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The common cold. The common cold. Viral illness that symptoms of rhinorrhea and nasal obstruction are prominent . The most common pathogens are the rhinoviruses . Coronaviruses and RSV are occasional . Influenza , parainfluenza , Adenoviruse and Entroviruses are uncommon. Epidemiology. - PowerPoint PPT Presentation
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The common cold
The common coldViral illness that symptoms of rhinorrhea and
nasal obstruction are prominent .
The most common pathogens are the rhinoviruses .
Coronaviruses and RSV are occasional . Influenza , parainfluenza , Adenoviruse and
Entroviruses are uncommon
EpidemiologyYoung children have an average of 6-7 colds
per year.The incidence of illness higher in the daycare
group in the first 3 yr of life
Colds occur year round. Incidence is greater from the early fall until the late
spring.The highest incidence of rhinovirus infection occurs in
the early fall and in the late spring .
pathogenesisViruses are spread by small-particle aerosols, large-
particle aerosols ,and direct contact .
Direct contact is an efficient mechanism for RSV and rhinoviruses.
Infections with rhinoviruses and adenoviruses result in development of serotype-specific protective immunity.
Re-infection with parainfluenza viruses and RSV occurs and protective immunity to these pathogens dose not develop.
Clinical manifestation
The onset of symptoms that typically occurs 1-3 days after viral infection are :
sore throat , nasal obstruction and rhinorrhea . and by the 2- 3 day of illness nasal symptoms predominate .
Cough is associated with approximately 30% of colds .
Influenza viruses , RSV ,and adenoviruses associated with fever and other constitutional symptoms .
( low – grad fever, sneezing )
Clinical manifestation
The usual cold persists about 1 wk ( 10% last 2 wk)
Increased nasal secretion is obvious .Change in the color or consistency of the secretions is
common and is not indicative of sinusitis or bacterial superinfection .
Persistent rhinorrhea following a cold suggests sinusitis or bacterial superinfection .
Condition may mimic common cold
Allergic rhinitis Prominent itching and sneezing and nasal eosinophilia
Foreign body Unilteral,foul-smelling dischargewith
Sinusitis Headache,facial pain,or periorbital edema persistence of
rhinorrhea or cough for longer than 10-14 days
Condition may mimic common cold
Streptococcal nasopharyngitis Nasal dischar that excoriates the nares
Pertussis Onset of persistent or paroxysmal cough
Congenital syphilis Persistent Rhinorrhea (snuffles) with onset in the first 3 mo of life
Rhinorrhea
Rhinorrhea is a common manifestation of : infectious , allergic , mechanical condition . Infectious rhinitis : mucopurulent discharge with PMN .
Allergic rhinitis : lack of fever ,eosinophils in discharge . ( allergic shiners , nasal polyps , pale edematous nasal
mucosa ,transverse crease on the nasal bridge ) .
Less common causes are : foreign body, choanal atresia vasomotor rhinitis , CSF fistula , diphtheria , tumor , congenital syphilis.
treatmentSymptomatic treatment for : Fever , Nasal obstruction, rhinorrhea, Sore
throat, cough.Antibacterial therapy is not benefit in the
treatment of the common cold.Antiviral treatment
specific antiviral therapy is not currently available for rhinovirus.
Ribavirin which is approved for treatment of RSV infections has no role in the treatment of the common cold .
treatment Topical or oral adrenergic agents may be
used as nasal decongestant 1. not approved <2yr .2. prolonged use should be avoided to prevent of
rhinitis medicamentosa.
oral adrenergic agents are less effective than the topical and are associated with systemic effects
( hypertension , palpitation)
treatment Rhinorrhea the first - generation antihistamines reduce
rhinorrhea that related to the anticholinergic rather than the antihistaminic properties .( by 25- 30% )
Sore throat is not severe but mild analgesics is occasionally
indicated particulary if there is associated myalgia or headache.
Cough may be result of viruse- induced reactive
airway disease (bronchodilator)
Treatment Cough Cough suppression is generally not necessary .
but in some patients is due to upper respiratory tract irritation and post nasal drip .
(first generation antihystamin may be helpful )
Vitamin c , guaifenesin , inhalation of warm , humidified air have all been found no more effctive than placebo.
Echinacea is a popular herbal treatment .
prevention Chemoprophylaxis or immunoprophylaxis is
generally not available for common cold .
– Chemoprophylaxis or immunoprophylaxis against influenza may be useful.
– Cold can prevented by interrupting the chain spread of virus .with good hand washing
Complications The most common complication of a cold is
otitis media ( 5-30%)Symptomatic treatment has no effect on the
development of acute otitis media .or sinusitis
Exacerbation of asthma
Sinusitis is a relatively frequent complication (0.5 -2% in adult and 5-13% in
children)1. Rhinorrhea or daytime cough
persists without improvement for 10-14 days
2. or if signs ( fever , facial pain , facial swelling) develop.
sinusitisSuppurative infection of the paranasal sinuses. Complicates the common cold and allergic rhinitis .
