2. Upper Respiratory Tract Infection URTI ?

3. Upper Respiratory Tract Infection URTI
Common Cold / Influenza
Sore Throat
Acute Otitis Media
Sinusitis

4. Common Cold = Influenza?

5. Pharyngotonsillitis Tonsillophayngitis
Acute Pharyngitis
Pharyngotonsillitis
Tonsillophayngitis

6. Inflammation of the Pharynx and Tonsils
One of the most common pediatric infections.

7. Pathogens:

8. Pathogens: Viral: Rhino/Adeno/Corona/EBV/CMV HSV Bacterial:
Streptococcus spp. (GAS,GCS,GGS)
Cor. Diphth, Gonococcus, Tularemia etc.
Mycoplasma.
Toxoplasmosis.

9. Pathogens:
0-2 years Viral ++++ GAS+
5-above Viral GAS++
(15-20%)

10. A Study in Makkah showed 40% GAS and high resistance to Penicillin
Telmesani/Ghazi 2002

11. Presentation:
Cough
Sore throat
Dysphagia
Fever

12. O/E: Erythemetous Throat Enlarged tonsils Exudates Palatine Petechiae
Ant. Cervical Lymphadenopathy
Ulceration&vesiculation(HSV/Coxack)
Conjuncitvitis(adenovirus)
Gray-white fibrinous pseudomem (diphtheriae)
Macular rash/white tongue(GAS)

13. Complications: Peritonsillar abcess
Internal jugular vein septic thrombophlebitis (Lemierre Synd.)
Lymphadenitis and abcess
Nonsuppurative e.g. rheumatic fever

18. Diagnosis: Throat culture Rapid GAS antigens testing
EBV (heterophil/serology)
Cold agglutinations (mycoplasma)

19. TTT: Penicillin for GAS
Macrolides (alternative/Mycoplasma) Erytheromycin/Clarithomycin/
Azethromycin

20. TTT: Lactamase producing bacteria needs Amoxicillin-clavulanate acidor
2nd generation Cephalosporin's
e.g. Cefuraxim, Cefaclor

21. TTT: Aspiration or Derainage for abscess
Proper management for any other complications

22. Tonsillectomy

23. Tonsillectomy Recurrent tonsillitis Peritonsillar Abscess (Quinsy)
Obstructive Sleep Apnea (Kissing Tonsils)

24. Adenoidectomy

25. Adenoidectomy Chronic Secretory Otitis Media
Upper Airway Obstruction (Snoring)

27. Ottits Media

28. Suppurative infection of the middle ear cavity

29. Epidemiology 6/12 to 2 y High risk group Boys Cleft Palate
Formula Feeding
Down
Eskimos
Winter- Low Socioeconomic

30. Pathogenesis

32. Pathogenesis Blocked estachian canal Micro-organism
Viral RSV CMV Rhino etc
Streptococcus Pneumonia
H.Influenzae
Moraxella Catarrhalis
Mycoplasma
Staphylococcus

34. Presentation Preceding URTI Fever, irritability, pulls ears
V/D,bulging A/F
Bulging, immobile injected T.M
Loss of land marks
Perforation

36. Normal ear drum and other one with central perforation

37. large central perforation in the right ear of a patient
who had suffered a long standing ear infection.

38. Therapy Antibiotics ( Beta Lactamase) Amoxycillin-Clavulenic acid
Cephalosporins
TMP-SMX
Macrolides
Oral/nasal decongestants
Tympanocentesis

39. Prevention
S. Pneumoniae conjugated vaccine
(small effect)

40. Chronic Secretory Otitis Media (Glue Ear)

41. Chronic Secretory Otitis Media (Glue Ear)
Secondary to recurrent O.M
Treatment Prevents conductive Deafness
-Long term Antibiotics
-Insertion of ventilation tubes (Grommets)

43. Sinusitis
Suppurative infection of the sinuses

44. Predisposition Common cold, Allergic rhinitis
Nasotracheal/nasogastric intubations
Cyanotic heart disease
C.F, Ig disorders ,immotile cilia syndrome
HIV, immune compromised patients

45. Sinus Formation At birth Maxillary ,Ethmoid and Sphenoid are present.
At one year
Frontal sinus
Pneumotization comes later

47. Pathogenesis

48. Pathogenesis Mucociliary flow obstruction Bacterial growth
S. peunoniae
H.Influenzae (nontypable)
M.Catarrhalis
Anaerobic bacteria
Strept/Staph
Gm –ve (nosocomial)
Aspergillus (nutropenic pt.)

49. Presentation Mucopurulent rhinorrhea. Night cough. Nasal speech.
Facial swelling (pain,headache,tenderness).
X-Ray/CT shows clouding/air fluid level.

51. Therapy Amoxicillin /Amox+clavulenic acid
Cephalosporin(2nd generation)

52. Complications orbital cellulitis (read it) epidural/subdural empyema
brain abscess
dural sinus thrombosis
Meningitis
Pott’s puffy tumor

53. TTT of complications
Drainage
Broad spectrum antibiotics.

55. 8/12 comes to your clinic with the problem of not growing well?

56. 5 years boy comes to E/R with the problem of high fever and crying?