1 / 49

URTI Pharangitis

URTI Pharangitis. Mohammed El-Khateeb MSVL-4 Nov 26 th 2013. OVERVIEW. URTI: WHY IS THIS IMPORTANT?. The respiratory system is the most commonly infected system. Health care providers will see more respiratory infections than any other type.

bela
Download Presentation

URTI Pharangitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. URTIPharangitis Mohammed El-Khateeb MSVL-4 Nov 26th 2013

  2. OVERVIEW

  3. URTI: WHY IS THIS IMPORTANT? • The respiratory system is the most commonly infected system. • Health care providers will see more respiratory infections than any other type.

  4. Geography of the respiratory system (and sites of infection)

  5. …THE RESPIRATORY SYSTEM A major portal of entry for infectious organisms • The upper respiratory tract: • Mouth, nose, epiglottis, Nasal cavity, sinuses, pharynx, and larynx • Infections are fairly common. • Usually nothing more than an irritation • The lower respiratory tract: • Lungs and bronchi • Infections are more dangerous. • Can be very difficult to treat

  6. ANATOMY OF THE RESPIRATORY SYSTEM • The most accessible system in the body, continuously exposed to potential pathogens. • Breathing brings in clouds of potentially infectious pathogens. • The body has a variety of host defense mechanisms. • Innate immune response The cells and mechanisms that defend the host from infection by other organisms, in a non-specific manner • Adaptive immune It is adaptive immunity because the body's immune system prepares itself for future challenges.

  7. Protective structures of the • respiratory system • Ventilatory flow • Involuntary responses such as coughing, • sneezing and swallowing • Mucous membranes • Hairs; ciliated epithelia • Lymphoid tissues (tonsils) • “Mucociliary escalator” keeps microbes • out of lower respiratory tract • Alveolar macrophages; IgA

  8. The Respiratory Tract and Its Defenses • Normal Flora: • Moraxella, • nonhemolytic and a-strep, • Coryenbacterium, • Diphtheroids, • Candida albicans, • Others

  9. Pharnygitis Definition: Inflammation of the mucous membranes and submucosal structures of the oropharynx but not tonsils Sore Throate

  10. ETIOLOGY • 30%-65%: idiopathic • 30%-60%: viral • 5%-10%: bacterial • Group A beta-hemolytic: most common bacterial pathogen • 15%-36%: pediatric cases • 5%-10% : adult pharyngitis • Disease of children

  11. Etiology • Strep.A • Mycoplasma • Strep.G • Strep.C • Corynebacterium diphteriae • Toxoplasmosis • Gonorrhea • Tularemia • Rhinovirus • Coronavirus • Adenovirus • CMV • EBV • HSV • Enterovirus • HIV

  12. Pharyngitis • Pharyngeal mucosa exhibits an inflammatory response to many other agents other than viruses • Opportunistic bacteria • Fungi • Environmental pollutants • Neoplasm • Granulomatous disease • Chemical and physical irritants

  13. Incidence • Sore throatis estimated to account for 10% of all general practice consultations • Asymptomatic carriage of streptococcus • Is common with rates of 6 - 40% • Carriers have low infectivity and are not at risk of developing complications such as rheumatic fever

  14. Pharyngitis • Inflammation of the throat • Pain and swelling, reddened mucosa, swollen tonsils, sometime white packets of inflammatory products • Mucous membranes may swell, affecting speech and swallowing • Often results in foul-smelling breath • Incubation period: 2-5 days

  15. Clinical manifestation (Viral) • Sore throat • Pain on swallowing • Fever • Hoarseness if laryngeal involvement • Gradual onset • Rhinorrhea • Cough • Diarrhea • Headache • Malaise

  16. Signs • Redness of the pharynx and tonsils • Presence of exudate • Enlarged tonsils • Swollen tender neck glands. • Note that a streptococcal sore throat is impossible to diagnose on clinical grounds alone.

