Upper Respiratory Tract Infections

Question 1

What are the URTIs?

Answer 1

Common cold, influenza, pharyngitis, rhinosinusitis

Question 2

What are the symptoms of common cold?

Answer 2

Gradual onset
Low grade fever (if any, more common in children)
Rhinorrhea (more)
Nasal congestion (more)
Sneezing (more)
Sore throat
Pdtive cough
Normal HR
Lungs clear to bilateral auscultation

Question 3

What are the symptoms of influenza?

Answer 3

Abrupt onset
Fever
Headache
Malaise
Myalgia
Anorexia
Rhinorrhea (less)
Nasal congestion (less)
Sneezing (less)
Sore throat
Dry cough

Question 4

What are the symptoms of general pharyngitis?

Answer 4

Sore throat (worse when swallowing)
Fever
Erythema or inflamm of tonsils
Tender and swollen lymph nodes

Question 5

What are the symptoms of viral pharyngitis?

Answer 5

Low grade fever
Malaise
Rhinorrhea
Cough
Hoarseness

Question 6

What is the Cantor criteria?

Answer 6

Fever >38 deg C
Swollen, tender cervical lympadenopathy = 1
Tonsillar exudates = 1
No cough: 1
Age:
0-14 = 1
15-44 = 0
>=45 = -1

0-1: no indication for abx
2-3: dep on how quickly patient may progress to 4-5 treat w abx

Question 7

What are the symptoms of rhinosinusitis?

Answer 7

Fever
Nasal congestion
Purulent nasal discharge
Cough
Reduced sense of taste or smell
Bad breath
Headache
Facial pain or pressure
Ear fullness or pressure
Dental pain

Question 8

When are antibiotics indicated in rhinosinusitis?

Answer 8

1. Symptoms persist >10d without clinical improvement
2. Worsening of symptoms following an initial period of improvement
3. Severe symptoms for >3d (High fever >39 deg C, facial pain, purulent nasal discharge)

Question 9

When is antiviral therapy indicated for influenza?

Answer 9

Hospitalised, complicated presentation, comorbidities, more sick, immunocompromised

Question 10

What is the recommended antiviral therapy for influenza?

Answer 10

PO Oseltamivir 75 mg BD x5d

Question 11

When should we initiate antiviral treatment for influenza?

Answer 11

Within 48h of symptoms onset for most benefit. However for sick pts within 5d.

Question 12

What is the recommended antibiotic regimen for pharyngitis?

Answer 12

PO pen V 250 mg Q6H
PO amoxicillin 500 mg Q12H

Pencillin allergy:
Non-severe allergy - PO Cefuroxime 250 mg Q12H/ PO Cephalexin 500 mg Q12H

Severe allergy - PO azithromycin 500 mg once daily
PO clarithromycin 250 mg Q12H
PO clindamycin 300 mg Q8H

Treatment duration: 10d(5d for azithromycin)

Question 13

What is the recommended antibiotic regimen for bact rhinosinusitis?

Answer 13

PO amoxicillin 500 mg Q8H
PO amoxicillin-clavulanate 625 mg Q8H

Penicillin allergy:
Non-severe allergy - Cefuroxime 500 mg Q8H

Severe allergy - Levofloxacin 500 mg daily
Moxifloxacin 400 mg daily

Treatment duration: 5-7d

Question 14

What bugs do we need to cover for pharyngitis?

Answer 14

Beta-hemolytic strep

Question 15

What bugs do we need to cover for rhinosinusitis?

Answer 15

S. pneumoniae, H. influenzae&raquo_space; Beta-hemolytic strep, moraxella catarrhalis, anaerobes (gram +ve)

Question 16

What is the pathophysiology of URTI?

Answer 16

Touching formites colonised w bact, touching nose or mouth.
Sharing food without serving spoon.
Cross innate immunity –> Colonisation of bact, overgrowth –> infection.

Question 17

What are the natural host defense mechanisms to URTI?

Answer 17

1. Nostril hairs trap organisms (filter inhaled air)
2. Mucus traps organisms
3. Angle bet pharynx and nose prevents particles from falling into airwats
4. Mucociliary sys in lower airways transport pathogen pack to pharynx
5. Adenoids and tonsils contain immunologic cells that attack pathogens

Question 18

What are the risk factors for URTI?

Answer 18

Contact with children
Poor personal, hand hygiene
Immunocompromised
Smoking
Anatomical anomalies incl facial dysmorphic changes or nasal polyposis

Question 19

What are the prevention strategies against URTI?

Answer 19

Proper personal/hand hygiene
Mask wearing
Social distancing
Vaccination
Manage known risk factors