A CONCISE FORM OF URTI

1. Shree sahjanand institute of nursing,
Upper Respiratory Tract Infections
Presented by
Mr. AKRAM KHAN
M.S.N. (HOD)
ASST. PROFESSOR
SSIN, BHAVNAGAR
1

2. Upper Respiratory Tract
Infections
• Acute tonsillitis
• Acute pharyngitis
• Acute otitis media
• Acute sinusitis
• Common cold
• Acute laryngitis
• Otitis externa
• Mastoiditis
• Acute apiglottis
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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
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4. Tonsilitis-pharyngitis
• Bacteria
– S. pyogenes
– C. diphteriae
– N. gonorrhoeae
• Viruses
– Epstein-Barr virus
– Adenovirus
– Influenza A, B
– Coxsackie A
– Parainfluenzae
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5. Causative organisms
• < 3 years
–  100 % viral
• 5-15 years
– 15-30 % GABHS
• Adult
– 10 % GABHS
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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 6

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

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
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9. Exudates
• GABHS
• EBV (Epstein-Barr virus)
• Adenovirus
• Primary HIV infection
• Candida albicans
• Francisella tularensis
(GN aerobic bacteria)
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10. Lymphadenopathy
• GABHS
• Epstein-Barr virus
• Adenovirus
• Human herpesvirus type 6
• Tularemia
• HIV infection
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11. Laboratory
• Throat swab
– Gold standard
• Rapid antigen test
– If negative need swab
• ASO
– May remain + for 1 year
• WBC count
• Peripheral smear
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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?
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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
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14. Aim of Treatment
• Prevention of complications
• Symptomatic improvement
• Bacterial eradication
• Prevention of contamination
• Reducing unnecessary antibiotic use
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15. Treatment
• Many different antibiotics can
eradicate GABHS from pharynx
• Starting treatment within 9 days is
enough to prevent ARF
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16. Antibiotics NOT to be used
• Tetracycline
• Sulphonamides
• Co-trimoxasole
• Cloramphenicole
• Aminoglycosides
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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
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18. Mc Isaac Scoring
• Developed by Mc Isaac and friends
• Decreases antibiotic usage by 48%
• No increase in throat swabs
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http://www.cmaj.ca/cgi/content/abstract/163/7/811

19. Antibiotics in Tonsillitis/pharyngitis due to
GABHS
ORAL
Penicilline V Children:2x250 mg or 3x250mg,10 days
Adults:3x500 mg or 4x500mg,10 days
PARENTERAL
Benzathine penicilline Adults:<27kg:600 000 U single dose, IM
>27 kg:1.200 000 U single dose, IM
ALLERGY TO PENICILLINE
Erithromycine estolate 20-40 mg/kg/day, 2x1 or 3x1, 10 days
Erithromycine ethyl succinate 40 mg/kg/day, 2x1 or 3x1, 10 days
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20. Acute Otitis Media
• AOM
• AOM not responding to treatment:
Sustained clinical and autoscopy findings
despite 48-72 therapy
• Recurrent otitis media: 3 AOM attacks
within 6 moths or 4 attacks within 1 year
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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
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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.
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23. Signs and Symptoms
• Symptoms
– Autalgia
– Ear draining
– Hearing loss
– Fever
– Fatigue
– Irritability
– Tinnitus,
vertigo
• Otoscopic findings
– Tympanic membrane
erythema
– Inflammation
– Bulging
– Effusion
• Hearing loss
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24. Antibiotics
First choice
Amoxicilline 40 mg/kg/day, 3 doses
Trimet./Sulfamethoxazole 8mg TM/40mg SMX/kg 2 dose
Second choice
Amoxicilline/clavulanate 45 mg/kg/day, 2 doses
Erythromycin 40-50 mg/kg/day, 3 doses
Reurrent AOM prophylaxis
Sulfisoxazole 75 mg/kg/day, single dose 3-6 mo
Amoxicilline 20 mg/kg/day, sinle dose 3-6 mo
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25. Acute Rhinitis / Sinusitis
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
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26. Acute Sinusitis
• Paranasal sinuses:
– Frontal
– Ethmoid
– Maxillary
– Sphenoid
• Most common during childhood
– Maxillary
– Ethmoid
• After age 10
– Frontal
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27. / 42 27

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...
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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
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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
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31. Diagnosis
• 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
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32. Treatment
• Ampirical
– Specific microbiologic diagnosis
difficult
• Primary pathogens
– S. pneumoniae
– H. influenzae
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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
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34. Support Therapy
• Decongestants
– Short duration 3-5 days
• Antihistamines
– If allergy
• Normal saline
• Local steroids
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35. Common Cold
• Adults
Rhinovirus
• Children
Parainfluenzae
and Respiratory
syncytial
virus (RSV)
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36. Common Cold
• Fatigue
• Feeling cold, shuddering
• Nose burning, obstruction, running
• Sneezing
• Fever
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37. Influenza (flu)
• Causes epidemics and pandemics
• Highly contagious
• Viral infection.
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38. / 42 38
Cause
• 80 % Influenzae virus
• Parainfluenza %2-9
• Rhinovirus %3
• Adenovirus %4

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
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40. Treatment of common cold and
influenza
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41. Assignment …………????
• What about nursing
management….??????
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42. • THANKS TO ALL
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