Please enable JavaScript.
Coggle requires JavaScript to display documents.
Upper Respiratory Tract Infections - Coggle Diagram
Upper Respiratory Tract Infections
Common Cold
Acute minor coryzal illness caused by viruses belonging to a number of dif families
Aetiological agents
Rhinovirus - 40%
Coronavirus 10%
Adenovirus
Influenza
Parainfluenza
RSV
hMPV
Enterovirus - Coxsakievirus
Bocavirus
Diagnosis
Clinical Presentation
Management
NO ANTIBIOTICS - VIRAL
Paracetemol / ibprofen - symptom relief
Hand washing
Decongestants
Sinusitis / Acute Rhinosinusitis
Acute inflammation of mucosal + nasal passage + paranasal sinuses lasting up to 4 weeks
Aetiology
Viral
Secondary bacterial infx
Immunocompromised
Foreing body
Trauma
Fungal
Asergillus spp
Rhizopus spp
Mucor spp
Scedeosporium abiospermum
Candida
Crytococcus neoformans
Non-Infectious
GPA
Chemical irritants
Foreign bodies
Clinical Features
Nasal congestion / obstruction
Purulent nasal discharge
Facial pressure / pain
Hyposmia / asnosmia
Fever halitosis - bad breath
Acute Bacterial Rhinosinusitis
Symptoms
Children
1. Peristant nasal discharge or cough lasting 10 days or more without imporvement
Worsening course after initial impovement
Severe onset (fever 38.9) at least 3 consec days
Adults
Localised to effected sinus
Pain
Pressure
Pathogens
S. Pneumoniae
H. Influenza
Moraxella catarrhalis
Saph. aureus
Diagnosis
Clinical
Radiology
Microbiological culture
Treatment
Difficult to differentiate ABRS from biral Rhinosinusitis
When to treat
Persistent signs or symtoms no improving >=10 days
Sevre signs and symtoms 3-4 days
Worsening signs and symptoms after inital improvemetn
Empirical Treatment
Amoxicillin
Co-amociclav
Levofloxacin
Cefuroxime
Chronic Sinusitis
Signs / Symptoms
=12 weeks
Facial discomfort
Mucopurulent discharge
Pathogenesis
Sinus cavity colonised with bacteria
Biofilm production
Treatment
Often unsatisfactory response to antimicrobials alone
Aim: Decrease inflammation and eradicate pathogens
Irrigations / washout
Steroids
Antibiotics
Complications
Orbital cellulitis
Cerebral abcess
meningitis
Empyema
Dural vein septic thrombophlebitis
Pharyngitis
Aetiology
Viral
Rhinovirus
Adenovirus
HSV
Vesicular lesions
Coxsackie viruses A and B
Coronavirus
EBV
CMV
HIV
Bacterial
Strep pyogenes
Diagnosis
Throat swab
Serology -ASOT
Inflammation of the pharynx
Epidemiology
Children 4-7 yrs
Symptoms / Presentation
Systemic malaise
Sore throat
Erythema of tonsils / pharynx
Exudate (esp strep, EBV)
Conjuctivitis (viral)
Laryngitis
Aetiology
Resp viruses
Bacterial
GAS
Moraxella catarrhalis
H. influenza
Mycoplasma pneumoniae
Chlamydophila pneumoniae
C. diphhtheriae
Mechanical
Treatment
Symptom treatment
Treatment of underlying cause
Inflammation of the larynx
Epidemiology
Adults 18-40 yrs
Presentation
Hoarse / harsh voice - dysphonia
Epsisodes of aphonia
Sore throat
3-8 days
ENT assessment if hoarse > 3 weeks
Croup
Acute Laryngotracheitis / Laryngotracheobronchitis
Aetiology
Typically viral
Measles
