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IDMM > URTIs (3) > Flashcards

URTIs (3) Flashcards

1
Q

list the URTIs we are required to know

A
  1. common cold
  2. pharyngitis
  3. croup
  4. pertussis
  5. otitis media
  6. sinusitis
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2
Q

what is the common cold

A

it is a VIRAL URTI

acute and self limiting

most frequent human illness

seasonal

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3
Q

how is the common cold transmitted

A

most significant = inoculation of conjunctiva or nasal mucosa in 10 seconds

less significant is infective droplets on mucosa

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4
Q

when and for how long is the common cold infective

A

viral shedding peaks on the third day (coincides with peak of symptoms)

low level shedding can persist for 3 weeks

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5
Q

what is the incubation period of the common cold

A

24-72 hours from contact to symptoms

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6
Q

list some viruses that cause the common cold

A
  1. rhinovirus
  2. RSV
  3. influenza virus
  4. parainfluenza virus
  5. adenovirus
  6. enterovirus (coxsackievirus, echovirus)
  7. coronavirus
  8. human metapneumavirus
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7
Q

which viruses usually cause the common cold in october/november

A

parainfluenza virus

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8
Q

which virus is mostly responsible for the common cold in may/june/july/aug

A

enterovirus (coxsackievirus and echovirus)

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9
Q

which virus is mostly responsible for the common cold in september and march/april

A

rhinovirus

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10
Q

which viruses are mostly responsible for the common cold in dec/jan/feb

A

influenza, RSV, coronavirus, adenovirus

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11
Q

pathophysiology of the common cold

A

virus deposits on nasal/conjunctival mucosa and attaches to the epithelial cell receptors and damages cells–> this results in activation of host defence and release of CYTOKINE IL8

IL-8 attracts PMNs which increase nasal secretion and decrease mucociliary clearance

severity of symptoms corresponds to IL-8

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12
Q

pathophysiology of rhinovirus (common cold)

A

release of ALBUMIN and BRADYKININS which cause increased vascular permeability

bradykinins cause sore throat and rhinitis

minimal damage to nasal epithelium (like coronavirus)

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13
Q

pathophysiology of adenovirus and influenza A (common cold)

A

CYTOPATHIC effect and DESTRUCTION of nasal epithelium

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14
Q

how do you diagnose the common cold

A

differential

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15
Q

clinical presentation of the common cold

A 
rhinorrhea
nasal congestion
sneezing
sore throat
cough
low grade fever
headache 
malaise

duration = 10 days (cough may last 2-3 weeks)

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16
Q

Tx of common cold

A

prevention-based (i.e hand washing)

symptomatic treatment
saline irrigation
decongestants (dont shorten duration)
steam inhalation
antipyretic/pain control
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17
Q

what is pharyngitis

A

one of most common reasons for physicians visits

majority are VIRAL

swelling of the back of the throat/pharynx, between the nostrils and larynx

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18
Q

epidemiology of pharyngitis

A

peak incidence in winter and early spring

mostly school aged kids

GAS pharyngitis:

  • 20-30% in kids//5-15% in adults
  • incubation period of 2-5 days
  • highly communicable but noninfectious within 24 hours of abs use
  • transmission via droplet person to person
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19
Q

viruses that cause pharyngitis

A
  1. respiratory viruses
    - adenovirus
    - influenza virus
    - parainfluenza virus
  2. other viruses
    - coxsackie virus
    - echovirus
    - HSV
    - epstein barr
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20
Q

bacteria that cause pharyngitis

A

*Strep pyogenes (GAS) “strep throat”

groups C and G strep
N. gonorrhea
corynebacterium diphteriae
fusobacterium necrophilum 
arcanobacterium hemolyticum
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21
Q

pathophysiology of GAS pharyngitis + virulence factors

A

(S. pyogenes)

  • URT colonization (highly virulent)
  • capsule = compromised of HYALURORIC ACID which has a chemical structure very similar to connective tissue and therefore escapes host defenses and allows for colonization

virulence factors:

