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UPPER RESPIRATORY INFECTION
CHILDREN
DR. DAVID TRISH
G1
2017
UPPER RESPIRATORY TRACT IFECTIONS
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Common cold
Pharyngitis
Sinusitis
Laryngitis and laryngotracheitis
• The most common cause of
cough in children is represented
by airways respiratory
infection, mostly concerning
the upper airway and of viral
origin (URTI).
THE COMMON COLD
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Short, mild and usually self-limiting illness.
Children may have up to12 colds per year.
There are over 200 virus that can cause the
common cold
• Rhinoviruses cause approximately 30-50% of colds
in adults. They grow optimally at temperatures near
32.8°C (91°F), which is the temperature inside the human
nares.
• Coronaviruses are a significant cause of colds.
However, exact case numbers are difficult to
determine, because unlike rhinoviruses, coronaviruses
are difficult to culture in the laboratory.
• Enteroviruses, including coxsackieviruses, echoviruses,
and others, are also leading causes of common colds.
• Adenoviruses, orthomyxoviruses (including influenza A
and B viruses), paramyxoviruses (eg, parainfluenza
[PIV]), RSV and EBV account for many URIs. Varicella,
rubella, and rubeola infections may manifest as a
nasopharyngitis before other classic signs and
symptoms
CLINICAL FEATURES OF COMMON
COLD:
• Rhinorrhea, sore throat,cough,fever and malaise
lasting up to 7 days and often lingering
mucopurlant nasal discharge.
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In infants cold may manifest as irritability,
snuffles and difficulty with feeding.
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Infants under 3 months of a age are susceptible to
LRTI.
TREATMENT OF COMMON COLD
Echinacea, humidified air, nasal decongestants, vitamin C
and zinc have reported some positive results but there
insufficient data to recommend any of these for treatment.
CONSIDER: DRUG
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Analgesic drug
Paracetamol Indication Temporary relief of pain. Reduces fever >38. Precautions- Renal or
hepatic dysfunction. Accidental paracetamol hepatotoxicity Dyspepsia, nausea, allergic and
haematological reactions. Overdose can result in severe liver damage, renal tubular necrosis.
NSAID
Ibuprofen Indication Temporary relief of pain. Reduces fever >38. Short term use only.
Precautions- prolonged use, history of GI bleeding,
Decongestant
Oxymetazoline Hydrochloride Nasal and middle ear congestion
Antibiotics
Phenoxymethylpenicillin Oral therapy for mild to moderate infections due to penicillin
sensitive organisms – Sore throat
THE NASAL CAVITY
Presenting symptoms
• Pain and tenderness
over sinuses
• Headache
• Mucopurulent nasal
discharge (>7-10 days)
• Stuffy nose
• Facial pressure
SYMPTOMS OF SINUSITIS
• Symptoms specific for frontal sinus infection
• Tender forehead
• Symptoms specific for maxillary sinus infection
• Aching upper jaw
• Aching teeth
• Tender cheeks
• Symptoms specific for ethmoid sinus infection
• Swollen eyelids
• Swelling around eyes
• Pain between eyes
• Tenderness of sides of nose
• Loss of smell
• Stuffy nose
• Symptoms specific for sphenoid sinus infection
• Earaches
• Neck pain
• Aching top of head
COMPLICATION SINUSITIS
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Orbital complications
: preseptal cellulitis, orbital cellulitis, subperiosteal abscess,
orbital abscess, and cavernous sinus thrombosis (dural
thrombophlebitis).
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Intracranial complications
: meningitis, subdural empyema, epidural abscess and
cerebral abscess may all complicate acute and chronic
sinusitis
Meningitis
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Fever and chills
Severe headache
Nausea and vomiting
Stiff neck (meningismus)
Sensitivity to light (photophobia)
Mental status changes
Bony complications
:Osteomyelitis (and osteitis) are usually related to acute
frontal sinusitis
INVESTIGATING SINUSITIS
• Physical examation
• X-ray of sinuses
• CAT scan of sinuses
• Nasal swab test
TREATMENT OF SINUSITIS
ACUTE SORE THROAT
PRESENTING WITH AN ACUTE SORE THROAT
ACUTE PHARYNGITIS: PHYSICAL EXAM
• Viral: edema and hyperemia of tonsils and
pharyngeal mucosa
• Streptococcal: exudate and hemorrhage
involving tonsils and pharyngeal walls
• Epstein-Barr virus (infectious mono): may
also cause exudate, with nasopharyngeal
lymphoid hyperplasia
• Adenoviruses: exudate may sometimes be present
• Herpes simplex virus and some coxsackie A
infections: vesiculation and mucosal ulceration may
be present
• Diphtheria: fibrous pseudomembrane with necrotic
epithelium and leukocytes
Ƅ BACTERIAL INFECTION:
GROUP A BETA-HEMOLYTIC STREPTOCOCCUS
• MOST COMMON AND IMPORTANT
• COMMONLY PRESENTS IN CHILDREN AGED 5–6
• FEVER, DRY SORE THROAT, CERVICAL ADENOPATHY,
DYSPHAGIA, AND ODYNOPHAGIA
• THE TONSILS AND PHARYNGEAL MUCOSA ARE
ERYTHEMATOUS AND MAY BE COVERED WITH
PURULENT EXUDATE
• THE TONGUE MAY ALSO BECOME RED ("STRAWBERRY
TONGUE")
• SEQUELAE: ACUTE RHEUMATIC FEVER AND
POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
STREPTOCOCCUS INFECTION CAUSING
INFLAMMATION OF THE THROAT AND TONSILS.
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TREATMENT
ACUTE
PHRYNGITIS
Penicillin
V 250 mg/dose OF
for children
and 500mg/dose
for
adolescents and adults.
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Amoxicillin; 750 mg once daily for10 days or 50 mg/kg/day
for 6 days divided bid.
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A single IM injection of benzathine penicillin (600,000U for
children < 27 kg; 1,2 million U for larger children and adults.
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Erythromycin 40 mg/kg in divided doses for 10 days.
• Azithromycin offers convenience of once-daily administration
and shorter length of therapy.
• Cephalosporins appear to be as, good as or better than
penicillin, perhaps because these drugs are more effective in
eradicating streptococcal carriage. Evidence is not sufficient to
recommend shorter courses of cephalosporins for routine
therapy at this time
Pappas and Henley: Nelson textbook of pediatrics, 2007
CANDIDA
COXSACKIE VIRUS:
• HERPANGINA
ULCERATIVE VESICLES OVER THE TONSILS,
POSTERIOR
PHARYNX, AND PALATE
• COMMONLY OCCURS IN CHILDREN
UNDER THE AGE OF 16
• GENERALIZED SYMPTOMS OF HEADACHE,
HIGH FEVER,
EBV
• Diagnosis
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By Clinical presentation
CBC with differential (atypical lymphocytes –T lymphocytes)
Detection of heterophil antibodies (Monospot test)
IgM titers
EBV PETECHIAE
INFLAMED PHARYNX AND TONSILS MARKED BY A
GRAYISH PSEUDOMEMBRANE FORMED BY THE
BACTERIA ARE CHARACTERISTIC SIGNS OF
DIPHTHERIA.
MISCELLANEOUS CAUSES OF PHARYNGITIS
• Primary HIV infection
• Gonococcal infection
• Diphtheria
• Yersinia entercolitica (can have fulminant course)
• Mycoplasma pneumoniae
• Chlamydia pneumoniae