  17. Physical Examination • Full head and neck exam • General – respiratory distress, toxic • Face – mouth breathing • Nose – rhinorrhea • Neck – lymph nodes, thyroid, • Mucosal edema, tonsillar swelling, exudates, discrete lesions, deviation of the uvula or tonsillar pillars, bulges in the posterior pharyngeal wall • Laryngoscopy • Nasal endoscopy - sinusitis

  18. PHARYNGITIS • Treatment • VIRAL – Supportive care only – Analgesics, Antipyretics, Fluids • No strong evidence supporting use of oral or intramuscular corticosteroids for pain relief → few studies show transient relief within first 12–24 hrs after administration • EBV – infectious mononucleosis • activity restrictions – mortality in these pts most commonly associated with abdominal trauma and splenic rupture

  19. Complications

  20. Sinusitis • Commonly called a sinus infection • Most commonly caused by allergy • Can also be caused by infections or structural problems • Generally follows a bout with the common cold • Symptoms: nasal congestion, pressure above the nose or in the forehead, feeling of headache or toothache • Facial swelling and tenderness common • Discharge appears opaque with a green or yellow color in case of bacterial infection • Discharge caused by allergy is clear and may be accompanied by itchy, watery eyes

  21. Acute Otitis Media (Ear Infection) • Also a common sequel of rhinitis • Viral infections of the upper respiratory tract lead to inflammation of the Eustachian tubes and buildup of fluid in the middle ear- can lead to bacterial multiplication in the fluids • Bacteria can migrate along the eustachian tube from the upper respiratory tract, multiply rapidly, leads to pu production and continued fluid secretion (effusion) • Chronic otitis media: when fluid remains in the middle ear for indefinite periods of time (may be caused by biofilm bacteria) • Symptoms: sensation of fullness or pain in the ear, loss of hearing • Untreated or severe infections can lead to eardrum rupture

  22. Figure 21.2

  23. Infectious causes of pharyngitis

  24. Viruses • Most common agents in pharyngitis are the rhinovirus and coronavirus • Both single stranded, + sense RNA picornaviruses • Grow best at 33 degrees Celsius • Approximates the temperature of the nasopharynx • Disease is self-limited • Clinical signs and symptoms may be identical to bacterial pharyngitis • Evaluation for Group A streptococcus is advisable

  25. Viruses • Major cause of acute respiratory disease • Rhinovirus &Coronaviruses • Respiratory syncicial virus • Parainfluenza viruses • Respiratory syncicial virus • Herpes Group • HIV

  26. VIRAL INFECTIONS OF THE UPPER RESPIRATORY TRACT (URT) • RHINOVIRUS INFECTION -There are several hundred serotypes of rhinovirus. • Fewer than half have been characterized. • 50% that have are all picornaviruses. • Extremely small, non-enveloped, single-stranded RNA viruses • Optimum temperature for picornavirus growth is 33˚C. • The temperature in the nasopharynx

  27. …VIRAL INFECTIONS OF THE UPPER RESPIRATORY TRACT • PARAINFLUENZA: There are four types of parainfluenza virus. • All belong to the paramyxovirus group. • Single-stranded enveloped RNA viruses • Contain hemagglutinin and neuraminidase • Transmission and pathology similar to influenza virus, but there are differences. • Parainfluenzavirus replicates in the cytoplasm. • Influenza virus replicates in the nucleus.

  28. ..PARAINFLUENZA • Parainfluenza is genetically more stable than influenza. • Very little mutation • Little antigenic drift • No antigenic shift • Parainfluenzais a serious problem in infants and small children. • Only a transitory immunity to reinfection • Infection becomes milder as the child ages.

