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Upper Respiratory Tract Infections

Upper Respiratory Tract Infections. Resat Ozaras, MD Professor Infectious Diseases. Upper Respiratory Tract Infections. Common cold Ph ar y n gitis A c ut e l a r y n gitis A c ut e lar y ngot h ra ch eobron ch it is Otitis e x terna Otitis media Mastoidit is A c ut e sin us it is.

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Upper Respiratory Tract Infections

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  1. UpperRespiratoryTractInfections Resat Ozaras, MD Professor InfectiousDiseases

  2. UpperRespiratoryTractInfections • Commoncold • Pharyngitis • Acute laryngitis • Acutelaryngothracheobronchitis • Otitis externa • Otitis media • Mastoiditis • Acute sinusitis

  3. Common cold • Generally mild, self-limiting • Many viruses can cause similar clinical picture • 2-4 times/year in adults 6-8 years in children. • September to August • Transmitted with respiratory secretions.

  4. Common Cold: etiology Virus Antigenic type% • Rhinovirus 101 30-40 • Coronavirus>3 >10 • Parainfluenza virus 4 10 • RSV 2 10 • Influenza virus 3 10-15 • Adenovirus 47 5 • Undefinedviruses25-30 • Group A beta-hemolyticstrep. 5-10

  5. Common Cold • Clinical:nasal congestion, sneezing, sore throat, decreased taste • Complications: acute sinusitis and acute otitis media

  6. Common Cold: Treatment • NO ANTIBIOTICS. • Drops and sprays with 0.25-0.5% phenilephin or 1% ephedrine • Antitussives, antipyretics • Bed rest • High dose vitamin C?

  7. Acute Pharyngitis • Majority (40%) due to viruses • Group A beta-hemolytic streptococcus 15-30% • May associate: • Common cold • Influenza • Herpetic • Infectious mononucleosis • Vincent’s angina • Peritonsillar abscess • Dyphteria

  8. Acute Pharyngitis • The majority (75%) are given antibiotics • To prevent rheumatic fever • Patient’s expectations!

  9. Acute Pharyngitis: diagnosis • Yielding GABHS in throat swab culture is diagnostic in 90-95% • Acute infection-carrier? • Clinical features and rapid antigen tests are helpful

  10. Acute pharyngitis: Dx • Clinical features: • Tonsillary exudate • Painfull anterior cervical lymphadenopathy • Absence of cough • Fever *any 3, sensitivity and specificity around 75% CDC Position Paper, 2001

  11. Acute Pharyngitis: Throat culture

  12. Exam.: GABHS

  13. Exam.: EBV

  14. EBV

  15. Acute Pharyngitis: Tx • In GABHS, it decreases complications, decreases the course of the disease by 1-2 days

  16. Acute pharyngitis: Tx 1. Look for 4 criteria: a. fever b. tonsillary exudate, c. No cough d. Painful anterior cervical LAP. 2. 0-1 criterion: no lab study, no antibiotics tx. CDC Position Paper, 2001.

  17. Acute Pharyngitis: Tx 3. If >2 criteria: you may, a. For those with 2,3, or 4 criteria, study rapid antigen test, and if positive give antibiotics b. For those with 2 or 3, study rapid antigen test, and if positive or with 4 criteria c. No further test is needed, for those with 3, or 4 criteria give antibiotics CDC Clinical Practice Guideline, 2001.

  18. Acute Pharyngitis • First choice • Benzathin penicillin: 1.2 MU, IM, single dose • Penicillin V: 500 mg, 2-3 times in a day, for 10 days • Penicillin allergy • Erythromycine

  19. Acute Rhinosinusitis • Frequently antibiotics are given (85-98%). • Almost always follows an upper RTI (inflammation in mucosa and obstruction of ostia of sinuses) • Acute sinusitis lasts <4 weeks

  20. Viscosity and content of secretions Normal Mucus content Normal Mucus absorbtion Normal Mucus secretion Normal OSTIUM OPEN Mucociliary activity Normal Systemic Host Defense Normal

  21. Acute sinusitis: Etiology • S. pneumoniae %31 • H. influenzae %20 • Anaerobs %6 • S. aureus %4 • S. pyogenes %2 • M. catarrhalis %2 • Gram-negative bacteria %5 • Viruses %30

