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infec y3s1 > IC15 Upper respiratory tract infections > Flashcards

IC15 Upper respiratory tract infections Flashcards

1
Q

risks factors of URTI

A

Close contact with children → daycares & schools increases risk
* Lack of personal/ hand hygiene

Medical disorder: people with chronic respiratory diseases
* ie: asthma/ allergic rhinitis ⇒ poorer innate immunity

Smoking

Immunocompromised individuals
* Cystic fibrosis, HIV, use of corticosteroids, transplantation, post-splenectomy

Anatomical abnormalities
* Facial dysmorphic changes, nasal polyposis

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2
Q

common cold: clinical presentation

A

Low grade temperature; lack of high temperature (~37-38℃)
Rhinorrhea, nasal blockage, sneezing
Sore throat, productive cough
Headache, bodyache
normal heart rate, and lungs that are clear to auscultation
(No compromise in air entry for breathing)

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3
Q

common cold: microbiology

A

caused by rhinovirus/ coronavirus

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4
Q

common cold: therapy
(also - general symptomatic relief for other conditions)

pharm & non-pharm

A

no indication for AB

provide only symptomatic relief
pharm
Paracetamol, NSAIDs, Nasal decongestants, Antihistamine, Lozenges, Mucolytics, Cough suppressants, Expectorant

non-pharm
Normal saline nasal irrigation, Warm water/tea, Honey

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5
Q

influenza: monitor therapy

symptoms improvement, nasal discharge

A
  • Mostly self-limiting & will recover in 7-10 days
    To see doctor if symptoms do not improve after 10 days/ worsening of symptoms (may be secondary infection)
  • Usually will feel better within 3-4 days but symptoms may linger for weeks
  • Normal for nasal discharge to change colour (clear → yellow)
    Important to not determine if infection is bacteria/ virus based on sputum colour
  • Cough may last 2-3 weeks
    May have post-nasal drip ⇒ irritates throat
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6
Q

influenza: possible complications

A
  • Primary viral pneumonia
    Due to weakened immune system ⇒ allows invasion of bacterial pathogen
  • secondary pneumonia → S.aureus, Streptococcus pneumoniae, haemophilus influenzae
  • Exacerbation of respiratory diseases
  • Myocarditis
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7
Q

influenza: impact of infections

A

Influenza A & B ⇒ causes seasonal epidemics of diseases
* Occur all year round in SG, with small peaks in middle & end/ beginning of the year
* Temperate countries → usually higher rates of infections during winter

Influenza A ⇒ can cause pandemics
Influenza C ⇒ causes febrile mild upper respiratory illness; do not occur in epidemics

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8
Q

influenza: monitor response
when to see doctor

A
  • symptoms do not improve after 10 days OR
  • Symptoms improve then develop new fevers, worsening dyspnea or cough
    Possible secondary bacterial infections; may require AB
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9
Q

influenza: treatment
indications

patients at risk, normal patients

A
  • To initiate ASAP (best within first 48 hours, up to 5 days) from symptom onset for individuals fulfilling any of the criteria:
    Hospitalised
    High risk for complications
    Severe, complicated or progressive illness
  • Can be considered for others presenting within 48 hours of symptoms onset
    Beyond 48 hours ⇒ take symptomatic relief
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10
Q

influenza: treatment (drug choice)

MOA, dosing, SE

A

Oseltamivir

MOA: Neuraminidase inhibitor
Interferes with protein cleavage ⇒ inhibits release of new virus

Dose
PO 75 mg BD x5 days
Requires dose adjustment in renal impairment patients (CrCl <60 mL/min)

Possible AE: headache, mild GI discomfort [N/V]
* Generally well tolerated

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11
Q

influenza: requirements for diagnostic testing + purpose

A

usually for hospitalised patients/ LTC to confirm indication for antivirals

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12
Q

influenza: RF for complications

CAPON

A
  • Children < 5 years & elderly ≥ 65 years [age]
  • Women who are pregnant or within 2 weeks postpartum
  • Residents of nursing homes or long-term care facilities
  • Obese individuals with BMI ≥ 40 kg/m2
  • Individuals with chronic medical conditions
    ie: asthma, COPD, HF, DM, CKD, immunocompromised
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13
Q

pharyngitis: general clinical presentation

A

Sore throat (worse with swallowing)
Fever
Erythema & inflammation of pharynx & tonsils
* With or without patchy exudates

Tender & swollen lymph nodes

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14
Q

pharyngitis: viral clinical presentation

A

Erythematous tonsils without hypertrophy/ exudates

Low-grade fever, malaise, fatigue
Rhinorrhea, cough, hoarseness
Oropharyngeal lesions (ulcers/ vesicles)
Conjunctivitis

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15
Q

pharyngitis: bacterial clinical presentation

A

Tonsillar exudates & hypertrophy
Sore throat with tonsillar exudates
Fever
Cervical lymphadenopathy without typical viral symptoms
Swollen lymph nodes → to identify by pulsating

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16
Q

pharyngitis: viral treatment

A

Usually self-limiting, do not require any antiviral treatment → give symptomatic treatment

17
Q

pharyngitis: causative agent for bacteria

A

S.pyogenes (beta-hemolytic strepA)

