upper respiratory tract infections dr. meenakshi aggarwal md emory family medicine
TRANSCRIPT
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Upper Respiratory Tract Infections
Dr. Meenakshi Aggarwal MD Emory Family Medicine
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Definition
Inflammation of the respiratory mucosa from the nose to the lower respiratory tree, not including the alveoli.
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Objectives
List the various categories of upper respiratory tract infectionsObtain a pertinent history in a patient with a suspected URI.Perform a targeted and thorough physical examination to confirm the diagnosis of URI.Perform and interpret selected tests to diagnose URIManage and treat uncomplicated URI’s.
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Categories
Acute Rhinosinusitis Acute Pharyngitis Acute Bronchitis
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Differential Diagnosis
Influenza Pneumonia Tuberculosis Asthma
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Anatomy of Sinuses
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Acute Rhinosinusitis (Viral) Common Symptoms: Nasal discharge, nasal congestion, facial pressure, cough, fever, muscle aches, joint pains, sore throat with hoarseness.
Symptoms resolve in 10-14 days
Common in fall, winter and spring.
Treatment: Symptomatic
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Acute Bacterial Sinusitis
Causative agents are usually the normal inhabitants of the respiratory tract.
Common agents: Streptococcus pneumoniae Nontypeable Haemophilus
Influenzae Moraxella Catarrhalis
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Signs and Symptoms
Feeling of fullness and pressure over the involved sinuses, nasal congestion and purulent nasal discharge. Other associated symptoms: Sore throat, malaise, low grade fever, headache, toothache, cough > 1 week duration. Symptoms may last for more than 10-14 days.
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Diagnosis
Based on clinical signs and symptoms Physical Exam: Palpate over the sinuses, look for structural abnormalities like DNS. X-ray sinuses: not usually needed but may show cloudiness and air fluid levels Limited coronal CT are more sensitive to inflammatory changes and bone destruction
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Ethmoid Sinusitis
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Coronal computed tomographic scan showing ethmoidal polyps. Ethmoid opacity is total as a result of nasal polyps, with a secondary fluid level in the left maxillary antrum.
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Treatment About 2/3rd of patients will improve without treatment in 2 weeks.
Antibiotics: Reserved for patients who have symptoms for more than 10 days or who experience worsening symptoms.
OTC decongestant nasal sprays should be discouraged for use more than 5 days
Supportive therapy: Humidification, analgesics, antihistaminics
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a) Amoxicillin (500mg TID) OR b) TMP/SMX ( one DS for 10 days).
c) Alternative antibiotics: High dose amoxi/clavunate, Flouroquinolones, macrolides
Antibiotics
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Acute Pharyngitis
Fewer than 25% of patients with sore throat have true pharyngitis. Primarily seen in 5-18 years old. Common in adult women.
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EtiologyA) Viral: Most common. Rhinovirus (most common). Symptoms usually last for 3-5 days.
B) Bacterial: Group A beta hemolytic streptococcus (GABHS).
Early detection can prevent complications like
acute rheumatic fever and post streptococcal GN.
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Signs and Symptoms
Absence of Cough Fever Sore throat Malaise Rhinorrhoea Classic triad of GABHS: High fever, tonsillar exhudates and ant. cervical lymphadenopathy.
NO COUGH
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Diagnosis
Physical Exam: Tonsillar exhudates, anterior cervical LAD Rapid strep: Throat swab. Sensitivity of 80% and specificity of 95%.
Throat Cultures: Not required usually.
Needed only when suspicion is high and rapid strep is negative.
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Exhudates
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Management
A) Symptomatic: Saline gargles, analgesics, cool-mist humidification and throat lozenges.
B) Antibiotics: a) Benzathine Pn-G 1.2 million units IM x 1OR Pn V orally for 10 days b) For Pn allergic pts: Erythromycin 500mg QID x 10 days OR Azithro 500 mg Qdaily x 3 days.
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Acute Bronchitis
Inflammation of the bronchial respiratory mucosa leading to productive cough.
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Acute Bronchitis
Etiology: A)Viral B) Bacterial (Bordetella
pertussis, Mycoplasma pneumoniae, and Chlamydia pneumoniae)
Diagnosis: Clinical
S/S: Productive cough, rarely fever or tachypnea.
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Treatment
A) Symptomatic
B) If cough persists for more than 10 days:
Azithro x 5 days OR
Clarithro x 7 days
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Non specific URI’sCommon ColdEtiology: Rhinovirus
Adenovirus RSV Parainfluenza EnterovirusesDiagnosis: ClinicalTreatment: Adequate fluid intake, rest,
humidified air, and over-the-counter analgesics and antipyretics.
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Influenza
Etiology: Influenza A & BSymptoms: Fever, myalgias, headache, rhinitis, malaise, nonproductive cough, sore throatDiagnosis: Influenza A &B antigen testingTreatment: Supportive care, oseltamivir, amantidine
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Questions?