Parainfluenza virus
Presentation
Inflammtion of larynx
Stridor
Hoarseness
Cough - bacrking, seal like
Night onset
Obstruction at subglottic level
Sevre obstruction: Hypercapnia + hypoxia
Child hx of URTI with sore throat, fever, mild cough
Dyspneoa
Rhonchi / wheeze on auscultation
Indications of Impending Respiratory Failure
Stridor at rest
Sternal wall retractions
Lethargy
Decreased level of conciousness
Paradoxical breathing
Quiet breath sounds
Diagnosis
Clinical
Distinguish other causes of stridor
WCC
Normal or Increased
Hypoxia
Hypercapnia
Viral identification
IF and RT-PCR
Management
Resp failure - Intubation and VEntilation
Monitor RR
Pulse oximetry / arterial CO2 measurement
Nebulised budesonide
Moderate-severe cases
PO / IM steroid
Nebulised adrenaline for severe stridor
Epiglottitis
Inflammation of epiglottis
Medical Emergency
Presentation
Inflammation
Oedema and obstruction of epiglottis and surrounding strx
Abrupt onset
Severe sore throat
Fever
Stidor
Refusal to eat
Children sitting up leaning forward
Epidemiology
Children 3-7 yrs
Aetiology
Haemophilus influenza type B
Adult population
GAS/GBS/GCS
S.pneumoniae
Klebsiella pneumoniae
S aureus
H. parainfluenzae
C. albicans
N. meningitides
Management
Secure Airways
Avoid tongue depressor until airway secure
Defer IV cannulation until ansethetic support availavle
ABx
IV Cephalosporin 7-10 days
Prophylaxis
Riampicin
Investigations
After airwway secure
WCC/CRP
Blood cultures
Radiology
Lateral neck x-ray thumb sign
Differential Diagnosis
Croup
Inhaled foreign body
Diphtheria
Complications
Bacteraemia
Pneumonia
Meningitis
Arthritis
Cellulitis
Pertussis
Whooping Cough
Highly infectious condition, characterised by severe coughing fitsfollowed by high pitched gasp
Diagnostic Criteria
Clinical
Cough > 2 weeks
Porxysms of coughing or inspiratory whoop or post-tussive vomiting
Apnoeic epidsodes in infants
Lab
Culture pos
PCR pos
Specific antibody response
Epidemiology
Link by human-human transmission
Case Classification
Possible
Clinical criteria
Probable
Clinical + epi link
Confirmed
Clinical + lab
Aetiology
Gram (-) Coccobacillus Bordetella pertussis
Phases
Approx 2-4 weeks each
Catarrhal Phase
Indistinguishable from common cold
Paroxysmal phae
Paroxysms of coughing followed by loud characteristic "whoop"
Infants <6mths have apnoeic episodes
Convalescent phase
Chronic cough for weeks
Diagnosis
Clinical. Lab may be delayed
Culture
Special media Bordet Gengou agar
Pernasal swab
Increased chance of pos cx in first 3/52
Decreased chance if given antibiotic or vaccinated
PCR
Non- viable organisms may be detected
More sensitive than culture
Serology
Restrospective
Useful in prolonged symptomatic pts
Not usefull if vaccinated in previous year
Management
ABx
Erythromycin 7/7
Chemoprophylaxis to at risk contacts
Presentation
Coughing, violently and rapidly, until all the air has left the lungs and a person is forced to inhale, causing a "whooping" sound.
Sneezing.
Nasal discharge.
Fever.
Sore, watery eyes.
