7.4 Upper Respiratory Tract Infections Flashcards
How many URTIs does the typical child/adult get in a year?
Child: 7
Adult: 2-3
What percentage of missed work days are due to URTIs?
40%
What percentage of URTIs are viral/bacterial?
75% viral
25% bacterial
What is a syndrome?
A group of symptoms
What is the common cold?
Syndrome including:
- Rhinorrhoea
- Nasal congestion
- Cough
- Sneezing
- Sore throat
- Etc.
What differentiates common cold from other syndromes?
No prominent localisation to one anatomical location
What percentage of common colds are caused by viruses vs bacteria?
Bacteria: 0%
Viruses: 100%
What is the most common virus that can cause a cold?
Rhinovirus
Describe transmission of the common cold
- Hand-hand contact (fomites)
- Respiratory particles (droplets/aerosols)
Is antibacterial treatment indicated for common cold?
Very rarely
In what percentage of common colds does secondary bacterial infection occur?
0.5-2%
What are coryzal symptoms?
Cold symptoms
Is pharyngitis predominantly caused by bacteria or viruses?
Viruses (in high income countries, bacterial rate is dropping more and more)
Can pharygnitis ever have non-infective aetiology? Provide examples if applicable.
Yes:
- GORD
- Chemo
- Allergy
Epstein-Barr virus (glandular fever) can cause pharyngitis. List some additional symptoms caused by this virus
- Tender cervical lymphadenopathy
- Tonsillar exudate
- Fever
- Splenomegaly
- Weeks/months of fever/malaise
List two bacteria that can cause pharyngitis
- Gonorrhoea
- Group A streptococcal
Clinical features of peritonsillar abscess
- Voice change
- Severe unilateral throat pain
- Fever
- Dysphagia
Does peritonsillar abscess require hospital admission? Why, or why not?
- Yes
- May block airway
Complications that can occur alongside pharyngitis (other than peritonsillar abscess/quinsy)
- Rheumatic fever
- Post-streptococcal glomerulonephritis
- Scarlet fever
A patient who is at high risk of rheumatic fever comes in with non-life-threatening pharyngitis. Do you prescribe antibiotics?
Yes. Always.
Overview: steps of pharyngitis management.
- Check if life-threatening (airway obstruction, sepsis etc.)
- Check if viral/bacterial
A patient has coryzal symptoms while concurrently having pharyngitis. Is this more likely to be bacterial or viral?
Bacterial
What are the four centor criteria for bacterial pharyngitis?
- Fever
- Tender cervical lymphadenopathy
- Tonsillar exudate
- Absence of cough
Under what circumstances would you prescribe antibiotics for bacterial pharyngitis?
- Severe symptoms
- No improvement after 3-7 days
- Immunosuppression
- ‘Shared decision making’
Is epiglottitis life-threatening?
- Yes
- Can cause airway obstruction within minutes to hours
Symptoms of epiglottitis
- High fever
- Resp. distress
- Stridor
- tripod position
Managemment/treatment of epiglottitis
- Priority is securing airway
- Limit interventions (in kids: IV access)
- Treated by airway management + IV antibiotics +/- steroids
Diagnosis of epiglottitis
- Normally on direct inspection
- Lateral X-ray can be used
What is acute otitis media? Provide a common mechanism
- It is the accumulation of infected fluid/inflammation in the middle ear
- Often caused by inflammation of eustachain tube leading to fluid accumulation and viral/bacterial colonisation
Bacteria and viruses can be found simultaneously in some instances of acute otitis media. Does this happen in a majority or minority of cases?
Majority
What symptoms do people present with when they have acute otitis media?
- Pain
- Hearing loss
- Fever
- Lethargy
- Ear discharge (if tympanic membrane ruputed)
In which age group is acute otitis media most common?
6-24 months
How is acute otitis media diagnosed?
Otoscopy
What proportion of acute otitis media cases self-resolve within 3 days?
> 80%
Describe acute otitis media with effusion
- Presence of middle ear effusion after resolution of infection
- If persistent, can cause hearing loss (learning difficulty etc.)
Describe chronic suppurative otitis media
- Perforated tympanic membrane and >=6 weeks purulent drainage
Describe mastoiditis as a consequence of acute otitis media. How is it treated?
- Spread of infection into mastoid air cells of temporal bone
- Can lead to postauricular swelling, erythema, systemic illness, and pain
- Treated with IV antibiotics and possibly surgical intervention
What is universal treatment for acute otitis media? What kind of patients would require antibiotics?
- Universal: analgesia
Give antibiotics if:
- <6 months old
- Bilateral infection
- Perforated TM
Symptoms of sinusitis?
- Severe nasal congestion
- Purulent nasal discharge
- Facial pressure/fullness; often worsened when lying down
- Maxillary tooth pain
Are the vast majority of acute sinusitis cases caused by viruses or bacteria?
Viruses
Mechanism of sinusitis
- Epithelial inflammation
- Limiting mucous drainage
- Pressure buildup
How does vigorous nose-blowing increase sinusitis risk?
- Pushing more material into sinuses
- Increased risk of secondary infection
Complications of sinusitis
- Orbital cellulitis (inflammation of eye socket)
- Frontal bone subperiosteal abscess
- Intracranial complications (meningitis etc.)
Acute sinusitis management (except antibiotics)
- Analgesia
- Nasal saline/corticosteriods
Is purulent nasal discharge a sign of bacterial sinusitis?
NO
Signs of bacterial sinusitis
- Duration >7-10 days
- High fever
- Worsening of symptoms after improvement
