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INFEKSI RESPIRATORIK AKUT(IRA) ATAS
Finny Fitry Yani
Respirologi Bagian IKA
RS M Djamil-FK Unand
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The upperrespiratory tractconsists of the partsoutside the chest cavitythe air passa!es of thenose" nasa# cavities"pharyn$" #aryn$" and
upper trachea
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%O&&ON %O'
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...COMMON COLD
n acte! sel" limited! mild pper respiratory
#iral illness
nee$ing! nasal congestion and disc%arge&r%inorr%ea'! sore t%roat! cog%! lo( grade"e#er! %eadac%e and malaise)
to *e distingis%ed "rom in+en$a!
p%aryngitis! acte *ronc%itis! acte *acterialsinsitis! allergic r%initis! and pertssis)
,
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irus
R%ino#irses
orona#irses
In+en$a #irses
Respiratory syncytial #irs
.arain+en$a #irses
Adeno#irses
/ntero#irses
Metapnemo#irs
Esti*ated annua# proportion of cases (percent
31-1
1-
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4
4
Un0no(n
ira# cause of the co**on co#d
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5iral transmission may occr #ia
– in%alation o" small particle aerosols!
–
deposition o" large particle droplets on nasalor conjncti#al mcosa!
– or direct trans"er #ia %and-to-%and contact
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...COMMON COLD
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Symptoms sally appear -2 days a"ter #iralinoclation
symptoms are not t%e reslt o" #iral destrction
o" t%e nasal mcosa)nasal epit%elim remains intact! alt%og% t%ere
an in+7 o" .M8s into t%e nasal s*mcosa anepit%elim
iral in"ection increases #asclar permea*ility it%e nasal s*mcosa! releasing al*min and0inins
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...COMMON COLD
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• olored nasal disc%arge
– ~ increased presence o" .M8s
– : increase in positi#e *acterial cltre
– presence o" .M8s &yello( or (%ite color' or o"
.M8 en$ymatic acti#ity &green color'
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...COMMON COLD
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• Symptomatic t%erapy
– may inclde antipyretics! saline nasal irrigation!
ade?ate %ydration! and t%e se o" a %midi=er – %ildren (it% reacti#e air(ay disease or ast%ma
s%old se *eta-agonist medications to relie#e
associated *ronc%ospasm)
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...COMMON COLD
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• Antipyretics
– Acetaminop%en &or i*pro"en! in c%ildren greate
t%an 6 mont%s o" age' may *e sed to alle#iate
"e#er dring t%e =rst "e( days
...COMMON COLD
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• Saline irrigation
– In in"ants! *l* sction (it% saline nose drops m
%elp to temporarily remo#e nasal secretions
– in t%e older c%ild! a saline nose spray may *e
sed)
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...COMMON COLD
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• Anti%istamines
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• Decongestants
– sympat%omimetic medications t%at case
#asoconstriction o" t%e nasal mcosa)
– a#aila*le in oral and topical "ormlations)
– psedoep%edrine l! and p%enylep%rine l! a
o7ymeta$oline)
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– In adlts decrease nasal congestion and increas
patency!
– no stdies demonstrating t%e e@ecti#eness o"
t%ese medications in c%ildren) – Side e@ects may inclde tac%ycardia! ele#ated
diastolic *lood pressre! and palpitations)
...COMMON COLD
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Becase o" t%e s*stantial ris0s o" t%ese prodcts(it%ot pro#en *ene=t
not recommended "or pediatric se)
It is concei#a*le t%at t%e older adolescent may*ene=t as an adlt (old "rom t%e se o" adecongestant! sc% as psedoep%edrine
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...COMMON COLD
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• Anti*iotic t%erapy
–
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%e se o" anti*iotics s%old *e reser#ed "or
clearly diagnosed secondary *acterialin"ections! inclding *acterial otitis media!sinsitis! and pnemonia
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• .R/5/8
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A''ER+I% R,INITIS
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)))allergic rhinitis
%e occrrence o" annoying nasal symptoms
inclding disc%arge! itc%ing! snee$ing!congestion! and pressre
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• Allergic r%initis
– associated (it% a symptom comple7 c%aracteri$
*y paro7ysms o" snee$ing! r%inorr%ea! nasal
o*strction! and itc%ing o" t%e eyes! nose! andpalate)
– It is also "re?ently associated (it% postnasal dri
cog%! irrita*ility! and "atige
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)))allergic rhinitis
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st *e distingis%ed "rom t%e ot%er "orms
r%initis
pisodic e7posre to in%aled allergens sc% a
cat sali#ary proteins! %orse dander! mrinerinary proteins! pollen! or %ose dst mite"eces may pro#o0e acte allergic symptoms
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)))allergic rhinitis
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•
•
•
•
Allergic! seasonal! and perennial
.erennial nonallergic
In"ectios
Miscellaneos categories! (%ic% incldecom*inations o" t%e a*o#e
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)))allergic rhinitis
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llergic r%initis is classi=ed as seasonal i" symptoms typicall
occr at a particlar time o" t%e year!
