upper and lower respiratory tract infections Flashcards
Serum procalcitonin
Amino acid biomarker produced by thyroid C cells
Levels increase with bacterial infections, Rapid rise with inflammatory insult, rapid decline with immune control, hospital setting, expensive
Antimicrobial stewardship
Rational, systemic approach to the utilization of antimicrobials to optimize outcomes
Select corrct antimicrobial agent, dose medication properly, utilize appropriate duration, minimize toxicity/ resistance
Viral upper respiratory tract infections from most common to least, transmission
Rhinovirus, coronavirus, influenza, RV/parainfluenza, adenoviruses/enteroviruses
Transmission: hand contact: direct vs indirect, can survive for 2 hours on skin, large droplet, small droplet (aerosolized)
tissues and cotton handkercheifs dont support viral survival
Viral upper respiratory tract infections symptoms
odynophagia (pain when swalloing), nasal obstruction, malaise, low grade fever, cough, plugged ears, rhinorrhea (color/consistency varies, yellow or green does not garuntee bacterial infection)
Clinical conundrum: symptoms mimic bacterial infections, treatment is very different, cost is different, potential for harm if treat inappropriately
Otitis media
the ear drum is full of liqquid–> painful
fussy,
Serous otitis media (non infectious, clear)
Suppurative otitis media (Bacterial, inflammed budging out)
Risk factors: young (6-24 months), family history, daycare exposure, lack of breast feeding, tobacco air pollution exposure, Native american, canadian inuit, indigenous australians
Microbiology of otitis media, and treatment
Acute bacterial otitis media: streptococcus pneumonia, haemophilus influenza, (sometimes moraxella catarrhalis or group a strep pyogenes)
Chronic bacterial otitis media: Staphylococcus Aureus, pseudomonas, proteus, anaerobes (peptostreptpcoccus, fusobacterium, prevotella)
Immediate antimicrobial therapy: children less than 6 months, children with sever symptoms (pan and high fever), bilateral bacterial otitis media, immune compromised pts
Observation: for immune competent patients, non sever otalgia less than 48 hours, temp under 39, unilateral infections, close follow up if not working give antimicrobial
Antimicrobials: Amoxicillin (90mg/kg/day 2x day, max 3 grma a day). Augmentin (25-45 mg/kg/day divivded q12)
Penicillin allergy: mild delayed rxns: Cephalosporins (cefdinir, cefs). Immediate/sever rxns: macrolides (mycin)
What if otits media is still being bethersome bc theres fluid build up, but the infections is gone
tympanostomy tube placement, allows ventilation of middle ear space, conduit for topical medications, relieves effusion, improves the hearing, >3 months
Acute adult rhinosinustus
1 in 7/8 will happen annualy, women> men, adult most common 45-65 yrs od, vast majority of infections are viral
Risk factors: previous viral URI, older age, smoking, allergies, asthma, immunocompromised, dental disease, swimming, deep sea diving
most common reason for adults to be seen in primary care office
Viral vs bacterial sinustits
Viral sinusitis: nasal obstruction, nasal secretions clear- discolored, facial pain/pressure, malaise, headache, ear pressure fullness
Bacterial: nasal obstruction, nasal secretions (often discolored), facial pain pressure, malaise, headach, earpressure and fullness
Culture, physical and history best tools
Use of antibiotics: symptoms lasting more than 7 days, if microbe is for sure bacterial , initial improvement followed by worsening symptoms
Viral etiology 96 %, (bacterial infections- streptococcal pneumoniae, h. flue, moraxella, dental infection)
Acute Respiratory treatment
Symptoms: intranasal steroids, analgesics, saline nasal irrigations, nasal decongestants, antihistamines, guaifenesin
Antimicrobial therapy: high dose amoxicillin, Amox/ clavulanate, penicillin allergy? (doxy fluoroquinolon- oxacins)
Complications: orbital cellulitis, meningits, brain abcess, septic cavernous sinus thrombosis
Symptoms: fever, sever pain, proptosis, vision loss, sever headache, mental status
Tonilliitis/ peritonsillar abscess
Usually group A Streptococcus (GAS): most common cause of bacterial pharyngits (30-40%)
Peaks in winther and early sprint
–> acute rheumatic fever, peritonsillar abcess
Rapid onset of symptoms: Fever odynophagia, tender cervical lymphadenopathy, ab pain, nausea vomiting, tonsillar hypertrophy, patal petichiae, scalatiniform rash
Rapid strep test, sensitive spcific,
Tonsillitis microbiology
Bacterial: Gas, group C and G streptococci, neisseria gonorhea, fusobacterium necrophorum, diptheria, A haemolyticum, tularemia
Viral: infectious mono, primary HIV, herpes simplex, enterovirus, adenovirus
Treatment: Antimicrobial (penicillin V or amoxicillin/clavulanate, 1st gen or second gen cephs, clindamycin, macrolides (azithromycin, clarithromycin)
Group A strep tonsillitis complications
Acute rheumatic fever: carditis and valvulitis (50-70%), leads to rheumatic heart disease in 10 -20 years, arthritis, CNS, subQ nodules, erythema marginatum
Post streptococcal glomerulonephritis, peritonsillar abscess
Peritonsillar abscess (purulent infection, deep neck space, usually unilateral, polymicrobial, diagnosis via history and physical)
Peritonsillar abscess
Symptoms rapid onset, sever odynophagia, drooling, fever, arthralgia/myalgias, referred otalgia, difficulty opening mouth
Exam: look very sick, hot potato voice, drooling, possible airway obstruction, trismus, fullness superior tonsillar
Complications: septicemia, internal jugular thrombosis, lemierre syndrome, carotid rupture, mediastinitis, aspiration pneumonia
Fungal lesions of upper respiratory tract
common opportunistic infection, candida albicans, infects to older adults, diagnosis, treatment- oral antifungals, extensive recalcitrant disease– HIV,
Risk factors; advanced age, denture use, xerostromia, recent antibiotic use, ICS use, radiation, HIV
Erythematous candidiasis, angular cheilitis, Practice good oral hygiene
