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Upper Respiratory Tract Infections. Dr. Meenakshi Aggarwal MD Emory Family Medicine. Definition. Inflammation of the respiratory mucosa from the nose to the lower respiratory tree, not including the alveoli. Objectives. List the various categories of upper respiratory tract infections

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upper respiratory tract infections

Upper Respiratory Tract Infections

Dr. Meenakshi Aggarwal MD

Emory Family Medicine

definition
Definition

Inflammation of the respiratory mucosa from the nose to the lower respiratory tree, not including the alveoli.

objectives
Objectives
  • List the various categories of upper respiratory tract infections
  • Obtain a pertinent history in a patient with a suspected URI.
  • Perform a targeted and thorough physical examination to confirm the diagnosis of URI.
  • Perform and interpret selected tests to diagnose URI
  • Manage and treat uncomplicated URI’s.
categories
Categories

Acute Rhinosinusitis

Acute Pharyngitis

Acute Bronchitis

differential diagnosis
Differential Diagnosis

Influenza

Pneumonia

Tuberculosis

Asthma

acute rhinosinusitis viral
Acute Rhinosinusitis (Viral)

Common Symptoms: Nasal discharge, nasal congestion, facial pressure, cough, fever, muscle aches, joint pains, sore throat with hoarseness.

Symptoms resolve in 10-14 days

Common in fall, winter and spring.

Treatment: Symptomatic

acute bacterial sinusitis
Acute Bacterial Sinusitis
  • Causative agents are usually the normal inhabitants of the respiratory tract.
  • Common agents:

Streptococcus pneumoniae

Nontypeable Haemophilus Influenzae

Moraxella Catarrhalis

signs and symptoms
Signs and Symptoms

Feeling of fullness and pressure over the involved sinuses, nasal congestion and purulent nasal discharge.

Other associated symptoms: Sore throat, malaise, low grade fever, headache, toothache, cough > 1 week duration.

Symptoms may last for more than 10-14 days.

diagnosis
Diagnosis

Based on clinical signs and symptoms

Physical Exam: Palpate over the sinuses, look for structural abnormalities like DNS.

X-ray sinuses: not usually needed but may show cloudiness and air fluid levels

Limited coronal CT are more sensitive to inflammatory changes and bone destruction

slide13

Coronal computed tomographic scan showing ethmoidal polyps. Ethmoid opacity is total as a result of nasal polyps, with a secondary fluid level in the left maxillary antrum.

treatment
Treatment
  • About 2/3rd of patients will improve without treatment in 2 weeks.
  • Antibiotics: Reserved for patients who have symptoms for more than 10 days or who experience worsening symptoms.
  • OTC decongestant nasal sprays should be discouraged for use more than 5 days
  • Supportive therapy: Humidification, analgesics, antihistaminics
slide15

Antibiotics

a) Amoxicillin (500mg TID) OR

b) TMP/SMX ( one DS for 10 days).

c) Alternative antibiotics: High dose amoxi/clavunate, Flouroquinolones, macrolides

acute pharyngitis
Acute Pharyngitis

Fewer than 25% of patients with sore throat have true pharyngitis.

Primarily seen in 5-18 years old. Common in adult women.

etiology
Etiology

A) Viral: Most common.

Rhinovirus (most common).

Symptoms usually last for 3-5 days.

B) Bacterial: Group A beta hemolytic streptococcus (GABHS).

Early detection can prevent complications like acute rheumatic fever and post streptococcal GN.

signs and symptoms18
Signs and Symptoms
  • Absence of Cough
  • Fever
  • Sore throat
  • Malaise
  • Rhinorrhoea
  • Classic triad of GABHS: High fever, tonsillar exhudates and ant. cervical lymphadenopathy.

NO COUGH

diagnosis19
Diagnosis
  • Physical Exam: Tonsillar exhudates, anterior cervical LAD
  • Rapid strep: Throat swab. Sensitivity of 80% and specificity of 95%.

Throat Cultures: Not required usually. Needed only when suspicion is high and rapid strep is negative.

management
Management

A) Symptomatic: Saline gargles,

analgesics, cool-mist humidification and

throat lozenges.

B) Antibiotics:

a) Benzathine Pn-G 1.2 million units

IM x 1OR Pn V orally for 10 days

b) For Pn allergic pts:

Erythromycin 500mg QID x 10 days

OR Azithro 500 mg Qdaily x 3 days.

slide23

Acute Bronchitis

Inflammation of the bronchial respiratory mucosa leading to productive cough.

acute bronchitis
Acute Bronchitis
  • Etiology: A)Viral

B) Bacterial (Bordetella pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae)

  • Diagnosis: Clinical
  • S/S: Productive cough, rarely fever or tachypnea.
slide26

Treatment

Symptomatic

If cough persists for more than 10 days:

Azithro x 5 days OR

Clarithro x 7 days

non specific uri s
Non specific URI’s
  • Common Cold
  • Etiology: Rhinovirus

Adenovirus

RSV

Parainfluenza

Enteroviruses

Diagnosis: Clinical

Treatment: Adequate fluid intake, rest, humidified air, and over-the-counter analgesics and antipyretics.

influenza
Influenza

Etiology: Influenza A & B

Symptoms: Fever, myalgias, headache, rhinitis, malaise, nonproductive cough, sore throat

Diagnosis: Influenza A &B antigen testing

Treatment: Supportive care, oseltamivir, amantidine