Upper Airway Infections Notes

Lecture 10

Upper airway infections

• The “respiratory viruses”

  • Rhinovirus (group of heterogenous viruses-“cold”)

  • Parainfluenza (effects upper & lower RT)

  • Influenza

  • Respiratory syncytial virus (paediatrics, causes bronchitis, wheezing)

  • Adenovirus (can cause conjunctivitis)

  • Other URTI viral culprits

    • Herpes simplex virus (HSV) (DNA viruses, long term infections)

    • Epstein Barr Virus (EBV) (Glandular fever)

    • Enteroviruses (Coxsackie, Echo, Polio) (does not cause gastroenteritis [rotavirus], faeco-orally transmitted)

• Bacteria

  • Shape

    • Cocci- round

    • Bacilli- rods

  • “Nasal” bacteria

    • Haemophilus influenza Gneg c/b

    • Streptococcus pneumoniae Gpos c

    • Branhamella/Moraxella catarrhalis Gneg c (rarely invasive disease, kids)

    • Staphylococcus aureus Gpos C (skin & back of nose)

    • Bordetella pertussis Gneg b

  • “Throat”/“Mouth” bacteria

    • Streptococcus pyogenes (Gp A beta haemolytic strep=nose) Gpos C (sore throat)

    • Corynebacterium diphtheriae Gpos b

    • Alpha haemolytic streptococci (many species) Gpos c (holes in teeth, endocarditis causer)

    • “Anaerobes” e.g. peptococcus, bacteroides. Usually Gpos

• Syndromes

  • RHINITIS- Common Cold

    • Winter time epidemics (don’t understand seasonality, not temperature)

    • Remedies- 100s on offer, none work

  • INFLUENZA

    • Types A & B (two of both)

    • Virus can jump species

    • Yearly epidemics (drift)/occasional pandemics (shift)

    • Mortality principally in elderly

    • Transmission principally in children (vaccinate kids instead of elderly, US)

    • In children: otitis media, febrile fits

  • STOMATITIS

    • Viral- primary HSV, enteroviruses

    • Perioral- recurrent HSV, impetigo (GP A strep, Staph)

    • Ulcers in mouth, cold sores, impetigo (HSV or staph. infection on face)

  • SINUSITIS

    • Difficult diagnosis, variably made

    • Rhinorrhoea +/- abnormal x-rays

    • Presumed bacterial- treated with antibiotics

    • Maxillary sinusitis x-ray=asymmetrical, cerebral abscess

  • TONSILLITIS, PHARYNGITIS, & associated abscesses

    • Bacterial or respiratory viral

    • Relevant diagnosis “Gp A strep” because of complications including

      • Immune response to group A strep. makes you sick

      • Scarlett fever, or post-strep: Rheumatic fever, glomerulonephritis

      • Primary EBV

      • Abscesses- patronsillar- mixed aerobic anaerobic. Important to drain

  • DIPHTHERIA

    • Corynebacterium diphtheriae & phage

    • Severe exudative pharyngitis, lymphadenitis

    • Associated cardiac and CNS pathology

    • Rapid decline in incidence with immunisation from 1940s

    • Some return in Eastern bloc following fall of Soviet Empire

  • OTITIS MEDIA (ear)

    • In virtually all children by age of five

    • Not viral or bacterial- BOTH: Pneumo H infl Moraxella

    • Eustachian tube from nasopharynx when ear affected by respiratory virus

    • Often Rxd with antibiotics (first line) amoxicillin. Second line- Cephalosporin

    • Chronic= “...

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