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ARI

ARI. Done by: Ahmad Mukharsham 423 810 212 Almoatasim….. 424 810 305 Abdulmohsen Abdullah Saad 425810059. Upper Respiratory Tract Infections. Acute tonsillitis Acute pharyngitis Acute otitis media Acute sinusitis Common cold Acute laryngitis Otitis externa Mastoiditis

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ARI

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  1. ARI Done by: Ahmad Mukharsham 423 810 212 Almoatasim….. 424 810 305 Abdulmohsen Abdullah Saad 425810059 / 42

  2. Upper Respiratory Tract Infections • Acute tonsillitis • Acute pharyngitis • Acute otitis media • Acute sinusitis • Common cold • Acute laryngitis • Otitis externa • Mastoiditis • Acute apiglottis / 42

  3. Objectives • At the end of this session, the participants should be able to; • List upper respiratory tract infections • Make differential diagnosis between URTI • Define criteria for antibiotic use • Apply and interpret the McIsaac scoring / 42

  4. Bacteria S. pyogenes C. diphteriae N. gonorrhoeae Viruses Epstein-Barr virus Adenovirus Influenza A, B Coxsackie A Parainfluenzae Tonsilitis-pharyngitis / 42

  5. Causative organisms • < 3 years •  100 % viral • 5-15 years • 15-30 % GABHS • Adult • 10 % GABHS / 42

  6. Due to streptococci: • Spreads by close contact and through air • Spread more in crowded areas (KG, school, army..) • Most common among 5-15 age group • More frequent among lower socio-economic classes • Most common during winter and spring • Incubation period 2-4 days / 42

  7. Sore throat Anterior cervical LAP Fever > 38 C Difficulty in swallowing Headache, fatigue Muscle pain Nausea, vomiting Signs/symptoms • Tonsillar hyperemia / exudates • Soft palate petechia • Absence of coughing • Absence of nose drip • Absence of hoarseness / 42

  8. Viral tonsillitis/pharyngitis • Having additional rhinitis, hoarseness, conjunctivitis and cough • Pharyngitis is accompanied by conjunctivitis in adenovirus infections • Oral vesicles, ulcers point to viruses / 42

  9. GABHS EBV Adenovirus Primary HIV infection Candida albicans Francisella tularensis Exudates / 42

  10. GABHS Epstein-Barr virus Adenovirus Human herpesvirus type 6 Tularemia HIV infection Lymphadenopathy / 42

  11. Throat swab Gold standard Rapid antigen test If negative need swab ASO May remain + for 1 year WBC count Peripheral smear Laboratory / 42

  12. Throat Culture • Pathogens looked for • Group A beta hemolytic streptococci • C. diphteriae (rare) • N. gonorrhoeae (rare) • If GABHS do we need antibiogram? • Is there resistence to penicilline? / 42

  13. Tonsillitis due to Streptococci • Supurative complications • Abscess • Sinusitis, otitis, mastoiditis • Cavernous sinus thrombosis • Toxic shock syndrome • Cervical lymphadenitis • Septic arthritis, osteomyelitis • Recurrent tonsillitis/pharyngitis • Nonsupurative complications • Acute romatoid fever • Acute glomerulonephritis / 42

  14. Aim of Treatment • Prevention of complications • Symptomatic improvement • Bacterial eradication • Prevention of contamination • Reducing unnecessary antibiotic use / 42

  15. Treatment • Many different antibiotics can eradicate GABHS from pharynx • Starting treatment within 9 days is enough to prevent ARF / 42

  16. Antibiotics NOT to be used • Tetracycline • Sulphonamides • Co-trimoxasole • Cloramphenicole • Aminoglycosides / 42

  17. GABHS • Control culture after full dose treatment? • NO • If history of ARF: • Take control culture after treatment • No need to screen or treat carriers / 42

  18. Mc Isaac Scoring • Developed by Mc Isaac and friends • Decreases antibiotic usage by 48% • No increase in throat swabs http://www.cmaj.ca/cgi/content/abstract/163/7/811 / 42

  19. Antibiotics in Tonsillitis/pharyngitis due to GABHS / 42

  20. Acute Otitis Media • AOM • AOM not responding to treatment: Sustained clinical and autoscopy findings despite 48-72 therapy • Recurrent atitis media: 3 AOM attacks within 6 moths or 4 attacks within 1 year / 42

