IC15 URTI Flashcards
Transmission of URTI
- Droplets or aerosols (cough, sneeze, talk)
- Spread indirectly (touch contaminated surface)
microbes inhaled into respiratory tract -> invade upper airway mucosa
innate immunity against URTI
- Nostril hair lining traps organisms
- Mucus traps organisms
- Angle between the pharynx and nose
- Mucociliary system in the lower airways
- Adenoids and tonsils also contain immunological cells that attack the pathogens
RF for URTI
- Close contact with children
- Lack of personal/hand hygiene
- Chronic respiratory disease (asthma, AR)
- Smoking
- Immunocompromised individuals (cystic fibrosis, HIV, use of corticosteroids, transplantation, and post-splenectomy)
- Anatomical anomalies (facial dysmorphic changes or nasal polyposis)
Prevention of URTI
- Hand/personal hygiene, wearing mask, staying away from sick contact and crowds
- Vaccination
- Manage known risk factors eg smoking cessation, control asthma and AR
when to use abx in URTI
- never indicated for common cold and influenza
- sometimes indicated for pharyngitis, rhinosinusitis, otitis media
Common cold: clinical presentation
Low grade temperature, rhinorrhea, nasal blockage, sneezing, sore throat, productive cough, some headache, body ache
- lack of high fever, normal HR, lungs clear to auscultation
Common cold: diagnosis and pathogens
no diagnostic required
pathogen - rhinovirus, coronavirus
Common cold: abx for tx
none
Common cold: monitoring
- recover in how many days
- cough last how many days
- when to see doctor
- Self-limiting, recover in 7-10 days
- Normal for nasal discharge to change colour
- Cough may last 2–3 weeks
- Feel better within 3-4 days, but symptoms can linger for a few weeks
- See a doctor if symptoms does not improve after 10 days or if symptoms worsen
Influenza: clinical presentation
Fever, chills, headache, malaise, myalgia, and anorexia.
- Respiratory symptoms include sore throat, dry cough and nasal discharge.
- Elderly patients may present with confusion.
Influenza: complications
- primary viral pneumonia and
- secondary bacterial pneumonia
- Staphylococcus aureus,
- Streptococcus pneumoniae
- Haemophilus influenzae
- exacerbation of chronic respiratory disease, myocarditis
Influenza: diagnostics
- rapid detection kits, POCT (IF, EIA, immunochromatographic method)
- reverse transcriptase PCR
-> more for hopsitalised/ long term care not in outpatient
Influenza: RF
- Children < 5 years
- Elderly ≥ 65 years
- Women who are pregnant
- within 2 weeks post-partum
- Residents of nursing homes or long-term care facilities
- Obese individuals with BMI ≥ 40 kg/m2
- Individuals with chronic medical conditions (e.g.asthma, COPD, HF, DM, CKD, immunocompromised)
differentiate cold from influenza
cold: gradual onset, sneezing, stuffy nose, sore throat
flu: more sick, more discomfort, more obvious sx (abrupt onset, fever, chills, headaches)
influenza vs covid 19 (similarities and differences)
similarities:
- wide spectrum of disease (self limiting to severe)
- tx and vaccination available
differences
- covid 19 more contagious
- covid 19 cause more severe illness
diagnostic test to differentiate
Influenza: pathogens
human influenza A (H1N1, H3N2) and B (yamagata, victoria) virus - cause epidemics
influenza C - cause mild upper respiratory illness, not occur in epidemics
which months is influenza more common in SG
middle of year
end/start of year (christmas, holiday, CNY)
Influenza: when to start antivirals
less severe influenza (outpatient): start within 48hrs
severe influenza: start within 5 days
Influenza: criteria for severe influenza
any one of the following
- hospitalised
- high risk of complications
- severe, complicated or progressive illness
Influenza: antiviral drug, dose, duration, MOA, SE
PO oseltamivir 75mg BD x5days
MOA: neurominidase inhibitor (cannot cleave protein and inhibit the release of new virus)
ADR: well tolerated
- headache
- mild GI discomfort (N/V)
Influenza: monitoring
- most do not need antivirals
- pt may have sx for a week
- see a dr if
- sx does not improve after 10 days
- sx improved and then develop new fevers, worsening dyspnea, cough
influenza vaccination from…
inactivated trivalent or quadrivalent
prevailing strains of influenza A and B
how often is influenza vaccines updated
recommended for who?
updated every year
IM injection once a year
for person >=6mths old
takes 2 weeks to confer immunity
Pharyngitis: clinical presentation
- Sore throat (often worse with swallowing)
- Fever
- Erythema and inflammation of the pharynx and tonsils
- With or without patchy exudates
- Tender and swollen lymph nodes