  1. M proteins–> resist phagocytosis
  2. extracellular exotoxins/hemolysins/invasins–> tissue damage
  3. streptolysin O –> toxic to variety of cells including myocytes (causes rheumatic fever in 3% of untreated patients)
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22
Q

with what symptoms of pharyngitis do you suspect viral etiology

A

COUGH

hoarseness
conjunctivitis
rhinorrhea
diarrhea
rash

*do not test children and adults with signs and symptoms of viral etiology

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23
Q

when do you suspect GAS as the etiologic agent in pharyngitis (symptoms)

A

ABSENCE OF COUGH

pharyngeal/tonsillar exudate
tenderness/enlargement of anterior cervical lymph nodes

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24
Q

what might you suspect when pharyngitis in a teen or young adult presents with:

  1. neck pain
  2. rash
A
  1. Lemierre’s disease (fusobacterium necrophorum)

2. consider arcanobacterium haemolyticum

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25
Q

pharyngitis diagnosis procedure

A

throat culture (90-95% sensitive for GAS)

rapid antigen test (highly specific; sensitivity 70-90%)

confirmatory culture of RADT is negative in children

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26
Q

Tx of pharyngitis

  1. viral
  2. bacterial
A
  1. symptomatic

2. if GAS, penicillin (alternative is clindamycin)

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27
Q

what is croup

A

laryngotracheitis (inflammation of larynx and trachea)

self limiting infection

28
Q

in what age range is croup most common

A

3-36 months (rare after that)

29
Q

in what sex is croup most common

A

boys

30
Q

when is croup most common

A

fall/winter (coincides with parainfluenza, influenza, RSV)

31
Q

when in the day are croup symptoms most prominent

A

late evenings and early mornings (leading to ER visits)

32
Q

is croup viral or bacterial

A

viral

33
Q

what types of viruses cause croup

A

**parainfluenza type 1

RSV
adenovirus
coronavirus
influenza (rare but more severe)
measles (in endemic areas)
rhino/enterovirus (mild cases)
34
Q

pathophysiology of croup

A

viral infection of nasal pharyngeal mucosa–>invasion of respiratory epithelium –> inflammation of CARTILAGINOUS SUBGLOTTIC REGION –> narrowing of trachea –> fibrinous exudates may worsen the narrowing

host factors = genetic predisposition, anatomic narrowing, hyperactive airways

35
Q

what is the hallmark of croup in infants

A

barking cough

36
Q

clinical presentation of croup

A

infants: barking cough

stridor, cough, hoarseness

in older children, hoarseness is a prominent symptom

typical presentation = sudden onset of symptoms, rapidly progressive, previous Hx of croup

37
Q

how is croup diagnosed

A

DDx

38
Q

Tx of croup

A

NOT antibiotics because its viral

systemic/nebulized STEROIDS

symptom Tx

severe presentations can require nebulized epinephrine, blow-by O2 if hypoxic

39
Q

transmission of pertussis

A

direct contact of inhalation of respiratory droplets

incubation is 7-10 days (or 4-21 depending on source)

40
Q

what causes pertussis

A

*Bordatella pertussis

obligate human pathogen
fastidious gram - coccobacilli

other strains of bordatella that can cause pertussis are: B. parapertussis, B. bronchoseptica and B. holmesii (severe)

41
Q

pathophysiology of pertussis

A

B. pertussis produces toxic and virulence factors–>
adhesins
tracheal cytotoxin/dermonecrotic toxin

these toxins cause local tissue damage and interfere with host immune mechanisms

endotoxins –> systemic manifestations and lymphocytosis

organisms found in ALVEOLAR MACROPHAGES and CILIATED RESPIRATORY EPITHELIAL CELLS

42
Q

describe the classical clinical manifestations of pertussis

A

“whooping cough”

paroxysmal cough
inspiratory whoop
post-tussive emesis

adolescents and adults have milder symptoms (protracted cough, considerable morbidity, important reservoir)

