Diseases of the upper respiratory tract

Ala’a Aljohani family medicine

Common cold

Strep pharyngitisinfluenza

Common cold (coryza):

Cause : viral in origin, most commonly rhinovirus

Transmission of common cold: infections is mostly through hand-to-hand contact, with subsequent passage to the nostrils or eyes—rather than, as commonly perceived, through droplets in the air

Incubation period: 12hours to 5 days

Symptoms :

Diagnosis:

Upper respiratory infection (URI) is diagnosed clinically based on nasal congestion, rhinorrhea, cough, or sore throat in the absence of streptococcal pharyngitis, acute bacterial sinusitis, lower respiratory tract infection, influenza, or allergic rhinitis.

Testing is usually not needed.

Management

is it a self limiting disease?What is the role of vit C

What medication should we give ?Should we prescribe antibiotic ?

advice ?

The receiving of information and reassurance is strongly associated with patient satisfaction in patients with acute respiratory tract symptoms. Consider education about hand washing, expected duration of symptoms, and when to report worsening symptoms.

Consider any of the following for symptomatic treatment:◦Acetaminophen: (paracetamol) or nonsteroidal

anti-inflammatory drugs (NSAIDs) to reduce fever or discomfort

◦decongestants (nasal or oral) for short-term relief of nasal congestion

◦a nonprescription antihistamine/decongestant (such as dexbrompheniramine/pseudoephedrine) which may reduce cough

◦ipratropium nasal spray to improve rhinorrhea

Do not prescribe antibiotics for upper respiratory infection (URI) treatment

influenza

Type A(avian, swine influenza,….)

Type B(Seasonal influenza)

Can cause significant diseaseGenerally causes milder disease but may also cause severe disease

Infects humans and other species (e.g., birds; H5N1) Limited to humans

Can cause epidemics and pandemics (worldwide epidemics)

Generally causes milder epidemics

Caused by Influenza viruses transmitted primarily from person to

person through respiratory droplets disseminated during sneezing, coughing, and talking, and through contact with contaminated surfaces

Incubation period : 1-3 days

Symptoms :

Managementis it a self limiting disease?What medication should we

give ?Should we prescribe

antibiotic?Antiviral medication ?

advices ?

The flu vaccine is recommended for nearly all people six months of age and older. The vaccine is especially important for:

Adults age 50 or olderPeople who live in nursing homes and

other long-term care facilitiesAdults and children who have chronic lung

or heart conditions. This includes children with asthma

Adults and children with chronic diseases, such as diabetes or kidney disease

Adults and children with HIV infection or who have received organ or stem cell transplants

Children and teenagers age 6 months to 18 years who are taking long-term aspirin therapy and might be at risk for Reye syndrome

Women who will be pregnant during the influenza season

Adults and children who might transmit influenza to high-risk individuals (including people listed above). This includes healthcare workers, workers in nursing homes, home health workers, and people who live with a high-risk individual.

Is it a cold or the flu?

Flu cold symptoms

Usual ; high. Higher in young children last3-4 days

rare fever

common rare headache

Usual often sever slight General aches,pain

Usual; can last up to 2-3 weeks

sometimes Fatigue, weakness

Ueual:at the beginning of the illness

never Extremes exhaustion

sometimes common Stuffy nose

sometimes usual sneezing

sometimes common Sore throat

Common can become sever

Mild,moderate Chest discomfort, cough

Streptococcal Pharyngitis

Cause:group A beta-hemolytic streptococcus

The infection is transmitted via respiratory secretions

Incubation period :24 to 72 hours. school-aged children

Symptoms:

Diagnosis: Clinical:

the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical finding is difficult .

History and Physical Examination Findings Suggesting GABHS Pharyngitis

Cervical lymphadenopathy

Headache

Palatine petechiae

Streptococcal exposure in past two Weeks

Absence of coughfever (temperature greater than 100.4° F [38° C]),

 tonsillar inflammation or exudates 

Myalgia

Clinical Decision Rule for Management of Sore Throat

Patient with sore throat apply streptococcal score..

point Criteria

1 Absence of cough1 Swollen & tender

anterior cervical node1 temperature >38c1 Tonsillar exudate or

swelling 1 Age 3 to 14 years0 15-44 years-1 45 year and older

No further testing or Abd indicated

Risk of GABHS pharyngitis 1-2.5%

Score<= 0

No fuether tesing or abd indicated

Option:perform test

5-10% =1

Perform throat culture or RADT

11-17% =2

Perform throat culture or RADT

28-35% =3

Consider empiric ttt with Antibiotcs

51-53% =>4

LABORATORY DIAGNOSIS

highly specific and is useful in establishing the diagnosis of GAS pharyngitis, allowing for rapid initiation of antibiotic therap

:Rapid antigen detection test

Throat culture :

has been considered the gold standard method to establish the microbial cause of acute pharyngitis. However, compared with RADT, cultures delay diagnosis as they take 24 to 48 hours to grow. Throat culture is primarily used as a backup test in patients with negative RADT where clinical concern for GAS or bacterial pharyngitis is still high.

Management is it a self limiting

disease?What medication should we give ?

Should we prescribe antibiotics ?

GABHS pharyngitis is self-limited and resolves within a few days, even without treatment.rguments for antibiotic treatment include acute symptom relief, prevention of suppurative and nonsuppurative complications, and reduced communicability

Antibiotic Options for GABHS :Pharyngitis

PenicillinAmoxicillinMacrolideCephalosporin 

Tonsillectomy ??

:Complications of GABHS PharyngitisNonsuppurative SuppurativePoststreptococcal

glomerulonephritisBacteremia

Rheumatic fever Cervical lymphadenitisEndocarditisOtitis mediaMeningitis

Peritonsillar/retropharyngeal abscess

Pneumonia

Sources:

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