25 - URT Infections Flashcards
What diagnostic tool is often used to investigate an upper respiratory infections and their sensitivity?
Culture!
- Easily accessible and allows for identification of offending agent
- Sensitivity testing directs antimicrobial treatment
What diagnostic tests other than culture can be used in an upper respiratory infection?
IMAGING (remember, one view is no view!)
- plain xray (airway only - sinus xrays are USELESS)
- CT scans (not standard!)
- CBC
- CRP
- Monospot
- Serum procalcitonin
What is serum procalcitonin? When does it rise and fall?
Amino acid biomarker made by thyroid c cells.
- Levels increase with bacterial infections and infmallatory insult.
- There’s a rapid decline with immune control.
- Helps us know in the hospital when patients can stop taking antibiotics.
What is antimicrobial stewardship?
Rational, systemic approach to the utilization of antimicrobials to optimize outcomes.
Involves selecting the correct agent, dosing the medication properly, and utilizing the appropriate duration all to minimize toxicity and resistance.
What are 5 the most common causative agents of viral upper respiraotry tract infections?
- Rhinovirus (30-50% of URIs)
- Coronavirus (10-15%)
- Influenza (5-15%)
- RV/parainfluenza (5%)
- Adenovirus/enteroviruses
How are viral URIs transmitted?
- Hand contact: direct or indirect (survives ~2 hours in skin)
- Large droplets
- Small droplets (aerosols)
Note: tissue and cotton handkerchiefs do NOT support viral survival
What are some symptoms of viral URIs?
- Odynophagia (painful swallowing)
- Nasal obstruction
- Malaise
- Low grade fever
- Cough
- Pkugged ears
- Rhinorrhea: color and consistency varies (yellow or green does not necessarily mean it’s bacterial!)
What is the difference between these two ears? How would each be treated?
The left ear is serous otitis media (non-infectious) - since it’s not infectious you don’t need an antibiotic!
Right right ear is suppurative otitis media (bacterial) - you can tell because it is erythematous, buldging from pus behidn the eardrum, and has dilated BVs. Treat with an antibiotic!
What are some risk factors for acute otitis media?
- Peak incidence from 6-24 months
- Family hx
- Daycare exposure
- Lack of breast feeding
- Tobacco or air pollution exposure
- Race and ethnicity
What organisms are common causes of acute bacterial otitis media?
- Strep pneumonia (50%)
- Haemophilus influenza (45%)
- Moraxella Catarrhalis (10%)
- Group A Strep
What organisms cause chronic bacterial otitis media?
- Staph aureus
- Pseudomonas
- Proteus
- Anaerobes: peptostreptococcus, fusobacterium, prevotella
What are the recommendations for therapy for bacterial otitis media?
Immediate antimicrobial therapy for:
- children less than 6mo
- children with severe symptoms (pain, fever over 102.2 (39)
- bilateral bacterial otitis media
- immune compromised pt
When should you choose to just observe pts with bacterial otitis media?
- Immune competent pts
- Non sevre otalgia (<48 hrs)
- Temp less than 39 C
- Unilateral infection
But - close follow-up is essential! Failure to improve within 48-72 hrs means you should start antimicrobial therapy.
What meds would you use to treat bacterial otitis media?
- Amoxicillin
- Augmentin (penicillin + Clavulanate)
If penicillin allergy:
- mild allergy (rash) use cephalosporins
- severe allergy: macrolides
What is the function of tympanostomy tube placement? When should pts get them?
They allow for ventilation of middle ear space and a conduit for topical mediactions.
They relieve effusions and improve hearing.
Should get tubes if you have an effusion lasting >3 months.
What are risk factors for acute rhinosinusitis?
- Previous viral URI
- Older age
- Smoking
- Allergies/asthma
- Immunocompromise
- Dental disease
- Swimming
- Deep sea diving
The VAST majority of acute rhinosinusitis is casused by what?
VIRUSES!!!!!!!! (>96%)
What are the symptoms of viral vs bacterial sinusitis?
They are the same!
- Nasal obstruction
- Nasal secretions (clear to discolored)
- Facial pain/pressure
- Diminished smell/taste
- Malaise
- Headache
- Ear pressure/fullness