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PR3151 Finals > IC15 URTI > Flashcards

IC15 URTI Flashcards

1
Q

Transmission of URTI

A
  1. Droplets or aerosols (cough, sneeze, talk)
  2. Spread indirectly (touch contaminated surface)

microbes inhaled into respiratory tract -> invade upper airway mucosa

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2
Q

innate immunity against URTI

A
  1. Nostril hair lining traps organisms
  2. Mucus traps organisms
  3. Angle between the pharynx and nose
  4. Mucociliary system in the lower airways
  5. Adenoids and tonsils also contain immunological cells that attack the pathogens
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3
Q

RF for URTI

A
  • 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)
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4
Q

Prevention of URTI

A
  • Hand/personal hygiene, wearing mask, staying away from sick contact and crowds
  • Vaccination
  • Manage known risk factors eg smoking cessation, control asthma and AR
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5
Q

when to use abx in URTI

A
  • never indicated for common cold and influenza
  • sometimes indicated for pharyngitis, rhinosinusitis, otitis media
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6
Q

Common cold: clinical presentation

A

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

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7
Q

Common cold: diagnosis and pathogens

A

no diagnostic required
pathogen - rhinovirus, coronavirus

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8
Q

Common cold: abx for tx

A

none

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9
Q

Common cold: monitoring
- recover in how many days
- cough last how many days
- when to see doctor

A
  • 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
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10
Q

Influenza: clinical presentation

A

Fever, chills, headache, malaise, myalgia, and anorexia.
- Respiratory symptoms include sore throat, dry cough and nasal discharge.
- Elderly patients may present with confusion.

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11
Q

Influenza: complications

A
  • primary viral pneumonia and
  • secondary bacterial pneumonia
    • Staphylococcus aureus,
    • Streptococcus pneumoniae
    • Haemophilus influenzae
  • exacerbation of chronic respiratory disease, myocarditis
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12
Q

Influenza: diagnostics

A
  • rapid detection kits, POCT (IF, EIA, immunochromatographic method)
  • reverse transcriptase PCR

-> more for hopsitalised/ long term care not in outpatient

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13
Q

Influenza: RF

A
  • 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)
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14
Q

differentiate cold from influenza

A

cold: gradual onset, sneezing, stuffy nose, sore throat
flu: more sick, more discomfort, more obvious sx (abrupt onset, fever, chills, headaches)

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15
Q

influenza vs covid 19 (similarities and differences)

A

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

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16
Q

Influenza: pathogens

A

human influenza A (H1N1, H3N2) and B (yamagata, victoria) virus - cause epidemics

influenza C - cause mild upper respiratory illness, not occur in epidemics

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17
Q

which months is influenza more common in SG

A

middle of year
end/start of year (christmas, holiday, CNY)

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18
Q

Influenza: when to start antivirals

A

less severe influenza (outpatient): start within 48hrs
severe influenza: start within 5 days

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19
Q

Influenza: criteria for severe influenza

A

any one of the following
- hospitalised
- high risk of complications
- severe, complicated or progressive illness

20
Q

Influenza: antiviral drug, dose, duration, MOA, SE

A

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)

21
Q

Influenza: monitoring

A
  • 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
22
Q

influenza vaccination from…

A

inactivated trivalent or quadrivalent
prevailing strains of influenza A and B

23
Q

how often is influenza vaccines updated
recommended for who?

A

updated every year
IM injection once a year
for person >=6mths old
takes 2 weeks to confer immunity

24
Q

Pharyngitis: clinical presentation

A
  • 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
25
Q

clinical presentation of viral pharyngitis

A

erythematous tonsils, no hypertrophy/ exudates

low grade fever, malaise, fatigue, rhinorrhea, cough, hoarness, oropharyngeal lesions (ulcers, vesicles), conjuctivitis

26
Q

clinical presentation of bacterial pharyngitis

A

sore throat with tonsil exudates, hypertrophy, no cough

cervical lymphadenopathy (enlarged lymph nodes)

27
Q

are viral and bacterial pharyngitis self limiting

A

viral: self-limiting
bacterial (S.pyrogenes): self limiting but possible complications occurring in 1-5 weeks

28
Q

complications of bacterial pharyngitis
can they be treated with abx?

