ID- respiratory infections Flashcards
Describe the presentation of tonsillitis/pharyngitis
Sore throat, difficulty swallowing
+/- lymphadenopathy, viral symptoms (cough, coryza)
+/- fever, dehydration, systemically unwell
Describe how to differentiate between bacterial and viral tonsillitis
Centor criteria or Fever PAIN score Centor: -Exudates -Fever >38 -No cough -Lymphadenopathy
FeverPAIN:
- Fever, no cough, short history (<3 days)
- Tonsillar exudates + inflammation
Describe the investigations for tonsillitis/pharyngitis
Not routinely done.
Consider swabs for viral PCR/MC&S
Further tests if severely unwell
Describe the management of tonsillitis/pharyngitis
Supportive Mx: fluids, paracetamol, gargle, etc
- No ABx if mild: Centor 0-2/ Fever PAIN 0-1.
- Backup/delayed ABx if mod: Fever PAIN 2-3
- ABx if likely bacterial: Centor 3-4/ Fever Pain 4-5
Antibiotics:
- 1st line 5 days phenoxymethylpenicillin 500mg QDS
- Alternative: clari/erythro
Describe the common pathogens causing tonsillitis/pharyngitis
Viral: most common. Rhinovirus, coronavirus, RSV, influenza etc. Also EBV (glandular fever)
Bacterial: Strep pyogenes (Grp A beta-haemolytic), gonorrhoea rarely
Describe the presentation of rhinosinusitis
-Runny nose, congestion
-Headache/facial pain
-Itchy, watery eyes
+/- fever
Describe the investigations of rhinosinusitis
Not routinely done. Can swab
Describe the management of rhinosinusitis
Supportive Mx: fluids, paracetamol, nasal decongestants (spray, breathing steam, etc)
Advise resolves in 2-3 weeks spontaneously
Antibiotics:
-Usually don’t prescribe.
-Consider if 10 days and no improvement
1st line phenoxymethylpen 5 days 500mg QDS
-Alternatively clari/erythro or co-amox in v unwell kids
Describe the common pathogens in rhinosinusitis
Almost always viral: rhinovirus, coronavirus, adenovirus
2% bacterial eg. Grp A Strep
Describe the presentation of otitis media and otitis externa
Otitis media: ear pain, coryza/cough/sore throat, fever. If perf -> purulent discharge w no pain. O/E- bulging, red TM with no cone of light
Otitis externa: usually just ear pain, itching. Normal TM with redness/crusting of external meatus
Describe the common pathogens in otitis media and externa
Otitis media: resp viruses mostly. Some bacteria: Strep pneumo, HiB etc
Otitis externa: bacterial. Pseudomonas or S aureus
Describe the management of otitis media and externa
Otitis media: supportive. Fluids, paracetamol.
- Advise that usually resolves in 3 days-1 week
- Consider antibiotics if perf/young child with bilateral
- ABx: amox TDS for 5-7 days or clari
Otitis externa:
- Conservative: avoid swimming, keep ears dry
- Consider topical ABx drops +/- steroid
Describe the presentation of acute bronchitis
Cough- acute onset, worse at night + exercise. May last for several weeks/>1 month (postbronchitis syndrome)
+ sputum production, wheeze, chest pain/tightness, fever
***Key differentiation with asthma is presence of other viral symptoms eg. coryza, sore throat
Describe the investigations for acute bronchitis
Usually not needed. Spirometry can show obstruction + may be confused with asthma
CXR may be used if suspecting pneumonia
Describe the management of acute bronchitis
Supportive: fluids, paracetamol
-Advise usually viral. Cough may last for significant time
-Bronchodilator if wheezing
-Antibiotics only if systemically unwell or at high risk of complications eg. immunosuppressed, elderly
1st line doxy. Alternatively amox/clari
Describe the presentation of glandular fever
Typically symptomatic in teenagers. Children are subclinical, most adults have been infected already
-Fever
-Sore throat
-Lymphadenopathy
-Fatigue. May last for months
+/- enlarged spleen, palatal petechiae, rash, hepatitis
Describe the investigations for glandular fever
- Swab: viral PCR
- Bloods (in 2nd week of illness): atypical lymphocytosis (FBC + film), agglutination test eg. Monospot test/Paul-Bunnell (tests for heterophile antibodies), serology
Describe the course of TB infection
Infection -> primary TB (symptoms) or becomes latent
Can re-activate to active TB or stay latent as granuloma
Describe the presentation of TB
Latent TB: granulomas found incidentally
Pulmonary TB: most common. Cough, fever, haemoptysis, chest pain, night sweats, weight loss, fatigue, clubbing, erythema nodosum
Extra-pulmonary TB: can affect anywhere eg. GIT, urinary tract, adrenals, bone etc
Describe the investigations for TB. What is the gold standard?
Active TB:
- Sputum sample x3: culture (Lowenstein-Jensen medium), Ziehl-Nielson AFB stain, auramine stain, NAAT etc
- Bloods: FBC, CRP, U+Es, LFTs
- CXR
Latent TB:
- TST
- IGRA (better if BCG vaxed)
Describe the management for TB
Conservative: stop smoking, nutrition
Medical: anti-TB drugs
-Rifampicin, Isoniazid + pyridoxine, Pyrazinamide, Ethambutol
-6 months: 2 mos x 4 -> 4 mos x 2
+/- longer if risk factors eg HIV, DM, smoking
Describe the common side effects/complications of anti-TB drugs
Rifampicin: turns secretions orange. Hepatotoxic*
Isoniazid: causes peripheral neuropathy (give with pyridoxine). Hepatotoxic*
Pyrazinamide: hepatotoxic*. Gout
Ethambutol: causes visual loss, colour blindness.
*Some rise in ALT is normal. Allow up to 5x ULN + continue to monitor