  29. Respiratory Syncytial Virus Infection • Produces giant multinucleated cells (synctia) in the respiratory tract • Most prevalent cause of respiratory infection in the newborn age group • First symptoms: fever that lasts approximately 3 days, rhinitis, pharyngitis, and otitis • More serious infections give rise to symptoms of croup: coughing, wheezing, dyspnea, rales

  30. Epstein-Barr Virus (EBV) • Etiologic agent of infectious mononucleosis (IM) • Herpes virus 4 • Double stranded DNA virus • Selectively infects B-lymphocytes

  31. Ebstein-Barr Virus (EBV) • Early infections in life are mostly asymptomatic • Clinical disease is seen in those with delayed exposure (young adults) • Defined by clinical triad • Fever, lymphadenopathy, and pharyngitis combined with +heterophil antibodies and atypical lymphocytes

  32. Ebstein-Barr Virus (EBV) • Other clinical findings • Splenomegaly – 50% • Hepatomegaly – 10% • Rash – 5%

  33. Ebstein-Barr Virus (EBV) • Pharyngitis • White membrane covering one or both tonsils • Petechial rash involving oral and palatal mucosa

  34. Ebstein-Barr Virus (EBV) • Diagnosis • By Clinical presentation • CBC with differential (atypical lymphocytes –T lymphocytes) • Detection of heterophil antibodies (Monospot test) • IgM titers

  35. Treatment • Supportive management • Rest • Avoidance of contact sports (?->splenic rupture?) • Glucocorticoids (severe cases)

  36. Ebstein-Barr Virus (EBV) • Complications • Autoimmune hemolytic anemia • Cranial nerve palsies • Encephalitis • Hepatitis • Pericarditis • Airway obstruction

  37. Cytomegalovirus (CMV) • Herpes virus 5 • Ubiquitous • 50% of adults seropositive • 10-15% of children seropositive by age 5 years • Etiology of 2/3 of heterophil-negative mononucleosis

  38. Cytomegalovirus (CMV) • Clinical manifestation • Fever and malaise • Pharyngitis and lymphadenopathy less common • Esophagitis in HIV infected patients

  39. Cytomegalovirus (CMV) • Diagnosis • 4-fold rise in antibody titers to CMV

  40. Herpes Simplex Virus (HSV) • Herpes (Greek word herpein, “to creep”) • Two antigenic types (HSV-1, HSV-2) • Both infect the upper aerodigestive tract • Transmission is by direct contact with mucous or saliva

  41. Herpes Simplex Virus (HSV) • Clinical manifestations • Depends on • Anatomic site • Age • Immune status of the host • First episode (primary infection) • More systemic signs and symptoms • Both mucosal and extramucosal sites involved • Longer duration of symptoms

  42. Herpes Simplex Virus (HSV) • Clinical manifestations: • Gingivostomatitis and pharyngitis – most common in first episode • Usually in children and young adults • Fever, malaise, myalgias, anorexia, irritability

  43. Herpes Simplex Virus (HSV) • Physical exam • Cervical lymphadenopathy • Pharynx – exudative ulcerative lesions • Grouped or single vesicles on an erythematous base • Buccal mucosa • Hard and soft palate

  44. Herpes Simplex Virus (HSV) • Clinical manifestations • Acute illness evolves over 7-10 days • Rapid regression of symptoms • Resolution of lesions

  45. Herpes Simplex Virus (HSV) • Immunocompromised patient • Persistent ulcerative lesions are common in patients with AIDS • Lesions more friable and painful • Aggressive treatment with IV acyclovir

  46. Herpes Simplex Virus (HSV) • Diagnosis • Usually clinical • Isolation of HSV • Culture from scrapings of lesions • Results in 48 hours

  47. Herpes Simplex Virus (HSV) • Treatment • Acyclovir, 400 mg PO 5X/day X 10days • Valacyclovir, 1000 mg PO BID X 10 days • Recurrent disease • Acyclovir 400 mg PO 5X/day for 5 days • Duration reduced from 12.5 to 8.1 days • Acyclovir 400 mg po bid every day • Recurrence reduced 36% to 19%

  48. Human Immunodeficiency Virus (HIV) • Pharyngitis • Usually opportunistic infection • HSV • CMV • Candida • Viral particles have been detected in lymphoepithelial tissues of the pharynx

More Related