A

complications occurring in 1-5 weeks
- acute rheumatic fever (prevented with early initiation of abx)
- acute glomerulonephritis (not prevented by abx)

29
Q

Pharyngitis: likely pathogens

A

virus: Rhinovirus, coronavirus, influenza, parainfluenza, Epstein-Barr

bacteria: Group A β-hemolytic Streptococcus (i.e.Streptococcus pyogenes)
- Modified Centor Criteria to guide testing and initation of abx

30
Q

diagnostic testing for bacterial pharyngitis

A
  • throat culture (gold standard)
  • rapid antigen detection test (RADT) (mins)

not commonly done in SG

31
Q

Pharyngitis: goal of therapy with abx

A
  1. reduce sx severity and duration
  2. prevent acute complications
  3. prevent delayed complications (eg acute rheumatic fever)
  4. prevention of spread to others (no longer infectious afer 24hrs of abx)
32
Q

Pharyngitis: list all of centor criteria

A
  1. fever >38 (1 point)
  2. swollen, tender, anterior lymph nodes (1 point)
  3. tonsillar exudate (1 point)
  4. absence of cough (1 point) - bacteria no cough
  5. age
    - 3-14 yo (1 point)
    - 15 to 44 yo (0 point)
    - more than 45 (-1 point)
33
Q

what do the points in centor criteria mean?

A

0-1 point: no test needed, low risk of S.pyrogenes, presume viral, no abx

2-3: test for S.pyrogenes, if positive use abx

4-5: high risk for S.pyrogenes pharyngitis, initate empiric abx

34
Q

Bacterial pharyngitis: choice of abx

A
  • first line
    PO pen V 250mg BD (low dose)
    PO amoxicillin 500mg BD (low dose)
  • pen allergy
    PO cephalexin 500mg BD
    PO cefuroxime 250mg BD
    PO azithromycin 500mg OD
    PO clarithromycin 250mg BD
    PO clindamycin 300mg TDS

duration: 10 days (5 days for azithromycin)
- increasing resistance to mcrolides

35
Q

Pharyngitis: monitor response

A
  • not given abx: advice sore throat less than 1 week, abx not needed (likely viral)
  • given abx: fever and sx resolve 1-3 days
  • see dr when sx worsens

no microbiological test of cure needed
abx adr (GI SE)
- macrolides: QTc prolongation

36
Q

acute rhinosinusitis: pathogenesis

A

Acute (within 4 weeks) inflammation and infection of the paranasal and nasal mucosa

  • Direct contact with droplets of infected saliva or nasal secretions
  • Bacterial cases usually after viral URTIs (e.g.common cold, pharyngitis)
  • Inflammation results in sinus obstruction
  • Nasal mucosal secretions are trapped (trapped bacterial multiply)
37
Q

sinusitis: symptoms

A
  • Purulent nasal discharge (colour does not show viral/ bacteria, only inflammation)
  • Facial pain* or pressure
  • Fever
  • Nasal congestion and obstruction
  • Reduced sense of taste or smell (hyposmia or anosmia)
  • Headache
  • Cough
  • Ear fullness* or pressure
  • Bad breath
  • Dental pain*
38
Q

sinusitis: are cultures, diagnostic tests indicated?

A

no culture/ swabs/ imaging
dx based on clinical presentations

39
Q

sinusitis: red flag (emergency)

A

evidence of spread if infection to orbits (eye) or CNS -> emergency
sx:
- limited ocular movements
- acute vision changes
- confusion
- unilateral weakness

40
Q

sinusitis: pathogen

A

virus
bacterial rhinosinusitis is a secondary infection from obstruction from viral URTI
(common)
- Streptococcus pneumoniae
- Haemophilus influenzae
(others)
- Streptococcus pyogenes
- Moraxella catarrhalis
- anaerobic bacteria (gram positive)

41
Q

sinusitis: indication for abx

A

treat bacterial sinusitis with abx if have any 1 of the following:
1. sx persist more than 10 days w/o clinical improvement
2. sx are severe (fever >39, purulent nasal discharge, facial pain) lasting >3 consecutive days
3. sx worsen (new onset fever, headache, increased nasal discharge) after inital improvement for >3 days (day 5 to 6)

42
Q

sinusitis: goal of tx

A
  • Shorten duration of symptoms, faster symptom relief
  • Restore quality of life
  • Prevent complications
43
Q

sinusitis: choice of abx

A

first line:
- PO amoxicillin 500mg TDS
- PO amoxicillin clavulanate 625mg TDS
pen allergy:
- PO cefuroxime 500mg BD
- PO levofloxacin 500mg OD
- PO moxifloxacin 400mg OD

Duration: 5-7 days for adults

44
Q

which abx is Strep penumoniae increasingly resistant to

A

tetracyclines, bactrim, macrolides

45
Q

sinusitis: monitoring

A

not given abx - assure that sx will last 7-10 days, no need abx (likely viral or non severe bacterial sinusitis)

given abx - sx should improve in 7-10 days
- see a dr if they develop persistent, severe, worsening sx
- emergency: eye/ CNS involvement

abx ADR

PR3151 Finals (7 decks)

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