18
Q

pharyngitis: bacteria
possible complications

when does it occr

A

1-5 weeks after infection

Acute rheumatic fever ⇒ prevented with early initiation of effective AB
Occurs 2-4 weeks following infection of StrepA
Might cause presentations of arthritis, endocarditis, SC nodules

Acute glomerulonephritis ⇒ not prevented by AB

19
Q

bacterial pharyngitis: modified cantor criteria

A
  1. fever (1)
  2. swollen lymph nodes (1)
  3. tonsillar exudates (1)
  4. abscence of cough (1)
  5. age
    * 3-14 (1)
    * 15-44 (0)
    * >45 (-1)
20
Q

pharyngitis: viral causative agents

A

Rhinovirus, coronavirus, influenza, parainfluenza, Epstein-barr

21
Q

bacterial pharyngitis: treatment

duration of treatment

A

10 days

22
Q

bacterial pharyngitis: modified cantor criteria scores

additional testing, likelihood bacterial infection

A

Total: 0-1 points
No additional testing indicated
Low risk of S. pyogenes pharyngitis
Presumed viral
No antibiotics

Total: 2-3 points
Test for S. pyogenes pharyngitis
If test not avail, check for severity of condition
treat with antibiotic if positive

Total: 4-5 points
High risk for S. pyogenes pharyngitis
Initiate empiric antibiotics

23
Q

bacterial pharyngitis: treatment

first line

A

PO penicillin 250 mg q6h or amoxicillin 500 mg q12h

24
Q

bacterial pharyngitis: treatment

penicillin allergy

A

Non-severe: PO cephalexin 500 mg q12h
Common R1 side chain as penicillin & amoxicillin

others
PO azithromycin 500 mg OD
PO clarithromycin 250 mg q12h
PO clindamycin 300 mg q8h

Note: increasing resistance to macrolides
Generally can still challenge unless patient does not get better

25
Q

pharyngitis: monitoring outcomes

viral & bacterial symptoms relief

A

Viral pharyngitis: Sore throat should be <1 week only

Bacterial pharyngitis: fever & symptoms usually resolve within 1-3 days of starting treatment + resolution usually within 3-4 days
To see doctor if symptoms do not improve/ worsen

26
Q

Acute rhinosinusitis: pathogenesis

A
  • Direct contact with droplets of infected saliva/ nasal secretions
  • Bacterial cases usually comes after viral URTIs (common cold, pharyngitis)
  • Inflammation results in sinus obstruction (rhinorrhea)
    Nasal mucosal secretions trapped
    Medium of bacterial trapping & multiplication
27
Q

Acute rhinosinusitis: possible complications

& symptoms

A

Spreading of infection to orbits/ CNS ⇒ to refer to ED for further evaluation (imaging)

Symptoms: limited ocular movements, acute vision changes, confusion, unilateral weakness

28
Q

Acute rhinosinusitis: causative bacterias

A

Common: Streptococcus pneumoniae, Haemophilus influenzae
Others: Streptococcus pyogenes, Moraxella catarrhalis, anaerobic bacteria (G+)

29
Q

Acute rhinosinusitis: clinical presentation

A
  • Purulent nasal discharge, nasal congestion & obstruction, cough
  • Facial pain/ pressure, ear fullness/ pressure
  • Reduced sense of taste/ smell (hyposmia/ anosmia)
  • Headache, fever
  • Bad breath, dental pain
30
Q

Acute rhinosinusitis: diagnostic tests

A

not required unless no improvements even with treatment
to treat based on clinical presentation

31
Q

Acute rhinosinusitis: indication for therapy

A

Should have ≥ 1 of the following:

  • Symptoms persisting >10 days without clinical improvements
  • Severe symptoms:
    fever >39°C, purulent nasal discharge, facial pain lasting for >3 consecutive days
  • Worsening of symptoms after initial period of improvement, for >3 days (5-6 days)
    New onset fever, headache or increased nasal discharge
32
Q

Acute rhinosinusitis: therapy

duration of treatment

A

5-7 days

33
Q

Acute rhinosinusitis: therapy

first line + possible resistance

A

PO amoxicillin 500 mg q8h
If S.pneumoniae is resistant, it may also be resistant to amox/ clav → resistance is derived from PBP, not due to ꞵ-lactamase production

PO amoxicillin/ clavulanate 625 mg q8h
For Haemophilus influenzae ⇒ have resistance to amoxicillin due to ꞵ-lactamase production
Clavulanate → prevents binding of ꞵ-lactamase onto ꞵ-lactam ring

34
Q

Acute rhinosinusitis: therapy

penicillin allergy

A

Non-severe: PO cefuroxime 500 mg q12h
PO levofloxacin 500 mg OD or moxifloxacin 400 mg OD

35
Q

Acute rhinosinusitis: monitoring outcomes

viral vs bacterial

A

Viral/ non-severe bacterial sinusitis: counsel patient that symptoms typically lasts for 7-10 days & no AB is required
Severe bacterial sinusitis: Symptom improvement within 7-10 days
To see doctor if have development of persistent, severe or worsening symptoms
Signs & symptoms of complications → orbital/ CNS symptoms

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