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Upper Respiratory Diseases

Upper Respiratory Diseases

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Published by anreilegarde

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Published by: anreilegarde on Dec 04, 2010
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02/09/2013

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Diseases of the Respiratory System
Nose, Paranasal Sinuses and Larynx
1.InfluenzaInfluenza viruses, members of the
Orthomyxoviridae
family,include types A, B and C.-Outbreaks occur virtually every year and communicability isinfluenced by antigenic shifts and viral mutations that “confuse”the affected patient’s immune system.
 Clinical Manifestations
Incubation period of 3-6 days.Acute illness usually resolves over 2-5 days.Most patients largely recover within 1 week.Symptoms and Signs:Abrupt onset of headacheFever and chillsMyalgia and malaiseCough, sneezing and sore throat The major problem posed consists of its complications:Primary influenza viral pneumoniaSecondary bacterial pneumoniaMixed viral and bacterial pneumoniaExtrapulmonary complications:Reye’s syndromeMyositis, rhabdomyolysis and myoglobinuriaEncephalitis, transverse myelitisGuillain-Barré syndrome
Treatment 
 Treatment for uncomplicated influenza is symptomatic*Salicylates should be avoided in children because of its association with Reye’s syndrome.*Increased oral fluid intake.*Ascorbic acidAntivirals:Amantadine (Influenza A)Rimantadine (Influenza B)Ribavirin (Influenza A and B)Prophylaxis:Vaccination against Influenza A and BAmantadine and rimantadine
Viral Rhinitis
 The nonspecific symptoms of the ubiquitous commoncold are present in the early phases of many diseasesthat affect the upper aerodigestive tract.
Rhinoviruses
, members of the
Picornaviridae
family,are a prominent cause of the common cold, with seasonalpeaks in the early fall and spring.Infections highest among infants and young children anddecrease with age.
 
 The infection is spread by contact with infected secretionsOther Viral URTI:
Respiratory Syncytial Virus
Belongs to the Paramyxoviridae family.
 
or respiratory droplets or by hand-to-handcontact, withautoinoculation of the conjunctival or nasalmucosa.
 Clinical Manifestations
Incubation period of 1 to 2 days.Illness generally lasts 4 to 9 days and resolvesspontaneously.Symptoms:HeadacheNasal congestionWater rhinorrheaSneezingScratchy throatGeneral malaise and occasionally feverSigns:Reddened, edematous nasal mucosaWater nasal dischargeRhinoviruses are not a major cause of lowerrespiratory tract disease.
Rhinoviruses
may cause exacerbations of asthmaandchronic pulmonary disease in adults.Viral Rhinitis:Clinical ManifestationsComplications: Transient middle ear effusionSecondary bacterial infectionBecause of the mild nature and short duration of the illness,a specific diagnosis is not commonly needed;however, viralcultures can be performed.
Treatment 
No proven specific treatment.Supportive measures:*Decongestants should not be used formore than aweek because of rebound congestion notedaftercessation
(rhinitis medicamentosa)
.*Antipyretics*Liberal fluid intake*Ascorbic acidOther Viral URTI:CoronavirusAccount for 10 to 20% of common colds.Most active in late fall, winter and early spring – aperiod whenthe rhinovirus is relatively inactive.Symptoms are similar to those of rhinovirus, butthe incubationperiod is longer (3 days) and usually lasts 6 to 7days.Mutations of the virus brought about the SARSphenomenon.
 
Major respiratory pathogen of young children and is theforemost cause of lower respiratory disease in infants. Transmitted by close contact with fingers or fomites as wellas through coarse (not fine) aerosols produced by coughingor sneezing.
Incubation period of 4 to 6 days.
Viral shedding may last two weeks in children but is much shorter in adults.
Clinical Manifestations:
RhinorrheaLow-grade feverMild systemic symptomsCough and wheezing
25-40% with lower respiratory tract involvement Treatment:
Antiviral ribavirin for children and infants.No specific treatment for adults.
Parainfluenza Virus
Single-stranded RNA virus of the Paramyxoviridae family.Important cause of mild illnesses and croup (laryngotracheobronchitis), bronchiolitis and pneumonia.
Clinical Manifestations:
Cold or hoarseness with coughAcute febrile illness with coryzaBarking cough and frank stridor in children
Treatment:
In mild illness, treatment is symptom-based.Mild croup may be treated with moisturized air from avaporizer.More severe cases require hospitalization and closeobservation for development of respiratory distress.No specific antiviral treatment is available.
Adenovirus
Infections occur frequently in infants and children with a seasonaldistribution of fall to spring.Certain serotypes are associated with outbreaks of acute respiratorydisease in military recruits. Transmission can take place via inhalation of aerosolized virus, throughthe inoculation of the conjunctival sac, and probably by the fecal-oral route.
Clinical Manifestations:
RhinitisPharyngoconjunctival fever (bilateral conjunctivitis, low-gradefever, rhinitis, sore throat and cervical lymphadenopathy)In adults, the most frequent syndrome is the acuterespiratory disease seen in military recruits, with prominentsore throat, fever on the second or third day of illness, cough, coryza and regional lymphadenopathy.
Diagnosis and Treatment:
Diagnosis is established by isolation of the virus.No specific antiviral therapy is available.A live oral vaccine is available and used widely toprevent outbreaks among military recruits.
Acute Bacterial Sinusitis
 
Eye irritation, pruritus, erythemaand tearing
Signs:
Pale or violaceous turbinatesOccasional polyposis
Treatment
Symptomatic in most cases.Oral decongestantsAntihistaminesNasal corticosteroid spraysMaintaining an allergen-free environmentAir purifiers and dust filtersDesensitizationEpistaxisBleeding from Kiesselbach’s plexusPredisposing factors:Nasal trauma (nose picking, foreignbodies,forceful nose blowing)RhinitisDrying of the nasal mucosa fromlow humidityNasal septal deviationAlcohol useAntiplatelet medicationsBleeding diathesis
Epistaxis
 Treatment:Direct pressure on the bleedingsite.Venous pressure is reduced in thesitting position,and leaning forward lessens theswallowing of blood.Short-acting nasal decongestantspraysCautery Treatment of other possibleunderlying causes of bleedingAcute LaryngitisMost common cause of vocal hoarseness.May persist for a week or so aftersymptoms of upper airwayinfection have cleared.Etiologies:ViralBacterial
(Moraxella catarrhalis,Haemophilus influenzae)
  Treatment:Avoid vigorous use of voiceErythromycin and other macrolides

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