Upper Respiratory Tract Infection

URTI?

Upper Respiratory Tract Infection

URTI Common Cold / Influenza

Sore Throat

Acute Otitis Media

Sinusitis

Common Cold = Influenza?

Acute Pharyngitis

Pharyngotonsillitis

Tonsillophayngitis

Inflammation of the Pharynx and Tonsils

One of the most common pediatric infections.

Pathogens:

Pathogens: Viral: Rhino/Adeno/Corona/EBV/CMV HSV

Bacterial: Streptococcus spp. (GAS,GCS,GGS) Cor. Diphth, Gonococcus, Tularemia etc.

Mycoplasma.

Toxoplasmosis.

Pathogens:> 0-2 years Viral ++++ GAS+

> 5-above Viral +++ GAS++

(15-20%)

A Study in Makkah showed 40% GAS

and high resistance to Penicillin

Telmesani/Ghazi 2002

Presentation: Cough Sore throat Dysphagia Fever

O/E: Erythemetous Throat Enlarged tonsils Exudates Palatine Petechiae Ant. Cervical Lymphadenopathy

Ulceration&vesiculation(HSV/Coxack) Conjuncitvitis(adenovirus) Gray-white fibrinous pseudomem (diphtheriae) Macular rash/white tongue(GAS)

Complications: Peritonsillar abcess Internal jugular vein septic thrombophlebitis

(Lemierre Synd.) Lymphadenitis and abcess Nonsuppurative e.g. rheumatic fever

Diagnosis: Throat culture Rapid GAS antigens testing EBV (heterophil/serology) Cold agglutinations (mycoplasma)

TTT: Penicillin for GAS Macrolides (alternative/Mycoplasma)

Erytheromycin/Clarithomycin/

Azethromycin

TTT:ß Lactamase producing bacteria needs

Amoxicillin-clavulanate acid

or

2nd generation Cephalosporin's

e.g. Cefuraxim, Cefaclor

TTT: Aspiration or Derainage for abscess Proper management for any other

complications

Tonsillectomy

Tonsillectomy Recurrent tonsillitis

Peritonsillar Abscess (Quinsy)

Obstructive Sleep Apnea (Kissing Tonsils)

Adenoidectomy

Adenoidectomy Chronic Secretory Otitis Media

Upper Airway Obstruction (Snoring)

Ottits Media

Suppurative infection of the middle ear cavity

Epidemiology 6/12 to 2 y High risk group

Boys

Cleft Palate

Formula Feeding

Down

Eskimos

Winter- Low Socioeconomic

Pathogenesis

Pathogenesis Blocked estachian canal Micro-organism

Viral RSV CMV Rhino etc

Streptococcus Pneumonia

H.Influenzae

Moraxella Catarrhalis

Mycoplasma

Staphylococcus

Presentation Preceding URTI Fever, irritability, pulls ears V/D,bulging A/F Bulging, immobile injected T.M Loss of land marks Perforation

Normal ear drum and other one with central perforation

large central perforation in the right ear of a patient who had suffered a long standing ear infection.

Therapy Antibiotics ( Beta Lactamase)

Amoxycillin-Clavulenic acid

Cephalosporins

TMP-SMX

Macrolides Oral/nasal decongestants Tympanocentesis

PreventionS. Pneumoniae conjugated vaccine

(small effect)

Chronic Secretory Otitis Media

(Glue Ear)

Chronic Secretory Otitis Media

(Glue Ear) Secondary to recurrent O.M

Treatment Prevents conductive Deafness

-Long term Antibiotics

-Insertion of ventilation tubes (Grommets)

Sinusitis

Suppurative infection of the sinuses

Predisposition Common cold, Allergic rhinitis Nasotracheal/nasogastric intubations Cyanotic heart disease C.F, Ig disorders ,immotile cilia syndrome HIV, immune compromised patients

Sinus Formation At birth

Maxillary ,Ethmoid and Sphenoid are present.

At one year

Frontal sinus

Pneumotization comes later

Pathogenesis

Pathogenesis Mucociliary flow obstruction Bacterial growth S. peunoniae H.Influenzae (nontypable) M.Catarrhalis Anaerobic bacteria Strept/Staph Gm –ve (nosocomial) Aspergillus (nutropenic pt.)

Presentation Mucopurulent rhinorrhea. Night cough. Nasal speech. Facial swelling (pain,headache,tenderness). X-Ray/CT shows clouding/air fluid level.

Therapy Amoxicillin /Amox+clavulenic acid Cephalosporin(2nd generation)

Complications orbital cellulitis (read it) epidural/subdural empyema brain abscess dural sinus thrombosis Meningitis Pott’s puffy tumor

TTT of complications Drainage Broad spectrum antibiotics.

♂ 8/12 comes to your clinic with the problem of not growing well?

5 years boy comes to E/R with the problem of high fever and crying?