3. INTRODUCTION
URTIs represent the most common acute illness evaluated
in the outpatient setting.
They range from self-limiting illnesses such as common
cold to life-threatening illnesses such as epiglottitis.
Viruses account for most URTIs.
Bacterial primary infection or superinfection may require
targeted therapy.
9. Introduction
Also known as common cold.
Common cold syndromes include rhinitis, tonsillitis,
pharyngitis, laryngitis (including croup), pharyngo-
laryngitis among others.
Sometimes, influenza (the flu) and sinusitis are
characterized as a common cold syndrome.
10. Introduction
Viral infection of upper respiratory tract.
Usually lasts approximately 7 days.
Associated with a number of viruses like Rhinoviruses,
Parainfluenza viruses.
11. Mode of transmission
Very contagious.
Spread from person to person.
Usually from nasal secretions and from fingers of the
affected person.
Most contagious in the first 3 days after symptoms begin.
Viruses can last up to 5 hours on the skin and hard
surfaces.
12. Pathophysiology
Mechanism of immune response is virus-specific.
For example, the rhinovirus is typically acquired by direct
contact and it binds to human ICAM-1 receptors.
ICAM-1 receptors are present on respiratory epithelial cells.
As the virus replicates and spreads, infected cells release
chemokines and cytokines which in turn activate
inflammatory mediators.
The inflammatory mediators then produce the symptoms.
13. Symptoms
Begins with a feeling of dryness and stuffiness in the
nasopharynx (nose).
Presence of nasal secretions (usually clear and watery).
Watery eyes.
Red and swollen nasal mucous membranes.
Headache.
Lethargy.
Chills (in severe cases).
Fever (in severe cases).
Exhaustion (in severe cases).
If the pharynx and larynx (throat) are involved: sore throat
and hoarseness.
16. Prevention
Good handwashing.
Cough and sneeze into arm or tissue.
Use of aerosol sprays e.g., Lysol.
Use of antibacterial sanitizers.
17. Complications
Colds may aggravate the symptoms of other conditions
such as asthma and chronic obstructive pulmonary
disease.
Colds can also lead to:
- Acute bacterial bronchitis
- Strep throat
- Pneumonia
- Ear infections
19. Introduction
Inflammation of the tonsils that can be acute, sub-
acute, chronic, or recurrent.
Can either be bacterial or viral in origin.
Sub-acute tonsillitis is caused by the bacterium
Actinomyces.
Chronic tonsillitis, which can last for long periods if
not treated, is mostly caused by bacterial infection.
20. Causative agents
Bacteria (streptococci, staphylococci, treponema,
sphirocetes).
Viruses (Adenovirus)
The causative factors enter the upper respiratory tract
via the nose and mouth then cause inflammation to
the tonsils.
22. Signs and symptoms
Sore throat, with referred pain to the ears.
Dysphagia, odynophagia.
Cough.
Headache, fever, chills.
Red, swollen tonsils with pus.
Swelling and tenderness of submandibular glands.
23.
24. Diagnosis
History, physical examination.
Buccal swab for culture and sensitivity to identify
susceptible microorganisms.
Complete blood count for elevated white blood cells
and lymphocytes.
25. Treatment
Saline gargle (mouthwash if needed).
Analgesics.
Antipyretics.
Soothing lozenges.
Antibiotics (penicillin is drug of choice, but may use
erythromycin and cefuroxime).
Tonsillectomy for recurrent or chronic cases.
26. Complications
Peritonsillar abscess.
Lemierre’s syndrome (thrombophlebitis of internal jugular vein and
bacteremia caused by primarily anaerobic microorganisms, following a recent
oropharyngeal infection).
Hypertrophy of tonsils (snoring, mouth breathing, disturbed sleep, and
obstructive sleep apnea).
Rheumatic heart disease.
Glomerulonephritis.
Tonsillolith (tonsil debris in whitish color).
Halitosis.
28. Introduction
Collection of pus in retropharyngeal spaces.
The retropharyngeal space is a connective tissue space
between the buccopharyngeal fascia and pre-vertebral
fascia.
It extends from the skull base to the posterior
mediastinum.
It contains 1 retropharyngeal lymph node on each side.
The retropharyngeal lymph nodes regress at the age of
5.
29. Definition
Infection of retropharyngeal lymph nodes located in
space bound by posterior wall of esophagus and
anterior cervical fascia.
Most commonly occurs in children age <5 years.
30. Cause, Pathophysiology
Usually an infectious complication of antecedent URTI.
Less common causes: direct extension of vertebral
osteomyelitis, injury from penetrating trauma to
oropharynx or foreign body aspiration, or as complication
of dental trauma or intubation.
