Upper respiratory tract infection (URTI)

Description

Paediatrics (Respiratory) Mind Map on Upper respiratory tract infection (URTI), created by v.djabatey on 12/12/2013.
v.djabatey
Mind Map by v.djabatey, updated more than 1 year ago
v.djabatey
Created by v.djabatey over 9 years ago
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Resource summary

Upper respiratory tract infection (URTI)
  1. account for 80% of all respiratory infections
    1. involve nose, throat, ears or sinuses only
      1. involves many conditions
        1. Coryza (the common cold)
          1. the commonest infection of childhood
            1. Features
              1. Nasal discharge
                1. mucopurulent
                  1. clear
                  2. Nasal blockage
                  3. Pathogens
                    1. viruses
                      1. commonest causative orgs
                        1. rhinoviruses
                          1. >100 different serotypes
                          2. coronaviruses
                            1. RSV
                          3. self-limiting
                            1. no specific curative treatment
                              1. paracetamol/ibuprofen
                                1. for fever & pain
                                2. Abx of no benefit
                                  1. common cold is viral in origin
                                    1. secondary bacterial infection is uncommon
                                3. Sore throat (pharyngitis)
                                  1. inflamed pharynx & soft palate
                                    1. enlarged & tender local lymph nodes
                                      1. Pathogens
                                        1. Viral
                                          1. usual cause
                                            1. respiratory viruses
                                              1. adenoviruses
                                                1. enteroviruses
                                                  1. rhinoviruses
                                                2. Bacteria
                                                  1. group A beta-haemolytic streptococcus
                                                    1. common in older children
                                                3. Tonsillitis
                                                  1. a form of pharyngitis
                                                    1. intense inflammation of the tonsils
                                                      1. often w/ purulent exudate
                                                    2. Pathogens
                                                      1. bacteria
                                                        1. group A beta-haemolytic streptococci
                                                          1. marked constitutional disturbance more common
                                                            1. headache
                                                              1. headache
                                                                1. apathy
                                                                  1. abdo pain
                                                                  2. white tonsillar exudate more commmon
                                                                    1. cervical lymphadenopathy more common
                                                                      1. cause 1/3rd of cases
                                                                      2. virus
                                                                        1. Epstein-Barr virus (EBV) [infectious mononucleosis]
                                                                          1. surface exudates said to be more purulent than bacterial
                                                                        2. clinically not possible to distinguish btw viral & bacterial tonsillitis
                                                                        3. Rx
                                                                          1. Abx
                                                                            1. penicillin or erythromycin (if pen allergic)
                                                                              1. 10 days
                                                                                1. to eradicate strep (thus prevent rheumatic fever)
                                                                                  1. no longer indicated in UK
                                                                                    1. rheumatic fever is rare
                                                                                2. avoid amoxicillin
                                                                                  1. can cause maculopapular rash if tonsillitis is due to EBV
                                                                                3. for severe cases
                                                                                  1. hospital admission
                                                                                    1. IV fluid admin
                                                                                      1. if unable to swallow solids or liquids
                                                                                      2. analgesia
                                                                                    2. for recurrent tonsillitis
                                                                                      1. tonsillectomy

                                                                                        Annotations:

                                                                                        • other indications for tonsillectomy -peritonsillar abscess (quinsy) -obstructive sleep apnoea (adenoids also normally removed) NB: large tonsils aren't in themselves an indication for tonsillectomy- many kids have large ones & they shrink spontaneously in late childhood
                                                                                        1. reduces no of episodes of tonsillitis by 1/3 (from 3 to 2/ yr)
                                                                                  2. Rx
                                                                                    1. Abx
                                                                                      1. penicillin or erythromyin
                                                                                        1. for severe pharyngitis
                                                                                  3. Acute otitis media
                                                                                    1. epidemiology
                                                                                      1. most kids'll have min 1 episode
                                                                                        1. commonest at 6-12 mths old
                                                                                          1. up to 20% will have 3 or more episodes
                                                                                          2. infants & young children are prone
                                                                                            1. Eustachian tubes
                                                                                              1. short
                                                                                                1. horizontal
                                                                                                  1. don't work well
                                                                                                2. Presentation
                                                                                                  1. ear pain
                                                                                                    1. fever
                                                                                                      1. otoscopy
                                                                                                        1. tympanic mb
                                                                                                          1. red
                                                                                                            1. bulging
                                                                                                              1. loss of normal light reflection
                                                                                                            2. acute perforation of eardrum
                                                                                                              1. sometimes
                                                                                                                1. pus visible in external canal
                                                                                                              2. Pathogens
                                                                                                                1. Viruses
                                                                                                                  1. RSV
                                                                                                                    1. Rhinovirus
                                                                                                                    2. Bacteria
                                                                                                                      1. Pneumococcus
                                                                                                                        1. non-typeable H. influenzae
                                                                                                                          1. Moraxella catarrhalis
                                                                                                                        2. Complications
                                                                                                                          1. serious but uncommon
                                                                                                                            1. mastoiditis
                                                                                                                              1. meningitis
                                                                                                                              2. of recurrent AOM
                                                                                                                                1. otitis media w/ effusion (glue ear/serous otitis media)
                                                                                                                                  1. presentation
                                                                                                                                    1. asymptomatic
                                                                                                                                      1. but decreased hearing maybe
                                                                                                                                      2. eardrum
                                                                                                                                        1. dull
                                                                                                                                          1. retracted
                                                                                                                                            1. fluid level often visible
                                                                                                                                          2. Ix
                                                                                                                                            1. tympanogram
                                                                                                                                              1. flat trace
                                                                                                                                              2. pure tone audiometry
                                                                                                                                                1. conductive hearing loss
                                                                                                                                                2. distraction hearing test
                                                                                                                                                  1. reduced hearing in younger kids
                                                                                                                                                3. epidemiology
                                                                                                                                                  1. v common btw 2-7 years old
                                                                                                                                                    1. peak incidence btw 2.5 & 5 yrs
                                                                                                                                                      1. commonest cause of conductive hearing loss in kids
                                                                                                                                                        1. interfere w/ normal speech development
                                                                                                                                                          1. -> learning difficulties
                                                                                                                                                        2. usually resolves spontan
                                                                                                                                                          1. Rx
                                                                                                                                                            1. grommets
                                                                                                                                                              1. OME intefering w/ normal speech development
                                                                                                                                                                1. kids w/ recurrent URTIs and chronic glue ear that don't resolve w/ conservative measures
                                                                                                                                                                2. adenoidectomy
                                                                                                                                                                  1. more long term benefit
                                                                                                                                                                    1. adenoids harbour orgs within biofilms that spread up Eustachian tubes
                                                                                                                                                                      1. w/ reinsertion of grommets
                                                                                                                                                                        1. after grommet extrusion
                                                                                                                                                                      2. tonsillectomy + adenoidectomy

                                                                                                                                                                        Annotations:

                                                                                                                                                                        • also indicated for obstructive sleep apnoea
                                                                                                                                                                        1. for recurrent otitis media w/ effusion w. hearing loss
                                                                                                                                                                          1. esp if reinsertion of grommets considered
                                                                                                                                                                3. Treatment
                                                                                                                                                                  1. Analgesia
                                                                                                                                                                    1. paracetamol/ibuprofen
                                                                                                                                                                      1. regular
                                                                                                                                                                        1. up to a week until acute inflammn resolves
                                                                                                                                                                        2. most cases resolve spontaneously
                                                                                                                                                                          1. Abx
                                                                                                                                                                            1. shorten duration of pain
                                                                                                                                                                              1. don't reduce risk of hearing loss
                                                                                                                                                                                1. Amoxicillin
                                                                                                                                                                                  1. prescribe but
                                                                                                                                                                                    1. parents to use only if child remains unwell after 2-3 days
                                                                                                                                                                            2. sinustitis
                                                                                                                                                                              1. infection of paranasal sinuses
                                                                                                                                                                                1. pathogens
                                                                                                                                                                                  1. viral
                                                                                                                                                                                    1. secondary bacterial infection
                                                                                                                                                                                      1. pain
                                                                                                                                                                                        1. swelling
                                                                                                                                                                                          1. tenderness over cheek
                                                                                                                                                                                            1. infection of maxillary sinus
                                                                                                                                                                                        2. frontal sinusitis uncommon in 1st decade of life
                                                                                                                                                                                          1. frontal sinuses don't develop til late childhood
                                                                                                                                                                                          2. Rx
                                                                                                                                                                                            1. acute sinusitis
                                                                                                                                                                                              1. Abx
                                                                                                                                                                                                1. + intranasal corticosteroids/antihistamines
                                                                                                                                                                                                  1. quicker recovery (recent evidence)
                                                                                                                                                                                                2. analgesia
                                                                                                                                                                                          3. presentation
                                                                                                                                                                                            1. commonest
                                                                                                                                                                                              1. nasal discharge
                                                                                                                                                                                                1. nasal blockage
                                                                                                                                                                                                  1. fever
                                                                                                                                                                                                    1. painful throat
                                                                                                                                                                                                      1. earache
                                                                                                                                                                                                2. cough
                                                                                                                                                                                                3. complications
                                                                                                                                                                                                  1. difficulty feeding (infants)
                                                                                                                                                                                                    1. febrile convulsions
                                                                                                                                                                                                      1. acute exacerbations of asthma
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