Upper Respiratory Tract Infection PDF 2024

UPPER RESPIRATORY TRACT INFECTION PROF. DR.REDHA 2024 UPPER RESPIRATORY TRACT INFECTIONS RECOVER RAPIDLY AND SPECIFIC INVESTIGATION IS RARELY WARRANTED.  RESPIRATORY INFECTIONS CAUSED BY VIRUSES Clinical syndrome Usual cause (other causes in parentheses) Ep...

UPPER RESPIRATORY TRACT INFECTION PROF. DR.REDHA 2024 UPPER RESPIRATORY TRACT INFECTIONS RECOVER RAPIDLY AND SPECIFIC INVESTIGATION IS RARELY WARRANTED.  RESPIRATORY INFECTIONS CAUSED BY VIRUSES Clinical syndrome Usual cause (other causes in parentheses) Epidemic influenza Influenza A and B 'Influenza-like' illness Adenoviruses, rhinoviruses (enteroviruses) Pharyngitis Adenoviruses (enteroviruses, parainfluenza viruses, influenza A and B in partially immune) Common cold Rhinoviruses (coronaviruses, enteroviruses, adenoviruses, respiratory syncytial virus) (coryza) 'Feverish' cold Rhinoviruses, enteroviruses (influenza A and B, parainfluenza viruses, respiratory syncytial virus) Croup Parainfluenza 1, 2, 3 (rhinoviruses, enteroviruses) Bronchitis Rhinoviruses, adenoviruses (influenza A and B) Bronchiolitis Respiratory syncytial virus (parainfluenza 3) Pneumonia Influenza A and B, chickenpox (respiratory syncytial virus, parainfluenza, measles and adenoviruses)  COMMON UPPER RESPIRATORY TRACT INFECTIONS ACUTE CORYZA (COMMON COLD) CLINICAL FEATURES: RAPID ONSET. SNEEZING. SORE THROAT. WATERY NASAL DISCHARGE. COUGH (SIMILAR FEATURES IN NASAL ALLERGY). COMPLICATIONS: SINUSITIS, BRONCHITIS, PNEUMONIA. HEARING IMPAIRMENT, OTITIS MEDIA DUE TO BLOCKAGE.OF EUSTACHIAN TUBES MANAGEMENT: TREATMENT NOT USUALLY REQUIRED. PARACETAMOL 0.5-1 G 4-6- HOURLY. NASAL DECONGESTANT. ANTIBIOTICS NOT NECESSARY IF UNCOMPLICATED  ACUTE PHARYNGITIS CLINICAL FEATURES: MORE SEVERE SORE THROAT. HOARSE VOICE OR LOSS OF VOICE WITH PAIN ON SPEAKING. PAINFUL AND UNPRODUCTIVE COUGH. STRIDOR IN CHILDREN, CAUSED BY INFLAMMATORY OEDEMA LEADING TO PARTIAL OBSTRUCTION OF A SMALL LARYNX. COMPLICATIONS: RARE. CHRONIC LARYNGITIS, TRACHEITIS, BRONCHITIS OR PNEUMONIA. MANAGEMENT: REST VOICE. PARACETAMOL 0.5-1 G 4-6-HOURLY FOR RELIEF OF DISCOMFORT AND PYREXIA. STEAM INHALATIONS MAY HELP. ANTIBIOTICS NOT NECESSARY IF UNCOMPLICATED  SINUSITIS CLINICAL FEATURES: FEVER. SEVERE UNILATERAL PAIN OVER MAXILLARY OR OTHER SINUS. PURULENT NASAL DISCHARGE. COMMONLY VIRAL, BUT BACTERIAL (E.G. STREP. PNEUMONIAE, H. INFLUENZAE) LIKELY IF PERSISTS 7-10 DAYS COMPLICATIONS: CNS OR ORBITAL SPREAD OF INFECTION MANAGEMENT: STEAM INHALATION AND NASAL DECONGESTANTS. CO-AMOXICLAV IF BACTERIAL CAUSE SUSPECTED  ACUTE LARYNGO-TRACHEOBRONCHITIS (CROUP)* CLINICAL FEATURES: SUDDEN PAROXYSMS OF COUGH ACCOMPANIED BY STRIDOR AND BREATHLESSNESS. CONTRACTION OF ACCESSORY MUSCLES AND INDRAWING OF INTERCOSTAL SPACES. CYANOSIS AND ASPHYXIA IN SMALL CHILDREN COMPLICATIONS: DEATH FROM ASPHYXIA. SUPERINFECTION WITH BACTERIA, ESPECIALLY STREP. PNEUMONIAE AND STAPH. AUREUS. VISCID