  21. AOM causes • S. pneumoniae 30% • H. İnfluenzae 20% • M. Catarrhalis 15% • S. pyogenes 3% • S. aureus 2% • No growth 10-30% • Chronic otitis media:P. aeruginosa, S. aureus, anaerobic bacteria / 42

  22. Acute Otitis Media • 85% of children up to 3 years experience at least one, • 50% of children up to 3 years experience at least two attacks • AOM is usually self-limited. Rarely benefits from antibiotics. • 81 % undergo spontaneus resolution. / 42

  23. Symptoms Autalgia Ear draining Hearing loss Fever Fatigue Irritability Tinnitus, vertigo Otoscopic findings Tympanic membrane erythema Inflammation Bulging Effusion Hearing loss Signs and Symptoms / 42

  24. Antibiotics / 42

  25. Acute sinusitis Str. pneumoniae %41 H. influenzae %35 M. catarrhalis %8 Others %16 Strep. pyogenes S. aureus Rhinovirus Parainfluenzae Veilonella, peptokoccus Chronic sinusitis Anaerob bakteria: Bactroides, Fusobacterium S. aureus Strep. pyogenes Str. pneumoniae Gram (-) bakteria Fungi Acute Rhinitis / Sinusitis / 42

  26. Acute Sinusitis • Paranasal sinuses: • Frontal • Ethmoid • Maxillary • Sphenoid • Most common during childhood • Maxillary • Ethmoid • After age 10 • Frontal / 42

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  28. Predisposition to Sinusitis • Anatomical: septal deviation, • Mukociliary functions: cystic fibrosis, immotile cilia synd. • Systemic dis., immune deficiency.: DM, AIDS, CRF • Allergy: Nasal poliposis, asthma • Neoplasia • Environmental: smoking, air pollution, trauma... / 42

  29. Acute Rhinosinusitis • Most important: Headache and postnasal dripping • Face congestion • Fever, fatigue, headache increased by leaning forward • Nose obstruction • Nose dripping • Purulent secretions (rhinoscopy) • Sensitivity over the sinuses • Halitosis / 42

  30. Acute rhinosinusitis Rhinitis • Increased symptoms after 5 days • Symptoms lasting > 10 days • Decreasing viral symptoms, nasal secretion becoming more purulent are indicative for acute rhinosinusitis / 42

  31. Direct x-ray Diffuse opacification Mucosal thickening >4 mm air-fluid level Sinus aspiration Rarely performed Nasal endoskopy Tomography More sensitive compared with direct x-ray Indicated before surgery Diagnosis / 42

  32. Treatment • Ampirical • Specific microbiologic diagnosis difficult • Primary pathogens • S. pneumoniae • H. influenzae / 42

  33. Antibiotics for Sinusitis • Amoxycilline (Alfoxil) 3x500mg/d PO 10 d • Amoxycilline/clavulonate (Augmentin) 3x625 mg/d PO 10 d • Sefprosil(Serozil) 2x1000 mg/d PO 10 d • Sefuroxim (Zinnat) 2x250 mg/d PO 10 d • Azithromycine (Zitromax) First day 1x500 mg, then 1x250 mg/d PO 5 d / 42

  34. Support Therapy • Decongestants • Short duration 3-5 days • Antihistamines • If allergy • Normal saline • Local steroids / 42

  35. Common Cold • Adults Rhinovirus • Children Parainfluenzae and RSV / 42

  36. Common Cold • Fatigue • Feeling cold, shuddering • Nose burning, obstruction, running • Sneezing • Fever / 42

  37. Influenza (flu) • Causes epidemics and pandemics • Highly contagious • Viral infection. / 42

  38. Cause • 80 % Influenzae virus • Parainfluenza %2-9 • Rhinovirus %3 • Adenovirus %4 / 42

  39. Influenza • Sudden onset after 12-24 hours incubation • General weakness and fatigue • Feeling cold, shivering, temp. Up to 39-40 C • No sore throat or running nose • Severe back, muscle and joint pain / 42

  40. Treatment of common cold and influenza / 42

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