Upper Respiratory Tract Infections Flashcards
What makes up the upper respiratory tract?
*nasal cavity- defence- filters air
*pharynx- hallway for resp and digestive tract (epiglottis)
*larynx-passageway for air- vocal cords
*trachea- wind pipe
What are the defence mechanisms of the URT?
*smell
*mucociliary lining
*lymphatic tissue of tonsils and adenoids
*cough reflex
What is the normal flora of the URT?
S. aureus
-compete with pathogens for potential attachment sites
-produce toxins that are bactercidal
What are common URT infections?
*cold
*sinuitis
*cough
*croup
*sore throat
*otitis media- middle ear infection
What viruses cause the common cold?
*rhinovirus (most common)
*corona
*enterovirus
How is the cold transmitted?
Autoinoculation by contact with nose or eyes
What is the pathology of the cold?
*virus acquired
*virus infects cells lining nasal passage and pharynx
*virus sheds coat, releasing nucleic acids and replicates
*immune response triggered- inflammatory changes occur
*immune response- ciliated columnar epithelial cells destroyed and sloughed off
*destruction peaks day 2-5
*cells regenerate by roughly day 14
What is the timeline of the cold?
*after 2 days, symptoms start (immune response)
*sore throat, sneezing
*day 4- cough and sinus pain starts
*day 7- most symptoms gone but cough still there
*day 10- feel normal
What common cold management can be used?
Non pharmacological-
*lots of fluid
*rest
*eat healthy
Pharmacological-
*ibuprofen
*paracetamol
*symptom specific- cough bottle etc
What type of decongestants are there?
*oral
-pseudoephedrine
*topical
-ephedrine, oxymetazoline, xylometazoline (immediate effect-prolonged use causes rebound- no longer 7 days)
What groups are oral decongestants cautioned with? (Pseudoephedrine)
*diabetes
*hypertension
*hyperthyroidism
*hepatic or renal impairment
AVOID
*MAOI’s (type of anti depressants)
What can you not supply alongside pseudoephedrine?
Ephedrine products
What is (Rhino) sinusitis?
Inflammation of mucosal lining of sinuses
What are your sinuses?
*membrane lined air spaced in skull located near nose
*frontal sinuses- above nose on either side
*maxillary sinuses- under cheek bones
*ethmoid or sphenoid sinuses- deeper part of skill near eye sockets
What are the two classifications of sinusitis?
*acute sinusitis- resolves within 12 weeks
*chronic sinusitis- symptoms last more than 12 weeks
What pathogens usually cause sinusitis?
Bacterial- streptococcus pneumoniae
Virus- rhinovirus - main initial causes
How is sinusitis diagnosed?
*follows common cold, increase in symptoms after 5 days/10 days but less than 12 weeks
Adults- congestion, nasal discharge, dental or facial pain, reduced smell
Children- congestion, discoloured nasal discharge, cough during day or at night
What are red flag symptoms with sinusitis?
*bleeding
*sight issues
*immunocomp
How is acute sinusitis managed?
*if symptoms 10 days or less- usually viral- no antibiotic needed- advise might take 2-3 weeks to resolve
*paracetamol, ibuprofen, nasal saline or nasal decongestants can be tried
*10 days or more/no improvement- nasal corticosteroids- mometasone 200mcg twice daily
*if >3 weeks, systemically unwell or red flag symptoms > GP
If an antibiotic is needed (bacterial sinusitis), what is the treatment plan?
*1st line- phenoxymethylpen- 500mg four times daily for 5 days
*2nd line- doxycycline- 200mg stat, then 100mg once daily for 5 days
OR
Clarithromycin- 500mg twice daily for 5 days
SEVERE- co-amoxiclav 500/125mg- three times daily for 5 days
Pregnant- erythromycin 250-500mg four times daily
What are the main differences between viral and bacterial sore throat?
*bacterial causes grey furry tongue- viral does not
*bacterial causes white spots on tonsils- viral does not
*bacterial causes swollen uvula- viral does not
What bacteria is Scarlet fever caused by?
Streptococcus group A (strep A)
What are symptoms of scarlet fever?
*sore throat, fever, headache, fatigue
*sandpaper like blanching rash- flushed red face but pale round mouth
*strawberry tongue
How is scarlet fever managed?
*phenoxymethylpen for 10 days
*infection control- stay away from nursery, school etc for 24 hours after 1st dose of antibiotics
