The common cold

1. The common cold

2. The common cold • Viral illness that symptoms of rhinorrhea and nasal obstruction are prominent . • The most common pathogens are the rhinoviruses . • Coronaviruses and RSV are occasional . • Influenza , parainfluenza , Adenoviruse and Entroviruses are uncommon

3. Epidemiology • Young children have an average of 6-7 colds per year. • The incidence of illness higher in the daycare group in the first 3 yr of life • Colds occur year round. • Incidence is greater from the early fall until the late spring. • The highest incidence of rhinovirus infection occurs in the early fall and in the late spring .

4. pathogenesis • Viruses are spread by small-particle aerosols, large- particle aerosols ,and direct contact . • Direct contact is an efficient mechanism for RSV and rhinoviruses. • Infections with rhinoviruses and adenoviruses result in development of serotype-specific protective immunity. • Re-infection with parainfluenza viruses and RSV occurs and protective immunity to these pathogens dose not develop.

5. Clinical manifestation • The onset of symptoms that typically occurs 1-3 days after viral infection are : sore throat , nasal obstruction and rhinorrhea . and by the 2- 3 day of illness nasal symptoms predominate . • Cough is associated with approximately 30% of colds . • Influenza viruses , RSV ,and adenoviruses associated with fever and other constitutional symptoms . ( low – grad fever, sneezing )

6. Clinical manifestation • The usual cold persists about 1 wk ( 10% last 2 wk) • Increased nasal secretion is obvious . • Change in the color or consistency of the secretions is common and is not indicative of sinusitis or bacterial superinfection . • Persistent rhinorrhea following a cold suggests sinusitis or bacterial superinfection .

7. Condition may mimic common cold • Allergicrhinitis Prominent itching and sneezing and nasal eosinophilia • Foreign body Unilteral,foul-smelling dischargewith • Sinusitis Headache,facial pain,or periorbital edema persistence of rhinorrhea or cough for longer than 10-14 days

8. Condition may mimic common cold • Streptococcal nasopharyngitis Nasal dischar thatexcoriatesthe nares • Pertussis Onset of persistent or paroxysmal cough • Congenital syphilis Persistent Rhinorrhea (snuffles) with onset in the first 3 mo of life

9. Rhinorrhea Rhinorrhea is a common manifestation of : • infectious , allergic , mechanical condition .  Infectious rhinitis : mucopurulent discharge with PMN .  Allergic rhinitis : lack of fever ,eosinophils in discharge . ( allergic shiners , nasal polyps , pale edematous nasal mucosa ,transverse crease on the nasal bridge ) . Less common causes are : foreign body, choanal atresia vasomotor rhinitis , CSF fistula , diphtheria , tumor , congenital syphilis.

10. treatment • Symptomatic treatment for : Fever , Nasal obstruction, rhinorrhea, Sore throat, cough. • Antibacterial therapy is not benefit in the treatment of the common cold. • Antiviral treatment specific antiviral therapy is not currently available for rhinovirus. Ribavirin which is approved for treatment of RSV infections has no role in the treatment of the common cold .

11. treatment • Topical or oral adrenergic agents may be used as nasal decongestant • not approved <2yr . • prolonged use should be avoided to prevent of rhinitis medicamentosa. oral adrenergic agents are less effective than the topical and are associated with systemic effects ( hypertension , palpitation)

12. treatment • Rhinorrhea the first - generation antihistamines reduce rhinorrhea that related to the anticholinergic rather than the antihistaminic properties .( by 25- 30% ) • Sore throat is not severe but mild analgesics is occasionally indicated particulary if there is associated myalgia or headache. • Cough may be result of viruse- induced reactive airway disease (bronchodilator)

13. Treatment • Cough Cough suppression is generally not necessary . but in some patients is due to upper respiratory tract irritation and post nasal drip . (first generation antihystamin may be helpful ) • Vitamin c , guaifenesin , inhalation of warm , humidified air have all been found no more effctive than placebo. • Echinacea is a popular herbal treatment .

14. prevention • Chemoprophylaxis or immunoprophylaxis is generally not available for common cold . • Chemoprophylaxis or immunoprophylaxis against influenza may be useful. • Cold can prevented by interrupting the chain spread of virus .with good hand washing

15. Complications • The most common complication of a cold is otitis media ( 5-30%) Symptomatic treatment has no effect on the development of acute otitis media .or sinusitis • Exacerbation of asthma

16. Sinusitis is a relatively frequent complication (0.5 -2% in adult and 5-13% in children) • Rhinorrhea or daytime cough persists without improvement for 10-14 days • or if signs ( fever , facial pain , facial swelling) develop.

