upper respiratory tract infection urti ?
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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?