UPPER RESPIRATORY TRACT

INFECTIONS
By Dr.Dejen G. MD
 COMON COLD(RHINOSINUSITIS)
Is a viral illness in which the symptoms of
rhinorrhea and nasal obstruction are
prominent
ETIOLOGY
Rhino virus(most common cause)
Other causes include corona virus, RSV
influenza and Para influenza viruses
adeno virus and entero virus

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EPIDEMIOLOGY
Occurs year round but there is seasonal
variation for specific viruses
On average each child has 6-7 colds/year
10-15% have 12 infections/year
Incidence decreases with age(2-3×/year in
adults)

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 Cot’d
PATHOGENESIS
Mode spread -small particle aerosols
-large particle aerosols
-direct contact
Some routes of transmission appear to be more
efficient than others for particular organisms.
eg. Rhino and RSV by direct contact
Influenza by small particles
Rhino and adeno virus infection have sero type
specific protective immunity but repeated
infections occur b/c there are large number
distinct serotypes.
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C/M
IP – 1-3 days
1st Sm is sore scratchy throat followed by nasal
obstruction and rhinorrhea
Cough in 30% of the cases
Influ.,adeno and RSV are more likely than rhino
and corona to be associated with fever and
constitutional symptoms.
Common cold persists for 1week and in 10% for
2 weeks
Wet nose and inflamed tonsils are found in
physical examination.
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 DDX
• Allergic rhinitis
• Nasal foregin body
• Sinusitis
• Pertussis

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TREATMENT
• Antiviral
• Symptomatic treatment
COMPLICATIONS
• Otitis media(5-30%)
• Sinusitis(5-30%)-acute bacterial sinusitis
• Exacerbation asthma

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 ACUTE PHARYNGITIS
ETIOLOGY
• Viral and GABHS(most common causes)
• Group C strept.,A.haemolyticum,
F.tularensis,M.pneumonae,N.gonorrhoeae
and C.diphtheriae are other causess
EPIDEMIOLOGY
• Strept. Pharyngitis uncommon before 2-3yrs
• Group C strept. And A.haemolyticum are
causes in adults.

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 Clinical Manifestations
• Rapid onset with prominent sore throat &
fever
• Headache and GI symptoms are common
• Pharynx is red &tonsils are enlarged & with
exudates
• Uvula is red and swollen
• Tender and swollen ant. Cervical nodes
• Some may manifest with Scarlet fever-
circumoral pallor, strawberry tongue &red
and finely papular rash
• Onset of viral pharyngitis has more insidious
onset
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 Cot’d
• Adeno virus(pharyngoconjuctival fever)
• EBV has systemic manifestations as part of
infectious mononucleosis syndrome
• HSV- high grade fever and gingivostomatitis

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 DIAGNOSIS
• Throat culture is un imperfect gold standard
for Dx of GABHS pharyngitis
MANAGEMENT
• Penicillin v or amoxicillin for 10 days
• Erythromycin (if allergic to the above drugs)
• Symptomatic Mx with anti-
pyretics,analgesics,local anesthetics

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COMPLICATIONS
• Otitis media
• Local supperative complications like
parapharyngial abscess
• ARF and AGN
PREVENTION
• Antibiotics for ARF recurrence

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CROUP(laryngeotracheobronchitis)
• A respiratory illness characterized by inspiratory stridor,
cough, and hoarseness .
• Barking cough in infants and young children unlike older
children and adults which they predominantlly have
hoareseness of voice

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 Etiology
• Para influenza virus(types 1,2,3)-75% of cases
• Influenza(A &B),adenovirus,RSV&measles
• Rarely mycoplasma pneumonae
EPIDEMIOLOGY
• Age -3 months – 5years
• Peak is in the second year of life
• Males are more frequently affected
• Common in winter
• Recurrence common till 3-6yrs and decreases with age
• 15 %have strong family history of croup

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 Clinical manifestation
• Most common cause of upper resp. tract obstruction
• Pts usually have rhinorrhea,pharyngitis,mild cough &low grade fever
• Symptoms are worse at night
• Sms resolve with in a week
• Other Fx members may have mild resp. illness
INVESTIGATIONS
• PA chest X-ray steeple sign or inverted pencil sign
• Laryngoscope-erythematous edema with destruction of mucosal
epithelium

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 Steeple sign

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DOSES
• Dexamethasone 0.6mg/kg IM or oral
prednisolone 1-2mg/kg for 1-3days
• Aerosolized racemic epinephrine 0.25-0.5mo
of 2.25% solution diluted in1.8 or standard
epinephrine 1ml of 1:1000
complications
• Seen in 15% of patients
• Otitis media
• Bacterial tracheatis
• Bacterial pneumonia
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 Spasmodic croup
• Similar to croup but no fever usually occurs
b/n 1-3 years of age
• Cause is usually allergy
• Self limiting with in hours

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 EPIGLOTTITIS
• Hib (not common cause in westerns)
• Strept.pyogens,S.pneumonea,S.aureus
• 1st year to 7th year
• Peak 6-36 months
• Acute fulminating course with high fever, sore
throat,dyspnoea &rapidly progressing resp.
obstrn.
• Toxic, swallowing and breathing difficulty

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• Drooling of saliva and hyper extended neck
• Tripod positioning
• Air hunger,restlesness,cyanosis &finally coma

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• Laryngoscope-large cherry red epiglottis
• If Dx is certain or probable laryngoscope
should be done in the OR or ICU.
• Blood culture
• Lateral neck X-ray(thumb sign)
• Endotracheal tube or tracheostomy
• Iv Abcs for 7-10 days(ceftriaxone or
cefotaxime)
• oxygen

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 Otities-media
• AOM – If the ear pain or ear discharge is less than 2
weeks if morethan this its called chronic OM
• Peak incidence and prevalence of OM is during the
1st 2 yr of life.
• More than 80% of children will have experienced at
least 1 episode of OM by the age of 3 yr.
• Caused by commonly by the 3 pathogens
Streptococcus pneumoniae , nontypeable
Haemophilus influenzae and Moraxella catarrhalis
• In chronic case pseudomonas aeroginousa

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 CLINICAL MANIFESTATIONS
• Irritability or a change in sleeping or eating
habits- in young children
• Fever may also be present and may
occasionally be the only sign
• Ear discharge
• Holding or tugging at the ear

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 Management
• Antibiotics 1st line amoxacillin then augmentin
or cephalosporins
• Analgesic and antipyretic
• Make the ear dry by wicking and avoiding
contact to water to ear
• Ciprofloxacilline ear drop BID
• Surgical management

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 thank you !!

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