URTI, CNS Flashcards
Upper RTI Transmission
§ Droplets of aerosols containing virus are expelled when people with URTI cough/ sneeze/ talk
§ Spread indirectly when person touch surface with virus on it –> touch nose/ mouth
§ Shares food with others during mealtime w/o serving spoon
§ Inhaled into resp tract
- Invade upper airway mucosa (infection)
Innate immunity against URTI
§ Nostril hair lining traps organisms
§ Mucus traps organisms
§ Angle b. pharynx and nose, prevents particles falling into airways
§ Mucocilliary system in lower airways that transport pathogens back to pharynx
§ Adenoids and tonsils contain immunological cells that attack pathogens
Risk factors for URTI
Decr innate immunity
Incr bacterial load
§ Close contact with children (school, daycare)
§ Lack of personal/ HH
§ Medical disorder
□ Chronic resp disease – asthma, AR
§ Smoking
§ Immunocompromised indiv
□ Cystic fibrosis, HIV, corticosteroids, transplant, post-splenectomy
§ Anatomical anomalies
□ Facial dysmorphic changes
□ Nasal polyposis
Prevention of URTI
Hand/ personal hygiene, wear mask, stay away from sick contact/ crowds
Vaccination
□ Influenza
□ Pneumococcal
□ Haemophilus influenzae
Manage risk factors: smoking cessation, control asthma, AR
Management URTI
-Symptoms management
□ pharm, non-pharm self-care modalities
□ AB use
- Not indicated for COMMON COLD, INFLUENZA
- Sometimes for PHARYNGITIS, RHINOSINUSITIS, OTITIS MEDIA
- Prevent future recurrence (reduce risk factors)
sx relief of URTI by
paracetamol
NSAID
nasal decongestant
antihistamine
nasal irrigation (saline)
lozenges
mucolytics
cough supp
expectorant
warm water// honey
Common cold clinical presentation
Presence of infection
- Risk factors (URTI)
- Clinical presentation:
○ Low grade temp <38*C
○ Rhinorrhea
○ Nasal blockage
○ Sneeze
○ Sore throat
○ Productive cough
○ Headache
○ Body ache
- NO high fever, normal HR, lungs clear to auscultation support diagnosis of common cold
2) Identify pathogen of common cold
- No microbial diagnostics required
○ Unless rule out influenza/ covid19 - Pathogen – rhinovirus, coronavirus
common cold 3)Abx? 4) monitor
3) DO NOT USE ANTIBIOTICS
4) Monitor:
* Self-limit, recover in 7-10 days
* Normal for nasal discharge to change colour
○ Yellow, green due to infection viral/ bact
* Cough last 2-3 wks
○ Post nasal drip
* Feel better in 3-4 wks
○ Symptoms linger for few wks
○ May risk 2nd infection
See dr if symptoms does not improve after 10 days/ symptoms WORSEN
Influenza (flu) 1) presence of infection
- Clinical presentation
○ Classic influenza sx
§ Fever (>38)
§ Chills
§ Headache
§ Malaise
§ Myalgia
§ Anorexia
○ Resp sx
§ Sore throat
§ Dry cough
§ Nasal discharge
○Elder pt (confusion)
Complications of influenza
○ Primary viral pneumonia
○ 2nd bacterial pneumonia
§ Staphylococcus aureus
§ Streptococcus pneumoniae
§ Haemophiles influenzae
○ Exacerbation of chronic resp disease
myocarditis
pt at high risk of influ complications
- Child <5// elderly >65
- Preg/ 2wks post-partum
- Nursing homes/ LT care
- Obese BMI > 40kg/m2
- Chronic medical conditions
Asthma, COPD, HF, DM, CKD, immunocompromised
Confirm presence of influenza infection
- Diagnostics on nasopharyngeal swab/ aspirate
○ Rapid detection kits
○ POCT (immunofluorescence IF, enzyme immunoassay (EIA), immunochromatographic - Reverse-transcriptase, PCR
**hosp/ LT care
Not for outpatient setting
influenza types
Human influenza A,B,C,D
A: seasonal epidemic
§ Cause pandemic
§ Subtypes based on 2 surface proteins
□ Hemagglutinin (H)
□ Neuraminidase (N)
□ Usual: H1NI, H3N2
B: seasonal epidemic
§ Classified into 2 lineage
B/Yamagata
B/ Victoria
