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state pediatrics > 19. +++ Acute respiratory infections and their complications. > Flashcards

19. +++ Acute respiratory infections and their complications. Flashcards

1
Q

what are the acute infections of the upper respiratory tract ?

A 
nasopharyngitis 
acute epiglottitis 
bacterial pharyngitis 
croup 
rhinosinusitis
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2
Q

what are the symptoms in nasopharyngitis of viral

A

nose -
rhinorrhea - most characteristic of viral
goes from clear to opaque white to green to yellow within 2-3 days (THERFORE COLOR AND OPACITY DOES NOT RELIABILY DISTINGUISH VIRAL FROM BACTERIA)
obstruction of nasal breathing -DUE TO SINUSES being infected
grunting , tachypnea
sneezing

pharynx 
sore throat 
odynophagia 
dysphagia 
feeding compromised 
cough 
systemic 
headache 
Usually no fever (but infleunza as high as 40 ) 
fatigue 
malaise 
vomitting , diarrhea
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3
Q

on examination of acute infection of the upper respiratory tract what do we have to check ?

A

nasal mucosa erythema

pharyngeal erythema and edema

tonsillar hypertrophy an edema

anterior cervical lymphadenopathy - (EBV mononucleosis)

Conjunctivitis: in adenoviral pharyngoconjunctival

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4
Q

what are the symptom of bacterial pharyngitis ?

A

Sudden onset of symptoms

Fever:

Pharyngeal symptoms:
Sore or scratchy throat -Group A streptococcal infections often produce a sudden sore throat.

odynophagia, or dysphagia

Pain or feeling of a lump when swallowing.

Erythema and Edema of pharynx - especially prominent in persons with group A streptococcal pyogenes .
Palatal petechiae may be seen.
Pharangeal and tonsilar exudates
Scarlintiform rash - fine maculopapular rash that first appears on the torso and spreads to the extremities. Characteristically spares the palms, soles, and perioral area

No cough

Cervical lymphadenitis

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5
Q

Diagnosis of nasopharyngitis

A

Suspected acute bacterial tonsillopharyngitis: Evaluate for acute GAS
Initial test: rapid GAS antigen detection test (RADT)
Through tonsil and throat swab

Children ≥ 3 years: Obtain a throat culture - confirmatory test

———

Cbc

Consider CT of head and neck if there is clinical suspicion of suppurative complications

.

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6
Q

Etiology of nasopharyngitis

A

Acute tonsillopharyngitis
Viral (50–80% of cases): adenovirus, EBV, CMV, HSV, rhinovirus, coronavirus, influenza and parainfluenza viruses,

Bacterial (15–30% of cases)
Most common: Streptococcus pyogenes (also known as group A streptococcus or GAS)

Rare: Neisseria gonorrhoeae, Corynebacterium diphtheriae, Mycoplasma pneumoniae

Recurrent tonsillopharyngitis and chronic tonsillitis: polymicrobial infections with aerobic bacteria (typically streptococci, staphylococci, Haemophilus influenzae) and anaerobic bacteria

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7
Q

treatment for nasopharyngitis viral cause

A

antipyretics

antitussives

antihistamines and nasal decongestants in older children

supportive therapy
—> Most URIs are self-limited viral infections that resolve without prescription
drugs

—> antiviral drugs have no proven effect

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8
Q

treatment for bacterial nasopharyngitis

A

GAS pharyngitis and/or tonsillitis: self-limited; antibiotic therapy for acute GAS pharyngitis recommended to prevent rheumatic fever

Ensure adequate hydration.

Consider household remedies such as salt-water gargles.

Analgesics and antipyretics
Acetaminophen
NSAIDs: e.g., ibuprofen

Antibiotics for children more that two years old
First line- Penicillin v 250mg PO every 8-12 hrs for ten days

Amoxicillin po 50mg /kg /day for ten days

Or penicillin g single dose

Tonsillectomy in severe cases - such as extreme hypertrophy - kissing tonsils
Which can be total or subtotal

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9
Q

Etiology of acute epiglottis

A

bacterial - haemophilus influenza type b

Strep pyo
Strep pneumo
Staph aureu

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10
Q

what are the clinical features of acute epiglottis?

A

m SUDDEN ONSET -12-24HRS

high fever

DROOLING

sore throat
Dysphagia and odenophsgia

progressing resp obstruction
hyperextended neck
tripod position
Respiratory distress - inspiratory retractions, cyanosis

DYSPHONIA
Muffled vioice

Inspiratory stridor late finding

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11
Q

diagnosis of epiglottis ?

