Upper respiratory tract infection in a child COPY Flashcards
Define tonsilitis
Inflammation of tonsils; specifically an infection of parenchyma of palatine tonsils.
Explain the aetiology of URTIs.
Viruses cause >90% of URTIs.
Coryza: Rhinovirus, coronavirus, RSV.
Pharyngitis: Adenovirus, enterovirus, rhinovirus, group A beta-haemolytic streptococcus in older children.
Tonsillitis: EBV (infectious mononucleosis), group A beta-haemolytic streptococcus.
Otitis media: Influenza, parainfluenza, enteroviruses and adenovirus. Streptococcus pneumonia, non-typeable Haemophilus influenza (i.e not Hib), Moraxella catarrhalis.
Non-immunised child: Corynebacterium diptheriae is a severe, life-threatening cause of pharyngitis and tonsillitis.
What are risk factors for URTIs?
Associated/Related: M>F.
Immunodeficiency.
URTIs are universally prevalent and are not associated with factors associated with low socio-economic class (e.g. household smoking) as are LRTIs.
What is the pathophysiology of URTIs?
Reactive inflammation of the URT to infectious agent with production of serous discharge (coryza) and swelling of mucosal lining.
Summarise the epidemiology of URTIs.
Very common.
Two peaks: Starting nursery (2-3 years) and primary school (4-5 years).
What are the presenting symptoms of URTIs?
General: Lethargy, poor feeding.
Coryza: Sneezing, sore throat, fever is variable.
Pharyngitis/tonsillitis: Fever, sore throat, cough, abdominal pain; mesenteric adentitis is often preceded by a URTI with subsequent enlargement of the mesenteric lymph nodes.
Infectious mononucleosis: Prolonged lethargy, malaise, sore thorat.
Otitis media: Ear pain, infant may scream and pull at ear, conductive hearing loss in chronic secretory otitis media.
What are the signs of URTIs?
General: Pyrexia, tachycardia, cervical lymphadenopathy.
Coryza: Nasal discharge
Pharyngitis: The pharynx, soft palate and tonsillar fauces are inflamed and swollen.
Tonsillitis: Red, swollen tonsils with our without white exudates. Follicular tonsilittis with with exudates may be due to adenovirus, EBV, or group A beta-haemolytic streptococcus.
Otitis media: Tympanic membranes bright red and bulging on otoscopy with loss of normal light reflex. May see pus in the middle ear.
What are appropriate investigations for URTIs?
Throat swab: May grow group A beta-haemolytic streptococcus. Use in non-immunised child/complicated tonsillitis/pharyngitis to rule out diphtheria.
Bloods: Anti-Streptolysin O Titre (ASOT), monopost test (EBV)
What is the symptomatic management of URTIs?
Explain to parents that the aim of controlling fever is to ease symptoms and prevent dehydration. Tepid sponging and fanning are not recommended.
Regular paracetamol or ibuprofen may be used if the child is distressed by the fever. Reducing fever will not prevent febrile seizures.
Do not use aspirin as may precipitate Reye syndrome (severe liver disease).
What is the active management of URTIs?
Oral antibiotics such as penicillin or erythromycin (if penicillin allergic) for 10 days to prevent rheumatic fever are indicated if group A b-haemolytic streptococcus grows on throat swab.
What is the surgical management of URTIs?
Tonsillectomy is rarely indicated, only when recurrent tonsillitis is causing significant loss of schooling or upper airways obstruction and sleep apnoea.
What are complications associated with URTIs?
- Recurrent acute tonsillitis/tonsillar hypertrophy
- Peritonsillar abscess: quinsy
- Post-stretococcal immunological response, e.g. acute GN, rhematic fever
What is the prognosis of URTIs?
Excellent; duration of illness 1–2 weeks.
‘Treat a cold, it lasts a week, don’t treat and it lasts 7 days.’