17. sinusitis • Suppurative infection of the paranasal sinuses. Complicates the common cold and allergic rhinitis . • The maxillary , ethmoid , and sphenoid sinuses present at birth . • The frontal sinus develops at 1 year of life . And may not appear at air-filled spaces until 10 years of age.

18. sinusitis increased incidence of sinusitis ; • Cyanotic heart disease • CF • immunoglobulin deficiency • HIV • nasoteracheal intubation • immotile cilia syndrome • dental infection • immunocompromised children following organ transplantation.

19. Etiology of sinusitis • Culture of the nasal mucosa is not helpful in identifying the responsible bacteria . • If necessary , anteral puncture for maxillary sinusitis is the diagnostic procedure of choice . • Obstruction to mucociliary flow predisposes to bacterial proliferation.

20. Etiology of sinusitis • The bacterial producing acute sinusitis are : Pneumococci , non typable H.influenzae M.catarrhalis , anaerobic bacteri and rarely streptococci and staphylococci. • Nasocomial sinusitis may occurs by: gram- negative bacteria ( klebsiella, pseudomonas , entrobacter)

21. Clinical manifestations of sinusitis • Persistent mucopurulent rhinorrhea . • cough (at night ) . • nasal stuffiness, nasal quality to the voice . • facial swelling , tenderness , pain . • headache.

22. diagnosis of sinusitis • CT reveals clouding , thickened mucosa , or an air- fluid level . • Sinus aspiration usually is not needed in uncomplicated sinusitis

23. treatment of sinusitis • Amoxicillin or amoxicillin/clavulanate is usually effective in uncomplicated sinusitis . • Complications should be treated with : drainage and if indicated broad-spectrum parentral antibiotics . • Long of treatment 14-21 days

24. complications • Orbital cellulitis . • Epidural or subdural empyema . • brain absecess . • dural sinus thrombosis . • osteomyelitis and meningitis . • sinusitis may also exacerbate bronchoconstriction in asthmatic patients

25. otitis media

26. آيا كودك مشكل گوش درد دارد؟ • آيا درد گوش وجود دارد؟ • آيا از گوش ترشح خارج ميشود؟ براي چه مدت؟ معاينه: گوش را از نظر خروج چرك نگاه كنيد. گوش را معاينه كنبد.

27. نشانه هاي عفونت حاد گوش: • خروج چرك كمتر از 14 روز • درد گوش وپرده گوش در معاينه قرمز است درمان: آنتي بيوتيك به مدت 10 روز توصيه به مادر كه چه زماني فوري برگردد دو روز بعد جهت پيگيري مراجعه كند.

28. otitis نشانه هاي عفونت مزمن خروج چرك ازگوش بيش از 14 روز درمان: • خروج چرك بيش از 6 هفته ارجاع در غير اينصورت توصيه به خشك كردن گوش • آنتي بيوتيك بمدت 14 روز • جهت پيگيري2 روز بعد مراجعه كند.

29. Otitis media • Suppurative infection of the middle ear cavity and is the most common between 6 months and 2years of age .  High –risk populations: • HIV. Cleft palate .Down syndrome . • more common in boys . • in patients of low socioeconomic status . • In formula – fed infants . • in the winter months. • Day care

30. Pathogenesis Otitis media • When the eustachian tube is blocked by: • local infection . • Pharyngitis. • Hypertrophied adenoids .

31. Pathogenesis otitis media • Air trapped in the middle ear is reabsorbed , creating negative pressure in this cavity , that permit reflux of bacteria . • This bacteria plus obstruction of the flow of secration from the middle ear and leads to middle ear effusion.

32. The most common bacterial pathogens are : pneumococci ,nontypable H. influenzae .M.catarrhalis . • and less frequently group A streptococci andhighly resistant S .pneumoniae

33. Clinical manifestation • Usually occur 1-7 days after nasopharyngitis . • Patients often Febrile( 30% -50% ) and , irritable , • Vomiting ,diarrhea ,bulging of funtanel ,vertigo ,tinnitus , and draining ear may be seen . • Otoscopic examination: Erythematous TM ,loss of identifiable landmarks . Perforation of TM also may occur and usually is associated with acute relief of pain .

