Upper Respiratory Tract infection Flashcards
Give 4 organism of the normal URT flora?
1) Streptococcus Viridans
2) Commensal Neisseria spp
3) Diphtheroids
4) Anaerobes
Give 5 respiratory pathogens that may be carried asymptomatically?
1) Streptococcus pneumonia
2) Moraxella catarrhalis
3) Haemophilus influenza
4) Streptococcus pyogenes
What is the mode of transmission of most respiratory pathogens?
Droplet spread
Hand washing and decontamination very important
Which 3 groups of people most commonly suffer from URTIs?
1) Very young children
2) Teenagers
3) Immunosuppressed
What are the NICE guidelines for prescribing of Abx for RTI in patients over 3 years?
1 of 3 strategies
1) No prescribing
2) Delayed prescribing
3) Prescribe if risk of complications
What is the medical term for the common cold?
Coryza
What is the most common pathogen to cause coryza?
Rhinovirus
Other than rhinovirus which 5 other viruses commonly cause coryza?
1) Coronoviruses
2) RSV
3) Parainfluenza virus
4) Enteroviruses
5) Adenovirus
What are the 3 main symptoms of rhino-sinusitis?
1) Facial pain
2) Nasal blockage
3) Reduction in smell
What is the basic aetiology of rhino-sinusitis?
Post-viral inflammation
What are the 4 possible complications of rhino-sinusitis?
1) Chronic sinusitis
2) Osteomyelitis
3) Meningitis
4) Cerebral abscess
What 6 pathogens can cause rhino-sinusitis?
1) Streptococcus pneumonia
2) Haemophilus influenza
3) Streptococcus milleri group
4) Anaerobes
5) Fungi
What are the 3 possible investigations/treatment procedures for rhino-sinusitis?
1) Imaging for severe or suspected complications
2) Sinus washouts - ENT (relieves symptoms and enables sample for microbiology to be collected)
3) No Abx if viral otherwise cover suspected/proven pathogens eg. amoxicillin for severe disease
What are the 5 possible viral causes of pharyngitis/tonsillitis?
1) RSV
2) Influenza
3) Adenovirus
4) EBV
5) HSV1
What is the most common bacterial cause of pharyngitis/tonsilitis?
Streptococcus pyogenes
What are the 4 rarer bacterial causes of pharyngitis/tonsillitis?
1) Neisseria gonorrhoeae
2) Corynebacterium
Don’t forget STDs
3) Mycoplasma pneumonia
4) Chlamydophilia pneumoniae
What 2 investigations should be carried out in pharyngitis/tonsillitis?
1) Proper history
2) Throat swabs
What are the 6 signs/symptoms of pharyngitis/tonsillitis?
1) Sore throat
2) Dysphagia
3) Headache
4) Red tonsillar/uvular area +/- exudate
5) Fever
6) Lymphadenopathy
Pharyngitis/Tonsilitis in children can be caused by what pathogen which leads to what serious complications? 3
Group A streptococcal infection Complications: 1) Acute glomerulonephritis 2) Rheumatic fever 3) Scarlet fever
How is rheumatic fever prevented in children with a group A streptococcal infection causing pharyngitis/tonsillitis?
Give penicillin
Prevent suppurative complications (otitis media and quinsy (peritonsillar abscess))
What virus can cause pharyngitis/tonsillitis commonly in teenagers? What are the 3 signs of this?
EBV
1) Sore throat
2) Cervical lymphadenopathy
3) Fever
In people with pharyngitis/tonsillitis caused by EBV what drug should be avoided and what investigations should be carried out?
Avoid ampicillin (mac-pap rash, not a true allergy) Serology - IgM/IgG, Paul Bunnell test/ PCR
Diphtheria can cause pharyngitis/tonsillitis what is the treatment for this and what part of the history is important in identifying this?
1) Erythromycin/Penicillin/Antitoxin if toxins have been shown in microbiology lab
Immunisation/travel history important
What are the 4 main symptoms of diphtheria?
1) Malaise
2) Fatigue
3) Fever
4) Sore throat
What fungal infection can cause pharyngitis/tonsillitis, when is this likely to occur?
Candia, usually after Abx or steroids
Why should epiglottitis be identified as early as possible?
Its a medical emergency as can cause complete occlusion of airways
What is epiglottitis?
Cellulitis of epiglottis - airway obstruction
Epiglottitis commonly occurs in which group of people?
Child aged 2-4 years
What are the 8 common signs/symptoms seen in a child with epiglottitis?
1) Fever
2) Irritable
3) Difficulty speaking (sounds like hot potato in mouth)
4) Difficulty swallowing
5) Leans forwards
6) Drools
7) Stridor
8) Horse
What 2 investigations would be carried out in suspected epiglottitis?