A

TOUNGUE DEPRESSOR

cherry red epiglottis on INDIRECT laryngoscopy = however this is not suggested due to FEAR of complete obstruction

Pharyngoscopy - not used aswell

Direct laryngoscopy during or after intubation (not used)

thumb sing on lateral neck x ray
CT and MRI

Blood culture

Epiglottis swab

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12
Q

what is the treatment for acute epiglottis ?

A

it is an emergency and LIFE THREATENING
needs endotracheal intubation or tracheostomy

blood culture
IV ampicillin sublactum or ceftriaxone (effective against h influenza)

Emperic steroids can be considered dexamethasone or methylprednisone

humidification and oxygen

IV fluid

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13
Q 
infectious croup (syndrome)
also called laryngeotracheobronchitis is caused by ?
A

Parainfluenza virus (types 1, 2, and 3),

RSV,

influenza or adenovirus

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14
Q

croup the incidence is highest in?

A

2nd year of life

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15
Q

what are the clinical features of croup syndrome ?

A 
Barklike cough
•
Hoarseness
•
Inspiratory stridor and prolonged inspiration 
•
Respiratory distress of varying severity

symptoms worsens at night and lying down

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16
Q

how do we diagnose croup ?

A

exclude other obstructive conditions of the upper airway, especially
epiglottitis, an airway foreign body, subglottic stenosis, angioedema,

X-ray- subglottic narrowing

Nasopharyngeal washing and PCR test

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17
Q

what is the severity of croup defined by ?

A

WESTLEY score

chest wall retraction 
0 = none 
1 = mild 
2 = moderate
3 = severe

stridor
0= none
1 = mild
2= at rest

cyanosis
0=none
4 = with agitation
5 = at rest

level of consciousness
0 = normal
5= disorientated

air entry
0= normal
1- decreased
2- markedlydecreased

≤ 2 indicates mild croup
no stridor at rest.

3–5 is classified as
moderate
croup. It presents with
easily heard stridor

6–11 is severe
croup. presents with obvious
stridor, marked chest wall indrawing

≥ 12 indicates impending respiratory failure.

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18
Q

what is the treatment for croup ?

A

Mild:
—> Home therapy:
Cool mist air

Decrease infant anxiety

Make them go to sleep in upright position

Dexamethasone oral syrup IV or IM

———-

Moderate-Severe

Always hospitilised

Inhale nebuliser epinephrine

dexamethasone
Nebulized: budesonide

Humidified Air or oxygen

—> IV fluid

—> Endotracheal intubation, needed if:
Increased stridor or respiratory rate, onset of cyanosis,
exhaustion, confusion or failure to respond to nebulized
epinephrine

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19
Q

how can we differentiate between croup and acute epiglottitis ?

A

course
croup: days
epi : hours

cough
croup - barking
epi : slight if any

feeding
croup - can drink
epi - no

mouth
croup - closed
epi = DROOLING SALIVA

fever
<38.5
>38.5

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20
Q

etiology of rhino sinusitis ?

A 
often follows a common cold, which is of viral etiology
Rhinovirus
Coronavirus
Adenovirus
Influenza

predisposing factors: Obstruction of the sinus ostia due to deviation
of the nasal septum, presence of foreign bodies, polyps or tumors
Dental extractions or an extension of infection from the roots of the
upper teeth
Hypertrophy of nasal turbinates, nasal polyps, deviation of nasal septum
Impairments of ciliary function such as cystic fibrosis, primary ciliary dyskinesia,

21
Q

what are the bacterial etiology of rhino sinusitis ?

A

Streptococcus pneumoniae, Haemophilus
influenzae,
Moraxella catarrhalis

22
Q

signs and symptoms rhinosinusitis?

A

Mucopurulent nasal secretions are seen with both viral and bacteria

Frontal, facial, or retroorbital pain or pressure is common

—> Maxillary sinus inflammation may manifest as pain in the upper teeth on the affected side

—> Pain radiating to the ear may represent otitis media or a peritonsillar abscess

—> Sore throat may result from irritation from nasal secretions dripping on the posterior pharynx

—> Mouth breathing may especially noted in children

Cough:
—> The cough may also be most prominent on awakening, occurring in
response to the presence of secretions that have gathered in the posterior pharynx overnight
—>
Daytime cough that lasts more than 10-14 days suggests sinus
disease, asthma

Fever:
—> More likely to occur in children than adults with rhinosinusitis

periorbital swelling: may be present in ethmoid sinusiti

23
Q

diagnosis of rhino sinusitis ?

