Infeksi Saluran Pernafasan Atas

Simptom &Tanda-tanda utamaBatukSputumHaemoptysisDyspnoe (Sulit nafas)Tachypnoea (Bernafas cepat)Wheezing (Pengeluaran udara dr bronchi dan bronchiole yg sdh sebagian rusak)Sakit di pleura

1. BatukHampir semua symptom penyakit pernafasanMungkin muncul krn stimulus dr mukosa di tiap bag dr resp tractReflek batuk terjadi di larynx berupa:Batuk kerin dan tdk produktif Tahap awal dari ColdSpt menyalak di larynx (Laryngitis, pertussis), croup, batuk merusakAsthma (Penyempitan bronchus)ACEI Kering di awal lalu produktif Berkaitan dg sputum yg agak encer, umumnya infeksi bakteriPneumoniaBronchitis akutBronchirtasis

Produktif dan bekaitan dg sputum kental dan agak susah keluarBronchitis kronis AstmaBisa tiba2 muncul dan sulit di stop

Lainnya Batuk syncope atau batuk Cheyne - Stokes Death Rattle

2.Sputum / RiakKuantitas dan character penting:4Seous: jernih atau pink dan frothySpt Abu2Purulent umumnya bakteriMucopurulent

Sputum infeksi berwarna tgt bakteri yg menginfeksi, trkadang ada darah

Viskositas dan bau3. HaemoptysisMengeluarkan darah atau secercah darah dalam sputumJangan terkecoh dg darah dari lambung Haematemesis atau epistaxisBerfariasi dari frank haemoptysis (carcinoma) ke ru sty sputum (pneumococcal pneumonia-haemoglobin)Haemoptysis umumnya dari infeksi akut (Pneumonia)

Dyspnoe (Sulit bernafa) Infeksi akut, meningkatnya resistensi nafas, menurunnya fleksibilitas paru2 yg mungkin akibat: Kerusakan jalan nafas (Asthma)Kerusakan dead space spt pd (Pneumonia dan emphysema)Gagal jantungLainnya: Anemia, emboli pd pulmo, asidosisNyeri pleuraInflamasi atau distorsi dr membrane pleuraTachipnoea (Bernafas pendek dan cepat)Asthma, Asidosis, CHF, anemia

Wheezing (Keluarnya udara lewat bronchi atau bronchiole yg sebagian rusak)Bisa kering (rhonchi) atau lembab (spt ada suara cairan)Asthma, bronchitisCrepitasi (berkaitan dg adanya air di paru2, spt CHF)

Site of respiratory tract InfectionUmumnya hanya URTILRTI umumnya jarang dan yg mengancam kehidupanPatologi:InflamasiMeningkatnya jml pathogen dlm sel epitel atau sekresi respSekresi IgA jika sebelumnya ter eksposJika bakteri, pyogenesis

Acute Coryza ( Common Cold)

Acute Coryza ( Common Cold)Simptom:Mirip Rhinitis dan symptom mata (Conjunctivis & Photofobia)Penyebab selalu virus, banyak strain, tp yg utama adl rhinoviruses, coronaviruses, parainfluenza)

Rx : Atasi komplikasi sekunderCough suppressantsAntipyretic & analgesic; Acetaminophen, AINS(NSAID)

Swine influenza (H1N1)Salah satu infeksi dari berbagai tipe Swine influenza viruses

MANAGEMENT Annual vaccinationStay at homeGet plenty of restDrink a lot of liquidsDo not smoke or drink alcohol

Treatment Antivirals e.g. ZanamivirandoseltamivirAmantadineandRimantadine.

DiagnosisBlood TestChest X-RayNose or throat swab

Faringitis

Faringitis?Inflamasi pada faring akibat infeksi Paling banyak penyebab sore throatSimptom: Fever, headache, joint pain and muscle ashes, skin rashes, swollen lymph nodes in the neckPenyebab infeksi adalah: Sterptokokus dan virusSering muncul bersamaan dengan tonsilitis

Case 1: PharingitisKasus Pharyngitis13 tahun anak laki laki mengalami gatal tenggorokan dengan sulit menelan, demam, nafsu makan turun, lemas. Orang tua bercerita kalau anaknya sering mengalami tonsillitis (5-6 kali) saat 5-6 tahun. Akan tetapi selanjutnya tidak lagi dan hanya cold biasa.Pada pemeriksaan tonsil, bengkak dan merah dg pus putih. Pharynx dan lidah inflamasi. Lymph node membesar dan lagak lembek. Suara serak, suhu 39C. Kultur bakteri dan menentukan WBC di lakukan. Selagi menunggu hasil, pasien dianjurkan bedrest, suplay cairan dan resep amoxicillin 250mg 5 hari. 2 hari kemudian hasil menyatakan : beta haemolytic streptoccus dan WBC tinggi. Pasien mengeluh sakit perut dan mual.

Jelaskan Anatomi dan fungsi tonsil? Ada cincin lymphoid di mulut (Tonsil, adenoid, limph node di bawah llidah) yg bisa sbg tempat lokalisasi infeksi virus, mencegah viraemia (tdk seefektif infeksi bakteri spt: B-haemolytic Strep)

Pengeringan limph node dpt melibatkan infeksi

2. Simptom apa yg terlihat pd pasien ini? Apa bedanya dg pharyngitis sederhana? Diagnosisi apa yg berbeda pada kasus ini dan mengapa?

