Upper Respiratory Infections Flashcards
Parainfluenza, Respiratory Syncytial Virus (RSV), Rhinovirus, Coronavirus, Enterovirus
Influenza and adenovirus infections are usually associated with more severe illness
Seasonal incidence with epidemics in the colder months
Attack rates are highest in young children who are also the main reservoir
Transmission through direct contact with secretions and airborne droplets
Nasal drainage/obstruction, sneezing, sore throat, cough, fever
In young children, RSV or parainfluenza may lead to pneumonia, croup and bronchiolitis
Dx: Clinical; pharyngeal exudate warrants performance of rapid antigen test or throat culture to rule out infection with Group A beta hemolytic Strep
Tx: Symptomatic relief with vasoconstrictors, antihistamines and antipyretics
The Common Cold
Rhinoviruses, adenoviruses, influenza, parainfluenza, HSV, EBV, CMV
(bacterial causes: Groups A & C Strep, Neisseria gonorrhoeae, Corynebacterium diphtheria, Mycoplasma, and anaerobes
Bacterial:
Symptoms may be mild but patients usually experience pharyngeal pain, pain on swallowing, and fever
Pharyngeal erythema and exudate may be present, cervical adenopathy is common
Viral:
Usually milder except when caused by influenza
EBV and adenoviruses can cause exudative infection
Dx: Distinguish bacterial from viral etiology (bacterial requires antibiotic)
Rapid antigen detection test can be used for diagnosis of Strep, negative test followed by throat culture
Tx: viral - supportive; bacterial - penicillin or macrolide
Pharyngitis
Rapidly progressive cellulitis of the epiglottis that can potentially occlude the airway
Haemophilus influenzea type b in most pediatric patients
Strep pneumo, Staph
Common in the 2-4 age group
Dysphonia, sore throat, difficulty swallowing
Patient may be sitting up and drooling due to inability to clear secretions
Respiratory distress and stridor may be present
Dx: Direct visualization under anesthesia, usually see an edematous, red epiglottis
Blood and epiglottal cultures can be used
Tx: Protect the airway, intubation is recommended in children
Direct antibiotics against H. influenzae
Prophylaxis for those in close contact and less than 4 years old
Epiglottitis
Age-specific viral infection, producing subglottic inflammation, resulting in dyspnea and a characteristic inspiratory stridulous sound
Commonly caused by parainfluenza 1 & 3 (also 2), RSV, rhinoviruses, influenza, mycoplasma
Affects children 3-36 months old; can begin as hoarseness and cough and then proceed to stridor and rapid breathing
Some children experience repeated episodes (spasmodic)
Dx: clinical
Tx: Supportive - supplemental oxygen, monitor blood gases, nebulized epinephrine, and systemic corticosteroids can decrease subglottic inflammation
Croup
Acute Laryngobronchitis
If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues
Pustule or furuncle due to Staph or group A strep causes erysipelas of the canal
Antibiotics and drainage to treat
Acute localized otitis externa
If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues
Severe necrotizing infection that spreads from the epithelium to adjacent structures such as blood vessels, cartilage, and bone
More common in the elderly, diabetics, immunocompromised
Usually caused by Pseudomonas and requires long courses of antibiotics
Invasive/malignant otitis externa
If the canal is narrow, traps fluid and foreign objects causing maceration of the superficial tissues
Hot humid weather
Canal becomes edematous and red
Pseudomonas, other gram negatives
Treat with topical antibiotics, steroids – systemic antibiotics may be necessary
Acute diffuse otitis externa
swimmer’s ear
Most common in 6-24 months old
Most affected children have no anatomical defect, age at first episode is predictor of recurrent infections
Strep pneumo is the most common cause, other causes include haemophilus influenzae, Moraxela catarrhalis, Mycoplasma and viruses
Dysfunction of the Eustachian tube may either be due to inadequate drainage or disequilibrium of air pressure
Pain, drainage, fever, hearing loss
Erythema and fluid in the middle ear
Cephalosporins, amoxicillin-clavulanate, macrolides)
Myringotomy, adenoidectomy, and placement of tympanostomy tubes are sometimes used
otitis media
50% due to strep pneumo and H. influenzae
Viral, anaerobic bacteria (dental disease), S. aureus, gram-negatives in nosocomial infections
Patients experience nasal drainage, pressure over sinuses, headache, fever
Severe cases: infection can extend to bone or intracranially causing meningitis or brain abscess
Dx: Clinical or using sinus radiographs and CT scans
Specific causative organisms identified through sinus puncture and culture of specimens
Tx: Amoxicillin-clavulanate, cephalosporins, macrolides, quinolones
Sinusitis
More commonly caused by common cold viruses, adenoviruses, and influenza
Small proportion of cases are bacterial
Patients present with cough at times associated with nasal discharge and fever
50% of patients produce sputum that may become purulent
Diagnosed clinically, treated symptomatically with cough suppressants
acute bronchitis
Productive cough during at least 3 consecutive months for more than 2 consecutive years
Smoking, infection, irritants and impaired host defenses play a role
Increase in the number of goblet cells lining the bronchi as well as hypertrophy of the mucous glands; irritation of the airways causes increased secretions, cough, and bronchospasm
Common in men who smoke and complain of incessant productive cough
With acute infections there is an exacerbation of symptoms
Dx: clinical history
Tx: Concentrate on smoking cessation, avoidance of irritants, antibiotics directed against likely pathogens when acute exacerbations occur
chronic bronchitis