Lips, tongue, and nailbeds may turn blue during coughing spells
No wheeze
Coughing leading to Vomiting
Paroxysmal cough - bouts
URTIs
Common URTIS
Sinusitis
Pharyngitis
Laryngitis
Croup
Epiglottitis
Pertussis
Common cold
Quinsy
Tonsillitis
Mastoiditis
Otitis media
Barriers to Infx
Hair
Mucous
Ciliated cells
Adenoids and tonsils
Macrophages, monocytes, neutrophils, eosinophils
Bacteria
Streptococcus Pneumoniae
Risk Factors
Antibody deficiency
Complement deficiency
Neutropenia / impaired neutrophil fx
Asplenia
Corticosteroids
Alcoholisms
Malnutrition
Chronic illness
Pathogenesis / Virulence Factors
Capsular polysaccharide
Prevents phagocytosis
Activates complement
Cell wall polysaccharide
Activates complement
Activates cytokines
Pneumolysin
PspA/PspC
Inhibits phagocytosis
Autolysin
Causes release of bacterial components
Antimicrobial Resistance
Penicillin
Macrolides
Syndromes
Pneumonia
Meningitis
IE chronic bronchitis
Endocarditis, pericarditis
Septic arthritis
Osteomyelitis
Peritonitis
Epidural / cerebral abcess
Diagnosis
Gram (+) ciplococci
Alpha haemolytic on blood agar
Treatment
Depends on infx and drug susceptibility results
Prevention
Immunisation - PCV - 7 valent pneumococcal conjugate vaccine
Epidemiology
Colonises nasopharynx of 5-10% of healthy adults
20-40% of healthy children
Rate of invasive pneumococcal disease is 15/100,000 persons/yr
Group A Streptococcus - Streptococcus Pyogenes
Epidemiology
URT commensals in 3-5% adults, 10% children
Risk Factors
Age >65
Recent VZV infection
HIV +
Diabetes mellitus
IDVU
High dose steroids
Virulence factors
Somatic Constituents
Hyaluronic capsule
M protein
Lipotechnoic acid
Extracellular products (exotoxins?)
Streptolysin O
Streptolysin S
Streptococcal pyogenic exotoxins
Pie-ogenic
3 pyogenic diseases are pharyngitis, cellulitis/ ep??, and impetigo?
Streptokinase
Streptococcal superantigens
Diagnosis
Microscopy
Facultative anaerob
Gram + cocci
Form long chains
β Haemolytic on blood agar
Lancefield antigen Group A
Serology
Anti-streptolysin O titre (ASOT)
Treatment
Penicillin PO /IV
If allergic: Erythromycin / azithromycin
Severe disease
Add second agent
Clindamycin
Surgical debridement - necrotising faciitis
Clinical Features
Pharyngitis
Most common
Red hankerchief - pharyngitis
Scarlet fever
Rheumatoid fever
M protein prevents phagocytosis - chef with M hat bats away cook
M protein mimics myosin causing self-antigens causing endo/peri/myocarditis - valvular hat
JONES criteria
Post-strep GN post pharyngitis and skin infx
Impetigo
Cellulitis
E
Impetigo
Erysipelas
Cellulitis
Pyomyositis
Necrotising fasciitis type II
Toxic shock syndrome
Haemophilus Influenzae
Epidemiology
25-80% healthy people carry non-capsulated organisms
2-10% carry capsulated strains
Clinical Features
Invasive
Generally Capsular type b
Meningitis
Meningitis helmet
Epiglottitis
screaming child with cherry red epiglottis
Bacteraemia with no clear focus
Septic arthritis
Pneumonia
Cellulitis
Non-Invasive
Non-capsulated
Otitis Media
Plugging his ears
Sinusits
IE COPD
Diagnosis
Fastidious gram (-) coccobacilli
PiNk
Coccobacilli - ball and rod
Culture
Reqiures X (haemin) and V (NADP) factors
5c factor 5
Factor 10
Grows on chocolate agar in CO2 enriched conditions
Capsule detection
6 antigen types a-f
Treatment
3GC for life-threatening
Ceftiaxone
3 axes
Ceftiaxone
Other
Amoxicillin
Co-amoxiclav
Clarithromycin
Prevention
Vaccine
Vaccine needle for type B
Conjugated to DIP
Chemoprophylaxis rifampicin
Close contact of infected knights
Rifampicin rifle
Virulence Factors
Polysaccharide capsule
Invasion
Type B capule
Bee
Fimbriae
Attachment to epithelial cells
IgA protease
Colonisation
Outer membrane proteins
Invasions
