Respiratory Illness (pharyngitis/pneumonia)

Objectives

 

Pharyngitis

- an infection of the oropharynx.

Complications

Epidemiology Clinical Manifestations

Symptoms

Physical Findings
Epiglottitis
Diagnostic Tests and Differential Diagnosis Diagnostic Approach
Sinusitis

Definition

Bacterial, viral, and occasionally fungal infections of the paranasal sinuses may cause acute or chornic sinusitis. Acute sinusitis is most commonly caused by H. influenzae or S. pneumoniae. It is often difficult to distinguish infectious sinusitis from noninfectious allergic conditions.

Maxillary Sinusitis

Frontal Sinusitis Ethmoid Sinusitis Sphenoid Sinusitis Epidemiology and Predisposing Factors Diagnostic Approach
Pneumonia

- an inflammatory process invol-ving the lung parenchyma.

Epidemiology Pathogenesis Clinical Features Physical Exam Lab Evaluation Radiologic Evaluation Specific Common Pathogens

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus
Mycoplasma pneumoniae
Legionella pneumophila

Streptococcus pneumoniae

Haemophilus influenzae Mycoplasma pneumoniae Staphylococcus aureus Legionella pneumophila Influenza A
 
ETIOLOGY OF ACUTE PNEUMONIA
BASED UPON DIFFERENCES IN PRESENTATION
Features Classical
Presentation
Atypical
Presentation
Onset Abrupt Gradual
Fever>39C Common Less common
Chillls Common Uncommon
Pleuritic pain Common Uncommon
Tachycardia>130/min Frequent Rare
Consolidation More common Less common
Pleural effusion More common Less common
Sputum volume Abundant Minimal
Sputum character Thuck, purulent Thin, mucoid
Sputum Gram's Single predominant 
organism; many 
polys stain 
No polys, some monos;
scattered normal 
flora 
Leading causes S. pneumonia
H.influenzae 
Klebsiella pneumonia 
S.Aureus 
Mycoplasma
Viruses 
Legionella 
Chlamydia 
(TWAR) 

Recommended Diagnostic Approach

SPECIFIC ETIOLOGY
ESTABLISHED IN ONLY 60%,
EVEN WITH AGGRESSIVE
INVESTIGATION.

Tuberculosis

In 1990, 2.9 million deaths world-wide were TB-related, with 20,000,000 active cases. The incidence in the U.S. has been increasing over recent years:

1953 53/100,000
1984 9.4/100,000
1990 10.5/100,000

Screening Modalities

Screening modalities include the mantoux skin test (PPD), with results read 48 to 72 hours later; chest x-ray; and sputum smear studies.

Finding active disease requires a constant level of suspicion. Clinical clues include prior TB exposure, night sweats, weight loss, and prolonged respiratory symptoms. If in doubt, mask the patient and then proceed with your evaluation.

Chest X-ray findings particularly suspicious for TB include cavitary lesions, upper lobar infiltrates, miliary patterns, and pleural involvement.

Treatment

The advent of multi-drug resistant TB has made treatment much more complex, but treatment of active disease has always been multi-drug because resistance to single agent therapy develops rapidly.

Respiratory Syncytial Virus

RSV is the most important respiratory tract pathogen in early childhood. It also occurs in adults. It is the most common cause of bronchio-litis and pneumonia in children under one year of age.

Rapid antibody kits for RSV, similar to the rapid strep test, are available. An antiviral agent, Ribavirin, is available to treat severe cases.


D. Heard, MD
updated 8/30/05


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