FOR CHILDREN < 3
they don’t get RHEUMATIC FEVER
we ONLY treat to PREVENT POST-STREP SYNDROMES
–> can cause valvular damage
PCN Allergy:
Erythromycin or Azithromycin
Macrolides
or
1st gen Cephalosporin
Normal GAS treatment:
- *AMOXICILLIN_ or _PENICILLIN VK**
- *10 Days**
