Upper respiratory tract infection (URTI)

account for 80% of all respiratory infections
involve nose, throat, ears or sinuses only
involves many conditions
1. Coryza (the common cold)
  1. the commonest infection of childhood
  2. Features
    1. Nasal discharge
      1. mucopurulent
      2. clear
    2. Nasal blockage
  3. Pathogens
    1. viruses
      1. commonest causative orgs
      2. rhinoviruses
        >100 different serotypes
      3. coronaviruses
      4. RSV
  4. self-limiting
  5. no specific curative treatment
    1. paracetamol/ibuprofen
      1. for fever & pain
    2. Abx of no benefit
      1. common cold is viral in origin
      2. secondary bacterial infection is uncommon
2. Sore throat (pharyngitis)
  1. inflamed pharynx & soft palate
  2. enlarged & tender local lymph nodes
  3. Pathogens
    1. Viral
      1. usual cause
      2. respiratory viruses
        adenoviruses
        enteroviruses
        rhinoviruses
    2. Bacteria
      1. group A beta-haemolytic streptococcus
        common in older children
  4. Tonsillitis
    1. a form of pharyngitis
      1. intense inflammation of the tonsils
        often w/ purulent exudate
    2. Pathogens
      1. bacteria
        group A beta-haemolytic streptococci
        marked constitutional disturbance more common
        headache
        headache
        apathy
        abdo pain
        white tonsillar exudate more commmon
        cervical lymphadenopathy more common
        cause 1/3rd of cases
      2. virus
        Epstein-Barr virus (EBV) [infectious mononucleosis]
        surface exudates said to be more purulent than bacterial
      3. clinically not possible to distinguish btw viral & bacterial tonsillitis
    3. Rx
      1. Abx
        penicillin or erythromycin (if pen allergic)
        10 days
        to eradicate strep (thus prevent rheumatic fever)
        no longer indicated in UK
        rheumatic fever is rare
        avoid amoxicillin
        can cause maculopapular rash if tonsillitis is due to EBV
      2. for severe cases
        hospital admission
        IV fluid admin
        if unable to swallow solids or liquids
        analgesia
      3. for recurrent tonsillitis
        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
        reduces no of episodes of tonsillitis by 1/3 (from 3 to 2/ yr)
  5. Rx
    1. Abx
      1. penicillin or erythromyin
        for severe pharyngitis
3. Acute otitis media
  1. epidemiology
    1. most kids'll have min 1 episode
    2. commonest at 6-12 mths old
    3. up to 20% will have 3 or more episodes
  2. infants & young children are prone
    1. Eustachian tubes
      1. short
      2. horizontal
      3. don't work well
  3. Presentation
    1. ear pain
    2. fever
    3. otoscopy
      1. tympanic mb
        red
        bulging
        loss of normal light reflection
    4. acute perforation of eardrum
      1. sometimes
      2. pus visible in external canal
  4. Pathogens
    1. Viruses
      1. RSV
      2. Rhinovirus
    2. Bacteria
      1. Pneumococcus
      2. non-typeable H. influenzae
      3. Moraxella catarrhalis
  5. Complications
    1. serious but uncommon
      1. mastoiditis
      2. meningitis
    2. of recurrent AOM
      1. otitis media w/ effusion (glue ear/serous otitis media)
        presentation
        asymptomatic
        but decreased hearing maybe
        eardrum
        dull
        retracted
        fluid level often visible
        Ix
        tympanogram
        flat trace
        pure tone audiometry
        conductive hearing loss
        distraction hearing test
        reduced hearing in younger kids
        epidemiology
        v common btw 2-7 years old
        peak incidence btw 2.5 & 5 yrs
        commonest cause of conductive hearing loss in kids
        interfere w/ normal speech development
        -> learning difficulties
        usually resolves spontan
        Rx
        grommets
        OME intefering w/ normal speech development
        kids w/ recurrent URTIs and chronic glue ear that don't resolve w/ conservative measures
        adenoidectomy
        more long term benefit
        adenoids harbour orgs within biofilms that spread up Eustachian tubes
        w/ reinsertion of grommets
        after grommet extrusion
        tonsillectomy + adenoidectomy
        Annotations:
        also indicated for obstructive sleep apnoea
        for recurrent otitis media w/ effusion w. hearing loss
        esp if reinsertion of grommets considered
  6. Treatment
    1. Analgesia
      1. paracetamol/ibuprofen
      2. regular
      3. up to a week until acute inflammn resolves
    2. most cases resolve spontaneously
    3. Abx
      1. shorten duration of pain
      2. don't reduce risk of hearing loss
      3. Amoxicillin
        prescribe but
        parents to use only if child remains unwell after 2-3 days
4. sinustitis
  1. infection of paranasal sinuses
  2. pathogens
    1. viral
    2. secondary bacterial infection
      1. pain
      2. swelling
      3. tenderness over cheek
        infection of maxillary sinus
  3. frontal sinusitis uncommon in 1st decade of life
    1. frontal sinuses don't develop til late childhood
  4. Rx
    1. acute sinusitis
      1. Abx
        + intranasal corticosteroids/antihistamines
        quicker recovery (recent evidence)
      2. analgesia
presentation
1. commonest
  1. nasal discharge
    1. nasal blockage
      1. fever
        painful throat
        earache
  2. cough
2. complications
  1. difficulty feeding (infants)
  2. febrile convulsions
  3. acute exacerbations of asthma

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Upper respiratory tract infection (URTI)

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	Created by v.djabatey over 10 years ago