Acute Upper Respiratory Tract InfectionsMB,BS

8/14/2019 Acute Upper Respiratory Tract InfectionsMB,BS

1/33

AcuteUpper

Respiratory Infections(AURI)


2/33


3/33

Introduction

Acute respiratory infections (ARI) :infection of the respiratory tract ofless than 3 weeks(21 days) duration.

ARI = Acute upper respiratoryinfections (AURI)+ Acute lowerrespiratory infections (ALRI)


4/33

AURI Clinical Syndromes

Types of Acute URI

Acute viral rhinitis

Acute otitis media

Acute tonsillo-pharyngitis

Others (Otitis externa, otitis media witheffusion[OME], mastoiditis, rhinosinusitis)


5/33

Acute viral rhinitis (common cold,acute coryza, nasopharyngitis)

Definition

Aetiology: Rhinoviruses,parainfluenza, influenza, coronavirus,enterovirus and others. OccasionallyGroup A - haemolyticStreptococcus.


6/33

Acute viral rhinitis (contd.)

Clinical Features

Incubation period:1-6 days

Frequency (6 12 episodes/year)

Duration of illness: usually 7 days

Symptoms: sneezing, rhinorrhoea & blockednostrils (classical triad), cough, headache,

low grade fever Thin rhinorrhoea mucoid rhinorrhoea

mucopurulent rhinorrhoea


7/33

Others: sorethroat, malaise, loss ofappetite

Signs: swollen nasopharyngeal

mucosa, cervical lymphadenitis


8/33

Complications

Acute otitis media

Sinusitis

TonsilitisLaryngotracheobronchitis

Bronchiolitis

Pneumonia


9/33

Diagnosis

Clinical


10/33

Differential diagnoses

Allergic rhinitis

Flu

Pertussis (catarrhal stage)Prodromal measles

Nasal diphtheria

Foreign body in the nostril


11/33

Treatment

SymptomaticNasal toilettingAntipyretic/analgesic if fever 38.50C

If young infant do not expose to cold, keepwarmIf coughing:a) Exclusively breastfed infant liberal

breast milkb) If not exclusively breastfed simple home

remedy for cough like weak tea +lime,honey licks, palm oil + sugar.

Dextrometophan used if coughtroublesome


12/33

Acute otitis media (AOM)

It is common in infants becauseof high frequency of common coldsand the anatomy of the infants

eustachian tube, which is shorter,wider and straight.


13/33

Definition

Acute inflammation of middle ear resultingin an effusion and associated with rapid

onset of symptoms such as otalgia, fever,irritability, anorexia, or vomiting.

Cf: Otitis media with effusion (OME) defined

as an asymptomatic middle ear effusionthat often follows AOM, but may have nosuch antecedent history.


14/33

Aetiology

In neonates: Staphylococcus aureus,Pseudomonas spp., Escherichia coliand other Gram negative rods.

In older children: Streptococcuspneumoniae, Haemophilusinfluenzae, Moraxella catarrhalis,Streptococcus pyogenes and others


15/33

Clinical features

Classical symptoms : otalgia, fever,otorrhoea(


16/33

Diagnosis

Immobile red tympanic membrane,

serous/purulent fluid in the middle ear,

perforation of tympanic membrane.


17/33

Laboratory investigations

Microscopy, culture and sensitivity(mcs) of ear discharges.

Sepsis screen in toxic neonates .


18/33

Complications

Hearing loss

Mastoiditis,

PetrositisLabyrinthitis

Meningitis

Brain abscess


19/33

Treatment

In neonates: parenteral cefuroximeplus amikacin

Older children: oral amoxicillin (first

line), co-amoxiclav(2nd line).Oral co-trimoxazole and i.m. procaine

penicillin may be useful in areas of

low resistance by the infectingagents.

Supportive management : ear (aural)toiletting for otorrhoea,

antipyretic/analgesic


20/33

Acute tonsillopharyngitis

Definition

Inflamed tonsils and pharynx.

TypesExudative tonsillopharyngitis

Diphtheritic tonsillopharyngitis

Vesicular or ulcerativetonsillopharyngitis


21/33

Exudativetonsillopharyngitis

Aetiology: Gp. A -haemolytic

Streptococcus

Symptoms

In older children: fever, sorethroat,dysphagia, headache and malaise.

Young children: fever, nausea,vomiting and abdominal pain.


22/33

Exudative tonsillopharyngitis(contd.)

Pyrexia T>380C, exudative tonsillarenlargement.

Other signs include: oedema,

erythema, lymphoid hyperplasia ofthe pharynx, anterior cervicallymphadenitis.


23/33


Investigations and Diagnosis

Culture of throat swab

FBC: polymorphonuclear leucocytosis; usefulbut not diagnostic.

Blood culture in very ill patient.

Rapid latex agglutination test on throatswabs (10 60 mins), specific but lowsensitivity.


24/33


Differential diagnosis

Pharyngeal diphtheria grey membrane

Vesicular tonsillopharyngitis(herpagina) vesiclesor ulcers.

Infectious mononucleosis: aetiology is EB virus;features include epitrochlear lmphadenopathy,hepatosplenomegaly,and atypical lymphocytes in

blood film.Others: Viral pharyngitis( adenovirus,Herpes

simplex, enterovirus, influenza, parainfluenza ,measles etc.


25/33


Complications

Suppurative : acute otitis media,acute sinusitis, peritonsillar cellulitis

and abscess, retropharyngealabscess, suppurative cervicallymphadenitis.

Delayed non-suppurative: acuterheumatic fever and acutelomerulone hritis


26/33


Treatment

Antibiotics

Oral penicillin V 250mg qds x 10 daysSingle i.m. injection of benzathine penicillinG (600,000 900,000 units for children12 years)

Oral erythromycin(30 -50 mg/kg/day) 3 4divided doses, in penicillin- allergicpatients.

Oral amoxycillinOral azithromycin


27/33

Supportive

Analgesic/antipyretic:paracetamol/ibuprofen

Adequate fluid and caloric intake


28/33

Acute tonsillitis with vesicles(Herpagina)


29/33

Acute tonsillitis with membrane(Diphtheritic tonsillitis)


30/33

Chronic otitis media

Definition

Perforated, painless, discharging ear,almost always immobile tympanicmembrane.


31/33

Investigations

M/C/S of ear discharge

X-ray of mastoid

AudiometryTympanometry


32/33

Complications

Cholesteatoma

Mastoiditis

Central nervous system involvement

- Otogenic tetanus

- Meningitis

- Facial nerve palsy

- Lateral sinus thrombosis

- Abscesses: brain, subdural andeustachian


33/33

Treatment

Ear (aural) toiletting

Flavine-in-spirit dressing

Systemic antibiotics controversial

Acute Upper Respiratory Tract InfectionsMB,BS

Documents

Transcript of Acute Upper Respiratory Tract InfectionsMB,BS