Most infections are polymicrobial:
- S. aureus and GABHS are the predominant
microorganisms.
- Gram-negative aerobes and oral anaerobes may also be
present .
31. Clinical presentation
Common features include fever, ill-appearance,
decreased movement of neck particularly with
extension, tender cervical lymphadenopathy, drooling.
Always assess for upper airway obstruction and need
for emergent airway management.
32. Testing
Lateral neck radiograph: may show widening of prevertebral
space.
CT scan: most definitive imaging modality for deep neck
infections.
Elevations in WBC count, CRP, or ESR may help assess severity
of illness and response to therapy.
Rapid antigen detection test and/or throat culture for GABHS.
Gram stain and cultures of purulent fluid if drainage is
performed.
33.
34. Treatment
Admission to hospital for airway maintenance and
supportive care.
I.V antibiotics such as clindamycin and ampicillin-
sulbactam are used; may transition to oral antibiotics
at discharge.
More severe infections will require otolaryngology
consultation for incision and drainage.
36. Definition
Acute inflammatory condition confined to supraglottic
structures i.e. epiglottis, aryepiglottic folds and arytenoids.
It is most often caused by bacteria.
Other possible causes include burns and trauma to the area.
The condition can block airflow to the lungs and is potentially
life-threatening.
Children below 12 months of age are at high risk, but the peak
incidence occurs between 2-6 years of age.
37. Etiology
Haemophilus influenza type B (most common).
Haemophilus parainfluenza.
Streptococcus pneumoniae.
Group A streptococcus.
Others: group C streptococcus, Neisseria.
meningitidis, Klebsiella.
Previous viral infection.
Non infectious causes: burns, caustic injury, trauma,
post foreign body ejection.
43. Diagnosis
History, physical examination.
Direct laryngoscopy.
Neck X-ray (lateral view).
Throat and blood cultures.
44.
45.
46. Treatment
Secure airway by nasoendotracheal intubation.
Parenteral antibiotics: ampicillin or 3rd or 4th generation
cephalosporins (ceftriaxone, cefotaxime, cefuroxime).
Intravenous fluids for nutrition and hydration until able to
swallow again.
Steroids: hydrocortisone or dexamethasone I.V or I.M to
relieve edema.
Humidified oxygen.
Intubation or tracheostomy to relieve respiratory
obstruction.
49. Definition
Upper airway illness characterized by inflammation of
larynx and trachea, especially subglottic area where
trachea is ‘fixed’ by firm cartilaginous ring.
50. Etiology, epidemiology
Usually of viral etiology.
More common pathogens: parainfluenza, influenza.
Less common pathogens: RSV, human coronaviruses,
enteroviruses, adenovirus.
Most common in children aged 6 months to 3 years.
Peak incidence in fall and winter.
51. Risk factors
Family history.
Anatomic or acquired airway narrowing (e.g., history
of intubation).
52. Clinical features
Symptoms: gradual onset of rhinorrhea, congestion, fever, hoarseness,
barky cough, and, eventually, stridor.
Signs on physical exam:
- Mild disease: rhinorrhea, congestion, coryza, fever, hoarseness, barky
cough, stridor with agitation.
- More severe disease: tachypnea, stridor at rest, hypoxemia, respiratory
distress with nasal flaring, grunting, and retractions.
- Signs of impeding respiratory failure (rare): lethargy, decreased level of
consciousness, severe retractions or stridor, poor aeration, tachycardia,
cyanosis or pallor, apnea.
- Always assess hydration status: tears, moist mucous membranes.
53. Diagnosis
History and physical examination.
Laboratory findings: CBC may reveal elevated WBC
count.
Radiological findings: ‘steeple sign’ with subglottic
narrowing.
Laboratory and radiological investigations are not
routinely needed, as diagnosis is mainly clinical.
54.
55. Treatment
Mild croup:
- Supportive care: oral hydration, antipyretics.
- Dexamethasone: single oral dose of 0.6mg/kg (max=10mg)
prevents worsening of symptoms.
Moderate/severe croup:
- Supportive care: humidified air (oxygen if hypoxemic).
- I.V fluids if not maintaining sufficient hydration orally.
- Dexamethasone as above: P.O, I.V, or I.M.
- Racemic epinephrine via nebulizer: requires observation
for 3-4 hours after because some children relapse after drug
wears off.
56. Indications for hospitalization
Hypoxemia.
Stridor at rest.
Inability to maintain hydration PO.
Barriers to return for care if worsening at home.
57. Typical clinical course
1-2 days of upper respiratory symptoms followed by
worsening stridor and respiratory distress with gradual
resolution over 3-5 days.
