Chapter 64: Acute Bronchitis and Upper Respiratory Tract Infection Flashcards
Self-limited respiratory infection causing inflam- mation of the large airways characterized by cough without evidence of pneumonia
Acute bronchitis
Infection of the upper respiratory tract, primarily affecting the nasal mucosa causing congestion, rhinorrhea, and sneezing
Common colds
A respiratory illness with fever, myalgias, cough, and fatigue.
Influenza
Most common causative agents of acute bronchitis?
Viruses
Most common bacterial isolates in acute bronchitis?
H. influenza and S. pneumoniae
How many days of symptoms for you to consider acute bronchitis?
more than 5 days to 4 weeks
To differentiate bacterial from viral etiology of lower respiratory infections? What will you order?
calcitonin and rapid point-of-care molecular viral testing
Patient with acute bronchitis should avoid B2-agonist except?
with evidence of airflow obstruction (wheezing)
use to provide modest relief of cough with acute bronchitis
Benzonatate and guiafenesin
When is the peak activity of common colds?
Autumn months (up to 8 times in children)
Most common causative agent of common colds
Rhinovirus
What is the incubation period of common colds?
10-12 hours
Topical nasal decongestants that provide moderate benefit in reducing nasal airway resistance in common colds
Oxymetazoline
At what age were you able to give cough and colds preparations without harm?
more than 6 years old
This etiologic agent can cause seasonal, endemic, and pandemic infections of influenza
Orthomyxoviridae
This etiologic agent account for most seasonal influenza epidemic
Influenza viruses A and B
What is the incubation period of influenza?
1-4 days
Complications of influenza
- Bacterial pneumonia
- Viral pneumonia
- Severe hypoxemic respiratory failure
Prominent symptoms of influenza?
Fever and intense myalgia
When is the testing for influenza is preferred?
onset of symptoms and use swab or aspirates
What type of obese is at higher risk for complications of influenza infection?
morbidly obese (BMI =/>40kg/m2)
What age group is at higher risk for complications of influenza infection?
Children <5y (especially <2y) and adults =/>65y
Neuraminidase inhibitors for influenza A and B
- Oral oseltamivir 75mg bid x 5 days
- Inhaled zanamivir 10mg bid x 5 days
- Intravenous peramivir 600mg tiv single dose
Antivirus approved in 2018 that inhibits endonuclease involved in viral RNA replication
Baloxavir 40mg/tab single dose then 2 tabs OD if patient weighs over 80kg
When is the best time to start antiviral in patients with influenza?
first 48 hours of symptoms
What is the causative agent of pertussis (whooping cough)?
gram-negative rod B. pertussis
What age group is the usual sources of infection?
school-age children
A vaccine for pertussis that effective for about 10 years and is used in developing country
Whole-cell pertussis
Acellular vaccine
The acellular diphtheria, tetanus, and pertussis vaccine (DTaP), developed to remove toxins from the cell membrane, does not protect as long as the whole-cell vaccine and is typically used in the developed world
The typical immunization schedule for pertussis?
2, 4, 6 and 18 months of age with a booster at age 5. Adolescent should recieve a DTaP booster
If an adult patient is unimmunized. What is the recommended immunization?
one dose of DTaP
True or False:
There is no lifelong immunity after a clinical episode of pertussis?
True
When to consider that patient is with pertussis?
cough of >2 weeks in duration
True or False:
If elderly patient with >2 weeks of cough and presented with pneumonia in xray. Would it suggest a pertussis infectin?
False
Pertussis in adults is not associated with pneumonia
What is the treatment for pertussis?
- Azithromycin 500mg/tab on day 1 then 250mg/tab on day 2-5
- Trimethoprim-Sulfamethoxazole 160mg/800mg BID for 14 days
