URTI

Acute Pharyngitis Tonsillitis infectious mononucleosis epiglottis CROUP Acute sinusitis allergic rhinitis common cold MERS laryngitis Influenza
etiology viral: (most common) viral: (most common) Epstein Barr Virus bacterial: Para-infelunza type viral: most common genatic and Viral (almost always): Middle East respiratory viral “rhinovirus” 1- Influenza virus A
• Influenza A (H1N1) virus
adenovirus, rhino, adenovirus, rhino, H.influenza (1,3) (less than 10 days) environmental factors Rhinovirus syndrome coronavirus most common (swine )
EBV,influenza, para EBV,influenza, para rhino, adenovirus, (pets, moulds, pollen and other less common: (MERS-CoV) bacterial: the most • influenza A (H5N1) virus
(bird flu)
influenza influenza EBV, influenza, para dust) corona, parainfluenza, common causative • Type A viruses are the most
bacterial: group A bacterial: group A beta influenza influenza and RSV organism is H. virulent human pathogens
among the three influenza
beta hemolytic hemolytic bacterial: (more than influenza types and cause the most
streptococcus, streptococcus, 10 days and less than severe disease.
• They undergo two kind of
chlymidia , gonorreha chlymidia , gonorreha 1 month) changes:
fungal: fungal: 1-streptococcus • A) Antigenic shift
• B) Antigenic drift
pneumonea 2- Influenza virus B (infects
2- H.influenza humans only ): only
antigenic drift.
3-moraxella catharrhlis 3- Influenza virus C (infects
humans, dogs and pigs )

C\P viral: cough, viral: cough, rhinorrha, characterized by a triad of 1-Tripod position 1-Barky cough 1- facial pain and Nasal symptoms: • Runny/blocked nose • Fever >38°C hoarseness- •Fever
rhinorrha, low grade fever, no fever, tonsillar pharyngitis, (laying forward and 2-SOB tenderness, Pruritus, Sneezing, • Sneezing • Cough dysphagia- •Runny nose
low grade fever, no lymphadenopathy and lymphadenopathy. hands on knee) 3-Inspiratory stridor 2- purulent nasal Rhinorrhoea, Nasal • Sore throat • Dyspnoea odynophagia- •Severe malaise
lymphadenopathy Bacterial: no cough, Sings are: splenomegaly 2-Drooling saliva 4-Respiratory stress discharge and fever in congestion • Cough • Hemoptysis (less increase mucous •Headache
Bacterial: no cough, high grade fever >38C, and palatal petechia. 3-Dysphagia bacterial, Eye symptom: Eye • Headache common) production •Non productive cough
high grade fever anterior cervical 4-Dyspnea 3-nasal obstruction, redness, eye itching, • Malaise • Diarrhea/ Abdominal bacterial: (high •Sore throat
>38C, anterior lymphadenopathy, 3-fever 4-halitosis, Puffines, watery • mild or no Fever Pain/ Nausea/vomiting grade fever_ •Muscular pain
cervical pharyngeal exudate 4-Stridor 5-periorbital edema discharge (<38°C) • Myalgia & malaise anterior cervical
lymphadenopathy, with tonsillar 5-Muffled sound Associated symptoms • non-specific red • Contact with affected lymphadenopathy
pharyngeal exudate hypertrophy PLUS (hot potato) Palate, throat and ear pharynx person or respiratory and exudative
with tonsillar abdominal pain,nausea itching • nasal mucosal symptoms after tonsillophayngitis)
hypertrophy , vomiting,halitosis Constitutional edema/erythema hospitalization
symptoms: Fatigue
Irritability

