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The Vast Majority of These Illnesses, of Which Is by Far The Most Common, Are

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9 views17 pages

The Vast Majority of These Illnesses, of Which Is by Far The Most Common, Are

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mc22110521
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4th : Lecture:

Upper Respiratory Tract Infections (URTI)

The vast majority of these illnesses, of which acute coryza


(common cold) is by far the most common, are :
 caused by viruses
 Immunity is short-lived & virus-specific

Other viral infections :


 Influnzea
 acute laryngitis
 acute laryngo tracheo bronchitis.

Bacterial infection :
 epiglottitis.
upper respiratory tract infections

Most patients with URTI :


 recover rapidly & specific investigation is indicated only in more

severe illness ?.
 Viruses can be isolated from:

 exfoliated cells collected on throat swabs


 retrospectively by serological tests.
 fluorescent antibody technique.
 Throat swabs if streptococcal pharyngitis
 Blood picture: identify infectious mononucleosis, in CBP

 Radiographic may be required if an underlying chronic infection


involving the sinuses is suspected.
common cold (acute coryza)

 highly infectious illness


 causes a mild systemic upset & prominent nasal symptoms
 It is due to infection by a wide range of respiratory viruses, of which:
rhinoviruses, coronaviruses & adenoviruses.

 Infectivity from close personal contact in early stages


 spread is facilitated by overcrowding and poor ventilation.
 100 different antigenic strains of rhinovirus, (difficult to confer protection).
 On average, individuals suffer 2-3 colds/year
 incidence lessens with age, ( accumulating immunity ).
Clinical features :

 Tiredness
 Slight pyrexia, malaise
 sore nose & (sore throat) if involve pharynx.
 Sneezing & profuse, watery nasal discharge are followed by thick
mucopurulent secretions which may persist for up to a week.
 Horse voice if (larynx) involve
 If complicated by a tracheitis or bronchitis, chest tightness & wheeze
 Secondary bacterial infection occurs only in a minority of cases
Complications
 Sinusitis.
 LRTI (bronchitis/pneumonia).
 otitis media, Hearing impairment

Managements :
 Most do not require treatment.
 Analgesics & antipyretics for systemic symptoms.
 Nasal decongestant in some cases.
 Antibiotics not necessary in uncomplicated coryza.
Acute laryngitis
 Often a complication of acute coryza.
Dry sore throat, Hoarse voice or loss of voice. Attempts to speak
cause pain.
 Initially, painful & unproductive cough.

 Stridor in children (croup) because of inflammatory oedema leading

to partial obstruction of a small larynx


Complications rare, MAY include:
Chronic laryngitis. tracheitis, bronchitis, pneumonia
Treatments:
 Rest voice.

 Analgesics for relief of discomfort and pyrexia.

 Steam inhalations may be of value

 Antibiotics not necessary in simple acute laryngitis


Influenza

Influenza is an acute systemic viral infection that primarily


affects the respiratory tract; it carries a significant mortality.

It belongs to the orthomyxo virus group & exists in two main


forms, A and B.

Influenza B : localized outbreaks of milder nature

influenza A : world-wide pandemics, new antigenic


variants at irregular intervals.
Epidemeology

 The most serious influenza pandemic occurred in:


 1918, more than 20 million deaths worldwide.

 1957, a major shift in the antigenic make-up of the virus led to the

appearance of influenza A2 type H2N2, which caused a world-wide


pandemic.
 1968 further pandemic occurred owing to the emergence of Hong

Kong influenza type H3N2,


 A further pandemic is likely in the next few years.

 Recent concerns have focused on the H5N1 strain of influenza A

which was previously confined to birds but can be contracted by


humans who are in close contact with infected poultry.
Pandemic of influenza
Clinical features
The incubation period: usually 1–3 days.
 The illness starts abruptly with a fever, shivering and generalized aching in the
limbs, severe headache, soreness of the throat, dry cough that can persist for several
weeks.
 Diarrhoea occurs in 70% of cases of H5N1.
 prolonged period of debility and depression

:Complications
 Secondary bacterial infection: Strep.pneumoniae , H. influenzae

 Secondary pneumonia caused by Staph. Aureus is rarer, but more seriousa


mortality of up to 20%.

 Post infectious encephalomyelitis rarely occurs


Diagnosis and treatment

Laboratory diagnosis is not usually necessary, but a definitive


diagnosis can be established by demonstrating :

 a fourfold increase in the complement-fixing antibody


 haemagglutinin antibody measured at onset and after 1–2 weeks
 by demonstrating the virus in throat or nasal secretions.
Treatment
 bed rest & paracetamol
 antibiotics to prevent secondary infection in those with: chronic
bronchitis, cardiac& renal disease.

 Neuraminidase inhibitors :may help to shorten the duration of


symptoms, if given within 48 hours .
The cost–benefit remains unproven but currently recommended in
the UK for patients with :
 suspected influenza over the age of 65 &

 ‘at-risk’ adults, (to reduce admissions to hospital )


Management and prevention
 bed rest & paracetamol,
 antibiotics to prevent secondary infection in those with: chronic

bronchitis, cardiac& renal disease


 Administration of neuraminidase inhibitor,

oral oseltamivir (75 mg twice daily) or


inhaled zanamivir (10 mg twice daily) for 5 days,
can reduce the severity of symptoms if started within 48 hours of
onset

 prophylaxis in high risk individuals during the ‘flu' season.


 Resistance can emerge to all of these agents and so updated local

advice should be followed


Prophylaxis
Protection by vaccines is effective;
 in up to70% of people, but
 only lasts for about a year.

Routine vaccination is recommended for:


 over 65 years of age
 younger people with chronic heart disease

 Chronic lung disease (including asthma)

 chronic kidney disease

 diabetes mellitus

 those who are immunosuppressed

 During pandemics: in key hospital and health service personnel


Acute laryngo-tracheobronchitis (croup)*

 Initial symptoms like common cold.


 Sudden paroxysms of cough accompanied by stridor &breathlessness.

 Contraction of accessory muscles and indrawing of intercostal spaces.

 Cyanosis and asphyxia in small children, if appropriate treatment not given .

Complications:
 Asphyxia, Death.

 Super infection with bacteria, especially Strepts, pneumoniae &Staphy. aureus

Viscid secretions may occlude bronchi.


Treatments:
 Inhalations of steam and humidified air/high concentrations of oxygen.

 Endotracheal intubation or tracheostomy to relieve laryngeal obstruction & allow

clearing of bronchial secretions


 intravenous antibiotic therapy for seriously ill patients.

 Maintain adequate hydration


Acute epiglottitis
 Fever and sore throat, rapidly leading to stridor because of swelling of epiglottis
and surrounding structures ( infection with Haemophilus influenzae).

 Stridor and cough in absence of much hoarseness may distinguish acute epiglottitis
from other causes of stridor?

 Death from asphyxia which may be precipitated by attempts to examine the throat
 avoid using a tongue depressor or any instrument unless facilities for endotracheal
intubation or tracheostomy are immediately available ?

R/: Intravenous antibiotic therapy essential.


Other measures as for acute laryngo tracheo bronchitis
Acute bronchitis
 Often follows acute coryza.

 Initially irritating unproductive cough, retrosternal discomfort of

tracheitis.
 Chest tightness, wheeze and breathlessness when bronchi become

involved.
tracheitis causes pain on coughing.
 Sputum is initially scanty or mucoid.

 After a day or so, sputum becomes mucopurulent, more copious &

often blood-stained.
 Acute bronchial infection ,may be associated with a pyrexia of 38-

39°C &a neutrophil leucocytosis.


 Spontaneous recovery occurs over a few days

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