Nonspecific infections of the upper respiratory tract

Infections of the sinus

Infections of the ear and mastoid

Infections of the pharynx and oral cavity

Acute pharyngitis

GAS pharyngitis +/- tonsillitis

• H153 Streptococcal Infections
• DOES NOT USUALLY CAUSE A COUGH

Rapid test for group A streptococcus

• 70-90% sensitivity
• Positive rapid test or throat culture: Initiate antibiotic therapy for acute GAS pharyngitis.
• Negative rapid test: Wait for throat culture results; treat if culture positive.

Acute viral tonsillopharyngitis

Self limited

Oral infections

Vincent angina

Ludwig angina

• Cellulitis of the submandibular space.�
• Etiology
  • Dental infections in the mandibular molars that spread contiguously down the root into the submylohyoid� (and then sublingual) space
  • Usually polymicrobial
• Symptoms
  • Systemic: fever, chills, malaise
  • Local compressive: mouth pain, drooling, dysphagia, muffled voice, airway compromise. Floor of the mouth is often elevated, displacing the tongue.
• Diagnosis
  • CT scan of the neck
• Treatment
  • Early IV antibiotics prevents airway compromise.

Septic thrombophlebitis of the internal jugular vein (Lemierre disease)

• Rare, but life-threatening infection that affects young immunocompetent patients.
• Pathophysiology
  • Usually caused by the gram-negative anaerobic bacillus Fusobacterium necrophorum (part of the normal oral flora)
  • The bacterium invades the lateral pharyngeal space through the lymphatic system and affects the neurovascular structures, causing IJV thrombosis and infection.
  • Once the IJV is infected, septic thromboemboli can seed other organss, particularly the lungs, causing respiratory symptoms and leading to nodules on chest x-ray.
• Clinical presentation
  • Prolonged (eg, weeklong) duration of sore throat with high fever, rigors, dysphagia, and neck pain and swelling along the SCM muscle.
  • Respiratory difficulties.
• Diagnosis
  • Culture from blood or pus
• Management
  • IV antibiotics
  • Surgery (eg, incision and drainage, vein excision) in patients with no response to antibiotics.

Infections of the Larynx and Epiglottis

Laryngitis

Croup

Epiglottitis

• Epidemiology
  • S.pneumonia, H.influenzae
  • Risk reduced with H.influenzae vaccination
• Clinical manifestations
  • Rapidly progressive & life-threatening
  • Fever, sore throat, drooling, muffled voice
  • Airway obstruction (stridor, dyspnea)
  • Pooled oropharynx secretions
  • Laryngotracheal(anterior neck) tenderness
• Diagnosis
  • Direct visualization
  • Imaging (lateral neck x-ray)
• Treatment
  • Early artificial airway (if needed)
  • IV antibiotics (ceftriaxone + vancomycin)

FIGURE 31-3
Acute epiglottitis. In this lateral sox-tissue radiograph of the neck, the arrow indicates the enlarged edematous epiglottis (the �thumbprint sign�).

Infections of Deep Neck Structures