Upper Respiratory Tract Infections (URTIs)

1. Upper Respiratory Tract Infections (URTIs)

3. Rhinitis – The Common Cold Definition: Inflammation of nasal epithelium Symptoms • Rhinorrhea - Sore throat • Nasal congestion, itching - Fever/Chills rare • Sneezing - Nasal discharge Cause: Viruses are the leading cause – rhinovirus 40% of colds. Other common viruses: adenoviruses, coronaviruses, parainfluenza viruses, influenza viruses, respiratory syncytial virus. - Bacteria etiologies rare: Streptococcus pneumoniae, group A beta-hemolytic streptococci and Haemophilusinfluenzae. Duration: Symptoms peak on 2nd-4th day and last to a week. Most infectious in first 24 hrs. 25% may have persistent symptoms lasting weeks

4. Treatment: NOT ANTIBIOTICS • Bed rest and fluids • Symptomatic control: gargle salt water, inhale steam, OTCs (antihistamines, decongestants) Types • Allergic – hay fever • Chronic – sequel to repeated acute rhinitis attacks  Post nasal drip -mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose • Nasal polyps- protrusion of mucosa, may reach 3-4cm (recurrent rhinitis attacks)

5. Edematous mucosa: hyperplastic/cystic mucous glands, inflammatory cells, plasma cells with occasional neutrophils. Chronicity may lead to infection and ulceration.

6. Sinusitis Definition: Inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid. - common preceded by rhinitis - chronic most common Symptoms • Facial pressure/pain - symptoms of rhinitis • Fever - thick yellow/green mucous (acute) • Sore throat - decreased sense of taste/smell • Bad breath - thin clear mucous (chronic) Duration: Self limiting, lasts about 10 days. Chronic - symptoms last 3 months or longer

7. Cause:Most frequent bacteria for acute sinusitis– Streptococcus pneumoniae, Haemophilusinfluenzae, both 60% of cases, and Moraxellacatarrhalis. Chronic: Staphylococcus aureus and anaerobes Treatment – similar to rhinitis • Antibiotics can be used for bacterial etiologies

9. Pharyngitis Definition: an infection of the pharynx and its lymphoid tissues. Symptoms: • With/out tonsillarexudate - lack of cough • Anterior cervical adenopathy - Fever • erythematous posterior pharynx - vomiting, headache Duration • Resolves in a few days, use of antibiotics for bacterial causes shortens duration. Cause: Viral causes 90%- rhinovirus most common. Group A -hemolytic streptococci (GABHS) responsible for 50% bacterial cases. Diagnosis confirmed with throat swab.

10. Palatal Petechiae. Palatal petechiae and erythema of the tonsillar pillars in a patient with streptococcal pharyngitis. (Photo contributor: Kevin J. Knoop, MD, MS.) TonsilarExudate. White and yellow cryptic exudates are seen in this patient with rapid strep test proven streptococcal pharyngitis. (Photo contributor: Lawrence B. Stack, MD.)

11. Treatment • Antibiotic therapy is delayed until the diagnosis is established on the basis of a positive antigen test or culture. • The primary is to separate acute streptococcal pharyngitis from pharyngitis of other etiologies. • Strep infections have may have complications: rheumatic fever, glomerulonephritis, otitis media, mastoiditis, etc. • Treatment of viral pharyngitis is entirely symptom-based except in infection with influenza virus or HSV – antivirals

12. Epiglottitis Definition: is a rapidly moving cellulitis of the epiglottis and represents an airway emergency. - pre-vaccination era, most common in children - post-vaccination, more common in adults, although rare Symptoms • Fever - stridor (late sign) • Throat pain, swallowing pain - voice hoarseness • Difficulty breathing in supine • The 4 "D's" - dysphagia, dysphonia, drooling, and distress Causes: pre-vaccination, Haemophilusinfluenzaemost common in children. Adults : S pyogenes, S pneumoniae

13. Diagnosis • Lateral soft tissue X-ray • Children: if unstable or Dx is uncertain, should attend an operating room where laryngoscopy or endotracheal intubation can be accomplished. • All pediatric patients with epiglottitisshould be intubated for airway protection. Treatment: • The potential for rapid loss of airway patency is lower among adults, and most patients can have X-ray and emergency department flexible fiberopticlaryngoscopy without concern for rapid airway collapse • Antibiotics, corticosteriods, supplementary oxygen

14. the most useful diagnostic tool is a lateral neck x-ray, which classically demonstrates a swollen epiglottis (the "thumb print" sign)

15. Laryngitis Definition: Inflammation of the Larynx or voice box - most common cause of hoarseness Symptoms: • Fever - cough, sore throat • Swollen lymph nodes - nasal congestion • Reduced pitch, aphonia Duration: Symptoms peak 2-3 days, usually resolves in a week. Although voice changes may persist while vocal cords heal. Cause: Most due to viral infections. Common bacteria: M catarrhalis and H influenzae

16. Treatment • humidification and voice rest alone • NSAIDs for pain if required • Antibiotics are not recommended except when group A Streptococcus is cultured • Oral or intramuscular corticosteroids used by professional singers to speed recovery time.

18. Otitis Media Definition: Inflammation of the middle ear Symptoms • Otalgia (ear pain) - Pyrexia (fever) • Pre existing URI - Decreased hearing • Bulging, immobile tympanic membrane that is dull gray, yellow, or red in color • Otorrhea (discharge from ears) Cause: Most frequent-Streptococcus pneumoniae, thenHaemophilusinfluenzae Duration: Pain peaks within 2 or 3 days and resolves in 1-2 weeks, even without any specific treatment.

19. Treatment: • Antibiotic therapy: The first-choice oral antibiotic treatment is amoxicillin or erythromycin plus sulfonamidefor 10 days • Surgical drainage of the middle ear (myringotomy) is reserved for patients with severe otalgia or when complications of otitis (eg, mastoiditis, meningitis) have occurred. • Failure of this regimen to control infection is an indication for insertion of ventilating tubes.