URTI Flashcards
Describe the pathophysiology behind URTI.
Transmission can happen leading to inhalation of particles and invade upper airway mucosa.
How can URTI be transmitted
Droplets / aerosol containing virus that are expelled when people with URTI cough, sneeze and talk
Person touches surface with virus on it and then touch his nose
Infected person shares food with others during mealtime
Explain the innate immunity of the respiratory tract
Nostrail hair lining
Mucus
Angle between pharynx and nose: prevent particle from falling into airway
Mucociliary system: transport pathogen back into pharynx
Adenoids and tonsils: immunological cells attack pathogen
What are the risk factors associated with URTI?
Anatomical abnormalities
Immunocompromised: cystic fibrosis, transplant, HIV, corticosteroids, post spleenectomy
Smoking
Medical disorder: Asthma, COPD
Lack of personal and hand hygiene
Close contact with children in daycare and school
What are some preventive measures to take to discuss patients in reducing URTI?
Manage known risk factors with smoking cessation; asthma and allergic rhinitis
Vaccinations: Influenza, Pneumococcal, H.Influenzae
Hand/ Personal hygiene
Mask wearing
Stay away from crowds
How do I confirm the diagnosis of a common cold?
Risk factors - same as ARTI
Clinical presentations: low grade fever, rhinorrhea, sore throat, nasal blockade, sneezing, productive cough, headache, bodyache
Diagnosis: lack high fever, lung clear to ausculation, normal HR
Is there a need for microbiological test to identify the type of pathogens in a URTI?
No. Unless to rule out influenza and covid 19
Is there a need for antibiotics to treat a common cold ? If no, what can I do for the patient?
No. Symptomatic relief is sufficient
How long would it take for a common cold to recover? What do I advice a patient?
7-10 days
Nasal discharge can change colour
Cough may last for 2-3 weeks
Improvement in symptoms should take about 3-4 days
What is the difference between a cold and flu?
HINT: Consider onset, type of symptoms between both conditions
https://www.google.com/search?q=cold+vs+flu&rlz=1C1CHBD_enSG825SG825&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjiiriH8bT7AhXCS2wGHXPlBjcQ_AUoAXoECAIQAw&biw=1280&bih=569&dpr=1.5
Discuss the group of patients who are at risk of the potential complications of influenza
Children < 5y
Elderly > 65y
Pregnant
2 weeks post partum
Obese
Nursing homes
Long term care facilities
Chronic medical conditions (e.g. asthma, COPD, HF, CKD, DM, Immunocompromised)
What are the clinical presentations associated with influenza?
Fever
Chills
Headache
Sore throat
Dry cough
Nasal discharge
What are some potential complications associated with influenza?
Primary viral pneumonia
Secondary bacterial pneumonia from S.Aureus, S.Pnuemoniae, H.Influenzae
Exacerbation of chronic respiratory diseases
Myocarditis
What are some potential complications associated with influenza?
Primary viral pneumonia
Secondary bacterial pneumonia from S.Aureus, S.Pnuemoniae, H.Influenzae
Exacerbation of chronic respiratory diseases
Myocarditis
Are there any diagnostic test available for the diagnosis of influenza?
Nasopharyngeal swab / Aspirate
Test with POCT, EIA, IF
Do all patients need a diagnostic test for influenza? Why?
No. Only those who are hospitalized and have severe symptoms
Young and uncomplicated groups will not benefit antiviral use.
What are the types of pathogen associated with influenza?
Influenza A: H1N1 and H3N2
Influenza B: B/Yamagata and B/Victoria
When should antivirals be considered for use?
Hospitalization
High risk for complications based on risk factors
Severe, complicated or progressive illness
What is the ideal timeframe for antivirals to be initiated?
Within 48h of symptoms onset, best within 5 days of symptoms
Name the antiviral used for influenza and describe its mode of action
Oseltamivir
Interfere with protein cleavage and inhibits the release of new virus
What is the starting dose and duration of antivirals used?
PO 75mg two times a day for a duration of 5 days
When should antivirals be renally dose adjusted?
CrCl < 60mL/min
What are the ADR associated with antivirals used?
Headache
Nausea and vomiting
What is the duration of treatment for those with influenza?
7 days
What do you advice a patient on influenza self-management?
See a doctor if symptoms do not improve after 10 days OR if symptoms improve then develops new fever, worsening dyspnea and cough
Vaccinations should be done every year
What are the clinical presentations associated with viral pharyngitis?
