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Acute Upper

Respiratory Infections
(AURI)
Introduction
Acute respiratory infections (ARI) :
infection of the respiratory tract of
less than 3 weeks(21 days) duration.

ARI = Acute upper respiratory


infections (AURI)+ Acute lower
respiratory infections (ALRI)
AURI Clinical Syndromes
Types of Acute URI
•Acute viral rhinitis

•Acute otitis media

• Acute tonsillo-pharyngitis

• Others (Otitis externa, otitis media with


effusion[OME], mastoiditis, rhinosinusitis)
Acute viral rhinitis (common cold,
acute coryza, nasopharyngitis)
Definition

Aetiology: Rhinoviruses,
parainfluenza, influenza, coronavirus,
enterovirus and others. Occasionally
Group A β- haemolytic
Streptococcus.
Acute viral rhinitis (contd.)
Clinical Features
Incubation period:1-6 days
Frequency (6 – 12 episodes/year)
Duration of illness: usually 7 days
Symptoms: sneezing, rhinorrhoea & blocked
nostrils (classical triad), cough, headache,
low grade fever
Thin rhinorrhoea mucoid rhinorrhoea
mucopurulent rhinorrhoea
Others: sorethroat, malaise, loss of
appetite

Signs: swollen nasopharyngeal


mucosa, cervical lymphadenitis
Complications
Acute otitis media
Sinusitis
Tonsilitis
Laryngotracheobronchitis
Bronchiolitis
Pneumonia
Diagnosis
Clinical
Differential diagnoses
Allergic rhinitis
Flu
Pertussis (catarrhal stage)
Prodromal measles
Nasal diphtheria
Foreign body in the nostril
Treatment
Symptomatic
Nasal toiletting
Antipyretic/analgesic if fever ≥ 38.50C
If young infant – do not expose to cold, keep
warm
If coughing:
a) Exclusively breastfed infant – liberal
breast milk
b) If not exclusively breastfed – simple home
remedy for cough like weak tea +lime,
honey licks, palm oil + sugar.
Dextrometophan used if cough
troublesome
Acute otitis media (AOM)
It is common in infants because
of high frequency of common colds
and the anatomy of the infant’s
eustachian tube, which is shorter,
wider and straight.
Definition
Acute inflammation of middle ear resulting
in an effusion and associated with rapid
onset of symptoms such as otalgia, fever,
irritability, anorexia, or vomiting.

Cf: Otitis media with effusion (OME) defined


as an asymptomatic middle ear effusion
that often follows AOM, but may have no
such antecedent history.
Aetiology
In neonates: Staphylococcus aureus,
Pseudomonas spp., Escherichia coli
and other Gram negative rods.

In older children: Streptococcus


pneumoniae, Haemophilus
influenzae, Moraxella catarrhalis,
Streptococcus pyogenes and others
Clinical features
Classical symptoms : otalgia, fever,
otorrhoea(<14 days), hearing loss.

Non-specific symptoms: irritability, ear


pulling, diarrhoea, vomiting.
Diagnosis
Immobile red tympanic membrane,
serous/purulent fluid in the middle ear,
perforation of tympanic membrane.
Laboratory investigations
Microscopy, culture and sensitivity
(mcs) of ear discharges.

Sepsis screen in toxic neonates .


Complications
Hearing loss
Mastoiditis,
Petrositis
Labyrinthitis
Meningitis
Brain abscess
Treatment
In neonates: parenteral cefuroxime
plus amikacin
Older children: oral amoxicillin (first
line), co-amoxiclav(2nd line).
Oral co-trimoxazole and i.m. procaine
penicillin may be useful in areas of
low resistance by the infecting
agents.
Supportive management : ear (aural)
toiletting for otorrhoea,
antipyretic/analgesic
Acute tonsillopharyngitis
Definition
Inflamed tonsils and pharynx.
Types
Exudative tonsillopharyngitis
Diphtheritic tonsillopharyngitis
Vesicular or ulcerative
tonsillopharyngitis
Exudative
tonsillopharyngitis
Aetiology: Gp. A β-haemolytic
Streptococcus

Symptoms
In older children: fever, sorethroat,
dysphagia, headache and malaise.
Young children: fever, nausea,
vomiting and abdominal pain.
Exudative tonsillopharyngitis
(contd.)
Pyrexia T>380C, exudative tonsillar
enlargement.

Other signs include: oedema,


erythema, lymphoid hyperplasia of
the pharynx, anterior cervical
lymphadenitis.
Exudative tonsillopharyngitis
(contd.)
Investigations and Diagnosis

Culture of throat swab


FBC: polymorphonuclear leucocytosis; useful
but not diagnostic.
Blood culture in very ill patient.
Rapid latex agglutination test on throat
swabs (10 – 60 mins), specific but low
sensitivity.
Exudative tonsillopharyngitis
(contd.)
Differential diagnosis

 Pharyngeal diphtheria – grey membrane


 Vesicular tonsillopharyngitis(herpagina) – vesicles
or ulcers.
 Infectious mononucleosis: aetiology is EB virus;
features include epitrochlear lmphadenopathy,
hepatosplenomegaly,and atypical lymphocytes in
blood film.
 Others: Viral pharyngitis( adenovirus,Herpes
simplex, enterovirus, influenza, parainfluenza ,
measles etc.
Exudative tonsillopharyngitis
(contd.)
Complications
Suppurative : acute otitis media,
acute sinusitis, peritonsillar cellulitis
and abscess, retropharyngeal
abscess, suppurative cervical
lymphadenitis.

Delayed non-suppurative: acute


rheumatic fever and acute
glomerulonephritis
Exudative tonsillopharyngitis
(contd.)
Treatment

Antibiotics
•Oral penicillin V 250mg qds x 10 days
•Single i.m. injection of benzathine penicillin
G (600,000 – 900,000 units for children
≥12 years)
•Oral erythromycin(30 -50 mg/kg/day) 3 – 4
divided doses, in penicillin- allergic
patients.
•Oral amoxycillin
•Oral azithromycin
Supportive
• Analgesic/antipyretic:
paracetamol/ibuprofen
• Adequate fluid and caloric intake
Acute tonsillitis with vesicles
(Herpagina)
Acute tonsillitis with membrane
(Diphtheritic tonsillitis)
Chronic otitis media
Definition
Perforated, painless, discharging ear,
almost always immobile tympanic
membrane.
Investigations
M/C/S of ear discharge
X-ray of mastoid
Audiometry
Tympanometry
Complications
Cholesteatoma
Mastoiditis
Central nervous system involvement
- Otogenic tetanus
- Meningitis
- Facial nerve palsy
- Lateral sinus thrombosis
- Abscesses: brain, subdural and
eustachian
Treatment
Ear (aural) toiletting
Flavine-in-spirit dressing
Systemic antibiotics controversial