Common Respiratory Tract Infections Pt 2 Flashcards
definition and pathogenesis of sinusitis–> risk factors?
Definition: Inflammation of the mucosal lining of one or more of the paranasal sinuses
Pathogenesis: fluid stasis due to impaired mucociliary clearance, infection develops if contaminated with bacteria.
Predisposing factors: viral URTI, day care, allergic rhinitis, anatomic obstruction, mucosal irritants
acute vs subacute vs recurrent acute bacterial sinusitis
Acute Bacterial Rhinosinusitis: occurs when there is a bacterial infection (primary or secondary)
- Acute – symptoms resolve in <30 days
- Subacute – symptoms resolve between 30-90 days
- Recurrent acute – at least 3 episodes of <30 days’ duration, separated by intervals of being well ≥10 days. OR or at least four such episodes in a 12-month period
T/F chronic sinusitis often is due to bacterial infection
false.
Chronic sinusitis: Episodes of inflammation of the paranasal sinuses that last >90 days. Likely non-infectious. consider other causes like allergy, mucosal irritants.
T/F viral sinusitis is more common than bacterial sinusitis
true.
Microbiology: viral sinusitis more common than bacterial sinusitis
Most common bacterial pathogens→ streptococcus pneumonia, haemophilus influenzae, moraxella catarrhalis
clinical presentation of sinusitis
nasal symptoms, facial pain, halitosis, cough, fever, headache, sore throat.
- swelling and/or erythema over symptomatic area
- tenderness on palpation/percussion of paranasal sinuses
- periorbital swelling
- mucopurulent secretions
- post nasal drip
features that help differentiate from viral URTI
treatment for sbacterial sinusitis
Treatment: either observe x 3 more days OR prescribe antibiotics. If worsening, prescribe antibiotics
Amoxicillin
If mod-severe or high risk for host factor resistance (<2, daycare, Abx in past 4 weeks), → high-dose amox-clavulanate
Symptomatic treatment: saline irrigation, intranasal steroids, nasal decongestants, antihistamines
Complications: periorbital infection, intraorbital infection, intracranial complications: epidural and subdural abscess, brain abscess, venous thrombosis, meningitis
Look for proptosis, impaired/painful extraocular movements, impaired visual acuity
Recall: Viral infection causing Pharyngitis likely if: rhinorrhea, hoarseness, cough, and conjunctivitis → if classic viral symptoms predominante, the etiology is likely viral and no tests or antibiotics are needed
Key EBV viral presentation of pharyngitis
Fever, fatigue, headache, Pharyngitis, Lymphadenopathy, Splenomegaly, hepatomegaly, exudative EBV
Investigations: r/o GAS with throat swab, monospot, EBV +/- CMV serology, CBC, liver enzymes
Management: conservative, monitor for complications, abdominal US (splenomegaly)
Recall: Viral infection causing Pharyngitis likely if: rhinorrhea, hoarseness, cough, and conjunctivitis → if classic viral symptoms predominante, the etiology is likely viral and no tests or antibiotics are needed
Key HSV viral presentation of pharyngitis
Fever and oral lesions. Lesions are prominent in ANTERIOR mouth, vs COXSACKIE which has prominent sores posteriorly.
Treatment: acyclovir to lessen symptoms
Key Adenovirus presentation of viral pharyngitis
Pharyngitis, fever, conjunctivitis, cervical adenopathy, preauricular adenopathy, rhinitis
key Coxsackievirus A presentation of viral pharyngitis
Fever, oral ulcers and vesicles in posterior pharynx
Aka hand/foot/mouth disease, oral lesions + lesions on hands and feet
differentiate viral pharyngitis of HSV vs CSA
both have Fever and oral lesions. HSV Lesions are prominent in ANTERIOR mouth, vs COXSACKIE which has prominent sores posteriorly.
- Describe the most common clinical presentation of COVID-19 in the pediatric population
3 main presentations: asymptomatic, URTI, pneumonia
in symptomatic test-positive children: most have fever/chills, headache, anosmia, nausea, rhinorrhea, sore throat, nasal confestion, malaise, sneezing.
