Bronchitis and Pneumonia

Question 1

Acute bronchitis definition

Answer 1

• clinical syndrome produced by inflammation of trachea, bronchi and bronchioles
• occurs in associaton with viral lower respiratory tract infection
• rarely pirmary bacterial infeciton

Question 2

Etiology of Bronchitis

Answer 2

• 90% viral
• adenovirus
• influenza
• parainfluenza
  . RSV
• Rhinovirus
• HSV

10% bacterial

• S. Pneumoniae
• M. catarrhalis
• H. influenzae
• C. pneumoniae
• Mycoplasma species

Question 3

Clinical manifestation of bronchitis

Answer 3

• fever and malaise
• protracted cough for 1-3 weeks
• usually follows a viral URTI
• child first presents with nonspecific upper respiratory infectious symtpoms (rhintis,…)
• 3-4 days later: frequent, dry hacking cough (may or may not be productive)
• sputum later becomes purulent
• chest pain in older children
• coarse breath sounds, coarse and fine crackles and scattered high-pitched wheezing

Question 4

Symptoms of acute bronchitis

Answer 4

• dry or mucus filled cough
• vomiting, gagging
• runny nose
• chest congestion or pain
• bosy discomfort
• chills and slight fever
• back and muscle pain
• wheezing
• sore throat

Question 5

Chest Radiography in Acute bronchitis

Answer 5

• usually not neccessary

- in complicated bronchitis: atelectasis, hyperinflation, peribronchial thickening

Question 6

Testing in acute bronchitis

Answer 6

• CRP, CBC
• rapid diagnostic tests (PGR or Ag from nasopharyngeal swabs or BAL)
• Serological tests for specific Ab
• blood or sputum culture if antibiotic therapy is under consideration

Question 7

Treatment of acute bronchitis

Answer 7

• no specific treatment
• self - limited
• frequent shifts in position can faciliate pulmonary drainage
• humidity
• cough suppressants can relieve symptoms
• nonprescription cough and cold medicaments should not be used in children younger than 2

Question 8

Treatment in acute obstructive bronchitis

Answer 8

• Salbutamol

Question 9

Definition of chronic bronchitis

Answer 9

• 3 months or longer of productive cough each year for 2 or more years

Question 10

Differential diagnosis of acute bronchitis

Answer 10

• foreign body
• asthma
• immunosuppression
• acute sinusitis
• aspiration syndromes
• asthma
• bronchiolitis
• Penumonia
• Tuberculosis
• Common cold
• Influenza
• Passive smoking

Question 11

Definition of pneumonia

Answer 11

• infection that involves the airways and parenchyma, with consodilation of the alveolar spaces

Question 12

Etiology of Pneumonia

Answer 12

NONINFECTIOUS CAUSES
- aspiration, hypersensitivity reactions, drugs or radiation

BACTERIAL

• Streptococcus penumoniae is most common in children 3 weeks to 4 years
• mycoplasma pneumoniae and C. pneuminar in 5 years and older

VIRAL

• common in children older 1 months but younger than 5 years
• RSV and rhinoviruses most common (esp in children younger than 2 years)
• other: influenza, parainfluenza…
• in 20% more than one virus present

Question 13

Clinical manifestiations of pneumonia

Answer 13

• fever is lower in viral than bacterial
• tachypnea
• accessory breaching muscles, nasal flaring
• severe infections: cyanosis, lethargy
• crackles, rhonchi and wheezing
• bacterial: commonly sudden high fever, cough, chest pain
• abdominal pain in lower-lobe pneumomia

Question 14

Diagnosis of pneumonia

Answer 14

• infiltrate on chest radiograph
• viral: hyperinflation wih bilateral interstitial infiltrates and beribronchial cuffinf
• pneumococcal: confluent lobar consolidation, high WBC, high ESR, procalcitonin, CRP
• viral: isolation of virus or detection of the viral genome or antigen in secretions by rapid detection
• bacteria can be isolated from blood, pleural fluid, lung

Question 15

Treatment of Pneumonia

Answer 15

BACTERIAL

• mild: amoxicillin and go home
• school-age children and M. pneumoniae or C. pneumoniae –> clarithromycin, azithromycin
• in hospitalized child: ampicillin or penicillin G (or ceftriaxone)
• staphylococal: vancomycin or clindamycin

should be continued until patient has been afebrile for 72 hours and the total duration should not be less than 10 days

Question 16

Why does treatment of pneumonia not work?

Answer 16

• complications like empyema
• bacterial resistance
• nonbacteial etiologies such as viruses, fungi or foreign bodies or food
• bronchial obstruction or mucous plugs
• Preexisting diseases such as immunodeficiencies

Question 17

Complications of Pneumonia

Answer 17

• usually the result of direct spread of bacterial infection within the thoracic cavity (pleural effusion, empyema, percarditis) or bacteremia and metaologic spread
• H. influenza type b: meningitis, suppurative arthritis, osteomyeltis
• S. aureus, pneumoniae, pyogenes: parapneumonoc effusins and empyema