Acute URTI respiratory tract infections in Paed

Upper respiratory tract infections

1. ACUTE UPPER RESPIRATORY
TRACT INFECTION
DR NAKITTO SOPHIA
MMED PAEDIATRICS AND CHILD
HEALTH
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3. Upper Respiratory Tract
Infections
Common cold
Acute tonsillitis
Acute pharyngitis
Acute otitis media
Acute sinusitis
Acute laryngitis
Otitis externa
Mastoiditis
Acute apiglottis
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4. Common Cold
 Cause- para-influenza, RSV
S &S
Fatigue
Feeling cold, shuddering
Nose burning, obstruction, running
Sneezing
Fever
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5. Influenza (flu)
Causes epidemics and pandemics
Highly contagious
Viral infection.
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6. / 42 6
Causes
•80 % Influenzae virus
•Parainfluenza -2-9%
•Rhinovirus -3%
•Adenovirus - 4%

7. Influenza
Sudden onset after 12-24 hours incubation
General weakness and fatigue
Feeling cold, shivering, temp. Up to 39-40 C
No sore throat or running nose
Severe back, muscle and joint pain
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8. Treatment of common cold
Increased hydration
Nasal decongestants
Rarely anti- histamines
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9. Tonsilitis-pharyngitis- causes
Bacteria
S. pyogenes
C. diphteriae
N. gonorrhoeae
Viruses
Epstein-Barr virus
Adenovirus
Influenza A, B
Coxsackie A
Parainfluenzae
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10. Causative organisms
< 3 years
 100 % viral
5-15 years
15-30 % GABHS
Adult
10 % GABHS
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11. Transmission
Spreads by close contact and through
air
Spread more in crowded areas
(schools)
Most common among 5-15 age group
More frequent among lower socio-
economic classes
Incubation period 2-4 days
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12. Signs/symptoms

Sore throat
 Anterior cervical LAP
 Fever > 38 C
 Difficulty in swallowing
 Headache, fatigue
 Muscle pain
 Nausea, vomiting
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Tonsillar hyperemia /
exudates
Soft palate petechia
Absence of coughing
Absence of nose drip
Absence of hoarseness

13. Viral tonsillitis/pharyngitis
Having additional rhinitis,
hoarseness, conjunctivitis and
cough
Pharyngitis is accompanied by
conjunctivitis in adenovirus
infections
Oral vesicles, ulcers point to viruses
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14. Exudates
GABHS
EBV
Adenovirus
Primary HIV
infection
Candida
albicans
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15. Lymphadenopathy
GABHS
Epstein-Barr virus
Adenovirus
Human herpesvirus type 6
Tularemia
HIV infection
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16. Laboratory
Throat swab
Gold standard
Rapid antigen test
If negative need swab
ASO
May remain + for 1 year
WBC count
Peripheral smear/ 42 16

17. Tonsillitis due to Streptococci
Supurative complications
Abscess
Sinusitis, otitis, mastoiditis
Cavernous sinus thrombosis
Toxic shock syndrome
Cervical lymphadenitis
Septic arthritis, osteomyelitis
Recurrent tonsillitis/pharyngitis
Nonsupurative complications
Acute romatoid fever
Acute glomerulonephritis
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18. Aim of Treatment
Prevention of complications
Symptomatic improvement
Bacterial eradication
Prevention of contamination
Reducing unnecessary
antibiotic use
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19. Treatment
Many different antibiotics can
eradicate GABHS from pharynx-
penicillins first line- pen v , amoxyl,
amoxiclav, Benzathine penicilllin
Starting treatment within 9 days is
enough to prevent ARF
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20. Acute Otitis Media
AOM
AOM not responding to treatment:
Sustained clinical and autoscopy
findings despite 48-72 therapy
Recurrent Otitis media: 3 AOM
attacks within 6 moths or 4 attacks
within 1 year
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21. AOM causes
S. pneumoniae30%
H. İnfluenzae20%
M. Catarrhalis15%
S. pyogenes3%
S. aureus2%
No growth10-30%
Chronic otitis media: P. aeruginosa, S.
aureus, anaerobic bacteria
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22. Acute Otitis Media
85% of children up to 3 years
experience at least one,
50% of children up to 3 years
experience at least two attacks
AOM is usually self-limited. Rarely
benefits from antibiotics.
81 % undergo spontaneus resolution.
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23. Signs and Symptoms
Symptoms
Autalgia
Ear draining
Hearing loss
Fever
Fatigue
Irritability
Tinnitus,
vertigo
Otoscopic findings
Tympanic membrane
erythema
Inflammation
Bulging
Effusion
Hearing loss
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24. Antibiotics
First choice
Amoxicilline 40 mg/kg/day, 3 doses
Trimet./Sulfamethoxazole8mg TM/40mg SMX/kg 2 dose
Second choice
Amoxicilline/clavulanate45 mg/kg/day, 2 doses
Erythromycin 40-50 mg/kg/day, 3 doses
Reurrent AOM prophylaxis
Sulfisoxazole 75 mg/kg/day, single dose 3-6
mo
Amoxicilline 20 mg/kg/day, single dose 3-6
mo
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25. Acute Rhinitis / Sinusitis
Acute sinusitis
Str. pneumoniae
%41
H. influenzae %35
M. catarrhalis %8
Others %16
Strep. pyogenes
S. aureus
Rhinovirus
Parainfluenzae
Chronic sinusitis
Anaerobes:
Bactroides, Fusobacterium
S. aureus
Strep. pyogenes
Str. pneumoniae
Gram neg. bacteria
Fungi
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26. Acute Sinusitis
Paranasal sinuses:
Frontal
Ethmoid
Maxillary
Sphenoid
Most common during childhood
Maxillary
Ethmoid
After age 10
Frontal
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27. / 42 27

28. Predisposition to Sinusitis
Anatomical: septal deviation,
Mukociliary functions: cystic fibrosis, immotile
cilia synd.
Systemic disease, immune deficiency.: DM, AIDS,
CRF
Allergy: Nasal poliposis, asthma
Neoplasia
Environmental: smoking, air pollution, trauma...
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29. Acute Rhinosinusitis
Most important: Headache and postnasal drip
Face congestion
Fever, fatigue, headache increased by leaning
forward
Nose obstruction
Nose dripping
Purulent secretions (rhinoscopy)
Sensitivity over the sinuses
Halitosis
In young children-worsening symptoms of
runny nose, > 10 days usually with fever and
nasal congestion
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30. Acute rhinosinusitis
Rhinitis
Increased symptoms after 5 days
Symptoms lasting > 10 days
Decreasing viral symptoms, nasal
secretion becoming more purulent
are indicative for acute rhinosinusitis
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31. Diagnosis
Direct x-ray
Diffuse opacification
Mucosal thickening >4 mm
air-fluid level
Sinus aspiration
Rarely performed
Nasal endoscopy
Tomography
More sensitive compared with
direct x-ray
Indicated before surgery
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32. Treatment
Ampirical
Specific microbiologic diagnosis
difficult- Amoxicillin, amoxiclav,
azithromycin- for 10- 14 days
Primary pathogens
S. pneumoniae
H. influenzae
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33. Supportive Therapy
Decongestants
Short duration 3-5 days
Antihistamines
If allergy
Normal saline
Local steroids
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