CP17 - Upper Respiratory Tract Infections Flashcards
what is the normal flora of the upper respiratory tract?
strep viridans
commensal neisseria species
diphtheroids
anaerobes
what are potential respiratory pathogens that may be carried asymptomatically? (bacteria)
strep pneumoniae moraxella catarrhalis H. influenzae strep pyogenes N. meningitidis (not a resp pathogen)
which pathogens colonise the URT post antibiotics?
coliforms
pseudomonas
candida
which bacteria causes whooping cough?
bordetella pertussis
which bacteria causes diphtheria?
corynebacterium diphtheriae
which bacteria causes flu?
H. influenzae
which virus causes cold sores
herpes simplex
which viruses cause cough and cold?
influenza and parainfluenza
which virus commonly affects children?
respiratory syncytial virus
which other viruses can harm the URT?
adenovirus epstein-barr virus enterovirus coronavirus human metapneumovirus
other pathogens of the URT
mycoplasma pneumoniae
chlamoydophila pneumoniae
candida
how are URT pathogens transmitted?
droplet spread - coughing and sneezing
when are URTIs most commonly seen?
children and teenagers, frequent during winter
what are the NICE guidelines for management of URTIs in children under 3?
no antibiotics
delay prescribing antibiotics
prescribe antibiotics if there is a risk of complications
depending on the case
which organisms cause the common cold?
rhinovirus corona virus, RSV, parainfluenza, enterovirus, adenovirus
what are the clinical features of a common cold?
nasal discharge
sneezing
sore throat
how is a common cold treated?
DO NOT PRESCRIBE ANTIBIOTICS
wha organisms cause rhino-sinusitis?
strep pneumoniae H. influenzae strep millers anaerobes fungi
what are the clinical features of rhino sinusitis?
usually presents after a viral infection
complications - osteomyelitis, meningitis, cerebral abscess
what is osteomyelitis?
inflammation of the bone or bone marrow, usually due to infection
how is rhino-sinusitis diagnosed?
imaging for severe or suspected complications
see air fluid levels
sinus washouts allow samples to be taken
how is rhino-sinusitis treated?
no antibiotics if cause is viral
if disease is severe, provide antibiotics to cover suspected or proven pathogens, eg. amoxicillin
what are the pathogens causing laryngitis/tonsilitis?
viral - RSV, influenza, adenovirus, EBV, HSV1
bacterial - strep pyogenes
what is the clinical presentation of laryngitis or tonsillitis?
sore throat, dysphagia, fever, headache, red tonsillar/uvular area, exudate may or may not be present
lymphadenopathy
how is laryngitis to tonsillitis diagnosed?
history, throat swabs
what are the complications of a group A strep infection?
acute glomerulonephritis, rheumatic fever, scarlet fever, otitis media and quinsy (peritonsillar abscess)
how is a group A strep infection treated?
antibiotics, prevent other complications
what is rheumatic fever?
non contagious acute fever marked by inflammation and pain in the joints. mainly affects young people and is caused by a strep infection
what is scarlet fever?
infectious bacterial disease affecting especially children, causing fever and a scarlet rash. caused by streptococci
what causes infectious mononucleosis/glandular fever/kissing disease?
EBV
what is the clinical presentation of glandular fever?
often asymptomatic,
symptoms if any include - sore throat, fever, cervical lymphadenopathy
complications - spleen rupture
how is glandular fever diagnosed?
serology - IgM, IgG levels
paul bunnell test or PCR
what medication should be avoided in glandular fever?
ampicillin, since it reacts with EBV resulting in a mac pap rash, not a true allergy, only when the body is infected
what is a mac pap rash?
maculopapular rash - one containing both macule and papule. macule is a flat discoloured area of the skin. papule is a small raised bump
what is the clinical presentation of diphtheria ?
malaise, fatigue, fever, with or without a sore throat
what questions are important to ask in a history when you suspect diphtheria?
immunisation status and travel history
how is diphtheria treated?
erythromycin, penicillin, antitoxin
what is diphtheria?
a contagious condition, causes inflammation of mucous membranes, forming a false membrane in the throat
what pathogens cause epiglottitis?
respiratory bacteria and S. aureus.
H. influenzae type B if not vaccinated
it is a medical emergency!
what is the clinical presentation of epigottitis?
cellulitis of the epiglottis - looks cherry red
airway obstruction
fever, irritable child, difficulty speaking and swallowing (like a hot potato in their mouth)
drooling, stridor, leans forward
how is epiglottitis diagnosed?
lateral neck xray revealing enlarged epiglottis
blood cultures,
DO NOT swab/examine/stick anything down their throat or irritate it because this will close off their airway entirely
how is epiglottitis managed?
cefotaxime, maintain airway patency
what are the causes of acute laryngitis?
usually viral and self-limiting, especially in children
could be bacterial
non infective causes include voice abuse or a tumour
what is the clinical presentation of acute laryngitis?
hoarse, husky voice, globus pharyngeus, (lump in the throat)
fever, myalgia, dysphagia
how can acute laryngitis be managed?
no antibiotics unless severe disease
maintain airway patency if stridor present
symptomatic treatment only
what is the clinical presentation of whooping cough?
initially - runny nose, fever, malaise like any other URTI
later - dry non productive cough, which becomes paroxysms (whooping) usually due to slight weaning of immunity from vaccinations
complications include otitis media, pneumonia, secondary infection, convulsions, subconjunctival haemorrhages
how is whooping cough diagnosed?
perinasal swab and PCR
how is whooping cough treated?
incubation period 1-3 weeks. Supportive treatment and erythromycin
immunisation important
erythromycin to people they may have been in contact with
what is a convulsion?
a sudden, violent, irregular movement of the body caused by involuntary contraction of muscles
some other URTIs to keep in mind
vincent's angina ludwig's angina lemierre's syndrome gingivitis periodontal infection
how are URTIs generally diagnosed?
send swabs, blood cultures etc to the lab gram staining culture sensitivity testing for medication reference lab work serology and antibody detection
how are URTIs generally treated?
penicillin and amoxicillin
erythromycin if penicillin allergic, or if they have whooping cough or diphtheria