The maxillary , ethmoid , and sphenoid sinuses present at birth .
The frontal sinus develops at 1 year of life . And may not appear at air-filled spaces until 10 years of age.
sinusitis increased incidence of sinusitis ;
Cyanotic heart disease CF immunoglobulin deficiency HIV nasoteracheal intubation immotile cilia syndrome dental infection immunocompromised children following organ
transplantation.
Etiology of sinusitisCulture of the nasal mucosa is not helpful in
identifying the responsible bacteria .
If necessary , anteral puncture for maxillary sinusitis is the diagnostic procedure of choice .
Obstruction to mucociliary flow predisposes to bacterial proliferation.
Etiology of sinusitisThe bacterial producing acute sinusitis are :
Pneumococci , non typable H.influenzae M.catarrhalis , anaerobic bacteri
and rarely streptococci and staphylococci.
Nasocomial sinusitis may occurs by: gram- negative bacteria ( klebsiella, pseudomonas ,
entrobacter)
Clinical manifestations of sinusitis
Persistent mucopurulent rhinorrhea .
cough (at night ) .nasal stuffiness, nasal quality to the
voice .
facial swelling , tenderness , pain .
headache.
diagnosis of sinusitisCT reveals clouding , thickened
mucosa , or an air- fluid level .
Sinus aspiration usually is not needed in uncomplicated sinusitis
treatment of sinusitisAmoxicillin or amoxicillin/clavulanate is
usually effective in uncomplicated sinusitis .
Complications should be treated with : drainage and if indicated broad-spectrum
parentral antibiotics .
Long of treatment 14-21 days
complicationsOrbital cellulitis . Epidural or subdural empyema .brain absecess . dural sinus thrombosis .osteomyelitis and meningitis .sinusitis may also exacerbate bronchoconstriction
in asthmatic patients
دارد درد گوش مشكل كودك ؟آيا دارد؟ وجود گوش درد آيا ميشود؟ خارج ترشح گوش از آيا
مدت؟ چه براي
: معاينه . كنيد نگاه چرك خروج نظر از را گوش
. كنبد معاينه را گوش
: گوش حاد عفونت هاي نشانهاز 1. كمتر چرك روز 14خروجاست 2. قرمز معاينه در گوش وپرده گوش درد
درمان:مدت به بيوتيك روز 10آنتي
روز دو برگردد فوري زماني چه كه مادر به توصيه. كند مراجعه پيگيري جهت بعد
otitis
مزمن عفونت هاي نشانهاز بيش ازگوش چرك روز 14خروج
درمان: از بيش چرك غير 6خروج در ارجاع هفته
گوش كردن خشك به توصيه اينصورت بمدت بيوتيك روز 14آنتي پيگيري .2جهت كند مراجعه بعد روز
Otitis mediaSuppurative infection of the middle ear cavity and is
the most common between 6 months and 2 years of age .
High –risk populations:HIV. Cleft palate .Down syndrome . more common in boys . in patients of low socioeconomic status . In formula – fed infants . in the winter months.Day care
Pathogenesis Otitis mediaWhen the eustachian tube is blocked
by:
1. local infection .2. Pharyngitis.3. Hypertrophied adenoids .
Pathogenesis otitis mediaAir trapped in the middle ear is reabsorbed ,
creating negative pressure in this cavity , that permit reflux of bacteria .
This bacteria plus obstruction of the flow of secration from the middle ear and leads to middle ear effusion.
The most common bacterial pathogens are : pneumococci ,nontypable H. influenzae .M.catarrhalis .
and less frequently group A streptococci and highly resistant S .pneumoniae
Clinical manifestation Usually occur 1-7 days after nasopharyngitis .
Patients often Febrile( 30% -50% ) and , irritable ,Vomiting ,diarrhea ,bulging of
funtanel ,vertigo ,tinnitus , and draining ear may be seen .
Otoscopic examination:Erythematous TM ,loss of identifiable landmarks .Perforation of TM also may occur and usually is
associated with acute relief of pain .
treatment otitis media
Oral antibiotics frequent used are :
amoxicillin , amoxicillin/clavulanate trimethoprim/sufamethoxazole . erythromycin /sulfisoxazole .
Oral cphalosporins(cefaclor ,cefuroxime , cefexim ) also been approved for otitis caused by:
β-lactamase- producing organisms .
treatment otitis mediaFor Highly resistant pneumococci higher doses of
amoxicillin/clavulanate or clindamycin or a single dose of parenteral ceftriaxone may be efficacious .
