17 - URTI Flashcards
Normal flora of URT
Strep. viridans
Neisseria spp
Diptheroids
Anaerobes
Resp. pathogens carried asymptomatically
Strep. pneumoniae Moraxella catarrhalis Haemophilus influenzae Strep. pyogenes Neisseria miningitidis
Transient colonisation post antibiotics for URT
coliforms, pseudomonas, candida
Rhino-sinusitis - causative agents
Strep. pneumoniae Haemophilus influenzae Strep. milleri Anaerobes Fungal
Complications of chronic sinusitis
Osteomyelitis
Meningitis
Cerebral abscess
Viral causes of pharyngitis/tonsilitis
RSV, influenza, adeno, EBV, HSV1
Bacterial causes of pharyngitis/tonsillitis
Strep. pyogenes
Rarely - neisseria gonorrhoeaem, corynebacterium diphtheriae
Mycoplasma pneumoniae and chlamydophilia pneumoniae
Complications of group A strep pharyngitis/tonsillitis
Acute glomerulonephritis, rheumatic fever / scarlet fever.
Epiglottitis - what is it?
Medical emergency
Cellulitis of epiglottis causing airway obstruction
Epiglottitis - who?
child (2-4yrs)
Epiglottitis - clinical presentation
fever irritable difficulty speaking and swallowing leans forward drools stridor hoarse
Epiglottitis - investigations
must send blood cultures - DO NOT SWAB unless intubated
Epiglottitis - treatment
maintain airway & cefotaxime
Acute laryngitis - clinical presentation
hoarse/husky voice globus pharyngeus fever myalgia dysphagia
Whooping cough - causative agent
Bordella pertussis
Whooping cough - clinical presentation
1-3wks incubation
runny nose, fever, malaise but up to week later: dry non-productive cough which becomes whooping / paroxysms
Whooping cough - treatment
supportive and erythromycin
Whooping cough - complications
otitis media, pneumonia
convulsions
subconjunctival haemorrhages
immunisation very important
tell CCDC
Otitis externa -
infection of external auditory canal
Otitis externa - clinical presentation
skin/soft tissue infection
pain, itch, swelling and erythema, otorrhoea
Otitis externa - types
acute
chronic
malignant
Otitis externa - acute - causative organisms
S.aureus (is pustular)
Pseudomonas spp. (swimming)
Otitis externa - treatment
saline and/or -OH and acetic acid
Wick insertion Topical drops (w/ antibiotics/fungals/steroids
Otitis externa - chronic - what is it
irritation from drainage from perforated tympanic membrane
Otitis externa - chronic - clinical presentation and treatment
itchy
avoid aminoglycosides if perforated as resistance may form
Otitis externa - malignant
Severe, necrotising
Spreads locally -> deeply
May invade bone, cartilage and blood vessels
Otitis externa - complications
spread to temporal bone, base of skull, meninges and brain
Otitis externa - clinical presentation
Pain, drainage of pus from canal
Otitis externa - who?
Elderly, diabetics, immunosuppressed
Otitis externa - treatment
4-6 weeks altogether e.g. IV ceftazidime then ciprofloxacin po
Otitis media - who?
children
Otitis media - clinical presentation
fever, pain, impaired hearing
red bulging tympanic membrane
Otitis media - causative agents
viral - H.influenzae
S. pneumoniae
M. catarrhalis
Otitis media - treatment
watch and treat symptomatically
amoxicillin if unwell
Mastoiditis - what is it
inflammation of the mastoid air cells after middle ear infection
pus collects in cells and may proceed to necrosis of bone
Mastoiditis - clinical presentation
same as acute otitis media
Pain, swelling over mastoid
Mastoiditis - investigations
bacteriology
imaging - CT
Mastoiditis - treatment
treat like acute otitis media unless gram -ve suspected then use broader spectrum
co-amoxiclav is 1st line treatment (amoxicillin-clavulanate)
Other infections of URT
Vincent’s angina
Deep fascial space infections
