Acute Upper Respiratory Tract Infectionsmb,bs

Acute Upper Respiratory Infections (AURI)

Introduction Acute respiratory infections (ARI) : infection of the respiratory tract of less than 3 weeks(21 days) duration. ARI = Acute upper respiratory infections (AURI)+ Acute lower respiratory infections (ALRI)

AURI Clinical Syndromes Types of Acute URI •Acute viral rhinitis •Acute otitis media • Acute tonsillo-pharyngitis • Others (Otitis externa, otitis media with effusion[OME], mastoiditis, rhinosinusitis)

Acute viral rhinitis (common cold, acute coryza, nasopharyngitis) Definition Aetiology: Rhinoviruses, parainfluenza, influenza, coronavirus, enterovirus and others. Occasionally Group A β- haemolytic Streptococcus.

Acute viral rhinitis (contd.) Clinical Features Incubation period:1-6 days Frequency (6 – 12 episodes/year) Duration of illness: usually 7 days Symptoms: sneezing, rhinorrhoea & blocked nostrils (classical triad), cough, headache, low grade fever Thin rhinorrhoea mucoid rhinorrhoea mucopurulent rhinorrhoea

Others: sorethroat, malaise, loss of appetite

Signs: swollen nasopharyngeal mucosa, cervical lymphadenitis

Complications Acute otitis media Sinusitis Tonsilitis Laryngotracheobronchitis Bronchiolitis Pneumonia

Diagnosis Clinical

Differential diagnoses Allergic rhinitis Flu Pertussis (catarrhal stage) Prodromal measles Nasal diphtheria Foreign body in the nostril

Treatment Symptomatic Nasal toiletting Antipyretic/analgesic if fever ≥ 38.50C If young infant – do not expose to cold, keep warm If coughing: a) Exclusively breastfed infant – liberal breast milk b) If not exclusively breastfed – simple home remedy for cough like weak tea +lime, honey licks, palm oil + sugar. Dextrometophan used if cough troublesome

Acute otitis media (AOM) It is common in infants because of high frequency of common colds and the anatomy of the infant’s eustachian tube, which is shorter, wider and straight.

Definition Acute inflammation of middle ear resulting in an effusion and associated with rapid onset of symptoms such as otalgia, fever, irritability, anorexia, or vomiting. Cf: Otitis media with effusion (OME) defined as an asymptomatic middle ear effusion that often follows AOM, but may have no such antecedent history.

Aetiology In neonates: Staphylococcus aureus, Pseudomonas spp., Escherichia coli and other Gram negative rods. In older children: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes and others

Clinical features Classical symptoms : otalgia, fever, otorrhoea(<14 days), hearing loss.

Non-specific symptoms: irritability, ear pulling, diarrhoea, vomiting.

Diagnosis Immobile red tympanic membrane, serous/purulent fluid in the middle ear, perforation of tympanic membrane.

Laboratory investigations Microscopy, culture and sensitivity (mcs) of ear discharges.

Sepsis screen in toxic neonates .

Complications Hearing loss Mastoiditis, Petrositis Labyrinthitis Meningitis Brain abscess

Treatment In neonates: parenteral cefuroxime plus amikacin Older children: oral amoxicillin (first line), co-amoxiclav(2nd line). Oral co-trimoxazole and i.m. procaine penicillin may be useful in areas of low resistance by the infecting agents. Supportive management : ear (aural) toiletting for otorrhoea, antipyretic/analgesic

Acute tonsillopharyngitis Definition Inflamed tonsils and pharynx. Types Exudative tonsillopharyngitis Diphtheritic tonsillopharyngitis Vesicular or ulcerative tonsillopharyngitis

Exudative tonsillopharyngitis Aetiology: Gp. A β-haemolytic Streptococcus Symptoms In older children: fever, sorethroat, dysphagia, headache and malaise. Young children: fever, nausea, vomiting and abdominal pain.

Exudative tonsillopharyngitis (contd.) Pyrexia T>380C, exudative tonsillar enlargement.

Other signs include: oedema, erythema, lymphoid hyperplasia of the pharynx, anterior cervical lymphadenitis.

Exudative tonsillopharyngitis (contd.) Investigations and Diagnosis Culture of throat swab FBC: polymorphonuclear leucocytosis; useful but not diagnostic. Blood culture in very ill patient. Rapid latex agglutination test on throat swabs (10 – 60 mins), specific but low sensitivity.

Exudative tonsillopharyngitis (contd.) Differential diagnosis  Pharyngeal diphtheria – grey membrane  Vesicular tonsillopharyngitis(herpagina) – vesicles or ulcers.  Infectious mononucleosis: aetiology is EB virus; features include epitrochlear lmphadenopathy, hepatosplenomegaly,and atypical lymphocytes in blood film.  Others: Viral pharyngitis( adenovirus,Herpes simplex, enterovirus, influenza, parainfluenza , measles etc.

Exudative tonsillopharyngitis (contd.) Complications Suppurative : acute otitis media, acute sinusitis, peritonsillar cellulitis and abscess, retropharyngeal abscess, suppurative cervical lymphadenitis.

Delayed non-suppurative: acute rheumatic fever and acute glomerulonephritis

Exudative tonsillopharyngitis (contd.) Treatment Antibiotics •Oral penicillin V 250mg qds x 10 days •Single i.m. injection of benzathine penicillin G (600,000 – 900,000 units for children ≥12 years) •Oral erythromycin(30 -50 mg/kg/day) 3 – 4 divided doses, in penicillin- allergic patients. •Oral amoxycillin •Oral azithromycin

Supportive • Analgesic/antipyretic: paracetamol/ibuprofen • Adequate fluid and caloric intake

Acute tonsillitis with vesicles (Herpagina)

Acute tonsillitis with membrane (Diphtheritic tonsillitis)

Chronic otitis media Definition Perforated, painless, discharging ear, almost always immobile tympanic membrane.

Investigations M/C/S of ear discharge X-ray of mastoid Audiometry Tympanometry

Complications Cholesteatoma Mastoiditis Central nervous system involvement - Otogenic tetanus - Meningitis - Facial nerve palsy - Lateral sinus thrombosis - Abscesses: brain, subdural and eustachian

Treatment Ear (aural) toiletting Flavine-in-spirit dressing Systemic antibiotics controversial