Tympanocentesis may be needed in patients: who are difficult to treat . or do not respond to therapy.
Decongestants or antihistamines are not effective alone or with antibiotics
pharyngitis
از تر باال كودك دارد؟ 2آيا درد گلو سال
دارد؟ مشكل خوردن غذا موقع آيا: كنيد سئوال دارد؟ بيني از آبريزش آيا ميكند؟ عطسه و سرفه كودك آيا است؟ قرمز او چشمهاي آيا دارد؟ صدا آياخشونت
از تر باال كودك دارد؟ 2آيا درد گلو سال
: كنيد معاينه حلق قرمزي و ،اگزودا پتشي وجود گردني آدنوپاتي لنف بدن حرارت درجه
Pharyngitis
استرپتوكوكي درد گلودرد: زير هاي نشانه از نشانه ودو تب وجود
حلق در اگزودا گردن قدامي لنفادنوپاتي كام روي ياپتشي ها لوزه قرمزي
ويرال فارنژيت: باشد داشته را زير هاي نشانه از نشانه دو
چشمها آبريزش سرفه چشم قرمزي صدا خشونتعطسه
Acute PharyngitisEtiology:
– Bacterial-– Group A streptococcus– Group C streptococcus – Corynebacterium diphtheriae – Others (less often):– Mycoplasma pneumonia , spirochetes, Chlamydia
pneumoniae.
Acute Pharyngitis(Bacterial)
• Mycoplasma pneumoniae
• Arcanobacterium haemolyticum• Francisella toleransis (gram – coccobacillus)• Chlamydia pneumoniae
Acute Pharyngitis
– Viral >90% • Rhinovirus – common cold• Coronavirus – common cold• Adenovirus – pharyngoconjunctival
fever;acute respiratory illness • Parainfluenza virus – common cold; croup• influenza virus – influenza• Coxsackievirus - herpangina• EBV, CMV – infectious mononucleosis• HIV
Acute Bacterial Pharyngitis
– Group A beta-hemolytic streptococci (S. pyogenes) ,cocci gram+ • most common bacterial cause of
pharyngitis• Uncommon<2-3 yr, peak in winter and
spring ,spread to classmates • accounts for 15-30% of cases in
children and 5-10% in adults.
Epidemiology of Streptococcal Pharyngitis
Spread by contact with respiratory secretionsPeaks in winter and springSchool age child (5-15 yr)
Patient no longer contagious after 24 hours of antibiotics
Pharyngitis: Streptococcal
Clinical Features– Fever, sore throat, headache– Pharyngeal/tonsillar inflammation (often exudates)*– Tender anterior cervical adenopathy*– Scarlatiniform rash– Absence of viral symptoms (rhinorrhea, cough, hoarseness)
Group A beta-hemolytic streptococci
Often rapid sore throat, fever, vomiting ,abdominal pains.
red pharynx, enlarged tonsil with exudatePetechiae on the soft palate, Anterior cervical lymphadenophaty ,tenderScarlet fever DD:Viral phryngitis more gradual with rhinorrhea,
cough and diarrhea
Viral phryngitis
Gingivostomatitis (HSV-1)1-5 years old,(9-36 mo)incubation 7 days
Primary HSV more sever with:(high fever,drooling, fetid breath, vesicular
lesion on the tonge ,gums ,lips and tender lymphadenopathy)
herpanginaEntroviralSudden onset high fever ,vomiting,
disphagia ,conjunctivitis, drooling and sore throat
One or more small tender papule or pinpoint vesicular lesions with erythematous base (1-2 or 3-4 mm) on the soft palatea ,uvula ,tonge that over 3-4 days rupture and produce smalll ulcers
Diagnosis
Rapid screening test: latex agglutination or ELISA
– Specificity high: usually >98%– Sensitivity variable: 68-95%
Gold standard: culture of swab of tonsils and posterior pharynx
Diffrential diagnosis
Retropharyngeal and peritonsillar abcessDiphteriaMucositis (leukemia, apelastic anemia)TrushKawasakiAutoimmune ulseration
Vincent infection
Anaerobic pharyngitis( sertain spirochetal)Fulminant,acute necrotizing ulserative
gingivitis Gray pseudomembranes on the tonsils
(false diphteria)
Noma (gangrenous stomatitis) That seen in sever malnutration or
immunodeficiency focal gingivitis progress to gangrene
Ludwig anginaAnaerobic bacteril rapidly bilateral cellulitis of the
submandibular and sub lingual spaces. glottic and lingual swelling and air way
obstraction Odontogenic origin(priapical abscess of 2 or 3 mandibular
molare)
PFAPA
Priodic fever, aphthous stomatitis ,pharyngitis, servical adenitis
Usually <5 yrLast 5 daysThere is 28 days between episode.Duration is shorter with oral prednosone.
