Upper Respiratory Tract Infections (URIs) PDF

Upper respiratory tract infections (URIs) Dr. Denice Bay [email protected] 204-894-9160 Sept. 3, 2024 PHMD 1010 Medical Microbiology & Infectious Diseases We will use ANONYMOUS multiple choice polling questions durin...

Upper respiratory tract infections (URIs) Dr. Denice Bay [email protected] 204-894-9160 Sept. 3, 2024 PHMD 1010 Medical Microbiology & Infectious Diseases We will use ANONYMOUS multiple choice polling questions during this course 1. Please go the website “Socrative.com” 2. login as a STUDENT at: https://b.socrative.com/login/student/ 3. USE ROOM NUMBER: BAY6286 It may be easier to use this polling feature on your phones rather than your computer Learning objectives 1. Discriminate the epidemiology and risk factors for upper respiratory tract infections (URIs) 2. Define the medical terms associated with URIs 3. List the different types of URIs and describe their symptoms 4. Describe how URIs are diagnosed and the clinical tests that may be used to detect them 5. Describe the pathophysiology underlying URIs from the causative microorganisms to host symptoms 6. Explain the rationale for first- and second-line treatment strategies in managing URIs  Upper Respiratory Tract Infections (URIs) Most common patient physician/ emergency department infection Pre-COVID: 25 million visits/ yr (US) Rates increased 30% since 2022 URIs are a major driver of bacterial antibiotic resistance due to improper antibiotic prescriptions The 4 most common URIs are: 1. Acute otitis media 2. Acute rhinosinusitis 3. Acute pharyngitis 4. Acute laryngitis https://en.wikipedia.org/wiki/Respiratory_tract#/media/File:Illu_conducting_passages.svg  Otitis media (OM) Otitis media (latin: ‘oto’ = ear, ‘itis’ = inflammation, ‘media’ = middle) 1. Acute otitis media (AOM) 2. Otitis media with effusion (OME) → a.k.a. “glue ear” Hearing impairment, otorrhea but no inflammation of tympanic membrane 3. Chronic otitis media (COM) → long term middle ear inflammation causing damage often due to multidrug resistant infections >700 million cases of OM worldwide each year 50% cases in children 1% Low High Bacterial causes of AP are less likely → GABHS is the most common cause 10%-30% of persons of all ages with pharyngitis GABHS is the only commonly occurring form of AP for which antibiotic therapy is indicated AP signs and symptoms A sore throat of sudden onset that is mostly self-limited Fever and constitutional symptoms resolving in about 3 to 5 days (viral) Clinical signs and symptoms are similar for GABHS, viral causes, and non-streptococcal bacterial causes Bacterial AP Viral AP Swollen uvula White spots Red swollen tonsils Red swollen tonsils Throat redness Throat redness Grey furry tongue Signs Suggestive of Viral AP Conjunctivitis = Pink or red color in the white of the eye Coryza = acute inflammation of the mucous membrane of the nasal cavities Cough (*in GABHS often cough is absent) Viruses/ bacteria are usually spread by people coughing or sneezing. It can also be spread when a person touches a contaminated object and then touches their mouth or nose. GABHS AP Laboratory Tests Throat swab is taken and used for: Rapid antigen-detection test (RADT) → Point of care test that detects GABHS antigens (cannot detect viral AP) Microbiological culture (gold standard of bacterial or viral AP) Question 6 A B C D Which of the A) C) following images shows a viral AP B) D) infection? Viral AP Treatments prevent transmission to close contacts, and prevent acute rheumatic fever and suppurative complications Anti-pyretic (fever) medications analgesics, non-prescription lozenges and sprays containing menthol topical anesthetics for temporary relief of pain GABHS AP treatments GABHS has increasing resistance to penicillin treatments 10-day oral treatment with First-line antibiotics: Penicillin V, Penicillin G benzathine*, or Amoxicillin For penicillin allergies: cephalexin, cefadroxil, clindamycin, azithromycin**, clarithromycin *one dose only, intramuscular (IM), ** 5 day only treatment Acute laryngitis (AL) Acute infectious laryngitis is caused by inflammation of the larynx mild and self-limiting condition that typically lasts for 3 to 7 days If this condition lasts for over 3 weeks, then it is termed as chronic laryngitis most commonly caused by the viral organisms listed for other URIs (AVR, AVP) in pediatric AL also includes “croup” Inflammation (laryngotracheobronchitis) of the vocal caused by parainfluenza virus https://www.health.ha folds (and rvard.edu/a_to_z/laryn gitis-a-to-z cords) of larynx Signs and Symptoms voice changes (hoarseness or a "raspy" voice), aphonia (loss of voice), or a dry cough, pain swallowing, dryness of throat, malaise, and fever Risk factors: similar to AR/AP but also gastroesophageal reflux disease (GERD) is often a common co-morbidity Etiology Most commonly caused by viruses; the same viruses as AVR Bacterial causes are less common; same as ABR Diagnosis and Treatment Examination using laryngoscope (fiberoptic or mirror scope) Voice rest + similar supportive care as AVR unless bacterial etiology is suspected → then similar to AOM Treatment of uncontrolled GERD symptoms if present For croup add corticosteroid treatment  References Textbook: DiPiro et al. “Pharmacotherapy: A Pathophysiologic Approach”, 11th Edition Access Pharmacy http://accesspharmacy.mhmedical.com.uml.idm.oclc.org/boo k.aspx?bookid=2577 Chapter 126: Upper Respiratory Tract Infections Textbook: Goering et al. “Mim’s Medical Microbiology and Immunology”, 6th Edition https://www-clinicalkey- com.uml.idm.oclc.org/#!