Respiratory Tract infections Flashcards
Which bacterial pathogens can cause upper respiratory tract infections?
- Bordetella pertussis
- Corynebacterium diptheriae
- Haemophilus influenzae
- Moraxella catarrhalis
- Strep pneumoniae
- Strep pyogenes
- Staph aureus
Which viruses can cause upper respiratory tract infections?
- Adenovirus
- Epstein-Barr virus
- Herpes simplex
- Respiratory syncytial virus
- Rhinovirus
- Enteroviruses
- Coronaviruses
- Human metapneumovirus
- Influenza & parainfluenza
What viruses can cause the common cold/coryza? With treatment what should you not do?
- Mainly rhinovirus
- Coronoviruses
- Parainfluenza viruses
- Enteroviruses
- Adenovirus
- RSV
- DON’T GIVE ANTIBIOTICS
Describe Rhino-sinusitis
- Facial pain, nasal blockage, smell reduction
- From post viral infection
- Complications: Osteomyelitis, meningitis, cerebral abscess
- Strep pneumoniae, Haem influenzae, Strep milleri group, fungal, anaerobes
How is Rhino-sinusitis diagnosed & treated?
- imaging for severe/ suspected complications: X-ray, CT, MRI to see air fluid levels
- Sinus washout
- If viral-no antibiotics
- Amoxicillin if severe disease
What can cause pharyngitis/tonsillitis?
- Viral= RSV, influenza, adeno, EBV, HSV1
- Bacterial= strep pyogenes, corynebacterium diptheriae, chlamydophila pneumoniae
- Throat swab
What are the symptoms of pharyngitis/tonsillitis
- Dysphagia
- Fever
- Headache
- Red tonsillar/uvular area
- +/- exudate
- Lymphadenopathy
Describe Group A strep infection leading to pharyngitis/tonsillitis
- Common children
- Complications: acute glomerulonephritis, rheumatic fever/scarlet fever
- Aim to prevent rheumatic fever by giving penicillin & prevent suppurative complications
Describe infectious mononucleosis/glandular fever/kissing disease leading to pharyngitis/tonsillitis
- Epstein barr virus
- Teenagers & older
- Often asymptomatic
- Complications= splenic rupture
- Avoid ampicillin (mac-pap rash confused with penicillin allergy)
- Serology= IgM, IgG
- Fever & cervical lymphadenopathy
What can tonsillitis/ pharyngitis lead to?
- Diptheria
- Corynebacterium diptheriae
- Malaise, fatigue, fever, sore throat
- Immunisation, travel history
- Erythromycin, penicillin, antitoxin
What other problem can occur after using broad spec antibiotics for pharyngitis/tonsillitis?
Thrush
Describe epiglottitis
- Medical Emergency
- Cellulitis of epiglottis
- Airway obstruction
- Child 2-4
- Lateral neck x-ray
- Fever, irritable, difficulty speaking/swallowing, leans forward, drools, stridor, hoarse
How is epiglottitis diagnosed/ treated?
- Must send blood cultures
- Don’t swab/examine unless intubated
- Treatment mainly airway- cefotaxime
What is the cause of epiglottitis?
- Mainly H.influenzae type B prior to immunisation
- Rarer resp bacteria & S.aureus
Describe acute laryngitis
- Hoarse voice, globes pharynges, fever, myalgia, dysphagia
- Viral occasionally bacteria
- Self-limiting
- No use of antibiotics
- Airway patency is stridor
- Non infective causes-voice abuse & malignancy
What is croup?
- Acute laryngotracheobronchitis
- Inflammation of larynx & trachea after infection
- Children
- Viral= parainfluenza type 2= no antibiotics only symptomatic
Describe whooping cough
- Bordetella pertussis
- Incubation period 1-3wks
- Initially catarrhal phase-runny nose, fever, malaise
- Later dry non productive cough
- PCR & pernasal swab
What is the treatment & potential complications of whooping cough?
- Supportive & erythromycin
- Otitis media, pneumonia, often secondary infection or aspiration, convulsions, subconjunctival haemorrhage
- Immunisation
What is Otitis external?
- Infection of external auditory canal
- Pain, itch, swelling & erythema, otorrhoea
- Acute OE, chronic OE, malignant OE
Describe acute otitis externa
- Skin types S.aureus & pseudomonas
- Toilet with saline & alcohol & acetic acid, topical drops contain antibiotics
Describe chronic otitis externa
- Irritation from drainage from perforated tympanic membrane
- Itchy
- Treat underlying cause
- Avoid aminoglycosides if perforation
- Resistance may form & sensitisation occurs with prolonged course
Describe malignant otitis externa
- Severe necrotizing
- Spread from local area more deeply
- May invade bone, cartilage, blood vessels
- Life-threatening spread to temporal bone, base of skull, meninges & brain
- Often pseudomonas aeruginosa
- Severe pain, drainage of pus from canal, elderly, diabetes, immunosuppressed
- Treat with iv ceftazidime then ciprofloxacin
What is Otitis Media?
- Middle ear inflammation
- Fluid present in middle ear
- Common in children
- Fever, pain, impaired hearing, red bulging tympanic membrane
- Viral= H. influenzae, S. pneumoniae, M.catarrhalis
- Swab any pus discharge
- Unwell= amoxicillin/erythromycin not unwell= symptomatic
What is mastoiditis?
- Inflammation of mastoid air cells after middle ear infection
- Pus collects in cells and may proceed to necrosis of bone
- Signs= pain/swelling over mastoid
- Lower incidence after introduction of antibiotics
How is mastoiditis diagnosed?
- CT help to assess extent
- Similar to acute OM unless gram negatives are suspected
- Leeds first line treatment= co-amoxiclav
What are other important features of mastoiditis?
- Vincent’s angina
- Deep fascial space infections of head & neck (ludwig’s angina, limeade’s syndrome)
- Gingivitis/ peridontal infections
How is mastoiditis diagnosed?
- Send pus/throat swab/blood cultures
- Gram stain
- Culture
- Sensitivity testing
- Serology & antibody detection
What is the treatment for tonsillitis?
Fluids
Analgesia
Strep infection: Penicillin V
What is the centor criteria? What is it used for?
-Tonsillar exudate
-Absence of cough
-Hx of fever >38
-Tender anterior cervical lymphadenopathy
3/4 = empirical Abx treatment
What is glue ear?
Otitis media with effusion
90% of cleft palate kids
