Bronchitis and Pneumonia Flashcards
Acute bronchitis definition
- clinical syndrome produced by inflammation of trachea, bronchi and bronchioles
- occurs in associaton with viral lower respiratory tract infection
- rarely pirmary bacterial infeciton
Etiology of Bronchitis
- 90% viral
- adenovirus
- influenza
- parainfluenza
. RSV - Rhinovirus
- HSV
10% bacterial
- S. Pneumoniae
- M. catarrhalis
- H. influenzae
- C. pneumoniae
- Mycoplasma species
Clinical manifestation of bronchitis
- 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
Symptoms of acute bronchitis
- 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
Chest Radiography in Acute bronchitis
- usually not neccessary
- in complicated bronchitis: atelectasis, hyperinflation, peribronchial thickening
Testing in acute bronchitis
- 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
Treatment of acute bronchitis
- 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
Treatment in acute obstructive bronchitis
- Salbutamol
Definition of chronic bronchitis
- 3 months or longer of productive cough each year for 2 or more years
Differential diagnosis of acute bronchitis
- foreign body
- asthma
- immunosuppression
- acute sinusitis
- aspiration syndromes
- asthma
- bronchiolitis
- Penumonia
- Tuberculosis
- Common cold
- Influenza
- Passive smoking
Definition of pneumonia
- infection that involves the airways and parenchyma, with consodilation of the alveolar spaces
Etiology of Pneumonia
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
Clinical manifestiations of pneumonia
- 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
Diagnosis of pneumonia
- 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
Treatment of Pneumonia
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