investigation Rapid antigen test Rapid antigen test 1-CBC (initial test): atypical - clinically Usually clinically Usually clinically skin-prick test to detect No initial tests are 1-FBC > leukopenia; the viral is usually Clinically diagnosed in
+ve give IV AB +ve give IV AB lymphocytes diagnosed diagnosed, on CXR diagnosed but to specific IgE (confirm the needed (done only if lymphopenia; clinically diagnosed seasonal influenza
(penicillin) if -ve do (penicillin) if -ve do a 2- mono-spot test (positive * to confirm : (Steeple sign) confirm CT- sinus diagnosis symptoms for >2 thrombocytopenia but laryngoscopy outbreaks. but to
a throat culture throat culture hetrophillis antibody) - laryngoscopy without contrast weeks or atypical 2-comprehensive can be done by confirm
- latral –neck (opacity and air-fluid presentation) metabolic panel > otolaryngiology 1- CBC
radiograph > thumb level) elevated creatinine; specialist 2-RT-PCR
print sign elevated LFTs; 3-Viral isolation by
-FBC elevated LDH nasal or throat swabs
-Blood culture 3-RT-PCR > Confirms (culture).
MERS 4- CXR to exclude
4-chest x-ray > in all complication
patients with suspected
pneumonia

complication For group-A beta Local: retropharngeal 1-Ampicillin rash (most Respiratory failure Cranial problems, acute exacerbation of increase with age: airway compromise Pneumonia
hemolytic abscess common) Eyes pain, Nasal asthma or COPD Fatal pneumonia, acute especially with Respiratory failure
streptococcus: systemic : RF + Acute 2-Spleen rupture bleeding , Severe AND Otitis media or respiratory failure, diphtheria) formation shock
Rheumatic fever + glomerulonephritis otitis 3-CNS manifestations headache or deep Acute sinusitis ARDS, acute renal of true vocal fold seizure
Acute media teeth pain failure, multi-organ lesion(especially Failure of multiple
glomerulonephritis failure(rare) heavy voice use)- organs (e.g. kidney
laryngeal stenosis failure)
(especially untreated Death
T.B)
treatment viral: supportive viral: supportive 1-supportive treatment This is not done at Steroid Antibiotic Non-pharma Rx: 1st: Rest, Fluids, with pneumonia or 1- secure airway if Prevention: flu
treatment(rest- treatment(rest- 2-educate the patient (Avoid PHCC but in mild = steroid allergen avoidance prevent spread + comorbidities: admit there is airway vaccine
electrolytes- electrolytes-analgesic- sport in case of splenomegaly hospital after Nebulizer or oral Pharma: supportive therapy +isolation, supportive compromise. Analgesic: Ibuprofen
analgesic-antipyretic) antipyretic) to avoid rupture for 1 month) refferal: moderate = steroid + Intermittent mild (analgesic-antipyretic) care +monitoring, 2- if viral: supportive Cough suppressant:
bacterial: penicillin bacterial: penicillin • Secure airway + epinephrin nebulizer symptoms: + Nasal decongestant mechanical ventilation, treatmesnt - if hydrocodone, codeine
supplemtanl sever = (best Rx) IV • oral antihistamine empirical antimicrobial bacterial give Nasal decongestants
oxygen dextamethazone + O2 Persistent mild or therapy. antibiotics and (anticholinergic)
• IV Antibiotic + epinephrin intermittent without pneumonia or supportive care. Ipratropiumintra
• Corticosteroids moderate to severe comorbidities: nasal(Atrovent) –
• Analgesic- symptoms: consider home Antihistamine:
antipyretics • oral antihistamine isolation, supportive Chlorpheniramine –
* prevention : (Hib) Persistent moderate to care + monitoring. Antiviral drugs:
vaccine severe symptoms: •Amantadine.
• intranasal corticosteroid patient education:
wear mask, personal
hygiene

indication for recurrent infection recurrent infection referral to ENT or failure to respond to Recurrent infection MERS confirmed cases 1- airway
referral referral to ENTfor referral to ENT for Pediatric treatment > reffer referral to ENT are admitted to hospital compromise
tonsillectomy tonsillectomy anesthesia (first and isolated 2- hoarseness more
thing to do!!) than 3 weeks
3- uncertain
diagnosis
4- patients whose
their profession
relies on their voice