SECRETIONS MAY OCCLUDE BRONCHI MANAGEMENT: STEAM INHALATIONS AND HUMIDIFIED AIR/HIGH CONCENTRATIONS OF OXYGEN. ENDOTRACHEAL INTUBATION OR TRACHEOSTOMY MAY BE REQUIRED TO RELIEVE LARYNGEAL OBSTRUCTION AND ALLOW CLEARING OF BRONCHIAL SECRETIONS. INTRAVENOUS CO-AMOXICLAV OR ERYTHROMYCIN FOR SERIOUS ILLNESS. MAINTAIN ADEQUATE HYDRATION  ACUTE EPIGLOTTITIS CLINICAL FEATURES: MOSTLY AFFECTS YOUNG CHILDREN. FEVER AND SORE THROAT, PROGRESSING TO STRIDOR AND DYSPHAGIA CAUSED BY SWELLING OF EPIGLOTTIS AND SURROUNDING STRUCTURES. DUE TO H. INFLUENZAE TYPE B COMPLICATIONS: DEATH FROM ASPHYXIA, WHICH MAY BE PRECIPITATED BY ATTEMPTS TO EXAMINE THE THROAT-AVOID USING A TONGUE DEPRESSOR OR ANY INSTRUMENT UNLESS FACILITIES FOR ENDOTRACHEAL INTUBATION OR TRACHEOSTOMY ARE IMMEDIATELY AVAILABLE MANAGEMENT: I.V. CO-AMOXICLAV OR CHLORAMPHENICOL THERAPY ESSENTIAL. URGENT ENDOTRACHEAL INTUBATION OR TRACHEOSTOMY MAY BE NECESSARY. ROUTINE IMMUNISATION HAS REDUCED INCIDENCE IN THE UK  ACUTE BRONCHITIS AND TRACHEITIS CLINICAL FEATURES: OFTEN FOLLOWS ACUTE CORYZA. INITIAL DRY, PAINFUL COUGH WITH RETROSTERNAL DISCOMFORT IN TRACHEITIS.CHEST TIGHTNESS, WHEEZE AND BREATHLESSNESS IF BRONCHITIS DEVELOPS. SPUTUM IS INITIALLY SCANTY OR MUCOID, THEN BECOMES MUCOPURULENT, MORE COPIOUS AND, IN TRACHEITIS, OFTEN BLOOD-STAINED. ACUTE BRONCHITIS MAY BE ASSOCIATED WITH A PYREXIA OF 38-39°C. SPONTANEOUS RECOVERY OCCURS OVER A FEW DAYS. COMPLICATIONS: BRONCHOPNEUMONIA. EXACERBATION OF ASTHMA OR COPD WHICH, IF SEVERE, MAY RESULT IN TYPE II RESPIRATORY FAILURE MANAGEMENT: SPECIFIC TREATMENT RARELY NECESSARY IN PREVIOUSLY HEALTHY INDIVIDUALS. AMOXICILLIN 250 MG 8-HOURLY SHOULD BE GIVEN TO THOSE DEVELOPING BRONCHOPNEUMONIA. COUGH MAY BE EASED BY PHOLCODINE 5-10 MG 6-8-HOURLY. IN COPD AND ASTHMA, AGGRESSIVE TREATMENT OF EXACERBATIONS MAY BE REQUIRED  INFLUENZA CLINICAL FEATURES: RANGE FROM MILD TO RAPIDLY FATAL. SUDDEN ONSET OF PYREXIA WITH GENERALISED ACHING, HEADACHE, ANOREXIA, NAUSEA AND VOMITING, AND HARSH UNPRODUCTIVE COUGH. M OST RECOVER WITHIN 3-5 DAYS, BUT MAY BE FOLLOWED BY 'POST-VIRAL SYNDROME' WITH DEBILITY THAT PERSISTS FOR WEEKS. DURING EPIDEMICS, DIAGNOSIS IS USUALLY OBVIOUS. SPORADIC CASES DIAGNOSED BY VIRUS ISOLATION, FLUORESCENT ANTIBODY TECHNIQUES OR SEROLOGICAL TESTS FOR SPECIFIC ANTIBODIES COMPLICATIONS: TRACHEITIS, BRONCHITIS, BRONCHIOLITIS AND BRONCHOPNEUMONIA. SECONDARY BACTERIAL INVASION BY STREP. PNEUMONIAE, H. INFLUENZAE AND STAPH. AUREUS MAY OCCUR. RARELY, TOXIC CARDIOMYOPATHY (MAY CAUSE SUDDEN DEATH), ENCEPHALITIS, DEMYELINATING ENCEPHALOPATHY AND PERIPHERAL NEUROPATHY MANAGEMENT: o BED REST. o PARACETAMOL 0.5-1 G 4-6-HOURLY. o PHOLCODINE 5-10 MG 6-8-HOURLY FOR COUGH. o SPECIFIC TREATMENT FOR PNEUMONIA MAY BE NECESSARY. o ANTIVIRAL AGENTS (E.G. ZANAMIVIR) REDUCE THE RATE OF VIRAL REPLICATION AND MAY BE EFFECTIVE WHEN USED AS AN ADJUNCT TO VACCINATION. o ANTIVIRAL RESISTANCE IS A POTENTIAL PROBLEM