Lecture 19: Fever and Cough, Upper resp. tract infection

Question 1

What are the types of Upper resp. tract infections?

Answer 1

• Sinusitis
• Otitis media
• Pharyngitis
• Tracheitis
• Bronchitis
• Pneumonia

Question 2

What are the common causes of resp. infections?

Answer 2

Bacteria:

• S. pyogenes
• S. pneumoniae
• Haemophilus influenzae
• Bordetella pertussis
• Etc

Viruses

• Rhinovirus
• Coronavirus
• RSV
• Influenza virus

Question 3

What might a sore throat be indicative of?

Answer 3

• Pharyngitis
• Tonsillitis

May involve soft palate, uvula, tonsils

May have associated cervical lymphadenopathy

Question 4

Whats the aetiology of pharyngitis?

Answer 4

• Approx 50% due to virus. - often with no therapeutic implications
• Approx 50% due to streptococcus pyogenes - with potential therapeutic implications

Question 5

What are the clinical features of pharyngitis caused by s. pyogenes?

Answer 5

More severe illness; Fever, pain, dysphagia, adenopathy

Focal pharyngeal infection: Red pharynx

Question 6

What are the clinical features of pharyngitis caused by common viruses?

Answer 6

Less severe illness

More diffuse URT infection; Rhinorrhoea, hoarse virus, cough, conjunctival signs

Question 7

What bacteria normally inhabit the mouth?

Answer 7

Streptococci!

• Lots of different species in everyone. “Only” streptococcus pyogenes causes pharyngitis. Most other oral streptococci are much less virulent.

Question 8

How do you interpret the heamolysis of blood tests?

Answer 8

Partial haemolysis: Green: Alpha haemolysis = S. pneumoniae

Complete haemolysis: Clear: Beta hemolysis = S. pyogenes

No haemolysis: Nil: Gamma heamolysis = Enterococcus faecalis

Question 9

Whats the typical time course of viral URI?

Answer 9

• Fever 2-3 days at onset
• Cough for ~7-10 days (usually improving by 5)
• Rhinorrhoea progresses from clear to purulent to clear over 1-2 weeks

Question 10

What are the symptoms of rhinosinusitis?

Answer 10

• Purulent anterior nasal discharge
• Purulent posterior nasal discharge
• Nasal congestion or obstruction
• Facial congestion or fullness
• Facial pain or pressure
• Reduced or absent smell
• Fever

Question 11

What is the aetiology of sinusitis?

Answer 11

Viral (90-98%)

• Rhinovirus
• Influenza virus

Bacterial (2-10%)

• Streptococcus pneumoniae
• Haemophilus influenzae

Question 12

Write some notes on the presentation of rhinovirus and its transmission:

Answer 12

Transmitted by resp. droplets and contaminated surfaces

• Incubated period 1-4 days
• Infection of nose and sinuses
• Nasal mucous, sneezing, cough, sore throat, minor fever, muscle aches
• Recovery in 1-2 weeks

Question 13

Review lecture

Answer 13

Thanks