Fever and cough URTI Flashcards
What are the 6 big issues to address in a GP consultation
- What is the clinical diagnosis
- What microbe might be causing the illness
- What is the natural history and what difference might treatment make
- What investigations might be helpful
- Should you follow the example of the previous doctors and prescribe an antibiotic
- is the mothers anxiety about child’s illness justified
Most frequently managed problems in the NZ general practise
Hypertension URTI Acute bronchitis Pre and postnatal care otters media asthma tonsillitis
what are the types of respiratory infections
Sinusitis Otitis media Pharyngitis Tracheitis Bronchitis Pneumonia
Where are the most common sites of respiratory virus infection?
middle ear and sinuses of the head
Common bacteria causing respiratory infections
strep. pyogenes
strep. pneumoniae (pneumonia sinusitis and ottits media in children)
Haemophilus influenzae
Moraxella catarrhalis
Bordetella pertussis (whooping cough)
What gives the general indication the the URTI is viral not bacterial
If two or more parts of the respiratory tract are affected e.g. if have sore throat and runny nose + ears are a bit blocked
Sore throat
pharyngitis / tonsillitis
may involve soft palate, uvula, tonsils
may have associated cervical lymphadenopathy
aetiology of pharyngitis
If a sore throat is caused by bacteria it must be strep pyogenes this is the only bacterial cause of a sore throat
Approx 50% due to a virus
- often with no therapeutic implications
Less than half due to strep pyogenes - with potential therapeutic implications
Clinical features of pharyngitis
- s. pyogenes
- common viruses
- More severe illness: fever, pain, dysphagia, adenopathy. Focal pharyngeal infection = red pharynx
- Less severe illness, without high fever
More diffuse URTI = rinorrhea, horse voice, cough, conjunctival signs (itchy eyes), no tonsillar erythema, lack of cervical adenopathy, all suggests a viral aetiology
Criteria for S. pyogenes pharyngitis?
temp >38 degrees absence of cough swollen tender anterior cervical nodes Tonsillar swelling or exudate more common in children under 14, very uncommon in adults over 45
What bacteria normally inhabit the mouth
streptococci
lots of different species in everyone
only strep pyogenes cause illness
How to tell what type of strep by haemolysis of blood
partial / alpha haemolysis = S. pneumoniae
Complete haemolysis = S. pyogenes (group B,C and G)
SCENARIO: 9 year old pacific girl has a runny nose for 2 days now complaining of sore throat. Older brother had RF two years ago
What do you do???
if GAS is cultured from throat swab she should be given treatment that will eradicate infection and reduce chance of developing RF e.g. oral penicillin for 10 days
SCENARIO: 39 yrs NZ european woman, runny nose for two days, now sore throat
regardless of whether GAS is isolated from throat culture, should not be given treatment because chance of developing RF essentially zero
Rhinosinusitus
purulent anterior nasal discharge Purulent posterior nasal discharge Nasal congestion or obstruction Focal cogestion or fullness Focal pain or pressure Reduced or absent smell Fever
