(17) Upper respiratory tract infection Flashcards
1
Q
What is the normal flora of the URT?
A
- streptococcus viridans
- commensal Neisseria spp
- diphtheroids
- anaerobes
2
Q
Give some examples of respiratory pathogens that may be carried asymptomatically
A
- steptococcus pneumoniae
- moraxella catarrhalis
- haemophilus influenzae
- steptococcus pyogenes
3
Q
Give some examples of other pathogens that may be carried asymptomatically
A
- Neisseria meningitidis
4
Q
Give some examples of transient colonisation post antibiotics
A
- coliforms
- pseudomonas
- candida
5
Q
Give some examples of bacterial pathogens
A
- bordetella pertussis
- corynebacterium diphtheria
- haemophilus influenzae
- moraxella catarrhalis
- steptococcus pneumoniae
- streptococcus pyogenes (Lancefield group A b haemolytic strep)
- staphylococcus aureus
- group F b haemolytic strep (miller group)
6
Q
Give some examples of viral pathogens
A
- adenovirus
- epstein-barr virus (EBV)
- herpes simplex (HSV)
- influenza and parainfluenza viruses
- respiratory syncytial virus (RSV)
- rhinovirus
- enteroviruses
- coronaviruses
- human metapneumovirus (hMPV)
- and more!
7
Q
Give some examples of other pathogens (neither bacterial nor viral)
A
- mycoplasma pneumoniae
- chlamydophila pneumoniae
- candida spp.
8
Q
How are URT infections spread?
A
“coughs and sneezes spread diseases”
- droplet spread
9
Q
What is important in preventing the transmission of URT infections?
A
- hand washing
- decontamination
10
Q
Describe the epidemiology of URTI?
A
- 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 eg. RSV
11
Q
What are the NICE guidelines for prescribing of antibiotics for self-limiting RTI?
A
- for adults and kids >3
- history/exam
- address concerns - 1 of 3 strategies
- no prescribing
- delayed prescribing
- prescribe if risk of complications
12
Q
What virus may cause the common cold/coryza?
A
- rhinovirus
- coronavirus
- RSV
- parainfluenza viruses
- enteroviruses
- adenovirus
13
Q
What are the symptoms of common cold/coryza?
A
- nasal discharge
- sneezing
- sore throat
14
Q
Should antibiotics be prescribed for common cold/coryza?
A
No
It is viral, not bacterial
15
Q
What are the symptom of rhino-sinustitis?
A
- facial pain
- nasal blockage
- reduction in smell
16
Q
What is the aetiology in rhino-sinusitis?
A
Post-viral inflammation
or
- streptococcus pneumoniae
- haemophlius influenzae
- streptococcus miller group
- anaerobes
- fungal
17
Q
What are some complications of chronic sinusitis?
A
- osteomyelitis
- meningitis
- cerebral abscess
18
Q
What sorts of imaging would you do in rhino-sinusitits for severe or suspected complications?
A
- sinus X-ray
- CT scan
- MRI scan
See air fluid levels
19
Q
Why would you do a sinus washout in rhino-sinusitis?
A
- diagnostic
- therapeutic
After refer all to ENT (not GPs)
20
Q
What treatment would you give for rhino-sinustitis?
A
If viral, not antibiotics. Many patients improve without antibiotics anyway
Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
(beware of undiagnosed dental infection)
21
Q
What is the cause of pharyngitis/tonsillitis?
A
- viral (RSV, influenza, adeno, EBV, HSV1)
- bacterial (steptococcus pyogenes, rarely - neisseria gonorrhoeae, corynebacterium diphtheriae)
- (mycoplasma pneumoniae and chlamydophila pneumoniae)
22
Q
How would you diagnose pharyngitis/tonsillitis?
A
- throat swabs
- proper history
- rapid antigen testing
23
Q
What is the rapid antigen test?
A
A rapid diagnostic test that is widely used in clinics to assist in the diagnosis of bacterial pharyngitis caused by group A streptococci (GAS), sometimes termed strep throat
24
Q
What are the symptoms and signs of pharyngitis/tonsillitis?
