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Upper Respiratory Tract Infections: Diagnosis & Treatment Overview

Learn about URTI types, causes, symptoms, and treatment options, including antibiotic use criteria and complications. Improve your differential diagnosis skills and understand the McIsaac scoring system.

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Upper Respiratory Tract Infections: Diagnosis & Treatment Overview

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  1. ARI Done by: Ahmad Mukharsham 423 810 212 Almoatasim….. 424 810 305 Abdulmohsen Abdullah Saad 425810059 / 42

  2. Upper Respiratory Tract Infections • Acute tonsillitis • Acute pharyngitis • Acute otitis media • Acute sinusitis • Common cold • Acute laryngitis • Otitis externa • Mastoiditis • Acute apiglottis / 42

  3. Objectives • At the end of this session, the participants should be able to; • List upper respiratory tract infections • Make differential diagnosis between URTI • Define criteria for antibiotic use • Apply and interpret the McIsaac scoring / 42

  4. Bacteria S. pyogenes C. diphteriae N. gonorrhoeae Viruses Epstein-Barr virus Adenovirus Influenza A, B Coxsackie A Parainfluenzae Tonsilitis-pharyngitis / 42

  5. Causative organisms • < 3 years •  100 % viral • 5-15 years • 15-30 % GABHS • Adult • 10 % GABHS / 42

  6. Due to streptococci: • Spreads by close contact and through air • Spread more in crowded areas (KG, school, army..) • Most common among 5-15 age group • More frequent among lower socio-economic classes • Most common during winter and spring • Incubation period 2-4 days / 42

  7. Sore throat Anterior cervical LAP Fever > 38 C Difficulty in swallowing Headache, fatigue Muscle pain Nausea, vomiting Signs/symptoms • Tonsillar hyperemia / exudates • Soft palate petechia • Absence of coughing • Absence of nose drip • Absence of hoarseness / 42

  8. Viral tonsillitis/pharyngitis • Having additional rhinitis, hoarseness, conjunctivitis and cough • Pharyngitis is accompanied by conjunctivitis in adenovirus infections • Oral vesicles, ulcers point to viruses / 42

  9. GABHS EBV Adenovirus Primary HIV infection Candida albicans Francisella tularensis Exudates / 42

  10. GABHS Epstein-Barr virus Adenovirus Human herpesvirus type 6 Tularemia HIV infection Lymphadenopathy / 42

  11. Throat swab Gold standard Rapid antigen test If negative need swab ASO May remain + for 1 year WBC count Peripheral smear Laboratory / 42

  12. Throat Culture • Pathogens looked for • Group A beta hemolytic streptococci • C. diphteriae (rare) • N. gonorrhoeae (rare) • If GABHS do we need antibiogram? • Is there resistence to penicilline? / 42

  13. Tonsillitis due to Streptococci • Supurative complications • Abscess • Sinusitis, otitis, mastoiditis • Cavernous sinus thrombosis • Toxic shock syndrome • Cervical lymphadenitis • Septic arthritis, osteomyelitis • Recurrent tonsillitis/pharyngitis • Nonsupurative complications • Acute romatoid fever • Acute glomerulonephritis / 42

  14. Aim of Treatment • Prevention of complications • Symptomatic improvement • Bacterial eradication • Prevention of contamination • Reducing unnecessary antibiotic use / 42

  15. Treatment • Many different antibiotics can eradicate GABHS from pharynx • Starting treatment within 9 days is enough to prevent ARF / 42

  16. Antibiotics NOT to be used • Tetracycline • Sulphonamides • Co-trimoxasole • Cloramphenicole • Aminoglycosides / 42

  17. GABHS • Control culture after full dose treatment? • NO • If history of ARF: • Take control culture after treatment • No need to screen or treat carriers / 42

  18. Mc Isaac Scoring • Developed by Mc Isaac and friends • Decreases antibiotic usage by 48% • No increase in throat swabs http://www.cmaj.ca/cgi/content/abstract/163/7/811 / 42

  19. Antibiotics in Tonsillitis/pharyngitis due to GABHS / 42

  20. Acute Otitis Media • AOM • AOM not responding to treatment: Sustained clinical and autoscopy findings despite 48-72 therapy • Recurrent atitis media: 3 AOM attacks within 6 moths or 4 attacks within 1 year / 42