or perennial i" symptoms occr year rond)
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)))allergic rhinitis
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• perennial allergic r%initis
– more t%an 2 %ors per day and "or E > mos o" t%
year
– sally re+ects allergy to indoor allergens li0e d
mites! coc0roac%es! or animal dander
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)))allergic rhinitis
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•.ersistent G symptoms are present more t%an "or days per (ee0 an"or more t%an "or (ee0s
Mild G 8one o" t%e items listed *elo( "or moderate-se#ere are preseModerate-se#ere G Cne or more o" t%e "ollo(ing items is present
–
–
–
–
- Sleep distr*ance
- Impairment o" sc%ool or (or0 per"ormance
- Impairment o" daily acti#ities! leisre andHor sport acti#ities
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asal e7amination nasal mcosa "re?ently displays a pale
*lis% %e or pallor along (it% tr*inate edema! ¬ ani#ersal =nding'
e7i*le =*eroptic r%inoscopy &E years o" age' may "acilitat
e7amination
lear r%inorr%ea may *e #isi*le anteriorly or! (it% nasalo*strction! dripping do(n a posterior p%aryn7 t%at resemco**lestones
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)))allergic rhinitis
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• Allergen-speci=c testing
– properly per"ormed s0in testing may pro#ide an i
#i#o assessment o" *iologically rele#ant Ig/
anti*odies) It is t%e most con#enient and leaste7pensi#e screening met%od to detect allergicsensiti$ation) Ct%er tests are less se"l)
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)))allergic rhinitis
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/RJ/8 A5CIDA8/
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•
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• .ARMACCJI C.
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Intranasa# !#ucocorticoids
( IN+%s)opical I8Js are presently t%e most e@ecti#e singlmaintenance t%erapy and case "e( side e@ects att%e recommended doses)
particlarly e@ecti#e in t%e treatment o" nasalcongestion)
*eclomet%asone! +nisolide! *desonide! +ticaso
propionate! mometasone "roate! and +ticasone"roate)
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)))allergic rhinitis
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Second !eneration
antihista*ines
• inclde loratadine! cetiri$ine! and a$elastine
• Cnset o" action is (it%in %or "or most agents!
and pea0 serm le#els are attained in 2 - 3 %ors
• less impact on nasal congestion compared to
I8Js)
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)))allergic rhinitis
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%UTE -A%TERIA' SINUSITIS IN,I'REN
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,1
common dring URI!sally spontaneosly
resol#es
(%en t%ere issecondary *acterial
in"ection o" t%e sinses
...acute bacterial sinusitis
EFINITIONS
• Sinsitis is in+ammation o" t%e mcosal lining o" one or more o" t%e paranasal sinses
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...acute bacterial sinusitis
#iral in"ection associated (it% t%e common
cold is t%e most "re?ent etiology o" actesinsitis #iral r%inosinsitis)
ppr) 6 - 3 L o" #iral r%inosinsitis in c%ildre
is complicated *y ABS
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Uncomplicated #iral r%inosinsitis sally resol#e
(it%ot treatment in 9 - 1 days) Alt%og% ntreated ABS also may resol#e (it%ot
treatment
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anti*iotics %astens reco#ery and may decreaset%e ris0 "or or*ital and intracranial complications)
...acute bacterial sinusitis
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Distingis%ing *et(een acte #iralr%inosinsitis and ABS
• is important anti*iotics can *e sed
jdiciosly
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...acute bacterial sinusitis
acute bacterial sinusitis
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%#assi.cation
• Acte symptoms completely resol#e in 431 days
• S*acte symptoms completely resol#e in 31 and 4>
days
• Recrrent E3 episodes o" 431 days dration separatedinter#als o" 1 days (it%ot symptoms in a 6-mont%period! or E, sc% episodes in a 2-mont% periodN
indi#idal episodes respond *ris0ly to anti*iotic t%erapy
according to dration
and recrrence
...acute bacterial sinusitis
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%ronic sinsitis is de=ned *y episodes o"
in+ammation o" t%e paranasal sinses t%at last E>ays! dring (%ic% patients %a#e persistent
symptoms &cog%! r%inorr%ea! nasal o*strction')may *e related to nonin"ectios conditions sc% as
allergy! cystic =*rosis! gastroesop%ageal re+7! ore7posre to en#ironmental polltants
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...acute bacterial sinusitis
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Anatomic o*strction & septalde"ormitiesN cranio"acial anomaliesN
adenoidal %ypertrop%y'
Mcosal irritants &dry air! to*acco smo0e!c%lorinated (ater'
Sdden c%anges in atmosp%eric pressre&descent in an airplane'
esscommon
...acute bacterial sinusitis
Ris/ factors
• 5iral URI is t%e most important
• c%ildren (%o attend day care
• Allergic r%initis
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Streptococcs pnemoniae! aemop%ils in+en$a
&non-typea*le'! and Mora7ella catarr%alis are t%epredominant cases o" ABS
ecase o" its general e@ecti#eness! sa"ety! lo( cosand narro( spectrm! amo7icillin! (it% or (it%otcla#lanate! generally is considered to *e t%e =rstline agent "or t%e treatment o" ABS in c%ildren
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...acute bacterial sinusitis
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For c%ildren (it% ncomplicated ABS t%at is o" mild
to moderate se#erity
–
Amo7icillin &, to >1 mgH0g per day in t(o di#ided dosesor Amo7icillin-cla#lanate &, to >1 mgH0g per day o" t%amo7icillin component in t(o di#ided doses'
,;
Anti0iotics
...acute bacterial sinusitis
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For c%ildren (%o %a#e ncomplicated ABS o"
at least moderate se#erity – Amo7icillin-cla#lanate &;1 to >1 mgH0g per day
amo7icillin'
– e"dinir &, mgH0g per day in or 2 doses'! or
– e"ro7ime &31 mgH0g per day'! or
– e"podo7ime &1 mgH0g per day once daily'
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Anti0iotics
...acute bacterial sinusitis
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c%ildren (it% #omiting t%at precldes
administration o" oral anti*iotics – A single dose o" ce"tria7one &at 1 mgH0g per da
i)#) or i)m
–
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