URI Flashcards
Common cold Virology/timing
Usually Rhinovirus
coronavirus, influenza, parunfluenza, respiratory syncytial virus, adenovirus, enterovirus
Common Cold timing
Fall and late spring: rhino virus and parinfluenza
Winter/spring: RSV and coronavirus
Summer- enterovirus
adeno virus has no timing
Common Cold Sx
Peak shedding 2-3 with peak sx Rhinorrhea nasal congestion sore throat/ scratcy non productive cough malaise low grade fever (usually in kids)
Common Cold signs
nasal swelling, nasal discharge ( clear or purulent), conjuctive injection, usually no pulmonary findings and no adenopathy
Cold dx/ complications
clinical and based on observed signs
- acute rhinosinitius, Acute otitis media, asthma attack, pneumonia
Cold Tx
self limitng and supportive care - NSAIDs, Chloraseptic Antihist: - peudoephed/ Diphenhydramine Expectorants/antiussives - Guaifenesin (robitussin) - guaifenesin with dextromethorphan
Influenza etiology
influenza A and B
Risks
>65 years
COPD, DM, CVD, immunocomp
Influenza Sx
Peak shedding 48hrs
Common: abrupt onset, fever, myalgia, sore throat
Other: chills, malaise, HA, cough, nasal discharge
Influenza Signs
flushing, hot dry, pharynx wont look red even if sore, lymphadepathy, chest exam negative
Who do we test for influenza
Outpatient: routine is not recommended
- consider testing is sx when no known outbreak
- immuno competent pt after a hospital visit
- high risk
- influenza sx in healthcare workers or visitors to an instituion
Inpt.: any pt with sx upon admissions or during their stay
Dx FLue
- must be testes in first 3-4 days Rapid influenza dectection test: - low sensitivity/specificity - <15min Rapid Molecular Assay - diff types A/B -45 min - high sens/ specif Reverse- transcriptase polymerase chain raction - preferred by CDC - influenza type and subtype -NP swab 1-8 hrs - hgh sensitivity/specificty Viral Culture: 3-10 days very high sensitivity specificty * mostly to confirm
Neuraminidase inhibitors- flu tx
cover A/B -Oseltamivir (tamiflu) 75mg po bid x5d - Zanamivir(relenza) 10mg bid x5d Peramivir(rapivab)- 600mg IV x1 Baloxavir - 40mg po or 80mg (>80kg) - category C for pregnancy but better to take that risk than have the woman get the flu
Who gets flu vaccine
Everyone over 6mo
- usually given in october
- two weeks till the antibodies develop
Contrindications for vaccination
current moderate to severe illness
- hx of guillain barre syndome within 6wks
- hx of allergic reaction to flue vaccine
18-64
65
6mo-8yr
vaccines
- standard dose
- older get high dose
- live virus 2-49 yo not pregneacny though
6mo-8yr get 2 doses > 4wks apart
Pharyngitis etiology
- usually a viral illnes
- may occur as common cold
- if bacterial it is group A step
- non infectious causes: trauma, vocal strain, smoking, GERD
virus: rhinovirus, RSV, adenovirus, coronavirus, parainfluenza, influenza
Phayngitis- mononucelosis
Epstein barr virus - sore throat, erythems, exudates - large enlarged cervical lymph nodes - fatugue -fever splenomegaly Dx: monospot, CBC with diff (increases atypical lymphocytes Sx: supportive and no contact sports
Pharyngitis- bacterial diptheriae
Diptheriae
- rare now but will cause gray exudate tightly adherant to throat, nasal passagemway. Midful of the unvaccinated pt with recent travel
Tx: diphtheria anti-toxin+toxin or erythromycin
Pharyngitis- mycoplasma pneumoniae and Neisseria gonorrhoeae
Associated with LRI and HA
Tx: azithromycin
Neisseria gonorrhoeae;
- ^MSM and associated with oral sex
- pharyngitis with exidates and cervical LAD
Tx: ceftriaxone 250 mg IM x 1
Group A strep Pharyngitis Sx
Sx: sore throat, odynophagia, fever, mailas, anorexia, arthragials, N/V/ swollen glands
Signs: erythema, tonsilar hypertrophy, purulent exudate, tender and lager anterior cerv lymph, palatal petechiae
Strep Criteria
Symptoms- tonsillar exudatea, tender anterior cervical adenpathy, fever by history, abscense of a cough
* if 3 of 4 then do a rapid antigen detection test
Strep managment
First line therapy GAS pharyngitis (adult
- Pen G IM dose
-Pen V 500mg po TID x 10days
- Amoxicillin 500mg BID x 10 days
- Cephalexin 500 mg PO BID 10 days
Second line or Allergy :
- azithromycin 500mg po day 1 followed by 250 mg po days 2-5
- clindamycin 300 mg po tid x 10 days
** supportive care! lozenges, NSAIDs, acetaminophen
Strep Complications
- Acute rheumatic fever - may cause cardiac valve abnormalities
- Post step glomerulonephritis
- can progress to acute renal failure - step toxic shock syndrome