/browse/book/3-s2.0-C2015006511X Chapter (Upper respiratory tract infection in children) Practice exam question 1 A mother brings her 2-year old son to the clinic who has ear pain. The mother explains her child was treated a week ago with amoxicillin-clavulante and her child showed signs of a non-severe penicillin allergy. The child is rubbing their ears and has a low-grade fever. You perform an otoscopy and the tympanic membrane is inflamed, bulging but intact with otorrhea. What is the next recommended course of action? a) Treatment with over-the-counter antipyretic (fever) medications b) Treatment with first-line amoxicillin-clavulanate c) Treatment with first-line ceftriaxone d) Treatment with second-line cefdinir e) Referral for tympanocentesis Practice exam question 2 At the clinic a 10-year-old male presents with severe throat pain and dysphagia after 12 days of symptoms. His current temperature was 99.9°F (37.7°C). During the physical exam, he is found to have red, swollen tonsils but no swelling of the anterior cervical nodes or uvula. Conjunctivitis was observed during the exam. Based on the above information, what URI is likely indicated and what tests are recommended to confirm this diagnosis? a) Acute otitis media (AOM) and otoscopy b) Acute otitis media (AOM) and swab for culture c) Acute bacterial rhinosinusitis (ABR) and no test d) Acute viral pharyngitis (AVP) and throat swab for culture e) Acute bacterial pharyngitis (ABP) and rapid antigen- detection test (RADT) Practice exam question 3 During acute viral rhinosinusitis (AVR), which of the following nasal cavity symptoms explains nasal and facial congestion? a) Perforation of the sphenoid sinus b) Inflammation of the uvula and tonsils c) Obstruction of the sinus ostia d) Rupture of the otitis media e) Blockage of the eustachian tube Practice exam question 4 Which of the following infectious agents is most frequently identified from patients with acute viral pharyngitis (AVP)? a) Group A -hemolytic Streptococcus b) Respiratory syncytial virus c) Streptococcus pneumoniae d) Adenovirus e) Rhinovirus Practice exam question 5 A 52 year old female K-12 school teacher comes to the clinic presenting with a persistent headache, facial and sinus congestion, and cough after 14 days of worsening cold symptoms. The patient has a fever (38.0oC) and chills. The patient tested negative for COVID-19. In the last month, the patient recently had dental surgery and has significant halitosis. The patient’s medical history shows latex, nickel, and non-severe penicillin allergies. What is the ideal recommended treatment? a) Over the counter antipyretic and nasal decongestants with mucolytic b) 10 day high dose oral amoxicillin treatment c) 10 day high dose oral amoxicillin-clavulanate treatment d) 1-3 day intramuscular ceftriaxone treatment e) No treatment since this is a viral infection Practice exam question 6 Using the same information presented in question 5, what is the most likely cause of the 52 year old patient’s symptoms? a) Acute otitis media b) Acute laryngitis c) Acute bacterial rhinosinusitis d) Acute viral rhinosinusitis e) Acute viral pharyngitis Practice exam question 7 Which of the following patients are most at risk for acute otitis media? a) 1.5 year old male infant b) 5 year old female child c) 36 year old pregnant mother of two d) 51 year old male daycare worker e) 47 year old female waitress with GERD Practice exam question 8 Which of the following acute bacterial rhinosinusitis infections is most likely to be successfully treated with first-line amoxicillin-clavulanate therapy? a) Group A beta-hemolytic Streptococcus pyogenes b) Streptococcus pneumoniae c) Moraxella catarrhalis d) Non-typeable Haemophilus influenzae e) Haemophilus influenzae type B Practice exam question 9 Among the options listed in I-VI below, what type of image shown on the right, best describes the diagnosis of a 3 yr old toddler who has arrived to your clinic with an ear infection? I: Tympanocentesis IV: AOM II: Otoscopy V: OME III: Sinus puncture VI: COM a) I and V b) II and IV c) III and VI d) II and V e) III and IV Practice exam question 10 Which of the following is a sign or symptom that specifically distinguishes acute laryngitis from other URIs? a) Aphonia b) Sore throat c) Pain on swallowing d) Enlarged uvula e) Otalgia Practice exam question 11 Which of the following populations have the lowest risk for contracting acute bacterial rhinosinusitis infections caused by Streptococcus pneumoniae? a) Parents with school age children b) Adults with no children c) Military personnel d) High school students e) All groups listed as options are equally at risk Practice Exam Question Answers 1. C 11. B 2. D 3. C 4. E 5. D 6. C 7. A 8. B 9. B 10. A