RESPIRATORY INFECTIONS-1 (UPPER RESPIRATORY INFECTIONS)

1. RESPIRATORY INFECTIONS-1(UPPER RESPIRATORY INFECTIONS) Prof. Dr. RehaCengizlier 2014

2. AMAÇ: • Öğrencinin üst solunum yolu enfeksiyonlarını tanıyabilmesi • Etkenlerini, semptomlarını, risk faktörlerini belirleyebilmesi • Korunma yollarını ve tedavi ilkelerini öğrenmesi

3. HEDEF: • Üst solunum yolunu oluşturan bölümleri söyleyebilmeli • Bakteriyel-viral enfeksiyon ayırıcı tanısını yapabilmeli • Acil durumları saptayabilmeli • Ayaktan veya hastanede yatarak tedavi ayrımını yapabilmeli • Klinik bulguları bilmeli

5. COLDS or NASOPHARINGITIS • Most frequently occuring ilness in childhood (3-8 /yr) • Frequently during the fall and winter • Enviromental factors : passive exposure to smoke, low income, crowding

6. COLDS or NASOPHARINGITIS • Etiology: more than 200 viruses • Rhinovirus (1/3 of cases) • Parainfluenza (1-4) • RSV • Coronavirus • Incubation period :2-5 days

7. COLDS or NASOPHARINGITIS • Transmission: large particle droplets (short distance)  COUGH/ SNEEZE • Small particle aerosols (longer distance) • Direct physical contact (secretions, contamined hands etc...)

8. COLDS or NASOPHARINGITIS • Pathophysiology: • Virus invades the epithelial cells  inflammatory mediators are released  altering vascular permeability  edema, nasal stuffiness • Stimulation of cholinergic nerves  mucus production  rhinorrhea • Cellular damage  sore throat • Injury to cilia  impair clearance of nasal secretions

9. COLDS or NASOPHARINGITIS • Clinical manifestations: Nasal irritation, scratchy throat • sore throat • Myalgia, headache, decreased appetite • Low grade fever • Nasal discharge becomes thicken and purulent  2nd-3rd day

10. COLDS or NASOPHARINGITIS • Clinical manifestations: (continue) • Systemic symptoms subside in 5-7 days • Rhinitis and cough may persist for another week • Same infants may have mild diarrhea • Complications: A.O.M,Sinusitis, pneumonia

11. COLDS or NASOPHARINGITIS • Treatment : Directed toward a specific symptoms causing discomfort : acetaminophen (10/15 mg/kg/dose), ibuprofen (10 mg/kg/dose) • Nonpharmacologic treatment: Good hydration, saline nose drops, water vaporizer, elevation head, parents ceasing smoking

12. COLDS or NASOPHARINGITIS • Unnecessary treatment: • Antihistamines+Expectorans: No effect • Decongestants • Cough supresants : side effects • Antibiotics do not shorten the duration of cold symptoms and do not reduce the riskof complication

13. Ineffective Treatments • Vitamin C, guaifenesin, and inhalation of warm, humidified airhave all been found to be no more effective than placebo for the symptomatic treatment of colds • Zinc, given as oral route. The function of the rhinovirus 3C protease, an essential enzyme for rhinovirus replication, is inhibited by zinc, but there has been no evidence of an antiviral effect of zinc in vivo • Echinaceais a popular herbal treatment for the common cold

15. SINUSITIS • Maxillary and ethmoid sinuses are anatomically present at the birth • Maxillary sinuses are not pneumatized until 4 yr of age • Frontal sinuses begin the develop by age 1 • Frontal and sphenoid sinuses, are not usually seen radiographically until 5-6 years

16. SINUSITIS • Factors impair normal mucociliary transport  SINUSITIS Causative agents (same as AOM) : • S.pneumoniae • M. Catarrhalis • H. İnfluenzae •  hemolitic streptococcus • S. Aureus • Anaerobs

17. SINUSITIS Predisposing conditions: • allergic rhinitis, and cigarette smoke exposure • immune deficiencies • cystic fibrosis • ciliary dysfunction • abnormalities of phagocyte function • gastroesophageal reflux • anatomic defects (e.g., cleft palate) • nasal polyps • nasal foreign bodies (including nasogastric tubes)

18. SINUSITIS • Clinical manifestations : Headache, facial pain, tenderness, facial edema • Cough; occuring day time and frequently worse at bedtime • Nasal discharge (clear, purulent) • Malodorness breath • Mucopurulent material draining

19. SINUSITIS • Clinical manifestations : (continue) palpation of bone overlying sinuses pain • Facial, frontal pressure • Fever • If symptoms of URI persist without improvement for more than 10 days  acute sinusites should be considered