Pharynx + tonsil umumnya terlibat dg virus (60%)Exudat putih artinya bukan virus Mungkin conjunctivis juga (Viral)Pharingitis bakteri: Strep pyogenes -> toxinMuncul lymphadenopathy: beberapa memproduksi erythrogenic toxin (Scarlet fever)

Perbedaan pharyngitis bakteri dan virus

Differential between bacterial and viral PharingitisBacterialViralHighLow(37,7C)General illness (Toxic)Usually (Headache)NoDysphagiaSevereMildExudateUsually(Purulen)Not usuallyLocationTonsilarDiffuse in pharynxLymph nodesEnlarge n tenderLess effected not tenderOther resp involvementnoOften(Cough,nasal)Secondary involvement Otitis mediaSlowerOnsetSuddenSlower

Other course of sore throatDiphteria -> myocarditis (Msh jg bayak yg tdk imunisasi)Malnutrition, poor dental hygineInfection mononucleus (viral) caution amoxicillin administration (resembles bacterial infection) What are recommended for this disorders? What alternatives are available for penicillin allergic patients? How long shold therapy be continued?Rx Penicillin V recommended Erythromycin All treatment 10 days minimum

Tonsilitis

Acute Upper Respiratory Tract Infections in Children:Tonsillitis:What is tonsillitis?Tonsillitis is a viral or bacterial infection in the throat that causes inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the pharyngeal cavity. In the first six months of life tonsils provide a useful defense against infections. Tonsillitis is one of the most common ailments in pre-school children, but it can also occur at any age.

Tonsilitis ~ pharyngitisUncommon in children < 1 yrOccuring between 4-7 yr of ageCausative: Viruses or bacterial (grup A beta hemolytic streptococcus)

4. Under what circustances circumstances should tonsillectomy be considered?Tonsilectomy only required if chronic recurring infection occur, complication with obstruction. because of the problem of excessive blood loss & the possibility of re-growth or hypertrophy of lymphoid tissue, in young children.

5. What complication can arise from this condition? - Adenoidal obstruction of breathing - Can act as immune complex trigger causing glomerulus nephritis and rheumatic fever - Complication involves Staph infection producing a peritonsilar absess treatment require surgical drainage

Advice and treatment:Encourage bed rest.Introduce soft liquid diet according to the child's preferences.Provide cool mist atmosphere to keep the mucous membranes moist during periods of mouth breathing.Warm saline gargles & paracetamol are useful to promote comfort.If antibiotics are prescribed, counsel the child's parents regarding the necessity of completing the treatment period

Anatomic position of Eustachian tube in adult

Otitis Media

Otitis media: Background: Otitis media (OM) is the second most common disease of childhood, after upper respiratory infection (URI). Definition: It is defined as an inflammation of the middle ear.

Etiology of (O .M) :-

Obstruction of Eust. Tube by edematous mucosa during URI or enlarged adenoid.Eustachian tube obstruction lead to high ve pressure in the middle ear cavity lead to occurance of trasudative middle ear (ME) effusion.Organisms contaminate the ME effusion..otitis media occur.

Pathophysiology:Otitis media is the result of dysfunctioning Eustachian tube.The Eustachian tube, which connects the middle ear to the naso-pharynx, is normally closed, narrow &, directed downward, preventing organisms from the pharyngeal cavity from entering the middle ear.It opens to allow drainage of secretions produced by middle ear mucosa & to equalize air pressure between the middle ear & outside environment. Impaired drainage causes the pathological condition due to retention of secretion in the middle ear.

Acute Otitis media:Predisposing factors of developing otitis media in children:In children, developmental alterations of the Eustachian tube (short, wide, & straight), an immature immune system, and frequent infections of the upper respiratory mucosa all play major roles in AOM development.Furthermore, the usual lying-down position of infants favors the pooling of fluids, such as formula.

Therapeutic management of otitis media:

Administration of antibiotic (Ambicillin or Amoxicillin).

Anti-inflammatory (analgesic & antipyretic).

/ 42*Antibiotics

First choiceAmoxicilline40 mg/kg/day, 3 dosesTrimet./Sulfamethoxazole8mg TM/40mg SMX/kg 2 doseSecond choiceAmoxicilline/clavulanate45 mg/kg/day, 2 dosesErythromycin40-50 mg/kg/day, 3 dosesReurrent AOM prophylaxisSulfisoxazole75 mg/kg/day, single dose 3-6 moAmoxicilline20 mg/kg/day, sinle dose 3-6 mo

/ 42*TetracyclineSulphonamidesCo-trimoxasoleCloramphenicoleAminoglycosidesAntibiotics NOT to be used

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Complications of O.MExtr-acranial complication:-Hearing lossChronic suppurative O.MAdhesive otitisFacial palsyPerforationMastoiditisTympanosclerosis

Intra-cranial complication:-Meningitis.Focal encephalitis.Brain abscess.Sinus thrombophlebitis

Epiglotitis and Croup

Croup syndrome

Croup

Aetiology

Pathophysiology

Clinical features History Physical

Basic management of acute upper airways obstruction

Management

Acute epiglottitis

Aetiological agents

Pathophysiology

Clinical presentationHistory Physical

Treatment and management

Croup vs Epiglottitis

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