URTI & OM IN PEDIATRICS FOR PEDIATRIC RESIDENT

2. Lulwah AlThumali
Pediatric Resident
TCH

4. 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.

5. Etiology Rhinoviruses
30-50 %
Coronaviruses
10-15 %
influenza
viruses
5%-15%
Humen meta
pneumovirus
Unkown
Enteroviruses
&
Adenoviruses
Less than 5%
RSV
5%

7. 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

8. 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

9. 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

10. PATHOPHYSIOLOGY
rhinovirus infection increases vascular
permeability in the nasal submucosa
releasing albumin and kinins
(bradykinin)
Bradykinin causes rhinitis and sore
throat

11. Symptoms & Signs

12. 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

13. 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

14. Differential Diagnoses
Allergic, seasonal, or vasomotor rhinitis
Nasal foreign body
Inhaled foreign body
Pertussis
Bacterial pharyngitis or tonsillitis

15. COMPLICATIONS
Acute otitis media
Asthma exacerbation
Sinusitis
Lower respiratory tract disease
Epistaxis
Conjunctivitis
pharyngitis

16. 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

17. Treatment
Maintaining
adequate
hydration
Ingestion of
warm fluids
Topical
saline
Humidified
air
1- Supportive interventions

18. 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.

19. Treatment
3-Antiviral therapy
Antiviral therapy is not available for the viruses that
cause the URTI with the exception of influenza
virus(Tamiflu).

20. 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

21. 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

23. 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

24. 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.

25. 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

26. PATHOGENESIS

27. 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

28. 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

29. 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

30. DIAGNOSIS
Signs and symptoms of middle ear inflammation (eg,
bulging of the tympanic membrane, distinct erythema
of the tympanic membrane
or otalgia, fever)

31. DIAGNOSIS
Middle ear effusion (eg, tympanic membrane opacity,
decreased or absent tympanic membrane mobility

34. OTOSCOPY
COMPLETE
Color
Other conditions
Mobility
Position
Lighting
Entire surface
Translucency
External auditory canal and
auricle

35. 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

36. 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

37. Treatment
1 # SYMPTOMATIC THERAPY
2 # ANTIMICROBIAL THERAPY

39. References
UpToDate
Medscape