Upper respiratory tract infections Flashcards
Give examples of the normal flora of upper respiratory tract (URT).
Streptococcus viridans, commensal Neisseria spp., diphtheroids, anaerobes.
Give examples of respiratory pathogens that may be carried asymptomatically.
Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pyogenes.
What other pathogen may be carried asymptomatically?
Neisseria meningitidis
What kinds of pathogen can colonise the URT post-antibiotics?
Coliforms, Pseudomonas, Candida
What is the most common route of spread for respiratory disease?
Droplet - coughing/sneezing and contact with contaminated surfaces. Handwashing and decontamination very important.
Describe the epidemiology of URTI?
- Most often v. young children/teenagers
- Winter/viral. Bacterial and viral common in children.
- (Also immunosuppressed - Very ill with seemingly less pathogenic viruses in adults e.g. RSV)
What are the possible causes of the common cold?
- Viral esp. Rhinovirus. Also….
- Coronoviruses
- RSV,
- Parainfluenza viruses
- Enteroviruses
- Adenovirus
What are the symptoms of the common cold?
Nasal discharge, sneezing and S/T
Should antibiotics be given for the common cold?
Fuck no!
What are the symptoms of rhino-sinusitis?
Facial pain, nasal blockage, reduction smell.
What is the possible aetiology of rhinosinusitis?
- Post viral inflammation
- Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus milleri group, anaerobes, fungal
- Complications of chronic sinusitis
- Osteomyelitis, meningitis, cerebral abscess
(also allergic and non-infective)
What are the investigations that should be performed for rhinosinusitis?
Imaging for severe or suspected complications – Sinus X-ray, CT or MRI scans. See air fluid levels.
What treatment can be given for rhinosinusitis?
Sinus washouts (diagnostic and therapeutic) after referral to ENT (not GPs)
Treatment - if viral, no antibiotics. Many patients improve without antibiotics anyway. Otherwise cover suspected/proven bacterial pathogens e.g. amoxicillin if severe disease
(beware undiagnosed dental infection)
What are the possible pathogens responsible for pharyngitis/tonsillitis?
- Viral (RSV, Influenza, Adeno, EBV, HSV1)
- Bacterial (Streptococcus pyogenes, Rarely - Neisseria gonorrhoeae, Corynebacterium diphtheriae)
- (Mycoplasma pneumoniae and Chlamydophila pneumoniae)
What investigations should be done in pharyngitis/tonsillitis?
Throat swabs and proper history
What are the signs and symptoms of pharyngitis/tonsillitis?
S/T, dysphagia, fever, headache, red tonsillar/uvular area +/- exudate. Lymphadenopathy
What are the possible complications of a group A streptococcal pharyngitis/tonsillitis?
acute glomerulonephritis/ rheumatic fever/scarlet fever. Aim to prevent this rheumatic fever by giving penicillin and prevent suppurative complications too (e.g. otitis media and quinsy (peritonsillar abscess))
Which virus virus causes infectious mononucleosis (glandular fever)
Epstein-Barr virus
What are the symptoms and complications of infectious mononucleosis?
- S/T, fever, cervical lymphadenopathy
- Complications e.g. splenic rupture
What antibiotic should be avoided in infectious mononucleosis?
Ampicillin (can cause mac-pap rash - not true allergy)
- not that Abx should be given anyway coz it’s a bloody virus!!
What serology should be performed in suspected infectious mononucleosis?
IgM/IgG, Paul Bunnell Test/PCR
Why is epiglottitis a medical emergency?
Airway obstruction - cellulitis of epiglottis
What are the clinical features of epiglottitis?
Child (2-4 yrs), fever, irritable, difficulty speaking (“hot potato”) and swallowing. Leans forward, drools. Stridor, hoarse.
What investigations should be performed in suspected epiglottitis?
- Lateral neck X-ray – enlarged epiglottis
- Must send blood cultures. DO NOT swab or examine epiglottis unless already intubated, or can intubate immediately (theatre).
