27. LRTIs Children Flashcards by Vickey Kotts

What are 5 most common LRTIs?

tracheitis
pneumonia
bronchitis
empyaema
bronchiolitis

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How many children born will end up going to hospital for bronchiolitis?

1 in 5 children

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What is the most common LRTIs with the highest number of hospital admissions?

bronchiolitis

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What are common BACTERIAL infective agents causing bronchiolitis? (5)

strep penumoniae
haemophilus influenzae
moraxella catarrhalis
mycoplasma pneumoniae
chlamydia pneumoniae

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What are common VIRAL infective agents causing bronchiolitis? (4)

RSV
parainfluenza III
influenza A and B
adenovirus

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What are common symptoms for tracheatis?

barking cough and stridor that doesn’t go away

- fever

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Why are children at risk of tracheatis?

because they have small airways

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Describe the trachea in tracheatis.

swollen tracheal wall
narrowed tracheal lumen
luminal debris

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What are symptoms of bronchiolitis? (6)

At first like common cold (cough and runny nose):

fever
crackles and wheeze
dry and persistent cough
rapid and noisy breathing (wheezing)
tachypnoea
difficulty feeding

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What are common symptoms for bronchitis?

loose rattly cough with URTI
post-tussive vomit (glut)
chest free of wheeze/ creps
mostly self-limiting

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What does the child present as with bronchitis?

Completely well ( but parent worried)

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What 2 main pathogens cause bronchitis?

haemophilus

2. pneumococcus

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What type of infection is bacterial bronchitis?

secondary infection (so therefore antibiotics not needed)

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What does bacterial bronchitis disturb? What does it cause?

mucociliary clearance (no clearance)

- causes minor airway malacia (softening/ floppy tissue)

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What are 2 most common co-infections in children which can lead to bacterial bronchitis?

RSV (respiratory syncytial virus)

- adenovirus

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How long can cough last for in bacterial bronchitis?

around 4 weeks

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What does bacterial bronchitis usually follow? ( it’s a secondary infection)

It follows URTIs

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What bacteria cause bacterial bronchitis? (2)

pneumococcus

2. H flu

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What is the general trend in bacterial bronchitis cough?

It gets better every winter (cough morbidities decrease)

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What is the criteria for the very common PERSISTENT bacterial bronchitis? (3)

wet cough
more than 1 month
remission with antibiotics (gives relief)

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What is persistent bacterial bronchitis often misdiagnosed as?

asthma

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What are the 3 main steps for addressing persistent bacterial bronchitis?

make the diagnosis
reassure
do NOT treat

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Why should bacterial bronchitis not be treated?

Because side effects of antibiotics do more harm than good

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How many infants does bronchiolitis affect?

30-40% of all infants

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What virus mainly causes bronchiolitis?

RSV (but others include; paraflu III and HMPV; human metapneumovirus)

What time period is usually the worst for RSV infections?

week before Christmas

At how many months is there a bronchiolitis peak in infants?

At around 3 months (but is the commonest LRTI in infants<12 months )

How long does bronchiolitis last for?

Around 2 weeks

Is bronchiolitis a one off or recurrent?

Only a one off

Describe the trend in symptoms in bronchiolitis in an infant. Doctors can predict bronchiolitis very well.

day 1-5: getting worse symptoms (cough+snot) day 5-7: stabilising of bronchiolitis day 7-14: recovery

What analogy is used to describe a child suffering from bronchiolitis?

Similar to child having a golf ball in its mouth and only being able to breathe through the nose which eventually also gets blocked.

What is the course of action for a child who presents with bronchiolitis at day 5?

can be sent home for recovery as condition is stabilising

What are the 2 rules for management for bronchiolitis/

1. maximal observation | 2. minimal intervention

What investigations are done for a clinical diagnosis of bronchiolitis? (2)

1. NPA (cohorting | 2. Oxygen Saturations (severity)

What is NPA (cohorting of patients)

group of patients experiencing same symptoms and monitored over time, biological samples obtained from all patients and analysed

What is there NO routine need for in bronchiolitis?(3)

- chest x ray - bloods - bacterial culture

Is there medication that has been proven to work for treating bronchiolitis?

no; BUT evidence changes all the time

What medications are NOT proven to work for treating bronchiolitis?

- salbutamol - ipratropium broimde - adenaline -steroids - antibiotics - nebulised saline GRADE A EVIDENCE FOR THESE

What are indicators of a LRTI?

- fever (for 48hrs >38.5 degrees) - reduced bronchial breath sounds - several infective agents

What are some of the infective agents of LRTIs and what's their distribution? (3)

1. Viruses (<35% and higher in younger) 2. Bacteria: pneumococcus, mycoplasma, chlamydia 3. mixed infection (<40%)

What does wheeze indicate about the LRTI?

bacterial cause unlikely

Does bronchiolitis give us fever?

When to call an LRTI pneumonia? (3)

1. if signs are focal (centred) 2. creps/ crackles 3. high fever

In LRTIS, what should chest x rays only confirm?

they should only confirm clinical findings, not change management

What investigations can sometimes be done for community acquired pneumonia but aren't "routine"? (2)

- chest x ray | - inflammatory makers

What is the first line treated for community acquired pneumonia if symptoms are severe?

Oral amoxycillin (antibiotic)

What is the second choice treatment for community acquired pneumonia if symptoms are very severe?

Oral macrolide (antibiotic)

What is the treatment option for mild community acquired pneumonia?

nothing if symptoms mild

When should IV drugs be given to children with community acquired pneumonia?

Only if they are vomiting

What is the effect of vaccine on petussis/ whooping cough? (2)

- reduces risk of getting it | - reduces severity

What are pertussis/ whooping cough symptoms? (very common!) (4)

1. coughing fits 2. vomiting 3. fever 4. colour change under skin or eyes

Is empyema a complication of pneumonia?

Yes; should be suspected if patient with a resolving pneumonia develops recurrent fever but has good prognosis for children (not for elderly)

What is empyema treated with?

antibiotics and postural drainage

What should ALWAYS be maintained in children with LRTIs? (3)

1. oxygenation 2. hydration 3. nutrition

Is tracheatis treated with antibiotics? If so, which ones?

Yes; Augmentin

Is bronchitis treated with antibiotics? If so, which ones?

Is LRTI/pneumonia treated with antibiotics? If so, which ones?

Usually if 2 days of fever, cough and focal signs on one side ; Oral amoxycillin

Is bronchiolitis treated with antibiotics? If so, which ones?

Is empyema treated with antibiotics? If so, which ones?

Yes; IV antibiotics

What do you always do when symptoms get worse?

REVIEW