Low grade fever, malaise, fatigue, rhinorrhea, cough, hoarseness, oropharyngeal lesions, conjunctivitis
What are the clinical presentations associated with bacterial pharyngitis?
Fever
Sore throat with tonsillar exudates
Cervical lymphadenopathy
What are the complications associated with bacterial pharyngitis?
Acute rheumatic fever
Acute glomerulonephritis: Not preventable by antibiotics
Happens 1-5 weeks later
What are the viruses that causes pharyngitis?
Rhinovirus
Coronavirus
Influenza
Para-influenza
What is the main bacteria causing pharyngitis? How can it be detected?
Group A Streptococcus
Detected using a throat culture that gives results 24-48 hours
How do I determine if a patient requires antibiotics for their pharyngitis?
HINT: Modified centor criteria
Modified centor criteria assess if patient has fever, swollen and tender anterior cervical lymph nodes, absence of cough, tonsillar exudate and age
Upon cumulation of total points, decide if patient has a need to be treated with antibiotics.
0-1: No antibiotics or testing needed
2-3: Antibiotics needed if culture positive
4-5: Initiate empiric antibiotics
What empiric antibiotic should be initiated for a patient with bacterial pharyngitis?
PO Penicillin V 250mg q6h for 10 days
OR
PO Amoxicillin Clavulanate 500mg q12h for 10 days
For patients presenting with bacterial pharyngitis, and have a non-severe beta lactam allergy, what can you consider giving?
PO Cephalexin 500mg q12h for 10 days
For patients presenting with bacterial pharyngitis, but have a severe beta lactam allergy, what can you consider giving?
PO Azithromycin 500mg once daily for 5 days
PO Clarithromycin 250mg q12h for 10 days
PO Clindamycin 300mg q8h for 10 days
For the last stage of the systemic approach, what should I look out for and advice the patient for pharyngitis?
Duration of treatment usually takes 1-3 days for bacterial pharyngitis upon initiation of treatment
If not given antibiotics, sore throat takes a week to clear and inform patient of viral pharyngitis, hence antibiotic use not necessary.
No need for microbiological test clearance
Advice ADR and see doctor if symptoms worsen
What is acute rhinosinusitis?
Acute inflammation of the paranasal and nasal mucosa
Describe the pathogenesis of acute rhinosinusitis
Direct contact with droplets of infected saliva/ nasal secretion
Inflammation result in sinus obstruction
Nasal mucosa secretion trapped
Bacteria is then trapped and multiplication occurs
What are the clinical presentations of acute rhinosinusitis?
Purulent nasal discharge
Facial pain/pressure
Fever
Nasal congestion
Loss of taste and smell
Headache
Cough
Ear fullness
Bad breath
Dental pain
Are there any diagnostics available for the diagnosis of acute rhinosinusitis?
No.
What are the possible complications of acute rhinosinusitis? What are some symptoms?
Orbital cellulites and CNS infection
Symptoms include: limited ocular movement, acute vision change, confusion, unilateral weakness
What are the type of pathogen associated with bacterial rhinosinusitis?
S.Pneumoniae and H.Influenzae
When should I consider initiating antibiotics for bacterial rhinosinusitis?
Symptoms persisting for more than 10 days without clinical improvement
Symptoms severe for more than 3 consecutive days (fever, purulent nasal discharge, facial pain)
Symptoms worsen after initial improvement for more than 3 days
What are the antibiotics to start patient on for acute rhinosinusitis? Include dose, frequency and duration
PO Amoxicillin 500mg q8h
PO Amoxicillin clavulanate 625mg TD
Duration 5-7 days
For patients presenting with acute rhinosinusitis, and have a non-severe beta lactam allergy, what can you consider giving?
PO Cefuroxime 500mg q12h
For patients presenting with acute rhinosinusitis, and have a severe beta lactam allergy, what can you consider giving?
PO Levofloxacin 500mg daily
OR
PO Moxifloxacin 400mg daily
duration 5-7 days
What agents should be avoided for treatment of acute rhinosinusitis and why?
Tetracyclines, co-trimoxazole, macrolides
- Increased S.Aureus resistance
How do I monitor response for acute rhinosinusitis?
Advice that those those on antibiotics should improve in 7-10 days
See doctor if symptoms worsen, persist or become severe
Educate on antibiotics ADR
