19. Acute respiratory infections and their complications.

Question 1

Upper Respiratory Tract Infections

most common causes

Answer 1

• most common viruses:
  
  • Syncytical
  • human metapneumoviruses
  • coronaciruses
  • coxackieviruses
  • influenza
  • parainfluenza
  • adenoviruses

Question 2

URI

Clinic

Complications

Answer 2

• Clinic:
  
  • 1-3 days after infection
  • nasal congestion
  • rhinorrhea
  • sore/scratchy throat
  • non-productive cough
  • fever (common in children)
  • myalgia
  • headaches
• Complications:
  
  • Otitis media
  • Bacterial sinusitis
  • asthma exacerbation

Question 3

Pharyngitis

Causative agents

Answer 3

• Bacterial:
  
  • Group A-Streptococci - MOST COMMON (15-30%)
  • C & G-Streptococci
• Viral:
  
  • Rhinoviruses
  • Coronaviruses
  • Adenoviruses
  • Herpes Simplex
  • Parainfluenza
  • Influenza
  • EBV
  • CMV
  • Coxsackie

Question 4

Streptococcal Pharyngitis

Clinic

Answer 4

• sudden onset
• rough, promoinent sore throat
• moderate-high fever
• headache, nausea vomiting, abdom pain
• red pharynx, enlarged tonsils
• yellow covered, blood tinged exudate
• maybe petechiae on the soft palate & post. pharynx
• uvula may be red, stippled, swollen

Question 5

Viral Pharyngitis

Answer 5

more typical for viral infection:

• gradual onset
• rhinorrhea
• cough
• diarrhea
• conjunctivitis
• ulcers

Question 6

Streptococcal Pharyngitis

Treatment of

Complications

Answer 6

• Treatment:
  
  • Early antibiotic treatment may prevent rheumatic fever
  • 1st line: Penicillin, Amoxicillin 10 days
  • 2nd line: cephalexin, Clindamycin
  • Azithromycin bei beta-lactam allergie
• Complications:
  
  • local supporative:
    
    • pharyngeal abscess
    • infections of the deep facial spaces of the neck
  • non-suppurative
    
    • acute rheumatic fever
    • acute postinfectious glomerulonephritis

Question 7

Sinusitis

Treatment

Complications

Answer 7

• Treatment:
  
  • 10-14 days of Ampicilin = 1st line for children
  • Amoxiclav if no response after 2-3 daysa
• Complications:
  
  • Orbital cellulitis
  • epi-/subdural emphysema
  • brain abscess
  • dural sinus trhombosis
  • osteomyelitis of the frontal sinus
• Complications treatment:
  
  • Sinus drainage & broad-spectrum antibiotics

Question 8

Otitis Media

Etio & Epi

Clinic

Treatment

Answer 8

• suppurative infection
• due to blockage of eustachian tube
• most commonly caused by bacteria
  
  • (viruses as co-infection)
• <20% are only viral
• S.Pneumonia, H.Influenzae, M.Catarrhalis
• very common from 6-15months
• Clinic:
  
  • bulging tympanic membrane
  • visualization of purulent material, air fluid level
  • red color of tympanic membrane
• Treatment:
  
  • Amoxicillin 3days (amoxiclav after)
  • Tympanocentesis

Question 9

Bronchiolitis

Question 10

Croup

Question 11

Pertussis