A

Sinus CT
MRI

Nasal endoscopy

bacterial culture of the nasal discharge is not helpful.

An antral puncture to obtain sinusal specimens for bacterial culture is
needed to establish a specific microbiologic diagnosis

24
Q

what is the treatment for rhinosinusitus ?

A

analgesics
—> decongestants

—> antibiotics: amoxicillin + clavulanic acid and/or cephalosporin

—> For chronic sinusitis, when conservative treatment does not lead to a cure, surgical irrigation

25
Q

complication of acute infections in the upper respiratory tract ?

A

acute otitis media
adenoid vegetation
acute sinusitis

26
Q

what is acute otitis media ?

A

commonly follows an upper respiratory infection extending from the nasopharynx via
the eustachian tube to the middle ear

27
Q

etiology of acute otitis media ?

A

Etiology:
Streptococcus pneumoniae, Hemophilus influenzae
beta-lactamase producing Moraxella catarrhalis

risk factors :
Vigorous nose blowing during a common cold,
sudden changes of air pressure,
perforation of the tympanic membrane

28
Q

complication of otitis media ?

A

presence of purulent exudate in the middle ear may lead to a spread of infection to the
inner ear and mastoids or even meninges

29
Q

what is the clinical manifestation of otitis media ?

A

Otologic examination reveals a bulging, erythematous tympanic membrane with loss of
light reflex and landmarks
-
If perforation of the tympanic membrane occurs, serosanguinous or purulent discharge
may be present
-
In the event of an obstruction of the eustachian tube, accumulation of a usually sterile
effusion in the middle ear results in serous otitis media

30
Q

what is the treatment of otitis media ?

A

Amoxicillin is an effective and preferred antibiotic for treatment of acute otitis media
-
Since beta-lactamase producing H influenzae and M catarrhalis can be a problem in
some communities, amoxicillin-clavulanate is used by many physicians
-
second and third generation cephalosporins, tetracyclines and macrolides can also be
used
-
When there is a large effusion, tympanocentesis may hasten the resolution process by
decreasing the sterile effusion
-
In those patients with persistent effusion of the middle ear, surgical interventions with
myringotomy, adenoidectomy and the placement of tympanostomy tubes has been
helpful

31
Q

what is adenoid vegetation ?

A

hyperplasia of the pharyngeal tonsils
occur after an acute UTR
has familial predisposition

32
Q

what is the clinical picture of adenoidal vegetation ?

A

Bacterial nasopharyngitis symptoms

nasal speech , snorting ,breathing through the mouth since through the nose is impaired

nasal discharge

obstructive sleep apnea- tired during the day

facies adenoid - typical picture in children
permanent open mouth
visible tip of the tongue
teeth disarrangement

33
Q

what is the diagnosis of adenoidal vegetation ?

A

Direct visualisation of throat

Rapid gas antigen test - through nasal or pharyngeal swab

Children over three years throat culture

rhinos copy
otoscope
audiometry

transnasal endoscopy to differentiate between rhino sinusitis and adenoidiitis

34
Q

what is the treatment of adenoidal vegetation ?

A

GAS treatment for strep pyo

If viral self limited or
nasal corticosteroids

Analgesics
Antipyuretics
adequate hydration

surgical - tonsilectomy

35
Q

what re the reflex response to URT and LRT in irritation ?

A

URT - sneezing

LRT - coughing

36
Q

what are the common acute diseases in the lower respiratory tract ?

A

acute tracheitis
tracheobrochitis
acute bronchitis

37
Q

what is bacterial tracheaitis ?

A

occurs commonly in 3-5 years old

dangerous condition is similar to severe epiglottitis- EMERGENCY

38
Q

what causes bacterial tracheaitis / PSEUDOMEMBRANOUS CROUP

A

Usually preceding viral croup

Getting infected with organism

organism most often isolated is:
Staphylococcus aureus

but organisms
such as H. influenzae, 
group A Streptococcus pyogenes,
Neisseria species,
Moraxella catarrhalis
39
Q

what are the clinical manifestations of bacterial tracheitis ?

A

early clinical picture is similar to that of viral croup

but instead of gradual improvement, patients develop higher fever!!!

bark cough

dyspnea

patient will look like croup - but TOXIC appearing

inspiratory and expiratory stridor

copious purulent secretions

40
Q

what is the diagnosis of bacterial tracheitis ?

