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Upper Respiratory Tract Infection URTI ?

Upper Respiratory Tract Infection URTI ?. Upper Respiratory Tract Infection URTI. Common Cold / Influenza Sore Throat Acute Otitis Media Sinusitis. Common Cold = Influenza?. Acute Pharyngitis. Pharyngotonsillitis Tonsillophayngitis. Inflammation of the Pharynx and Tonsils.

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Upper Respiratory Tract Infection URTI ?

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  1. Upper Respiratory Tract InfectionURTI?

  2. Upper Respiratory Tract InfectionURTI • Common Cold / Influenza • Sore Throat • Acute Otitis Media • Sinusitis

  3. Common Cold = Influenza?

  4. Acute Pharyngitis Pharyngotonsillitis Tonsillophayngitis

  5. Inflammation of the Pharynx and Tonsils One of the most common pediatric infections.

  6. Pathogens:

  7. Pathogens: • Viral: Rhino/Adeno/Corona/EBV/CMV HSV • Bacterial: • Streptococcus spp. (GAS,GCS,GGS) Cor. Diphth, Gonococcus, Tularemia etc. • Mycoplasma. • Toxoplasmosis.

  8. Pathogens: • 0-2 years Viral ++++ GAS+ • 5-above Viral +++ GAS++ (15-20%)

  9. A Study in Makkah showed 40% GAS and high resistance to Penicillin Telmesani/Ghazi 2002

  10. Presentation: • Cough • Sore throat • Dysphagia • Fever

  11. O/E: • Erythemetous Throat • Enlarged tonsils • Exudates • Palatine Petechiae • Ant. Cervical Lymphadenopathy • Ulceration&vesiculation(HSV/Coxack) • Conjuncitvitis(adenovirus) • Gray-white fibrinous pseudomem (diphtheriae) • Macular rash/white tongue(GAS)

  12. Complications: • Peritonsillar abcess • Internal jugular vein septic thrombophlebitis (Lemierre Synd.) • Lymphadenitis and abcess • Nonsuppurative e.g. rheumatic fever

  13. Diagnosis: • Throat culture • Rapid GAS antigens testing • EBV (heterophil/serology) • Cold agglutinations (mycoplasma)

  14. TTT: • Penicillin for GAS • Macrolides (alternative/Mycoplasma) Erytheromycin/Clarithomycin/ Azethromycin

  15. TTT: • Lactamase producing bacteria needs Amoxicillin-clavulanate acid or 2nd generation Cephalosporin's e.g. Cefuraxim, Cefaclor

  16. TTT: • Aspiration or Derainage for abscess • Proper management for any other complications

  17. Tonsillectomy

  18. Tonsillectomy • Recurrent tonsillitis • Peritonsillar Abscess (Quinsy) • Obstructive Sleep Apnea (Kissing Tonsils)

  19. Adenoidectomy

  20. Adenoidectomy • Chronic Secretory Otitis Media • Upper Airway Obstruction (Snoring)

  21. Ottits Media

  22. Suppurative infection of the middle ear cavity

  23. Epidemiology • 6/12 to 2 y • High risk group Boys Cleft Palate Formula Feeding Down Eskimos Winter- Low Socioeconomic

  24. Pathogenesis

  25. Pathogenesis • Blocked estachian canal • Micro-organism Viral RSV CMV Rhino etc Streptococcus Pneumonia H.Influenzae Moraxella Catarrhalis Mycoplasma Staphylococcus

  26. Presentation • Preceding URTI • Fever, irritability, pulls ears • V/D,bulging A/F • Bulging, immobile injected T.M • Loss of land marks • Perforation

  27. Normal ear drum and other one with central perforation

  28. large central perforation in the right ear of a patient who had suffered a long standing ear infection.

  29. Therapy Antibiotics ( Beta Lactamase) Amoxycillin-Clavulenic acid Cephalosporins TMP-SMX Macrolides Oral/nasal decongestants Tympanocentesis

  30. Prevention S. Pneumoniae conjugated vaccine (small effect)

  31. Chronic Secretory Otitis Media (Glue Ear)

  32. Chronic Secretory Otitis Media (Glue Ear) • Secondary to recurrent O.M • Treatment Prevents conductive Deafness -Long term Antibiotics -Insertion of ventilation tubes (Grommets)

  33. Sinusitis Suppurative infection of the sinuses

  34. Predisposition • Common cold, Allergic rhinitis • Nasotracheal/nasogastric intubations • Cyanotic heart disease • C.F, Ig disorders ,immotile cilia syndrome • HIV, immune compromised patients

  35. Sinus Formation • At birth Maxillary ,Ethmoid and Sphenoid are present. • At one year Frontal sinus Pneumotization comes later

  36. Pathogenesis

  37. Pathogenesis • Mucociliary flow obstruction • Bacterial growth S. peunoniae H.Influenzae (nontypable) M.Catarrhalis Anaerobic bacteria Strept/Staph Gm –ve (nosocomial) Aspergillus (nutropenic pt.)

  38. Presentation • Mucopurulent rhinorrhea. • Night cough. • Nasal speech. • Facial swelling (pain,headache,tenderness). • X-Ray/CT shows clouding/air fluid level.

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