Upper Respiratory Tract Infections Flashcards
Acute bronchitis - what are the pathogens and clinical presentation?
Most common pathogens: Respiratory viruses
Clinical presentation: Cough, Sore throat, Coryza (runny/stuffy nose, sneezing, post-nasal drip), Malaise, Headache, Fever, Normal chest imaging (purulent sputum present, but doesn’t necessarily mean they have a bacterial infection)
Acute bronchitis - what is the treatment?
▪Self-limiting
▪Symptomatic management
▪Corticosteroids not necessary
▪Antibiotic therapy not necessary (please!)
Acute bronchitis - what are methods to reduce antibiotic prescribing?
▪Delayed antibiotic prescribing
▪Show empathy/listen to patient
▪Provide patient education on duration of illness (up to 2-3 weeks)
▪Provide patient education on the futility of antibiotic therapy
▪Discuss treatment plan with symptomatic management
▪Use terms related to viral infection when discussing with patient
Acute exacerbation of chronic bronchitis - what is the etiology?
inflammation, increased number of mucous glands, excess mucus, smooth muscle hypertrophy; harder for body to eliminate pathogens
Acute exacerbation of chronic bronchitis - what is the clinical presentation?
▪Established diagnosis of chronic bronchitis: Chronic cough with productive sputum on most days for ≥ 3 consecutive months for 2 consecutive years
▪Hallmark signs of acute exacerbation: Increased sputum purulence; Increased sputum volume; Increased cough or shortness of breath
Acute exacerbation of chronic bronchitis - what are the pathogens?
Most common organisms
▪Streptococcus pneumoniae
▪Haemophilus influenzae
▪Moraxella catarrhalis
Patients with frequent antibiotic use are at risk for:
▪Enterobacterales
▪Pseudomonas aeruginosa
Acute exacerbation of chronic bronchitis - what is the treatment?
preferred treatment options: amoxicillin/clavulanate, cefuroxime, cefpodoxime
alternative treatment options: doxycycline, TMP/SMX, azithromycin
risk for pseudomonas aeruginosa: levofloxacin
treatment duration: 5-7 days
Acute pharyngitis - what are the pathogens and considerations?
Most common pathogens
▪Respiratory viruses – rhinovirus, coronavirus, adenovirus most common
▪Bacteria – Streptococcus pyogenes (group A)
Concern for complications with bacterial cause
▪Rheumatic fever
▪Glomerulonephritis
▪Peritonsillar or retropharyngeal abscess
▪Mastoiditis
▪Otitis media
▪Rhinosinusitis
Acute pharyngitis - what are the clinical presentations?
▪Sudden onset of sore throat with dysphagia and fever
▪Pharyngeal hyperemia and tonsillar swelling (may have
exudates)
▪Enlarged, tender lymph nodes
▪Red, swollen uvula
▪Petechiae on soft palate
Acute pharyngitis - what is the testing that is done?
Historically, culture of the throat was the diagnostic standard
▪Limitation – takes 24-48 hours to return
Rapid antigen detection tests (RADT) have gained popularity
▪Limitation – sensitivity 70-90% compared to culture (chance for false-negative)
Back up testing with culture or PCR-based test needed if RADT negative
Acute pharyngitis - what is the treatment?
Targeted treatment for Streptococcus pyogenes (Group A) - incredibly susceptible to beta-lactams
Drugs of choice
▪Penicillin
▪Amoxicillin
Acute pharyngitis - what is the treatment option if penicillin allergy is present?
▪Non-anaphylactic reaction
⎻ Cephalexin
⎻ Cefadroxil
⎻ Cefuroxime
⎻ Cefpodoxime
▪Anaphylactic reaction
⎻ Azithromycin
⎻ Clindamycin
Acute bacterial rhinosinusitis - what are the types of infections?
acute rhinosinusitis, viral rhinosinusitis, acute bacterial rhinosinusitis, recurrent acute rhinosinusitis, chronic rhinosinusitis
Acute rhinosinusitis - description
- Purulent nasal drainage
- Nasal obstruction, facial pain/pressure
- May last ≥ 4 weeks
Viral rhinosinusitis - description
- Acute rhinosinusitis thought to be due to viral pathogen
- Symptoms present < 10 days, not worsening
usually resolves or starts to improve in less than 10 days
Acute bacterial rhinosinusitis - description
- Acute rhinosinusitis thought to be due to bacterial pathogen
- Persistent symptoms ≥ 10 days with no improvement
- Severe symptoms – fever, purulent nasal discharge, facial pain for
3-4 consecutive days at beginning of illness - Worsening symptoms – new onset of symptoms after initial
improvement in symptoms
Recurrent acute rhinosinusitis - description
- 4 or more episodes of ABRS per year
Chronic rhinosinusitis - description
- ≥ 2 signs/symptoms for 12 weeks or longer
Acute bacterial rhinosinusitis - what is the pathogenesis?
viral upper respiratory tract infection - mucosal inflammation –> decreased sinus drainage - mucosal secretions trapped –> local bacteria proliferate - bacterial infection established
Acute bacterial rhinosinusitis - what are the common pathogens?
Most common pathogens similar to other respiratory infections
▪Streptococcus pneumoniae
▪Haemophilus influenzae
▪Moraxella catarrhalis
Additional pathogens in patients with frequent antibiotic use
▪Staphylococcus aureus (MSSA, MRSA)
▪Pseudomonas aeruginosa
Acute bacterial rhinosinusitis - what is the clinical presentation?
major symptoms: purulent anterior and/or posterior nasal discharge, nasal congestions and obstruction, facial congestion and fullness, facial pain and pressure, hyposmia/anosmia, fever
minor symptoms: HA, ear pain, pressure, or fullness, halitosis, dental pain, cough, fatigue
Acute bacterial rhinosinusitis - what are the diagnostic considerations?
Clinical presentation with symptoms suggestive of ABRS
▪Persistent symptoms
▪Severe symptoms
▪Worsening symptoms (after initial improvement)
Sinus radiograph or CT scan
Culture from nasal secretions or cavity
Sinus puncture and culture (ouch!)
Acute bacterial rhinosinusitis - what are the two approaches to ABRS treatment?
- Initiate antibiotic therapy as soon as bacterial infection established
- Watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
oral 2nd and 3rd generation cephalosporins, macrolides, and TMP/SMX NOT recommended due to concern for S. pneumoniae resistance
Acute bacterial rhinosinusitis - what are the 1st line treatment options?
amoxicillin/clavulanate
Acute bacterial rhinosinusitis - what are the 2nd line treatment options?
doxycycline, levofloxacin, moxifloxacin
Acute bacterial rhinosinusitis - what is the treatment when there is concern for MRSA?
▪Add agent with MRSA coverage (e.g., doxycycline, TMP/SMX, linezolid, clindamycin?)
▪Maintain coverage for common organisms unless cultures suggest monomicrobial infection with MRSA
Acute bacterial rhinosinusitis - what is the treatment when there is concern for P. aeruginosa?
▪Levofloxacin – consider higher dose with 750 mg PO daily
▪Maintain coverage for common organisms unless cultures suggest monomicrobial infection with P. aeruginosa
Acute bacterial rhinosinusitis - what is the supportive care?
▪Intranasal saline irrigation
▪Warm facial packs
▪NSAIDs and/or acetaminophen
▪Maintain hydration – thin secretions
▪Avoid antihistamines – thickens mucus, more difficult to clear
▪Caution with decongestants – concern for rebound congestion
