Lecture 7 upper & lower respiratory tract symptoms.pdf

Upper and lower respiratory tract symptoms and infections By Nesrien Mohamed Shalabi Professor of Pulmonary Medicine Faculty of Medicine NMU  Objectives  Recognize symptoms of upper and lower respiratory system  The most common cause of upper and lowe...

Upper and lower respiratory tract symptoms and infections By Nesrien Mohamed Shalabi Professor of Pulmonary Medicine Faculty of Medicine NMU  Objectives  Recognize symptoms of upper and lower respiratory system  The most common cause of upper and lower respiratory tract infections.  Discuses the epidemiology and risk factors of upper and lower respiratory tract infection  Outline the management plane of upper and lower respiratory tract infection  Discuss preventive strategies for upper and lower respiratory tract infection.  Risk factors for URTI Close contact with children Medical disorder: asthma and allergic rhinitis Smoking Immunocompromised individuals including: DM, prolonged use of corticosteroids, transplantation and post splenectomy. Anatomical anomalies e.g. deviated nasal septum.  Symptoms of upper respiratory tract infections (URTI) 1) Cough 2) Sore throat 3) Running nose 4) Nasal congestion 5) Headache and facial pain 6) Low-grade fever 7) Facial pressure 8) Sneezing 9) Lethargy  Is it Cold or Flu Rhinitis and common cold Influenza (Flu) Etiology Rhinoviruses Influenza Onset Gradual Abrupt Fever Rare Usual Aches Slight Usual Chill Uncommon Common Fatigue, weakness Sometimes Usual Sneezing Common Sometimes Chest discomfort, cough Mild to moderate Common Stuffy nose Common Sometimes Sore throat Common Sometimes Headache Rare Common Treatment Symptomatic treatment Influenza vaccine Good health habit  Lower Respiratory Tract Infection 1-Bronchitis 2-Pneumonia Community acquired Hospital acquired  Acute Bronchitis Inflammation of bronchus, which occurs either as an extension of upper respiratory tract infection such as influenza or may be caused directly by bacterial agents. Causative organisms Bacterial: Streptococcal pneumonia, B.pertussis,Mycoplasma pneumoniae, and Chlamydophila pneumoniae Viral: Influenza viruses, Adenoviruses, Rhinoviruses and Coronaviruses  Clinical picture of acute bronchitis Symptoms Cough: start dry, later become productive sometimes streaked with blood. Fever: uncommon, may be present if infection is due to adeno or influenza virus or mycoplasma pneumonia. Retrosternal burning chest pain Wheeze and dyspnea Signs No signs There may be wheeze and coarse crackles  Treatment of acute bronchitis Symptomatic: - Cough syrup: antitussuve for dry cough, expectorants and mucolytic for productive cough. - Antipyretic. Antibiotics: should be used if sputum is mucopurulent: amoxicillin or a macrolid antibiotic e.g. erythromycin or clarithromycin. N.B: If cough lasts longer than 2 weeks, a chest radiograph should be done. Community acquired Pneumonia (CAP)  Definition  Is an inflammatory condition of the lung affecting primarily the alveoli.  Etiology  Bacterial as Streptococcus pneumoniae is the most common and Staph aureus pneumonia  Viral as Influenza, Parainfluenza virus, Respiratory syncytial virus and Corona viruses.  Atypical pneumonia caused by Legionella pneumophila, Mycoplasma pneumonia, Chlamydia and Coxiella burnetii (Q fever) Diagnosis of CAP  Clinical Features Fever, chills Cough and sputum production Dyspnea and pleuritic pain Tachypnea and tachycardia Hypoxemia Decreased breath sounds, Bronchial breath sounds Crackles on auscultation Dullness to percussion Egophony  Atypical Pneumonia Subacute onset and less severe than in other CAP Nonproductive cough CXR finding are worse than clinical finding Treatment by macrolide or tetracycline  Chest Radiography When pneumonia is suspected based on these clinical features, chest radiography is the standard for confirming the clinical diagnosis. Pneumococcal pneumonia: A. Chest radiograph demonstrates classical lobar infiltrate. (Courtesy of Dr. Pat Abbitt, University of Florida.) B. Sputum Gram stain shows S. pneumoniae. Note that the cocci come to a slight point, explaining the term “lancet-shaped.” Citation: Chapter 4 Pulmonary Infections, Southwick FS. Infectious Diseases: A Clinical Short Course, 4e; 1. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=2816&sectionid=240347212 Accessed: March 31, 2023 Copyright © 2023 McGraw-Hill Education. All rights reserved  Laboratory Tests ATS guideline notes that routine testing is not recommended Indication for laboratory testes – Cavitary infiltrates – Leukopenia – Active alcohol abuse – Chronic severe liver disease – Asplenia – Positive test result for pneumococcal urinary antigen – Pleural effusion – Severe obstructive/structural lung disease Management of CAP in adults  Decision making about: Site of care Empirical selection of antibiotics Timing of the first dose of antibiotics Timing of switch therapy (from parenteral to oral antibiotics) The duration of therapy  Site of care (severity) CRUB-65 (confusion, respiratory rate, Urea, blood pressure, age 65 years or older) – Confusion – Respiratory rate ≥ 30/ min – Urea >7mmol/L (20mg/dL) – Blood pressure SBP