URI- common cold, influenza, pharyngitis Flashcards
Common cold virology and timing
RHINOVIRUS- fall late spring corona virus- winter/spring influenza virus- fall late spring parainfluenza enterovirus- summer
common cold epidemiology
droplets
sneeze cough etc
common cold symptoms
rhinorrhea nasal congestion sore throat cough malaise
common cold signs
nasal mucosal swelling
clear watery or purulent discharge
common cold diagnosis
clinical
based on symptoms and observed signs
common cold treatment
self limiting supportive care analgesics anitihistimines/decongestants- psedophedrine sudafed, diphenhydramine- benadryl expectorants/antitussives- robitussen
Influenza epidemiology
influenza A and B virus
self limiting
mortality more common in >65 copd DM Cardiovascular disease
-deaths common due to secondary bacterial pneumonia
influenza transmission
aerosolized drops cough sneeze
hand to hand contact
incubation 1-4 d
peak viral shedding 48 hrs
influenza presentation
*** abrupt onset fever up to 106 mylagia (muscle aches) cough sore throat flushing
influenza who to test
when no known outbreak immunocompetent pts after hospitalization high risk healthcare workers ALL inpatient with symptoms
influeza whos high risk
>65 children less than 5 especially less than 2! chronic illness pregnant native american
Inlfuenza diagnostics
done within 3-4 days
Rapid influenza detection tests (RIDTs)
-fast in office <15 min LOW sensitivity/ high specificity
Rapid molecular assay (nucleic acid amplification test, NAAT)
-lab or inpatient 45 min
high sensitivity/specificity
Reverse transcriptase polymerase chain reaction (RT-PCR)
1-8 hrs
high s/s
Viral culture
- GOLD standard 3-10 days
- not for initial clinical management
influenza management
antiviral within 48 hrs neuraminidase inhibitors -oseltamivir/tamiflu -zanamivir/relenza -peramivir/rapivab -baloxavir/xofluza give in pregnancy if suspected influenza A
forms of pharyngitis and which is most common
viral 80%
bacterial
noninfectious
pharyngitis viral
Rhinovirus respiratory syncytial virus adenovirus coronavirus influenza usually fluid collects sometimes whitish
Herpes simplex 1&2 treatment: acyclovir, famciclovir ask sexual history hydration magic mouthwash
Mononucleosis- epstein-barr virus (EBV)
sore throat, pharyngeal erythema, tonsillar exudates
fever
enlarged lymph nodes
SPLENOMEGALY 50%
2-4 week duration up to 3 months contageous
TX: Supportive, avoid contact sports
pharyngitis bacterial
CORYNEBACTERIUM DIPTHERIAE
gray exudate tightly adherent to throat, nasal passage
unvaccinated
recent travel
Tx: diptheria anti-toxin + penicllin or erythromycin
report
mycoplasma pneumoniae
lower resp. infection and HA significant cough
tx: azithromycin
neisseria gonorrhoeae 15% men sex with men associated with oral sex pharyngitis with exudates, cervical lad tx: ceftriaxone (rocephin) 250 mg IM x 1
GROUP A STREPTOCOCCUS (GAS) often pyrogenes local invasion otitis media, meningitis immune mediated responses sore throat odynophagia fever, malaise, anorexia pharyngeal erythema purulent exudate palatal petechiae TONSILLAR EXUDATES, TENDER ANTERIOR CERVICAL ADENOPATHY, FEVER BY HISTORY, ABSENCE OF COUGH
RAPID ANTIGEN DETECTION TEST (RADT)
tx: penicillin G benzathine IM, penicillin V, amoxicillin, cephalexin (keflex)
pcn allergy then use azithromycin, clindamycin
no longer considered contagious after 24 of antibiotic
group C or G streptococcus
less common
same treatment
complications of streptococcal pharyngitis
acute reheumatic fever
-2-3 w delayed sequela post infection
-usually strep wasnt treated
may result in cardiac valve abnormalities, arthritis
post-streptococcal glomerulonephritis
can progress to acute renal failure
Streptococcal toxic shock syndrome
shock and organ failure
scarlet fever previous strep pyrogenes -petechial lines on flexor surfaces(pastias lines) , "strawberry tonge" facial flushing with circumoral pallor *can predispose to rheumatic fever