43
Q

what are the 3 phases of pertussis

A
  1. catarrhal (1-2 weeks, most contagious)
  2. paroxysmal (3-6 weeks)
  3. convalescent (>6 weeks)

investigations you order depend on lengths of symptoms
cough 3 weeks= B. pertussis PCR

44
Q

Tx of pertussis

A

antobiotics = MACROLIDE (azythromycin, clarithromycin, erythromycin) or TMP-SMX

if started in catarrhal phase, Abs reduce duration and severity of the disease and limit transmission (after this phase, only transmission is limited)

45
Q

vaccination schedule for pertussis

A

2, 4, 6 months; 18 months; 4-6 years; grade 9

46
Q

what is otitis media

A

inflammatory disease of the middle ear

47
Q

at what age is otitis media most prevalent

A

infancy

60-80% of kids have episode within first year
80-90% by 2-3 years

48
Q

in what sex is otitis media most prevalent

A

boys

49
Q

what vaccine has reduced the incidence of otitis media

A

pneumococcal vaccine

50
Q

risk factors for otitis media

A
  1. age 6-18 months
  2. family Hx
  3. day care
  4. lack of breastfeeding
  5. tobacco smoke/air pollution
  6. pacifier use
  7. race/ethnicity
  8. poverty
51
Q

what normally causes otitis media

A

66% of patients have combined viral and bacterial infections

S. pneumo = 50%
H. influenzae = 40-45%
M. catarrhalis>S. pyogenes>staph aureus

viral causes can include: RSV, rhino/enterovirus, coronavirus, influenza virus, adenovirus, human metapneumovirus

52
Q

what are 2 factors essential to the pathophysiology of otitis media

A
  1. antecedent viral URT infection (i.e cold)
  2. colonization with respiratory bacterial pathogen

inflammatory response to the virus obstructs the ISTHMUS of EUSTACHIAN TUBE–> causes negative pressure

secretions produced by the middle ear accumulate

bacteria colonizing URT access middle ear through aspiration or reflux, and grow in middle ear secretions

suppuration = acute otitis media

53
Q

how is otitis media diagnosed in infants

A

nonspecific signs and symptoms

fever is 33-66%

54
Q

how is otitis media diagnosed in children

A

otalgia (ear pain)
bulging of tympanic membrane
otorrhea (leak of CSF through ear structures)
hearing loss

55
Q

complications of otitis media

A 
tinnitus
vertigo
facial paralysis
mastoiditis
meningitis
56
Q

Tx of otitis media

A

70-80% resolve on their own
if strep. pneumo–> treat with AMOXICILLIN (best coverage for S. pneumo of all oral B-lactams)

watchful waiting, pain relief

57
Q

what is acute sinusitis

A

inflammation of paranasal sinuses lasting less than 4 weeks

58
Q

which sex gets more acute sinusitis

A

women

59
Q

which age group gets more acute sinusitis

A

45-75

60
Q

what percent of acute sinusitis resolves on its own

A

70% (Abs often misused)

61
Q

is viral or bacterial acute sinusitis more common

A

viral (200X)

62
Q

which viruses cause acute sinusitis

A

rhinovirus
influenzavirus
parainfluenza virus

typically resolves in 7-10 days

63
Q

what percent of acute sinusitis is bacterial

A

0.5-2% of viral URTI

10% related to dental disease

S. pneumo, H. influenzae, M. catarrhalis

64
Q

why is imaging not recommended in acute sinusitis diagnosis

A

because it cant distinguish between bacterial and viral causes

diagnose on Hx and physical

65
Q

when is bacterial acute sinusitis more likely (symptoms)

A
  1. URTI symptoms last for longer than 10 days or worsen after 5-7

AND

  1. nasal congestion/purulent nasal discharge with facial pain

+/-

  1. fever/maxillary toothache/facial swelling
66
Q

Tx for acute sinusitis

A

70% spontaneous resolution

normal saline irrigation is best option

antihistamines NOT recommended

steroids/Abs not shown to help

IDMM (29 decks)

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