  21. AOM causes • S. pneumoniae 30% • H. İnfluenzae 20% • M. Catarrhalis 15% • S. pyogenes 3% • S. aureus 2% • No growth 10-30% • Chronic otitis media:P. aeruginosa, S. aureus, anaerobic bacteria / 42

  22. Acute Otitis Media • 85% of children up to 3 years experience at least one, • 50% of children up to 3 years experience at least two attacks • AOM is usually self-limited. Rarely benefits from antibiotics. • 81 % undergo spontaneus resolution. / 42

  23. Symptoms Autalgia Ear draining Hearing loss Fever Fatigue Irritability Tinnitus, vertigo Otoscopic findings Tympanic membrane erythema Inflammation Bulging Effusion Hearing loss Signs and Symptoms / 42

  24. Antibiotics / 42

  25. Acute sinusitis Str. pneumoniae %41 H. influenzae %35 M. catarrhalis %8 Others %16 Strep. pyogenes S. aureus Rhinovirus Parainfluenzae Veilonella, peptokoccus Chronic sinusitis Anaerob bakteria: Bactroides, Fusobacterium S. aureus Strep. pyogenes Str. pneumoniae Gram (-) bakteria Fungi Acute Rhinitis / Sinusitis / 42

  26. Acute Sinusitis • Paranasal sinuses: • Frontal • Ethmoid • Maxillary • Sphenoid • Most common during childhood • Maxillary • Ethmoid • After age 10 • Frontal / 42

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  28. Predisposition to Sinusitis • Anatomical: septal deviation, • Mukociliary functions: cystic fibrosis, immotile cilia synd. • Systemic dis., immune deficiency.: DM, AIDS, CRF • Allergy: Nasal poliposis, asthma • Neoplasia • Environmental: smoking, air pollution, trauma... / 42

  29. Acute Rhinosinusitis • Most important: Headache and postnasal dripping • Face congestion • Fever, fatigue, headache increased by leaning forward • Nose obstruction • Nose dripping • Purulent secretions (rhinoscopy) • Sensitivity over the sinuses • Halitosis / 42

  30. Acute rhinosinusitis Rhinitis • Increased symptoms after 5 days • Symptoms lasting > 10 days • Decreasing viral symptoms, nasal secretion becoming more purulent are indicative for acute rhinosinusitis / 42

  31. Direct x-ray Diffuse opacification Mucosal thickening >4 mm air-fluid level Sinus aspiration Rarely performed Nasal endoskopy Tomography More sensitive compared with direct x-ray Indicated before surgery Diagnosis / 42

  32. Treatment • Ampirical • Specific microbiologic diagnosis difficult • Primary pathogens • S. pneumoniae • H. influenzae / 42

  33. Antibiotics for Sinusitis • Amoxycilline (Alfoxil) 3x500mg/d PO 10 d • Amoxycilline/clavulonate (Augmentin) 3x625 mg/d PO 10 d • Sefprosil(Serozil) 2x1000 mg/d PO 10 d • Sefuroxim (Zinnat) 2x250 mg/d PO 10 d • Azithromycine (Zitromax) First day 1x500 mg, then 1x250 mg/d PO 5 d / 42

  34. Support Therapy • Decongestants • Short duration 3-5 days • Antihistamines • If allergy • Normal saline • Local steroids / 42

  35. Common Cold • Adults Rhinovirus • Children Parainfluenzae and RSV / 42

  36. Common Cold • Fatigue • Feeling cold, shuddering • Nose burning, obstruction, running • Sneezing • Fever / 42

  37. Influenza (flu) • Causes epidemics and pandemics • Highly contagious • Viral infection. / 42

  38. Cause • 80 % Influenzae virus • Parainfluenza %2-9 • Rhinovirus %3 • Adenovirus %4 / 42

  39. Influenza • Sudden onset after 12-24 hours incubation • General weakness and fatigue • Feeling cold, shivering, temp. Up to 39-40 C • No sore throat or running nose • Severe back, muscle and joint pain / 42

  40. Treatment of common cold and influenza / 42

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