Upper Respiratory Tract Infection URTI ?

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Upper Respiratory Tract InfectionURTI?
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Upper Respiratory Tract InfectionURTI

• Common Cold / Influenza
• Sore Throat
• Acute Otitis Media
• Sinusitis

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• Common Cold Influenza?

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Acute Pharyngitis

• Pharyngotonsillitis
• Tonsillophayngitis

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Inflammation of the Pharynx and Tonsils

• One of the most common pediatric infections.

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Pathogens

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Pathogens

• Viral
• Rhino/Adeno/Corona/EBV/CMV
• HSV
• Bacterial
• Streptococcus spp. (GAS,GCS,GGS)
• Cor. Diphth, Gonococcus, Tularemia etc.
• Mycoplasma.
• Toxoplasmosis.

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Pathogens

• 0-2 years Viral GAS
• 5-above Viral GAS
• (15-20)

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• A Study in Makkah showed 40 GAS
• and high resistance to Penicillin
• Telmesani/Ghazi 2002

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Presentation

• Cough
• Sore throat
• Dysphagia
• Fever

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O/E

• Erythemetous Throat
• Enlarged tonsils
• Exudates
• Palatine Petechiae
• Ant. Cervical Lymphadenopathy
• Ulcerationvesiculation(HSV/Coxack)
• Conjuncitvitis(adenovirus)
• Gray-white fibrinous pseudomem (diphtheriae)
• Macular rash/white tongue(GAS)

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Complications

• Peritonsillar abcess
• Internal jugular vein septic thrombophlebitis
  (Lemierre Synd.)
• Lymphadenitis and abcess
• Nonsuppurative e.g. rheumatic fever

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Diagnosis

• Throat culture
• Rapid GAS antigens testing
• EBV (heterophil/serology)
• Cold agglutinations (mycoplasma)

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TTT

• Penicillin for GAS
• Macrolides (alternative/Mycoplasma)
  Erytheromycin/Clarithomycin/
• Azethromycin

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TTT

• Lactamase producing bacteria needs
• Amoxicillin-clavulanate acid
• or
• 2nd generation Cephalosporin's
• e.g. Cefuraxim, Cefaclor

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TTT

• Aspiration or Derainage for abscess
• Proper management for any other complications

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Tonsillectomy
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Tonsillectomy

• Recurrent tonsillitis
• Peritonsillar Abscess (Quinsy)
• Obstructive Sleep Apnea (Kissing Tonsils)

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Adenoidectomy
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Adenoidectomy

• Chronic Secretory Otitis Media
• Upper Airway Obstruction (Snoring)

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Ottits Media
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• Suppurative infection of the middle ear cavity

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Epidemiology

• 6/12 to 2 y
• High risk group
• Boys
• Cleft Palate
• Formula Feeding
• Down
• Eskimos
• Winter- Low Socioeconomic

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Pathogenesis
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Pathogenesis

• Blocked estachian canal
• Micro-organism
• Viral RSV CMV Rhino etc
• Streptococcus Pneumonia
• H.Influenzae
• Moraxella Catarrhalis
• Mycoplasma
• Staphylococcus

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Presentation

• Preceding URTI
• Fever, irritability, pulls ears
• V/D,bulging A/F
• Bulging, immobile injected T.M
• Loss of land marks
• Perforation

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Normal ear drum and other one with central
perforation
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large central perforation in the right ear of a
patient who had suffered a long standing ear
infection.
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Therapy

• Antibiotics ( Beta Lactamase)
• Amoxycillin-Clavulenic acid
• Cephalosporins
• TMP-SMX
• Macrolides
• Oral/nasal decongestants
• Tympanocentesis

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Prevention

• S. Pneumoniae conjugated vaccine
• (small effect)

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Chronic Secretory Otitis Media (Glue Ear)
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Chronic Secretory Otitis Media (Glue Ear)

• Secondary to recurrent O.M
• Treatment Prevents conductive Deafness
• -Long term Antibiotics
• -Insertion of ventilation tubes (Grommets)

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Sinusitis

• Suppurative infection of the sinuses

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Predisposition

• Common cold, Allergic rhinitis
• Nasotracheal/nasogastric intubations
• Cyanotic heart disease
• C.F, Ig disorders ,immotile cilia syndrome
• HIV, immune compromised patients

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Sinus Formation

• At birth
• Maxillary ,Ethmoid and Sphenoid are present.
• At one year
• Frontal sinus
• Pneumotization comes later

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Pathogenesis
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Pathogenesis

• Mucociliary flow obstruction
• Bacterial growth
• S. peunoniae
• H.Influenzae (nontypable)
• M.Catarrhalis
• Anaerobic bacteria
• Strept/Staph
• Gm ve (nosocomial)
• Aspergillus (nutropenic pt.)

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Presentation

• Mucopurulent rhinorrhea.
• Night cough.
• Nasal speech.
• Facial swelling (pain,headache,tenderness).
• X-Ray/CT shows clouding/air fluid level.

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Therapy

• Amoxicillin /Amoxclavulenic acid
• Cephalosporin(2nd generation)

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Complications

• orbital cellulitis (read it)
• epidural/subdural empyema
• brain abscess
• dural sinus thrombosis
• Meningitis
• Potts puffy tumor

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TTT of complications

• Drainage
• Broad spectrum antibiotics.

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• 8/12 comes to your clinic with the problem of
  not growing well?

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• 5 years boy comes to E/R with the problem of
  high fever and crying?