URTI I Flashcards
Influenza pharyngitis
– Fever – Constitutional symptoms* – Minimal (or rare) pharyngeal exudate or cervical adenopathy – Average duration 3-4 days (range 3-7days)
Adenovirus pharyngitis
– Peak incidence in children – Fever (which can persist for ~ 6 days) – Constitutional symptoms – Pharyngeal erythema & exudate ( thick and white) often present – Bilateral cervical adenopathy – 30-50% of cases have concurrent conjunctivitis
Adenovirus “pharyngoconjunctival fever syndrome”
– occurs in outbreaks associated with swimming/bathing – Spread by direct inoculation of the conjunctiva – Associated with fever, conjunctivitis, pharyngitis, and cough – Average duration, 1-2 weeks and symptoms resolve without sequelae
Herpes simplex virus pharyngitis
– Common amongst adolescents and young adults – Fever – Pharyngeal erythema and exudates – Enlarged tender cervical adenopathy – Characteristic ulcerations of the mouth, lips, and pharynx; swollen, tender, erythematous gingiva – Esophagitis may also be present in immunocompetent patients
Coxsackievirus pharyngitis
– Associated with signs of herpangina – Peak incidence in young children – Fever – Discrete ulcerations (1-4mm) present in the pharynx, and on the tonsillar pillars, uvula, and soft palate – Usually resolves spontaneously over ~ 1 week
Human immunodeficiency virus (HIV) pharyngitis
Presents with characteristic symptoms and signs of HIV infection. After 5-29 days incubation: – Fever – Non pruritic rash (on the face and chest) – Pharyngitis (rarely with exudate) – Cervical adenopathy – Constitutional symptoms plus abdominal symptoms ( nausea and vomiting) – Mouth ulcerations (lips, gingiva, hard and soft palate), as well as in the esophagus, along with oral thrush.
pstein Bar virus (EBV) and infectious mononucleosis (Glandular fever)
– Fever (38-39oC)* – Cough (5%) – Exudative tonsillitis/pharyngitis (85%)* – Cervical adenopathy (100%)* – Palatal petechiae (50%) – Abdominal discomfort – Mild hepatitis (signs of jaundice) with nausea (90%) – Splenomegaly (50%)* – Most cases resolves over a 2-3 week period; fatigue/malaise can persists for months
EBV and infectious mononucleosis rare complications
– Maculopapular, or erythema multi-forme-like rash (5% of cases) – Splenic rupture – Neurologic syndromes (encephalitis, meningitis, seizures) – Haematological abnormalities (mild thrombocytopenia) – Nasopharyngeal carcinoma – Pneumonia – Lymphoproliferative disease (uncontrolled proliferation of infected B- cells, for example) – Hodgkin’s lymphoma;; Burkitt’s lymphoma 
Streptococcus pyogenes pharyngitis
Usual incubation periodis 2-4days, followed by the abrupt onset of: – Sore throat – Fever (temperature ≥ 38oC) – Absence of cough* – Pharyngeal erythema and edema – Enlarged hyperemic tonsils – Patchy discrete tonsillopharyngeal exudates – Petechiae on soft palate and pharynx – Rash may or may not be present (Scarlet Fever [scarlatinal] ;caused by pyrogenic exotoxin [A, B, and C] producing strains) – Tender cervical adenopathy – Nausea, vomiting, and abdominal pain (especially in children)
Streptococcus pyogenes pharyngitis complications
Suppurative complications include: – Peritonsillar cellulitis/abscess (quinsy) – Acute sinusitis/otitis media Non-suppurative complications include: – Acute rheumatic fever – Acute post-streptococcal glomerulonephritis
Streptococcus pyogenes differential
Acanobacterium haemolyticum - - typically infects 10-30 year olds - Infection may also be associated with a RADT scaritiform rash - Distinguishing feature: a membranous pharyngitis similar to that associated with Corynebacterium diphtheriae (no membrane seen in Streptococcus pyogenes).
Corynebacterium diphtheriae
- Very rare in Australia (suspect in travellers & contacts of travellers; notifiable) Where present often affects:
- Populations with crowded/unsanitary living conditions
- Homeless
- Alcoholics
- IV drug users
- Onset usually subacute (over several days) with:
- Fever (temperature ≥ 38o C)
- Sore throat; mild pharyngeal injection
- Membrane (white glossy; becoming gray in colour with patches of green and black necrosis) typically on one or both tonsils, uvula, soft palate, oropharynx, and nasopharynx
- Cervical adenopathy, with swelling, creating a “bull neck” appearance and causing respiratory stridor
- Complications include: -
- Myocarditis, progressing to heart failure
- Glomerular damage, progressing to renal failure
- Muscle paralysis
Complications of the common cold
The common cold can progress to symptoms and signs of sinusitis otitis media, or pneumonia, all of which can be complicated by secondary bacterial infection.
Viruses associated with the common cold
- Rhinovirus
- Influenza virus
- Coronavirus
- Adenovirus
- Parainfluenza virus
- Respiratory synctial virus
- Metapnumovirus
Transmission of the common cold
Small (droplet nuclei) and large (secretion) particle aerosols, and by direct person to person contact.
Regardless of mechanism, initiation of illness requires that the pathogen contact/infect the nasal/respiratory epithelia
Pathogenesis of the common cold
Infection of the nasal epithelium is usually associated with:
- Destruction of the epithelial lining
- Acute inflammatory response accompanied by the elaboration of various secretions
- Large quantities of immunoglobulins
- Bradykinin
- Prostaglandin
- Histamine
- Interleukin 1 (IL-1)
Clinical manifestations of the common cold
Onset of symptoms generally occurs 1-3 days after viral infection, and include:
- Nasal obstruction
- Sore or ‘scratchy’ throat
- Rhinorrhea (can be associated with maceration of skin around the nose)
- Sneezing
- Cough
- Headaches
- Fever (more so with infections caused by Influenza virus, Adenovirus and RSV)
Uncomplicated colds usually last 1-2 weeks
Virus shedding occurs even after resolution of symptoms (persist for 2-3 weeks)
Differential Dx for the common cold
- Allergoic rhinitis - associated with nasal and eye itchind
- Foreign body obstruction of the nose (particularly in children)
- Complex examination of the nasal cavity, throat ears and sinuses for signs of progression to complications like pharyngitis, otitis media and/or sinusitis, for example
Pharyngitis definition
Inflammation of the pharynx, assoicated wiht pain that might radiate to the ears, and is aggrevated by swallowing.
Clinical manifestations pharyngitis
Examination often reveals
- Fever
- Pharyngeal erythema
- Tonsillar enlargement
- Pharyngeal or tonsillar exudate (suppuration)
- Cervical adenopathy
- Occlusion of the eustachian tubes may precipitate otitis media.
What is it important to do in pharyngitis?
Differentiate bacterial fro viral causes of pharyngitis because it is important to implement abx therapy in cases of bacterial infection.
Distinguishing viral from bacterial pharyngitis
There is no reliable way of distingusihing bacterial from viral pharyngitis - except herpangina from Coxsackievirus causes tiny vesicles yet severe symptoms and fever.
Corynebacterium diptheriae microbiology
Non sporulating, non-capsulated, non-motile, gram positive bacilli.
Some strains infected by a bacteriophage carring the tox gene, and can produce the diptheria exotoxin.
