key: cord-1049121-bj5hptbh
authors: Franco-Paredes, Carlos
title: Chapter 5 Upper Airway Infections
date: 2016-12-31
journal: Core Concepts in Clinical Infectious Diseases (CCCID)
DOI: 10.1016/b978-0-12-804423-0.00005-6
sha: c48821267e9864bfad7ca527fecdc497affef79f
doc_id: 1049121
cord_uid: bj5hptbh

Abstract Infections of the upper respiratory tract represent an important source of morbidity and potentially of life-threatening complications. This group of infections represents one of the most frequent outpatient consultations; and includes a range of clinical syndromes that may go from a self-limited common cold, to acute rhinosinusitis, otitis media, to life threatening condition such as epiglottitis. Importantly, acute respiratory illness account for approximately 75% of the total number of antibiotic prescriptions per year; an often many of these conditions are of viral origin. When acute pharyngitis is caused by Streptococcus pyogenes, it is important to consider treatment to prevent transmission, reduce symptoms, and prevent its associated suppurative and nonsuppurative complications. Acute bacterial sinusitis can be associated with severe complications. Upper respiratory infection can also lead to life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck.

There are many microorganisms capable of causing pharyngitis (sore throat) that could be a single disease manifestation or as part of a more generalized illness 3 (Table 5. 3). There are also noninfectious causes of pharyngitis that need to be considered in the differential diagnosis of "sore throat" syndromes. Pharyngitis may be part of the common cold and this is considered one of the most common reasons for outpatient medical consultation. Acute pharyngitis in adults is associated with Streptococcus pyogenes in 5-9% of cases with a similar number of cases in adolescents and young adults caused by Fusobacterium necrophorum. Acute pharyngitis due to S. pyogenes is always important to suspect when an individual reports with tonsillopharyngeal exudate, tender anterior cervical lymphadenitis, and fever greater than 100.4; absence of cough and coryza (ie, Centor criteria) make the possibility of group A streptococci infection likely; particularly if this occurs during winter and early spring and when it involves school-age children. Confirmation of streptococci through antigen testing and culture is recommended. Treating group A streptococci pharyngeal infection improves symptoms, prevent further transmission, prevents rheumatic fever, and probably prevent local and systemic spread of disease. Among adolescents and young adults (usually 15-18 years of age) presenting with acute pharyngitis, fever, tender cervical lymphadenopathy and a scarlatiniform rash and whose evaluation is negative for S. pyogenes or infectious mononucleosis, infection due to Archanobacterium haemolyticum should be suspected. Rapid progression to high fever, toxic appearance, drooling, and respiratory distress with no coughing May occur in children 2-5 years of age but cases are also seen in adolescents and young adults. "Thumb sign" which corresponds to the large swollen epiglottis is present on lateral neck radiograph Management priority is establishing an airway and antibiotic coverage including vancomycin and usually a third generation cephalosporin to cover H. influenzae or other respiratory pathogens 

The syndrome of chronic cough (>12 weeks) is also an important reason for infectious disease consultation and it can be caused by chronic smoking, post nasal drip due to chronic bacterial sinusitis, gastroesophageal reflux, anatomic abnormalities of the respiratory tract, drug-induced angiotensinconverting enzyme inhibitors (ACE), pertussis, 4 asthma, and chronic interstitial lung disease. Diagnostic workup of chronic should consider this differential diagnosis.

Bronchorrhea is defined as water sputum production of over 100 mL per day and sometimes it can be confused as a chronic cough syndrome. The most important considerations in the differential diagnosis include primary lung malignancies including bronchioloalveolar carcinoma since it involves some glandular component that produces excess mucous. Bronchorrhea can also be associated with lung metastases form adenocarcinomas of the colon, pancreas, or other glands. Nonmalignant conditions include endobronchial tuberculosis, and asthma. Patients with ruptured pulmonary echinococcosis (hydatid disease) into a bronchus may also present with bronchorrhea and often report a salty taste associated with expectoration. 

Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein. 1 F. necrophorum is the most common pathogen associated with this disease, and previously it was recognized as postanginal sepsis due to S. pyogenes pharyngitis. 5 It most often steams from ear, nose, and throat infections that spread into the vasculature that drains through the jugular vein. 6 Septic embolization to the lungs is often considered part of this syndrome. 6 These cases occurred in an era before antibiotics, when this illness had a mortality rate of 90%. After the introduction of antibiotics in the 1950s, Lemierre's syndrome vanished for several decades. Interestingly, in the past two decades, there have been at least 400 cases reported in the literature through case studies and many cases are caused invasive community-acquired methicillin resistant S. aureus MRSA. 6 The differential diagnosis of selected odontogenic infectious syndromes and necrotizing infectious processes of the nose are discussed in Table 5.4 and  Table 5 .5, respectively. 

IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults

Systemic corticosteroid therapy for acute sinusitis

Acute pharyngitis

Pertussis -not just for kids

Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review

Methicillin-Resistant Staphylococcus aureus USA 300 clone as a cause of Lemierre's syndrome