- shock and organ failure
Scarlet fever
other: abscess in tonsils, otitis media, rhinosinusitis, bacteremia, pneummonia
Peritonsillar cellulitis/abscess/epiglotiiis
etiologiy: S. pyogenes s. aureus
Cellulitis: infection between platine tonsil capsul and pharynx muscles . no pus collection
Abscess: collection of pus, requires drainage
Peritonsillar abscess Presentation
Sx: severe sore through
drooling, trismus. fever, neck swelling, ipsilateral ear pain, fatigue, anxiety, irritability
Signs: swelling with push tonisl with deviation of oppositice side. Fullnes of posterior of solft palate, cervical LAD, hot potato muffled voice
PTA dx
Labs: CBC, electroytes, throat culture, culture/gram stain of the abscess of fluid
Imaging
- CT with IV contrast- if unable to diagnose clinically
> r/o spread of infection to parapharyngeal space
* will disstinguidhe cellulitis from abscess
- US helpful an d good for needle guidance during aspiration
PTA managment Drainage
- needle aspiration ED/OR Antimicrobial therapy adults -Ampicillin 3gm q6hrs -clindamycin 600mg q8hrs -vancomycin if ^ mRSA Oral: Augmentin 875mg q 12hrs clindamycin 300 mg q6hrs \+ supportive care and fluids
Epiglottitis
h. influenzae
- consider unvaccinated children or older aldult
Sx: drooling, stridor (resp distress- squeeking sounds ), severe sore throat, toxi appearance
- danger of airway obstruction, rapid course
- if suspect do not exam oropharynx if patient is in resp distress
Imaging: X ray ( lateral neck x-ray) , thumb sign CT/MRI
Managment: hospitalizaions, intubation, antibiotics
Laryngitis etilogy
Virus is the MOST common
Bacterial- step, moraxella catarrhalis, influenza
Non infect: vocal abuse, intubation, toxi exposure, GERD, vocal cord coduels or laryngeal polyps, cancer, neuo disfucntion
Laryngitis Presentation
Hoarsness- key***
dysphnia
URI sx:rhinorrhea, nasal congestion, cough, sore throat
Signs:
if URI related: nasal edema, congestion, benign post parync
Direct laryngoscopy: erythema, edema, vascular engorgment of voca cords, nodes or ulcerations
ARS sx
- purulent nasal drainage and nasal obstruction and or facial pain with pressure or fullness
Sx: fever, congestion, cough, maxillary tooth discomfort, ear pressure, HA
Digns - purulent drainage in nose or post pharynx, nasal mucosal edema, tenderness to percussion of upper teeth, sinus tendernessto palpation
Acute viral RHinosinisitis (ARVC) Dx;
often rhinovirus, influenza, parainfluenza
clinically
< 10 days od sx with sx of ARS that are not worsening
- radiography is not indicated
limited use of plaing sinus fims
cultures not indicated
ARVC managment
supportive care 98%
- analgesics, salin irrigation, mucolytics, intranasal decongestants , intranasal glucocorticoids
Acute Bacterial Rhinosisnusitis (ABRS) Dx
strep, h ful, moraxella catarrhalis
persisitant sx >10days with no improvement or
onset with severe sx >102 purulent nasal discharge facial pain, lasting 3-4 consecutive days
or
viral URI for 5-6 dyas that was initally imprving followed by severe Sx “ double worsening”
Pt considered at high risk for abx resistance
> 65, severe infection temp >102
recent hospitalization, immunocomp, comorbidities, recent antimicrobial use
ABRS tx 1st line
First: Amoxicillin-clavulanate 875/125mg BID doxycyline 100mg BID levofloxacin 500mg qd moxifloxacin 400mg qd 5-7 days
ABRS 2nd line
if no repsonse or worsening of sx Amox-clav0 2000mg/125mg bid Levofloxacin 500mg qd Moxifloxacin 400mg qd Doxycycline 100mg bid 7-10 days
Complications of ABRS
extension of infection
- osteomyelitis, menegitis, brain or epidual abscess, presptal or orbital cellulitis
- Use CT or MRI is suspected complicated ABRS
- Sinus aspirate culture is gold standard**
Chronic RHinosinisitis risks
a;;ergic rhinitis hx chronic exp to envior irritants defects in muco clearance presence of mmuno def anatomocal ab latrogenic ( sinus surgeries )
CRS presentation
Adults - mucopurulent nasal discharge - nasal obstruction and congestion - facial pain, pressure, fullness - reduction or loss of smell Children may also have a cough not a disturbance sense of smell
CRS Dx
2-4 cardincal sx and infection lasting > 12wks
Recurrent RS
- non contrast CT and ENT referall
Tx: nasal saline lavage, intranasal corticosteroids, oral corticosteroids, antihistamines, topical antifungals
Laryngitis Dx/TX
Based on Hx and PE
hoarsnss > 2wks in absence of URI sx
Tx: Treat undlerlying cause / managment of systemic disease
-coice rest/humidifyers