20. SINUSITIS Diagnosis: • Sinus radiology- air-fluid levels, sinus opasification, mucosal thickening • CT • Sinonasal endoscopy: non-invasive • USG:For maxillary and frontal sinuses • Sinus aspiration : reliable method of obtaining bacterial culture (should be reserved for life threating conditions; immuncomprimised patients unresponsive to therapy)

21. SINUSITIS Treatment: • Antibiotic:should last 7 days after symptoms resolutions (14-21 days) • Amoxicillin • Amoxicillin+clavulanate • Macrolide • Second and third generation cephalosporins • Decongestants : some symptomatic relief • Antihistamines: not helpful • Nasal irrigation of saline solution

22. SINUSITIS

27. ACUTE PHARYNGITIS • Uncommon in children less than 1 yr of age • Peak at 4-7 year Generally caused by : • Viruses • Bacteria (15%) • Mycoplasma

28. ACUTE PHARYNGITIS Clinical manifestations: • Viral pharyngitis: fever, malaise, anorexia, moderate throat pain, conjuctivitis, rhinitis, cough, coryza • Exudation may appear on lymphoid follicles of the palate and tonsils • Cervical lymph nodes are often enlarged / tender • Entire illness doesn’t persist more than 5 days

29. ACUTE PHARYNGITIS • Streptococcal pharyngitis: 2-15 yr Headache, abdominal pain, vomiting • Fever (40 ºC) • Sore throat • Tonsiller enlargement • Anterior tender cervical LAP • Diffuse redness of tonsils with petechial mottling of the soft palate • 2yr: coryza, postnasal discharge, variable fever, tender cervical lymphadenitis

30. ACUTE PHARYNGITIS Diagnosis: • Rapid detection of Streptococal Ags. • Throat culture

31. Complications: 1) Supurative complications: • AOM • Retropharyngeal, peri-tonsillar abscess • Sinusitis • Meningitis (rare) 2) Non-supurative complications: • ARF • AGN

32. ACUTE PHARYNGITIS Treatment: • Penicillin • Amoxicillin • Cephalosporins • Macrolide • Dexamethasone for 3 days can decrease thesore throat

33. PHARYNGITIS

37. ACUTE INFECTIONS of the LARYNX and TRACHEA • Croup • Epiglottitis • Laryngitis • Laryngotracheobronchitis • Spasmodic laryngitis • Bacterial tracheitis

38. INFECTIOUS CROUP • The term croup refers to a heterogeneous group of mainly acute and infectious processes that are characterized by a barklike or brassy cough and may be associated with hoarseness, inspiratory stridor, and respiratory distress

39. INFECTIOUS CROUP • Croup usually affects to some degree the larynx, trachea, and bronchi • When the involvement of the larynx is sufficient to produce symptoms, they dominate the clinical picture over the tracheal and bronchial signs

40. INFECTIOUS CROUP • Parainfluenza (3/4 cases) • Adenovirus • RSV • Influenza • Measles • H. influenza type B

41. INFECTIOUS CROUP Clinical manifestations: • Mild cough with intermittant respiratory stridor • Nasal flaring, suprasternal, infrasternal, intercostal retractions • Air hunger, restlessness, sit-up in bed, hold upright • Cyanotic, pale child manipulation of the pharynx  cardiorespiratory arrest

42. ACUTE EPIGLOTITIS • 2-7 yr (peak 3.5 yr) • Dramatic, potentially lethal condition • Fever, sore throat, dyspnea, rapidly progresive respiratory obstruction • Neck may be hyperextended • Flaring alae nasi, inspiratory retractions • Shiny cherry red epiglotitis  by direct examination

43. ACUTE EPIGLOTITIS • Blood gas samples should be obtained • Lateral roentgenogram of the nasopharynx • Intubation may be required • Patients should be followed for 2-3 days- monitorizing • Parenteral AB: ceftriaxone , ampicillin+ chloramphenicol

44. EPIGLOTITIS

48. ACUTE INFECTIOUS LARYNGITIS • Viruses • URI (onset) hoarseness, inspiratory stridor, retractions, dyspnea, restlesness, air hunger, fatigue • Inflammatory edema of the vocal cords and subglottic tissue; may be demonstrated laryngoscopically • Subglottic tissue; Principal site of obstruction

50. ACUTE LARYNGOTRACHEOBRONCHITIS • Viruses • Most patients have URI for several days • Temperature high • Bilateral diminished sounds, ronchi, scattered rales • Symptoms worse at night • Rhinitis, conjunctivitis • Reccurrences frequent 3-6 yrs of age