34. treatment otitis media Oral antibiotics frequent used are : • amoxicillin , amoxicillin/clavulanate • trimethoprim/sufamethoxazole . • erythromycin /sulfisoxazole . • Oral cphalosporins(cefaclor ,cefuroxime , cefexim ) also been approved for otitis caused by: β-lactamase- producing organisms .

35. treatment otitis media • For Highly resistant pneumococci higher doses of amoxicillin/clavulanate or clindamycin or a single dose of parenteral ceftriaxone may be efficacious . • Tympanocentesis may be needed in patients: who are difficult to treat . or do not respond to therapy. • Decongestants or antihistamines are not effective alone or with antibiotics

36. pharyngitis

37. آيا كودك بالا تر از 2 سال گلو درد دارد؟ • آيا موقع غذا خوردن مشكل دارد؟ • سئوال كنيد: • آيا آبريزش از بيني دارد؟ • آيا كودك سرفه و عطسه ميكند؟ • آيا چشمهاي او قرمز است؟ • آياخشونت صدا دارد؟

38. آيا كودك بالا تر از 2 سال گلو درد دارد؟ • معاينه كنيد: • وجود پتشي ،اگزودا و قرمزي حلق • لنف آدنوپاتي گردني • درجه حرارت بدن

39. Pharyngitis

40. گلودرد درد استرپتوكوكي وجود تب ودو نشانه از نشانه هاي زير: • اگزودا در حلق • لنفادنوپاتي قدامي گردن • قرمزي لوزه ها ياپتشي روي كام

41. فارنژيت ويرال دو نشانه از نشانه هاي زير را داشته باشد: • آبريزش چشمها • قرمزي چشم سرفه • خشونت صدا • عطسه

42. Acute Pharyngitis • Etiology: • Bacterial- • Group A streptococcus • Group C streptococcus • Corynebacterium diphtheriae • Others (less often): • Mycoplasma pneumonia , spirochetes, Chlamydia pneumoniae.

43. Acute Pharyngitis(Bacterial) • Mycoplasma pneumoniae • Arcanobacterium haemolyticum • Francisella toleransis (gram – coccobacillus) • Chlamydia pneumoniae

44. Acute Pharyngitis • Viral >90% • Rhinovirus – common cold • Coronavirus – common cold • Adenovirus – pharyngoconjunctival fever;acute respiratory illness • Parainfluenza virus – common cold; croup • influenza virus – influenza • Coxsackievirus - herpangina • EBV, CMV – infectious mononucleosis • HIV

45. Acute Bacterial Pharyngitis • Group A beta-hemolytic streptococci (S. pyogenes) ,cocci gram+ • most common bacterial cause of pharyngitis • Uncommon<2-3 yr, peak in winter and spring ,spread to classmates • accounts for 15-30% of cases in children and 5-10% in adults.

46. Epidemiology of Streptococcal Pharyngitis • Spread by contact with respiratory secretions • Peaks in winter and spring • School age child (5-15 yr) • Patient no longer contagious after 24 hours of antibiotics

47. Pharyngitis: Streptococcal • Clinical Features • Fever, sore throat, headache • Pharyngeal/tonsillar inflammation (often exudates)* • Tender anterior cervical adenopathy* • Scarlatiniform rash • Absence of viral symptoms (rhinorrhea, cough, hoarseness)

48. Group A beta-hemolytic streptococci • Often rapid sore throat, fever, vomiting ,abdominal pains. • red pharynx, enlarged tonsil with exudate • Petechiae on the soft palate, • Anterior cervical lymphadenophaty ,tender • Scarlet fever DD: Viral phryngitis more gradual with rhinorrhea, cough and diarrhea

49. Viral phryngitis Gingivostomatitis (HSV-1) 1-5 years old,(9-36 mo) incubation 7 days Primary HSV more sever with: (high fever,drooling, fetid breath, vesicular lesion on the tonge ,gums ,lips and tender lymphadenopathy)

50. herpangina • Entroviral • Sudden onset high fever ,vomiting, disphagia ,conjunctivitis, drooling and sore throat • One or more small tender papule or pinpoint vesicular lesions with erythematous base (1-2 or 3-4 mm) on the soft palatea ,uvula ,tonge that over 3-4 days rupture and produce smalll ulcers