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Upper respiratory tract infection & otitis media

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URTI & OM IN PEDIATRICS FOR PEDIATRIC RESIDENT

Published in: Health & Medicine
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Upper respiratory tract infection & otitis media

  1. 1. Lulwah AlThumali Pediatric Resident TCH
  2. 2. DEFINITION Acute, self-limiting viral infection of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low grade fever, headache, and malaise. It can be caused by members of several families of viruses; the most common are the more than 100 serotypes of rhinoviruses.
  3. 3. Etiology Rhinoviruses 30-50 % Coronaviruses 10-15 % influenza viruses 5%-15% Humen meta pneumovirus Unkown Enteroviruses & Adenoviruses Less than 5% RSV 5%
  4. 4. Incubation period Period of infectivity 24 to 72 hours viral shedding peaks on the third day after inoculation; this coincides with a peak in symptoms . In experimental studies, viral titers in nasal washings returned to near baseline values by five days after inoculation . Low levels of viral shedding may persist for up to two weeks
  5. 5. PATHOPHYSIOLOGY innate immune response to infection viral replication occurs in only a small number of nasal epithelial cells The infected cells release cytokines, including interleukin (IL)-8
  6. 6. PATHOPHYSIOLOGY attracts polymorphonuclear cells (PMNs) Large numbers of PMNs (100-fold increase) accumulate in the nasal secretions and mucociliary clearance is slowed the severity of symptoms correlates with mucosal IL-8 concentrations. A change in the character of the nasal discharge from clear to yellow/white or green correlates with the increase in PMNs, but not with an increase in positive bacterial cultures
  7. 7. PATHOPHYSIOLOGY rhinovirus infection increases vascular permeability in the nasal submucosa releasing albumin and kinins (bradykinin) Bradykinin causes rhinitis and sore throat
  8. 8. Symptoms & Signs
  9. 9. Symptoms & Signs In infants :fever , nasal discharge, difficulty feeding, decreased appetite, and difficulty sleeping. In school-aged children:nasal congestion, sneeze, fever, nasal discharge, headache, sore throat , hoarseness and cough
  10. 10. DIAGNOSIS The diagnosis is made clinically, based upon history and examination findings, including exposure to someone with a cold Laboratory testing can identify the viral pathogen if it is necessary to do
  11. 11. Differential Diagnoses Allergic, seasonal, or vasomotor rhinitis Nasal foreign body Inhaled foreign body Pertussis Bacterial pharyngitis or tonsillitis
  12. 12. COMPLICATIONS Acute otitis media Asthma exacerbation Sinusitis Lower respiratory tract disease Epistaxis Conjunctivitis pharyngitis
  13. 13. Treatment Expected course In infants and young children, the symptoms of the common cold usually peak on day two to three of illness and then gradually improve over 10 to 14 days In older children and adolescents, symptoms usually resolve in five to seven days Antibiotics do not alter the course of the URTI and do not prevent secondary complications Re-evaluation may be warranted if the symptoms worsen
  14. 14. Treatment Maintaining adequate hydration Ingestion of warm fluids Topical saline Humidified air 1- Supportive interventions
  15. 15. Treatment 2-Antibiotic therapy there is no role for antibiotics in the treatment of the URTI . Antibiotic therapy does not prevent secondary bacterial infection, may cause significant side effects, and may contribute to increasing bacterial antimicrobial resistance . The use of antibiotics should be reserved for clearly diagnosed secondary bacterial infections, including bacterial otitis media, sinusitis, and pneumonia.
  16. 16. Treatment 3-Antiviral therapy Antiviral therapy is not available for the viruses that cause the URTI with the exception of influenza virus(Tamiflu).
  17. 17. Treatment Symptomatic therapy Discomfort due to fever Nasal congestion and rhinorrhea nasal suction, saline nasal drops or nasal spray, adequate hydration, and/or a cool mist humidifier
