11 April 2010

Upper Respiratory Tract Infections



Upper Respiratory Tract Infections
By: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
* 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
* Acute Rhinosinusitis
* Acute Pharyngitis
* Acute Bronchitis

Differential Diagnosis
* Influenza
* Pneumonia
* Tuberculosis
* Asthma

Anatomy of Sinuses
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
* Causative agents are usually the normal inhabitants of the respiratory tract.
* Common agents:

Streptococcus pneumoniae
Nontypeable Haemophilus Influenzae

Moraxella Catarrhalis
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
* 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

Ethmoid Sinusitis
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
* 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
a) Amoxicillin (500mg TID) OR
b) TMP/SMX ( one DS for 10 days).
c) Alternative antibiotics: High dose amoxi/clavunate, Flouroquinolones, macrolides

Antibiotics
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
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 Symptoms
* Absence of Cough
* Fever
* Sore throat
* Malaise
* Rhinorrhoea
* Classic triad of GABHS: High fever, tonsillar exhudates and ant. cervical lymphadenopathy.

NO COUGH
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.

Exhudates
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.

Acute Bronchitis
Inflammation of the bronchial respiratory mucosa leading to productive cough.
Acute Bronchitis
* Etiology: A)Viral
B) Bacterial (Bordetella pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae)
* Diagnosis: Clinical
* S/S: Productive cough, rarely fever or tachypnea.

Treatment
* Symptomatic
* If cough persists for more than 10 days:

Azithro x 5 days OR
Clarithro x 7 days
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
* 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

Upper Respiratory Tract Infections.ppt

0 comments:

All links posted here are collected from various websites. No video or powerpoint files are uploaded on this blog. If you are the original author and do not wish to display your content on this blog please Email me anandkumarreddy at gmail dot com I will remove it. The contents of this blog are meant for educational purpose and not for commercial use. If you use any content give due credit to the original author.

This site uses cookies from Google to deliver its services, to personalise ads and to analyse traffic. Information about your use of this site is shared with Google. By using this site, you agree to its use of cookies.

  © Blogger templates Newspaper III by Ourblogtemplates.com 2008

Back to TOP