  22. Viral-Bacterial Rhinosinusitis • Diagnosis: Sinus sampling • Clinical clues for bacterial sinusitis: • Purulant nasal discharge, unilateral maxillary or fascial pain • Unilateral sinus tenderness • Deterioration of symptoms after initial improvement

  23. Plain x-ray • Full opacity or air-fluid level  specificity 85% (76-91%) • Mucosal thickening  specificity 40-50%.

  24. Treatment • If not complicated, no need for X-ray. Consider clinical clues • If symptoms are mild to moderate, antibiotics are not given • Severe or persisting moderate symptoms are treated with antibiotics CDC Clinical Practice Guideline, 2001.

  25. Amoxicillin 500 mg x 3 (10-14 days) Amox/clav. 500/125 mg X 3 (10-14 days) Amp/sul. 375-750 mg x 2 (10-14 day) Cefuroxim axetil 250 mg X 2 (10-14 day) Clarithromycine 500mg X 2 (10-14 days) Azithromycine 500 mg (5 days) Levofloxacin 500mg (10-14 days Tx

  26. Acute Otitis Media • <15 y, a frequent cause of admission to doctor • <3 y, most frequent • 2/3 children>1, 1/3 children >3 times • Hearing loss, cholesteatoma, chronic perforation

  27. Acute Otitis Media:Etiology

  28. AcuteOtitis MediaClinicalfeaturesanddiagnosis • Ear pain, discharge, hearing loss. • Fever, irritability • Erythema on tympanic membrane • Fluid accumulation in middle ear • Tympanic f. sampling in selected cases • Severe disease • Unresponse to antibiotics within 48-72 h. • Immunsuppressives

  29. Acute Otitis Media: Tx • Amoxicillin • Beta-laktamase inhibitors • SAM, CAM • 2nd gen. Cephalosporins • Cefuroxim, cefaclor, cefprozil, loracarbef • Macrolides • Clarithromycine, azithromycine • Antihistamines

  30. Influenza

  31. 1918 , Oakland

  32. 1918, Iowa

  33. Ryan JR. Pandemic influenza

  34. İnfluenza Nedir? Influenza • A highlycontagiousrespiratoryinfectioncausedbyInfluenza A and B • Symptoms: • Highfever, cough, myalgias, fatigue, headache, sorethroatandnasalcongestion • May last 1-2 week • Affectsindividuals, families, populations, andeconomy of thecountries • May causesignificantmortality in vulnerablepatients Nicholson et al. Lancet 2003; 362: 1733–45.

  35. Incubation period 1-2 days • A sudden beginning • May cause a mild hyperemia in throat. UpToDate 2009

  36. Improvement: 2-5 days (>1 week in some) • In some, fatigue, tiredness may last for weeks

  37. Differential Dx • Common cold

  38. Influenza & CommonCold Symptom Common Cold Influenza Fever Generally high, 3-4 days unusual Headache Yes Unusual Generalized pain Usually, generally severe Mild Fatigue, tiredness May last 2-3 weeks Moderate Severe tiredness Early and severe Never Nasal congestion/ sore throat Sometimes Common Sneezing Sometimes Usual Chest discomfort General, may be severe Mild-to-moderate Cough Cough without sputum Very rarely National Institute of Allergy and Infectious Diseases

  39. Common cold etiology • 6 virus family • Orthomyxoviridae (Influenzavirus) • Paramyxoviridae (Parainfluenza, RSV) • Picornaviridae (Rhinovirus-89 tip, Coxsackievirus, Echovirus, Poliovirus) • Coronaviridae (Coronavirus) • Adenoviridae (Adenovirus) • Herpetoviridae (HSV, EBV)

  40. Complications • Pneumonia: mostfrequent • Generallyseen in thosewithunderlyingdisorders • Cardiovascular • Pulmonary • Renaldis. • DM • Immunosuppressives • Those in longtermcare • >50 y.

  41. Pneumonia • Primary (influenza pneumonia) • A gradual increase in signs and symptoms (high fever, dispnea, cyanosis) • Secondary (bacterial) • Deterioration after a temporary improvement • ¼ of death due to influenza • Pnomococci, staph.

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