A
- sore throat
- dysphagia
- fever
- headache
- red tonsillar/uvular area +/- exudate
- lymphadenopathy
25
Give some different types of pharyngitis/tonsillitis
- group A streptococcal infection
- infectious mononucleosis/glandular fever/kissing disease
- diphtheria
- candida
26
Who is group A streptococcal infection (pharyngitis/tonsillitis) common in?
Children
27
What are the complications of group A streptococcal infection?
- acute glomerulonephritis
| - rheumatic fever/scarlet fever
28
Rheumatic fever is a possible complication of group A streptococcal infection. How is this prevented?
Giving penicillin and present suppurative complications too (eg. otitis media and quinsy (peritonsillar abscess)
29
What test would you do for group A streptococcal infection?
- throat swab
- ASOT antibody test
Anti-streptolysin O is the antibody made against streptolysin O, produced by most strains of group A Streptococcus bacteria
30
Which virus is the cause of infectious mononucleosis/glandular fever?
Epstein-Barr virus (EBV)
31
Who is infectious mononucleosis common in?
Teenagers and older
Often asymptomatic
32
What are the symptoms of infectious mononucleosis?
- sore throat
- fever
- cervical lymphadenopathy
33
What is a possible complication of infectious mononucleosis?
Splenic rupture
34
What should be avoided in infectious mononucleosis?
Ampicillin (mac-pap rash, not a true allergy)
35
What would you do in infectious mononucleosis diagnosis?
Serology - IgM, IgG
Paul Bunnell Test/PCR
36
Which bacteria causes diphtheria?
Corynebacterium diphtheriae
37
What are the symptoms of diphtheria?
- malaise
- fatigue
- fever +/- sore throat
38
What treatment would you give for diphtheria?
- erythromycin
- penicillin
- antitoxin
39
What is important to ask about in a diphtheria history?
- immunisation
- travel history
- CCDC
40
Candida normally follows what?
Usually after use of antibiotics or steroids
41
What is candida commonly called?
Thrush
42
How serious is epiglottitis?
Medical emergency
43
How does cellulitis of epiglottitis present?
"cherry red"
Airway obstruction
44
What are the symptoms of epiglottitis?
Child (2-4 years)
- fever
- irritable
- difficulty speaking and swallowing
- leans forward
- drools
- stridor
- hoarse
45
What kind of imaging would you do in epiglottitis?
Lateral neck X-ray
See enlarged epiglottis
46
What must you do and what must you not do in a case of epiglottitis?
Send blood cultures
DO NOT swab or examine epiglottis unless already intubated, or can intubate immediately (theatre)
47
What is the treatment for epiglottitis?
Maintain airway
Cefotaxime
48
What was epiglottitis previously most commonly caused be?
H. influenzae type B prior to immunisation
49
Prior to immunisation, epiglottitis was most commonly caused by H. influenza - now it is rare. What are the causes now?
Variety of causes - especially resp. bacteria and s. aureus
50
What are the signs and symptoms of acute laryngitis?
- hoarse/husky voice
- globus pharyngeus (lump in throat)
- fever
- myalgia
- dysphagia
51
What are the cause of acute laryngitis?
Usually viral and self-limiting
Occasionally bacteria (the usual suspects)
+ non-infective causes
52
Are antibiotics needed in acute laryngitis?
No
Should only be considered in severe disease
53
What is done in hospital for acute laryngitis patients?
Airway patency - if stridor
54
What are some non-infective causes of acute laryngitis?
- voice abuse
- malignancy
etc
55
What is a croup?
Childhood condition hat affects the trachea, bronchi and larynx
Inflammation of larynx and trachea after infection of upper airways
56
How is croup/acute laryngotracheobronchitis caused?
Viral
Esp. parainfluenza type 2
57
How is croup/acute laryngotracheobronchitis treated?
Viral so no antibiotics
Symptomatic Rx only
58
What are the symptoms of croup?
- bark-like cough
- hoarse or croaky voice
- difficulty breathing
- stridor
59
What is the cause of whooping cough?
Bordetella pertussis
GN coccobacillus
Common, very contagious, adults too
60
What is the incubation period of whooping cough?
1-3 weeks
61
What are the symptoms of whooping cough?
Initial catarrhal phase
- runny nose
- fever
- malaise
(like any other URTI)
Later (up to a week)
- dry, non-productive cough
- this becomes whooping/paroxysms (short bursts on exhalation, then inspiratory gasp which is the whoop)
62
What is the treatment for whooping cough?