Treatment of Streptococcal Pharyngitis
Penicillin - drug of choice (9days)Started immediately : positive rapid test, scarlrt fever, symtomatic
pharyngitis whose sibling has strereptococcal pharyngitis, history of RF– One IM of long acting penicillin (benzathine) – oral therapy for 10 days
Erythromycin - if penicillin allergic(20-40/kg/day)First –generation cephalosporin?Clindamycin or amoxicillin –vlavulanate is effective
for carriage
Suppurative Complications of Group A Streptococcal PharyngitisOtitis mediaSinusitisPeritonsillar and retropharyngeal
abscessesSuppurative cervical adenitis
Nonsuppurative Complications of Group A Streptococcus
Acute rheumatic feverAcute glomerulonephritis
– May follow pharyngitis or skin infection (pyoderma)
Strawberry Tongue in Scarlet Fever
Rash of Scarlet Fever
Bull Neck of Diphtheria
Pseudomembrane in Diptheria
croup
acute inflammation caracterized by bark like or brassy cough
croup usually affects to some degree the larynx, trachea, and bronchi
Croup may be associated with hoarseness, inspiratory stridor, and respiratory distress
Infection upper airway obstruction
Viral agents account for most upper airway obstruction
Parainfluenza viruses account for 75% of casesMost patients with croup are between 3 mo and 5yr
Recurrences are frequent from 3-6yr of age
15% patients have a strong family history of croup
Laryngo trachebronchit
The most common form of acute upper respiratory obstruction
rhinorrhea, pharyngitis,mild cough ,low-grade fever for 1-3 days before the signs and symptoms
Barking cough, hoarseness ,inspiratory stridor
Symptoms worse at night and resolve within 1 wk
Other family members have mild respiratory ill
Laryngotracheobronchit
Alveolar gas exchange is usually normal
Rarely the upper airway obstruction progress
The child who is hypoxic ,cyanotic ,pale needs immadiate management
X-Ray may show the typical sub-glotic norrowing steeple sign
Spasmodic croup most often in children 1-3yr
History of a viral prodrome and fever in patient and family absent
Occurring most frequent in the eveningThe patient is usually afebrile
The severity of the symptoms diminishes within several hours
The pathogenesis is unknown allergic reaction to viral antigen??
Acute infectious laryngitis
Viruses cause most cases
diphtheria is an exception
Sore throat , cough ,hoarseness
Respiratory distress is unusual
Inflammatory edema of the vocal cords and sub glottic tissue
Acute epiglottit
An acute fulminant course of; high fever,sore throat,dispnea, progressing
respiratory obstruction
Toxic appearance ,swalloing is difficult ,drooling, tripod position or neck hyperextention ,cyanosis
The barking cough typical of croup is rare
Stridor is a late finding
No other family members are ill with respiratory symptoms
Diagnosis of epiglottitPhlebotomy , IV line , supine position , direct inspection of oral cavity should be avoided until the airway is secure
cherry red swollen epiglottis in laryngoscopy
Laryngoscopy should be performed in an operating room or ICU
Classic radiography of epiglottit is thumb sign
Establisheing an air way by nasotracheal intubation is indicated in patient with epiglottit regardless degree of apparent respiratory distress
Differential diagnosis
Bacterial tracheitis is the most important
Diphtheric croup
Measles croup that may be fulminant
Aspiration of foregin body
Retrophryngeal or peritonsillar abscss
Extrinsic compression of the air way
Differential diagnosis( con)
Intraluminal masses
Angioedema and anaphylaxis
Endotracheal intubation
Hypocalcemic tetany , trauma ,infectious mono ,tumors
Epiglottit
A croupy cough may be an early sign of asthma
Indication for child hospitalized
Progressive stridor
Sever stridor at rest
Respiratory distress
Hypoxia
Cyanosis
Depressed mental status
Need for reliable observation
Treatment
Most children with spasmodic croup or infectious croup can be managed at home
Antibiotic are not indicated
treatment
Cool mist; moistens airway secration ,soothes inflamed
mucosa ,provide comfort child
corticosteroid 0.6 mg/ kg
Nebulized epinephrine; Stridor at rest
the need for intubation respiratory distress
hypoxia and when stridor dos not respond to cool mist
Treatment of epiglottit Artificia airway placed in ICU or operating room
All patient should receive oxygen
B/ C , LP
Ceftriaxon ,or cefotaxim for 7-10 days
Rasemic epinephrin and corticosteroid are ineffective
Acute laryngeal swelling Epinephrin 1/1000 in dosage 0.o1ml/kg
Prednisone 2-4mg/kg
Racemic epinephrin
The need for intubation Reactive mucosal swelling . severe stridor respiratory distress unresponsive to mist therapy