Upper Respiratory tract Infec1on. Gassem Gohal FAAP FRCPC

Transcription

1 Upper Respiratory tract Infec1on Gassem Gohal FAAP FRCPC

2 Anatomy

3 Contents Sinusitis Common Cold Otitis media pharyngitis Epiglottitis Croup Trachitis

4 Sinuses

5 Sinus development Born with ME ( Maxillary, Ethomoid) School at 5, S ( Sphenoid) Frontal is last one to develop.

6 Sinusi1s Inflamma1on of the mucosal lining Usually viral URI ( resolve) Bacterial ( suspect if >10 days of URI) URI, allergic rhini1s predisposing factor

7 Sinusi1s /Clinical feature Cough Nasal symptoms Fever Headache Facial pain and swelling Sore throat Halitosis

8 Sinusi1s Microbiology Streptococcus pneumoniae Haemophilus influenzae (nontypeable) Moraxella catarrhalis

9 Sinusi1s Complica1ons Periorbital orbital celluli1s ( please know the differences) Sep1c cavernous sinus thrombosis Meningi1s Osteomyeli1s of the frontal bone Epidural, subdural, or brain abscess THINK ABOUT PROXIMAL ORGANS

10 Diagnosis?

11 Sinusi1s Treatment An1microbial therapy The choice is based upon severity of illness Treatment failure

12 Common Cold Acute minor viral croyzal infec1on Does it need An1bio1cs?

13 Otitis media (AOM) is defined by the presence of - fluid in the middle ear plus - acute signs of illness - signs or symptoms of middle ear inflamma1on, including bulging

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15 OM / Risk factors Viral URI Family history, day care No Breas[eeding Exposure to tobacco smoke Pacifier use

16 OM / Microbiology Streptococcus pneumoniae Haemophilus influenzae (nontypeable) Moraxella catarrhalis

17 OM / Clinical findings Nonspecific: (fever, fussiness, headache, anorexia, vomiting, and diarrhea) Specific: Ear pain, otorrhea, bulging of the tympanic membrane hearing loss, vertigo, nystagmus, tinnitus,, facial paralysis. Diagnosis AOM requires evidence of middle ear inflammation (eg, bulging) and middle ear effusion

18 OM / complica1ons Conduc3ve hearing loss ves1bular, balance, and motor dysfunc1ons tympanic membrane perfora1on inflamma1on of the mastoid and/or mastoidi1s, petrosi1s; and labyrinthi1s Intracranial complica1ons are rare Meningi1s epidural abscess, brain abscess lateral sinus thrombosis, cavernous sinus thrombosis, subdural empyema, and caro1d artery thrombosis

19 OM / Treatment Treat ear pain (ibuprofen or acetaminophen) Ear drop should not be used in children with tympanic membrane perfora1on

20 OM / An1bio1cs Less than 2 y = treat More than 2 y, treat if toxic, or not normal host Amoxicillin- first line amoxicillin- clavulanate ( if Abx within 30 days or fail 1 st line ) Higher dose Why? What type of resistance in OM Bacteria

21 Inflamma1on of any structure of pharynx pharyngi1s

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25 pharyngi1s Mostly self limiting Concern of Group A Strep GAS Supparative complication - Peritonsilar,retrophyrngeal abscess ( know presentations ) Non Supparative complication - Acute Rheumatic fever - Acute Glomerulonephritis

26 Pharyngi1s Rx GAS Rx Do throat swab before - Prevent ARF if begin with 9 days - Prevention of AGN uncertain - Reduce supparative sequelae

27 Case study 12 year old presented with - sore throat and fever for 3 days. - feeling tired for the past week. - P/E :tired but not toxic. - T of 38 C. tonsils are enlarged and erythematous. posterior cervical LNs bilaterally, mildly tender, no other lymphadenopathy. spleen tip is palpable below the left costal margin. A throat swab is for group A streptococcal antigen is negative. CBC mild leukocytosis with the presence of atypical lymphocytes Diagnosis?

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29 Epiglo<3s Haemophilus influenzae type b (Hib) HiB vaccine reduce incidence

30 Video Diagnosis?

31 Laryngotracheobronchi1s (CROUP) Typically occurs in children three months to three years of age Parainfluenza virus type 1 ( most common) Clinical presenta1on of croup depends upon the degree of upper airway obstruc1on. Coryza, fever, hoarseness, barking cough, and stridor. Respiratory distress

32 CROUP / RX Approach to treatment depend on severity

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34 Trachei1s Invasive exuda1ve bacterial infec1on of the soc 1ssues of the trachea Staphylococcus aureus is the most common cause stridor, cough, and respiratory distress Airway management, Consider ET intuba1on Abx cover MRSA,GAS, Strp. pneumoniae, H influenzae, Moraxella catarrhalis (eg, vancomycin or clindamycin) plus a third- genera1on cephalosporin (eg, cefotaxime or cecriaxone)

35 Research project Prepare one page diagram approach upper respirtory tract obstruc1on proper approach to wheeze versus stridor

36 THANK YOU