A

tracheal secretion culture - positive

blood culture - almost always negative

cdc - leukocytosis

X ray - lateral neck - normal epiglottis , but severe subglottic and tracheal narrowing

direct laryngoscopy confrims - normal epiglottis and copious purulent tracheal secretion and PSEUDOMEMBRANE

41
Q

what is the management of bacterial tracheitis ?

A

emergency airway treatmnet

IV antibiotics - Initial antibiotics should cover S. aureus, including methicillin-resistant S. aureus (MRSA), and streptococcal species; IV vancomycin and ceftriaxone may be appropriate empirically.

ceftriaxone plus nafcillin or vancomycin, or clindamycin plus a third-generation cephalosporin, or ampicillin-sulbactam.

IV fluids

42
Q

what is cause of acute tracheobronchitis ?

A

Influenza (the “flu” virus) and the viruses that cause the common cold

Occasionally, caused by a bacterial infection, particularly Chlamydia pneumoniae( azithromycin) and Mycoplasma pneumoniae.(erythromycin and azithromycin)

43
Q

what are the clinical manifestations of tracheobronchitis ?

A 
dry irritating cough
•
fever and night sweats
•
headache and malaise
•
shortness of breath, noisy breath, purulent sputum
44
Q

what is the etiology of acute bronchiolitis and demographic?

A

usually viral - MOST commonly RSV, parainfluenza , adenovirus , influenza
= highly contagious
spread from direct contact with nasal secretions and airborne droplets
INFANTS breastfed with colostrum rich in immunoglobulin A relatively protected from bronchiolitis

occurs at any age , but severe symptoms only evident in young infants less than 2 years old with peak at 3-6 months

MOST COMMON CAUSE OF LOWER RESPIRATORY TRACT INFECTION IN THE FIRST YEAR OF LIFE

45
Q

what is the clinical manifestations of acute bronchiolitis ?

A

Following viral cold symptoms

infants becomes fussy , difficulty feeding during the first 2-5 day incubation period

LOW GRADE FEVER - general cold symptoms and congestion

progresses from UTI to LTI !!

and these leads to sharp dry cough ,
dyspnea ,
wheezing

in severe forms : respiratory distress - subcostal and intercostal retraction
tachypnea ,
nasal flaring
possibly cyanosis

otitis media and pharyngitis are sometimes present

46
Q

what is the diagnosis of acute bronchiolitis ?

A

diagnosis is based on the age and seasonal occruance
occurs in children under 2 years of age and most commonly in the first year of life, peaking between 3 and 6 months.

When diagnosing bronchiolitis, take into account that symptoms usually peak between 3 and 5 days, and that cough resolves in 90% of infants within 3 weeks.
Diagnose bronchiolitis if the child has a coryzal prodrome lasting 1 to 3 days, followed by:
• persistent cough and
• either tachypnoea or chest recession (or both) and
• either wheeze or crackles on chest auscultation (or both).

Consider a diagnosis of pneumonia if the child has:
• high fever (over 39°C) and/or
• persistently focal crackles.

Think about a diagnosis of viral-induced wheeze or early-onset asthma rather
than bronchiolitis in older infants and young children if they have:
• persistent wheeze without crackles or
• recurrent episodic wheeze or
• a personal or family history of atopy.

auscultation fine end inspiratory crackles
fine end inspiratory crackles
prolonged expiration

ABG - hypoxia - determines the severity of the disease

Chest x-rays may be done on severely ill children to rule out other conditions.

47
Q

what is the treatmnet of bronchiolitis ?

A

symptomatic and anticipation

oxygen therapy - contiious positive airway pressure
warm humidified air high flow nasal canula
endotracheal intubation

children with compromised immune systems transplant patients and Children with congenital heart and lung disorders are also at higher risk, as are infants under six weeks old. treated with ribvarin (Virazole), a drug that keeps the virus from reproducing. This drug is reserved for the most critical cases.

Do not use any of the following to treat bronchiolitis in children:
• antibiotics
• hypertonic saline
• adrenaline (nebulised) • salbutamol
or corticosteroid!!!!
Nasal Saline drops 
Keep upright position 
Antipyurtiics
Frequent nasal suction
Adequate hydration
48
Q

complication of acute bronchitis ?

A

there is apnea in those age younger than 6 months
respiratory failure
dehydration

state pediatrics (55 decks)

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