Supportive and erythromycin
May be prolonged convalescence (weeks)
63
How is whooping cough diagnosed?
Pernasal swab and PCR
64
What are the possible complications of whooping cough?
- otitis media
- pneumonia (often secondary infection or aspiration)
- convulsions
- subconjunctival haemorrhages etc.
65
What is very important to prevent/control whooping cough?
- immunisation
| - erythromycin to household contacts/CCDC
66
What is otitis externa (OE)?
Infection of the external auditory canal (EAC)
67
What are the symptoms of otitis externa (OE)?
- pain
- itch
- swelling
- erythema
- otorrhoea
68
What are the 3 main types of otitis externa?
- acute OE
- chronic OE
- malignant OE
69
What are the main organism involved in acute otitis externa?
- skin types
- s. aureus (likely if pustular)
- pseudomonas spp (esp. after swimming)
70
How would you diagnose acute otitis externa?
Swab EAC
71
How would you treat acute otitis externa?
- toilet with saline and/or alcohol and acetic acid
- wick insertion
- topical drops (these may contain antibiotics, antifungals and steroids)
72
How is chronic otitis externa caused?
Irritation from drainage from perforated tympanic membrane - itchy
73
How would you treat chronic otitis externa and what should you avoid?
Treat the underlying cause
Avoid aminoglycosides (gentamicin etc) if perforation - resistance may form and sensitisation occurs with prolonged courses
74
What happens in malignant otitis externa?
It is severe and necrotising
Spreads from local area more deeply
May invade bone, cartilage and blood vessels
75
What makes malignant otitis externa potentially life threatening?
Can spread to temporal bone, base of skull, meninges and brain
76
Which bacteria often causes life threatening malignant otitis externa?
Pseudomonas aeruginosa
77
Who does malignant otitis externa occur in?
- elderly
- diabetics
- immunosuppressed
78
How would you treat malignant otitis externa?
Treat 4-6 weeks altogether eg. with IV ceftazidime then ciprofloxacin po
(((pain, drainage of pus from canal)))
79
What is otitis media?
Middle ear inflammation
Fluid present in the middle ear
80
Who is otitis media common in?
Very common in children
81
What are the symptoms of otitis media?
- fever
- pain
- impaired hearing
- red bulging tympanic membrane
82
What is the causes of otitis media?
VIRAL
- H. influenzae
- S. pneumoniae
- M. catarrhalis
(swab any pus discharging)
83
What would you give to treat otitis media?
If well:
- watch and treat symptomatically (decongestant etc) and review early
if unwell:
- amoxicillin
84
What is mastoiditis?
Inflammation of the mastoid air cells after middle ear infection
- pus collects in cells and may proceed to necrosis of bone
85
What are the signs/symptoms of mastoiditis?
- same as acute otitis media (AOM)
| - also pain/swelling over mastoid
86
How common is mastoiditis?
Much lower incidence after introduction of antibiotics
87
How would you diagnose mastoiditis?
- need bacteriology samples
| - CT scan helps to assess extent
88
How would you treat mastoiditis?
Similar Rx to otitis media (OM) unless gram negatives are suspected and then need broader spectrum cover as per organism isolated
89
What is the 1st line treatment of mastoiditis?
Co-amoxiclav
| amoxicllin-clavulanate
90
Name some infections of the deep fascial space of head and neck
- Vincent's angina
- Ludwig's angina
- Lemierre's syndrome
91
Name some infections of the teeth
- gingivitis
| - peridontal infection
92
Name some diagnostic methods of URTIs
- send pus/throat swab/blood cultures
- gram stain
- culture
- sensitivity testing
- reference lab work (typing, toxin detection)
- serology and antibody detection
93
When are antibiotics prescribed?
ONLY if needed
- side effects, increasing resistance etc
94
Which antibiotics are commonly used?
- penicillin and amoxicillin
- erythromycin (if pen allergic and whooping cough/diphtheria)
- gentamicin, ciprofloxacin
95
Give some key points conceding URTI
- avoid antibiotics for viral infections
- recognise those infections that are life threatening
- send microbiology samples where possible
