Upper respiratory tract infections

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Questions and Answers

What is the first step in managing a patient with epiglottitis?

Provide steam inhalation

Hospitalize the patient (correct)

Administer antibiotics

Perform intubation or tracheostomy

What is a characteristic of chronic laryngitis?

Less severe symptoms without constitutional manifestations (correct)

Short duration

Severe symptoms

Constitutional manifestations

What is a common risk factor for chronic URIs?

Allergies

Immune compromise (correct)

Vaccination

Good mouth and nose hygiene

What is a type of chronic URI?

All of the above Signup and view all the answers

What is the purpose of corticosteroids in epiglottitis management?

To reduce edema and improve critical airways Signup and view all the answers

What type of bacteria is commonly involved in chronic URIs?

Streptococci and Hemophilus influenzae Signup and view all the answers

What is a common finding in the pharynx of a patient with diphtheria?

Pseudomembrane that bleeds when removed Signup and view all the answers

What is the main differential diagnosis of Upper Respiratory Tract Infections (URTIs)?

Upper respiratory allergy Signup and view all the answers

What is the purpose of sampling for culture in URTIs?

To localize the main part affected of the upper airways Signup and view all the answers

What is the treatment of choice for bacterial URTIs?

Broad spectrum antibiotics Signup and view all the answers

What is the significance of rise of acute phase reactants in URTIs?

Indicates the severity of the infection Signup and view all the answers

What is the purpose of sinoscopy and laryngoscopy in URTIs?

To visualize the upper airways Signup and view all the answers

What is the treatment of choice for viral URTIs?

Antiviral drugs Signup and view all the answers

What is the significance of skin rashes in URTIs?

Indicates an allergic reaction Signup and view all the answers

What is the most common cause of chronic pharyngitis and laryngitis?

Chronic sinusitis with post nasal drip Signup and view all the answers

What is the role of surgery in the treatment of upper respiratory tract infections?

For tonsillitis, sinusitis, and correction of deformities Signup and view all the answers

What is a common complication of chronic streptococcal pharyngitis?

Rheumatic fever Signup and view all the answers

What is the risk of chronic laryngitis with leukoplakia?

Malignant transformation Signup and view all the answers

What is the commonest cause of upper respiratory tract infections in children?

Viral infections Signup and view all the answers

What is the importance of antibiotics in the treatment of upper respiratory tract infections?

Must be given on culture and sensitivity basis Signup and view all the answers

What is the role of chronic tonsillitis in children?

It is a common cause of rheumatic heart disease Signup and view all the answers

What is a common complication of post nasal drip?

All of the above Signup and view all the answers

Study Notes

Chronic Upper Respiratory Tract Infections (URTIs)

Chronic sinustis with postnasal drip is the most common cause of chronic pharyngitis and laryngitis
Chronic tonsillitis is also common in children and responsible for rheumatic heart disease

Diagnosis and Management

Diagnosis is essentially clinical due to long duration of symptoms
Investigations can help in proper management
Antibiotics must be given on culture and sensitivity basis
Surgery plays an important role in treatment, including: • Tonsilectomy • Correction of deformities in sinuses • Resection of laryngeal nodes

Complications

Postnasal drip can cause recurrent pneumonia, lung abscess, or bronchiectasis
Chronic streptococcal pharyngitis can cause rheumatic fever
Obstructive sleep apnea and its sequelae
Mucosal metaplasia and dysplasia with malignant transformation, especially in the larynx
Acts as a septic focus causing poor general health
Cervical lymph node ++ with chronic abscess formation

Review Questions

Infections in upper airways include the following except: tracheitis
Upper respiratory tract infections are the commonest among human infections, have many risk factors, and can be caused by viruses, bacteria, and fungi
Acute infective epiglottitis is a disease of children, caused by viruses and hemophilus influenzae, and a medical emergency as it could be fatal
Chronic upper respiratory infections almost follow poorly treated acute infections

Examination

General: • Fever • Aches • Prostration • Skin rashes • Red wet eyes
Local: • Evidence of inflammation in nasal mucosa • Pharynx is red and swollen with white spots in follicular tonsillitis • Laryngeal redness and swollen vocal cords and/or epiglottis on indirect laryngoscopy
In diphtheria: • Marked swelling of neck lymph nodes • A pseudomembrane covers the pharynx, which bleeds when removed

Investigations

General lab: • CBC: leukocytosis with neutrophilia in bacterial and lymphocytosis in viral and chlamydial infections • Increase in IgM against causative virus, chlamydia, and mycoplasma • Rise of acute phase reactants: ESR, CRP, and ferritin
Swabs from nasal, pharyngeal, or laryngeal secretions: • Examined for gram stain, bacterial culture • Viral markers and PCR
Sinoscopy and laryngoscopy: • Direct inspection of mucosal inflammation in nasal sinuses and larynx • Direct sampling: secretions, swabs, biopsy

Differential Diagnosis

The main differential diagnosis is from upper respiratory allergy, which is characterized by: • Other allergic manifestations like asthma, urticaria, eczema, or conjunctivitis • Relation to allergens, e.g., cats, hay • Seasonal recurrence • High IgE or positive skin tests for specific allergens

Treatment

In bacterial infections: • Start with broad-spectrum antibiotics, like amoxycillin clavulinate, macrolides, or quinolones • If response is poor, give according to culture and sensitivity
In viral infections: • Antiviral drugs, e.g., isoprinosine, oseltamivir, famivir
In paranasal sinusitis: • Decongestants and antihistamines help clearance of secretions • Alkaline nasal wash helps in killing organisms and healing of mucosa
Epiglottitis: • Hospitalize the patient • Steam inhalation soothes the airways • Racemic epinephrine inhalation by a nebulizer • Oxygen must be ready • Corticosteroids (iv & inhalation) reduce edema and improve the critical airways • Intubation or tracheostomy if the patient suffocates (stridorous) • Antibiotics to cover hemophilus influenzae & streptococci (amoxycillin clavulinate, 3rd gen cephalosporins) • Antivirals in viral causes