Lecture 20: Fever and cough: URTI

Question 1

Causes of URTI

Answer 1

Bacteria:

• Strep pyogenes
• strep pneumoniae (stand out for causing pneumonia, sinusitisor otitis media bacterially)
• haemophilus influenzae (2nd to strep pneumoniae)
• moraxella catarrhalis
• bordetella pertussis

Viruses:

• Rhinoviruses
• coronaviruses
• resp syncytial virus
• influenza.

VIRAL SO MUCH MORE COMMON

Question 2

Infection and localisation

Answer 2

Diffuse and multi-center: More often viral

Focal, one area- Typically bacterial

Question 3

Aetiology of pharyngitis

Answer 3

• MOST COMMON is rhinovirus
• strep pyogenes, somewhat common about a third
• Less common include EBV, influenza

Question 4

Strep pyogenes versus common virus

Answer 4

Strep: More severe, fever, pain, dysphagia adenopathy. A focal pharyngeal infection, may be swelling or exudate. Consider a higher temp, absence of cough, swollen cervical lymph nodes, tonsilar swelling w exudate, age

Common viruses: Less severe, more diffuse with rhinorrhea, hoarse voice, cough, conjunctival

Question 5

Blood haemolysis

Answer 5

Alpha: Partial haemolysis with green fragments seen. Includes strep pneumoniae

beta: GAS as well as B,C and G. Complete haemolysis

Gamma: No haemolysis, such as enterococcus faecalis

Question 6

If a sore throat and is a Group A Strep, when do you prescribe antibiotics?

Answer 6

Younger
Maori/Pacific
Family history

Question 7

Rhinosinusitis presentation and aetiology

Answer 7

Purulent anterior and posterior discharge
Nasal congestion or obstruction
Facial congestion or fullness
Facial pain/pressure
fever
reduced/absent smell

Viral-90-98% of the time, rhinovirus, influenza
Bacterial 2-10%, strep pneumoniae, haemophilus influenzae

Question 8

Typical viral URTI course

Answer 8

fever lasts short time

Resp symptoms can last up to 2 weeks!