IC15 PR3151 URTI Flashcards
what is the pathophysiology of URTI
transmission via
- droplets or aerosols spread through the air when person is talking/sneezing/coughing etc.
- indirect contact (e.g., surfaces)
- sharing food
inhalation and invasion into the upper mucosa
what are the GENERAL risk factors for URTI?
1) anatomical abnormalities e.g., facial dysmorphic changes, nasal polyposis
2) poor hand/personal hygiene
3) exposure to children e.g., schools and daycare
4) immunocompromised (e.g., CSC use)
5) chronic respiratory diseases e.g., asthma, allergic rhinitis
6) smoking
host defence to URTI?
1) mucocilliary action from lower respiratory tract.
2) mucus.
3) angle between nose and pharynx to prevent particles from falling into the tract.
4) nostril hair
5) adenoids and tonsils that have immunological cells.
what methods for prevention of URTI?
1) adequate hygiene; mitigating risk factors, e.g., controlling chronic respiratory diseases
2) vaccinations: pneumococcal, haemophillus infl-, influenza
when to initiate for ABX in URTI?
NEVER for common cold and influenza.
MAYBE: pharyngitis, rhino sinusitis, otitis media
what is the clinical presentation of common cold
what other exclusions?
physical exam
low grade fever, rhinorrhea, nasal blockage, productive cough, sore throat, sneezing, some headache/body ache
usually no high fever and bilateral auscultation of lungs (clear) + normal heart rate
what are the pathogens causing common cold
usually rhinovirus and coronavirus.
selection of abx regimen for common cold?
DO NOT USE ABX for common cold
how to monitor response for common cold
usually self limiting and will resolve in 7-10 days
if no resolution after 10 days, to go see a doctor.
usually cough may be 2-3 weeks due to post nasal drip
counsel patient that will usually feel better after 3-4 days and that it is normal for the nasal discharge to change colour.
common cold step 2: do we need to identify for pathogens?
no steps needed. typically no need to test for pathogens unless to differentiate from coronavirus or influenza.
what is the presentation of influenza
fever, malaise, anorexia, myalgia, chills, headache
nasal discharge, dry cough, sore throat.
some elderly may present with mental confusion.
what are the risk factors for influenza complications
elderly >65
children <5
pregnant and ≤2 weeks post-partum
long term care or nursing homes
obese individuals with BMI >40
individuals with chronic medical conditions
when do you test for influenza pathogens?
hospitalised patients or long term care patients.
what are the tests used for influenza pathogen testing?
rapid diagnostic testing, POCT- immunofluoroscence, enzyme immunoassay, immunochromatographic test,
reverse transcriptase PCR
what kind of complications can result from influenza
primary viral pneumonia and secondary bacterial pneumonia (often from s.aureus, strep pneumonia, haem influenza), exacerbation of chronic respiratory disease, and myocarditis.
when to initiate treatment for influenza
patients who are hospitalised, have high risk for complications, and have severe, complicated, progressive disease.
BEST to start treatment within 48 hours on onset, but may be up to 5 days if patient is severely ill.
what is the drug regimen for influenza?
counselling points (include ADR)
oseltamivir PO 75mg BD x 5 days
may cause GI side effects (N/V) and headaches.
renal dose adjustment if CrCL <60ml/min
what is the MOA for oseltamivir
neuramidase inhibitor that prevents protein cleavage and release of new virus.