C: mild, non epidemic
§ Febrile, mild URI
D: cattle
influenza season
Seasonal (beginning, end, middle) due to North, Southern hemisphere winter mnths + travel
north (NOV – FEB)
south (MAY – JULY)
Select antimicrobial tx for influenza
- Antiviral for documented or suspected influenza
○ Initiate ASAP best within 48HRS, up to 5 days
○ Of sx onset for indiv who fulfil:
§ Hosp, high risk of complications
§ Severe, complicated, progressive illness
○ Considered for outpt/ others if present within 48hrs of sx onset
1) oseltamivir
a. First line
b. Active against influenza A, B
MOA: neuraminidase inhibitors
i) Inhibit release of new virus
ii) Interfere with protein cleavage
c. Dose: i) PO 75 mg BD for 5 days ii) Dose adj if CrCL <60ml/min d. ADR: Well tolerated, mild GIT (NV)
influ vaccination
- Trivalent/ quadrivalent vaccine
- Prepared from prevailing strain of influenza A, B
- Vaccine updated every year (predicted predominant strain of season – guess work)
○ North: Nov, Feb
§ Vacc by oct
§ Release in apr/ may
○ South: May, Jul - IM once per yr
- For person > 6mnths old
○ Esp if high risk of complications - Takes 2 weeks for immunity
- Vaccine efficacy 75%
monitor for influenza
- With flu, do not need medical or antiviral
- Sx may last up to 1 wk
- See dr if:
○ Sx not improve after 10 days
○ Sz improved –> developed (DOUBLE SICKENING)
§ New fevers, worsen dyspnea, cough
§*2nd bact infection
pharyngitis presence of ifnection
- Clinical presentation
○ Sore throat
○ Fever
○ Erythema, inflammation of pharynx, tonsils
§ With or without patchy exudate (pus/ patch)
○ Tender, swollen lymph nodes
VIRAL PHARNGITIS
Erythematous tonsils w/o hypertrophy, exudates
○Low grade fever < 38
○ Malaise
○ Fatigue
○ Rhinorrhea
○ Cough
○ Hoarseness
○ Oropharyngeal lesions
§ Ulcer, vesicles
○ Conjunctivitis
BACT PHARYNGITIS
- Sore throat w/ tonsillar exudate
- Enlarged tonsils (hypertrophy)
- Fever
- Cervical lymphadenopathy
○ Enlarged lymph nodes
w/o typical viral symptoms
Identify pathogen for pharyngitis
i. Virus (80%)
a. Rhinovirus, coronavirus, influenza, parainfluenza, Epstein-Barr
ii. Bact (<20%)
a. Grp A (b-hemolytic) streptococcus
b. Streptococcus pyogenes
- SSTI (non purulent)
what tests to culture for pharyngitis
Strep. pyogenes:
○ Throat culture (24-48hr)**
○ Rapid antigen detection test (RADT) – in mins
viral vs bact pharyngitis
- Viral: self-limit
- Bact: S.pyogenes
a. Self-limit/ complications possible
b. Complication: 1-5/ 2-3 wks ltr
i. Acute rheumatic fever
- Prevented with early initiation of effective AB
ii. Acute glomerulonephritis
- Not prevented by AB
Centor criteria
○ Fever >38 (1)
○ Swollen, tender anterior cervical lymph nodes (1)
○ Tonsillar exudate (1)
○ Absence of cough (1)
○ Age
3-14 (1)
15-44 (0)
>45 (-1)
pts for centor criteria
0-1 (low risk s.pyogenes, viral)
2,3 (test for s.pyogenes, treat Abx if +ve)
4,5 (high risk s.pyogenes, empiric)
chocie of Abx for pharyngitis
○ PO penicillin VK 250mg q6h
- T > MIC, duration!
○ Amoxicillin 500mg q12h
No need broad spectrum, narrow (no need -ve, anaerobe cover) <– amox-clavu
* duration: 10days
Abx for pharyngitis if pen allergy
○ Non severe: PO cephalexin 500mg q12h
- Unless amoxicillin allergy, same R1)
○ PO azithromycin 500mg OD
○ Clarithromycin 250mg q12h
○ Clindamycin 300mg q8h
- Growing resistance to macrolide (ACE)
(5 days if azithromycin – accumulate well in tonsils)
monitor for pharyngitis
- Clinical response
○ If not given AB
§ Typical course of sore throat is <1wk, self limit
§ AB not for viral pharyngitis○ Given AB § Fever, symptoms resolve 1-2 days- NO NEED Microbiological test of cure
AB ADR
- NO NEED Microbiological test of cure