1) Lateral neck x-ray - shows enlarged epiglottis
2) Must send blood cultures
NB. Do not swab epiglottis unless already intubated or can intubate immediately as airway may collapse
What pathogen commonly caused epiglottitis prior to immunisations and which 2 types of pathogen are now more common causes?
Prior to immunisation - H. influenza type B
Now respiratory bacteria and staph aureus
What are the 5 symptoms of acute laryngitis?
1) Hoarse/husky voice
2) Globus pharyngeus (lump in throat)
3) Fever
4) Myalgia
5) Dysphagia
What is the medical name for croup?
Acute laryngotracheobronchitis
What is Acute laryngotracheobronchitis?
Inflammation of larynx and trachea after infection of upper airways
What is the most common cause of Acute laryngotracheobronchitis?
Viral - parainfluenza type 2
THUS NO ABX
Which group is Acute laryngotracheobronchitis common in?
Children
What is the therapy for Acute laryngotracheobronchitis?
Non Abx as viral cause
Symptomatic Rx only
What pathogen commonly causes whooping cough?
Bordetella pertussis (Gram negative coccobacillus)
What investigations are carried out for suspected whooping cough?
Pernasal swab and PCR
What is the symptomatic course of whooping cough?
1) Initially catarrhal phase - runny nose, fever and malaise (like any other URTI)
2) Later (up to a week) - dry non productive cough which becomes whooping/paroxysms (short bursts on exhalation, then inspiratory gasps which is the whoop)
What is the treatment for whooping cough?
Supportive and erythromycin
Immunisation is very important - erythromycin to household contacts
What are the 4 possible complications of whooping cough?
1) Otitis media
2) Pneumonia (often secondary infection or aspiration)
3) Convulsions
4) Subconjunctival haemorrhages
What is otitis externa?
Infection of the external auditory canal - like any other soft tissue infection in a way but as its a narrow canal can become easily blocked causing pain
What are the 5 main symptoms of otitis externa?
1) Pain
2) Itch
3) Swelling
4) Erythema
5) Otorrhoea (ear drainage)
What are the 3 main types of otitis externa?
1) Acute OE
2) Chronic OE
3) Malignant OE
Which 2 organisms are the most likely causes of acute otitis externa?
1) S. aureus
2) Pseudomonas spp (esp. after swimming)
What are the 3 possible treatments for otitis externa?
1) Toilet with saline and/or alcohol and acetic acid
2) Wick insertion
3) Topical drops (these may contain Abx, antifungals and steroids)
What is chronic otitis externa?
Irritation from drainage from perforated tympanic membrane - itchy
What is the treatment for chronic otitis externa?
Treat the underlying cause - nb. avoid aminoglycosides (gentamicin) if perforation as can lead to deafness
What is malignant otitis externa?
Severe, necrotizing, spreads from local area more deeply. May invade bone, cartilage and blood vessels.
What is the possible life threatening complication of malignant otitis externa?
Spread to temporal bone - base of skull, meninges and brain
What pathogen commonly causes malignant otitis externa?
Pseudomonas aeruginosa
What are the 2 main symptoms of malignant otitis externa?
Extreme pain
Drainage of pus from canal
Which 3 kinds of patients is malignant otitis externa common in?
1) Elderly
2) Diabetics
3) Immunosuppressed
What is the treatment for malignant otitis externa?
Treat 4-6 weeks altogether eg. with IV ceftazidime then ciproflaxin PO
What is otitis media?
Middle ear inflammation - fluid present in the middle ear
Which group is otitis media most common in?
V common in children
What are the 4 signs/symptoms of otitis media?
1) Fever
2) Pain
3) Impaired hearing
4) Red bulging tympanic membrane
What are the 3 common viral causes of otitis media?
1) H influenza
2) S. pneumonia
3) M. catarrhalis
What possible investigations can be carried out in otitis media?
Swab any discharging pus
What is the treatment for otitis externa?
If not unwell watch and treat symptomatically (decongestant etc.) and review early. If unwell give amoxicillin
What is mastoiditis?
Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and may proceed to necrosis of bone
What are the clinical signs of mastoiditis? 2
Signs same as acute otitis media
But pain/swelling over mastoid too
What change to healthcare has much reduced the incidence of mastoiditis?
Introduction of Abx
What 2 investigations would you carry out in suspected mastoiditis?
Bacteriology samples
Imaging - CT helps to assess extent
What is the therapy for mastoiditis?
Similar therapy to acute otitis media unless gram negatives are suspected and then need broader spectrum cover as per organism isolated
LTHT 1st line treatment if co-amoxiclav (amoxicillin-clavulanate)
What are Ludwig’s angina and lemierre’s syndrome?
Deep fascial space infections of head and neck
What 6 investigations aid diagnosis of URTIs?
1) Send pus/throat swab/blood cultures
2) Gram stain
3) Culture
4) Sensitivity testing
5) Reference lab work (typing, toxin detection)
6) Serology and Ab testing