  18. 18. Treatment Cough Honey – Honey has a modest beneficial effect on nocturnal cough and is unlikely to be harmful in children older than one year of age. In a randomized trial, 300 children (one to five years of age) with URTI and nocturnal cough were assigned to receive a single dose (10 g) of honey (eucalyptus, citrus, or labiatae) or placebo (an extract made from dates with structure, color, and taste similar to honey) before bedtime; caregivers completed a symptom survey on the days before and after the intervention; 270 children completed the study. Symptoms improved in all children after the intervention. However, children who received honey had greater mean improvement in cough frequency
  19. 19. DEFINITION Acute otitis media (AOM) is defined by moderate to severe bulging of the tympanic membrane (TM) or new onset of otorrhea not due to acute otitis externa accompanied by acute signs of illness and signs or symptoms of middle ear inflammation
  20. 20. EPIDEMIOLOGY incidence Between 60 and 80 % of children have at least one episode of AOM by one year of age Children who have had little or no experience with AOM by the age of three years are unlikely to have subsequent severe or recurrent disease. AOM is infrequent in school-age children, adolescents, and adults.
  21. 21. Risk factors Age – The age-specific attack rate for AOM peaks between 6 and 18 months of age Family history Day care – The transmission of bacterial and viral pathogens is common in day care centers. Lack of breastfeeding Tobacco smoke and air pollution Pacifier use
  22. 22. PATHOGENESIS
  23. 23. PATHOGENESIS The patient has an antecedent event (URTI) while colonized with an otopathogen(s) The event results in inflammatory edema of the respiratory mucosa of the nose, nasopharynx, and eustachian tube. obstructs the narrowest portion of the eustachian tube, the isthmus. poor ventilation and resultant negative middle ear pressure. This leads to the accumulation of secretions produced by the middle ear mucosa. . Viruses and bacteria that colonize the upper respiratory tract enter the middle ear via aspiration, reflux, or insufflation. The middle ear effusion may persist for weeks to months following sterilization of the middle ear infection
  24. 24. MICROBIOLOGY Other pathogenVirusesBacteria Mycoplasma pneumoniae respiratory syncytial virus Streptococcus pneumoniae 31.7 % Chlamydia trachomatis picornaviruses (eg, rhinovirus, enterovirus) Haemophilus influenzae 28.4 % C. pneumoniaecoronavirusesMoraxella catarrhalis 13.9 % influenza viruses adenoviruses human metapneumovirus
  25. 25. CLASSFICATION fluid in the middle ear cavity. Middle ear effusion acute bacterial infection of middle ear fluid Acute otitis media refers to middle ear fluid that is not infected Otitis media with effusion
  26. 26. DIAGNOSIS Signs and symptoms of middle ear inflammation (eg, bulging of the tympanic membrane, distinct erythema of the tympanic membrane or otalgia, fever)
  27. 27. DIAGNOSIS Middle ear effusion (eg, tympanic membrane opacity, decreased or absent tympanic membrane mobility
  28. 28. OTOSCOPY COMPLETE Color Other conditions Mobility Position Lighting Entire surface Translucency External auditory canal and auricle
  29. 29. DIFFERENTIAL DIAGNOSIS The main consideration in the differential diagnosis of acute otitis media (AOM) is otitis media with effusion (OME). OMEAOM it is usually retracted or in the neutral position. tympanic membrane is usually bulging typically amber or bluetympanic membrane is typically white or pale yellow fluid level or bubbles may be seen pus may be visualized behind the tympanic membrane ; the tympanic membrane may be perforated with acute purulent otorrhea, or bullae may be present
  30. 30. COMPLICATIONS Intracranial complicationsIntratemporal complications MeningitisHearing loss Epidural abscessBalance and motor problems Brain abscessTympanic membrane perforation, tympanosclerosis Lateral sinus thrombosisMiddle ear atelectasis Cavernous sinus thrombosisCholesteatoma Subdural empyemaOssicular fixation Carotid artery thrombosisExtension of the suppurative process to adjacent structures
  31. 31. Treatment 1 # SYMPTOMATIC THERAPY 2 # ANTIMICROBIAL THERAPY
  32. 32. References UpToDate Medscape

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