infection of the respiratory tract Flashcards
list respiratory tract symptoms
fever
cough
dyspnoea
wheezy
list signs of respiratory tract
stridor wheeze clubbing lymphadenopathy cyanosis tachynoea (abnormally rapid breathing) chest wall deformity decreased expansion dull to percussion decreased air entry, crepitation's
list some of the main URTI
conjunctivitis
infections of the middle ear:
Otis media and sinusitis
viral infections of the throat and mouth:
common cold, enteroviral pharyngitis, endenoviral sore throat, infectious mononucleosis
bacterial throat infections:
streptococcal tonsillitis, acute epiglottitits, diptheria, reteropharyngeal abscess
laryngitis
mastoiditis
list some of the main LRTI
viral infections:
croup, bronchiolitis, pneumonia
pyogenic bacterial respiratory infections:
COPD, bronchiectasis, cystic fibrosis, community-acquired pneumonia, lung abscess
fungal infections:
aspergillosis, histoplasmosis, blastomycosis, coccidioidomycosis
list some of the main viral causes of respiratory infections that we should know about
RSV influenza adenovirus coronavirus enterovirus metapneumovirus parainfluenza rhinovirus
common cold
incidence - commonest infection of childhood
aetiology - 40% rhinovirus, 30% coronaviruses, Enterovirus Parainfluenza virus
clinical presentation - slight pyrexia, malaise, sneezing in early stages, profuse and watery nasal discharge, sore nose and pharynx
investigation- none
management - self-limiting, advice, fluids, food, rest
sore throat - pharyngitis
incidence- common
aetiology- usually due to viral infection with respiratory viruses (adenovirus, coronavirus, enteroviruses and rhinovirus)
clinical presentation - inflamed pharynx and soft palate and local lymph nodes are enlarged and tender
investigation - hallmarked by acute onset sore throat; absence of cough, nasal congestion and discharge suggests bacterial aetiology (streptococcus): rapid antigen test
management - symptomatic
Tonsillitis
incidence -
aetiology- 50 to 80% of infective sore throat = viral cause. additional 1-10% of cases are caused by EBV. The most common bacterial organism identified is group A beta-haemolytic streptococcus (GABHS), which causes 5-36% of infections
clinical presentation - form of pharyngitis where there is intense inflammation of the tonsils
investigation - distinguish viral/bac cause. bacterial: use CENTOR score and throat culture (+ve confirms, -ve doesn’t rule out).
management - AB’s over analgesics is marginal in reducing duration of severity. streptococcal pharyngitis treated with AB’s (prevent rheumatic fever)
acute otitis media
incidence - 75% of children will have at least one episode before 5 yrs
aetiology - viral: RSV and rhinovirus, bac: streptococcus pneumonia and haemophilus influenza
clinical presentation - fever, pain, diarrhoea and vomiting
investigations - clinical diagnosis. auroscope may show fluid levels, inflamed TM or discharge with perforation
management - symptomatic (ibruprofen, paracetamol, fluids), AB’s if required. grommets in OM with effusion
sinusitis (Mucosal swelling prevents muco-ciliary clearance of infection. Blockage of the eustachian tube or sinuses)
incidence -
aetiology - S. pneumoniae, H. influenza, S. milleri
clinical pres - pain and headache over the affected sinus, usually maxillary and frontal
investigation - (not usually done) x rays shows thickening of the soft tissue of the cavity +/- fluid level
management - Antibiotics and analgesia are used for acute sinusitis in addition to topical decongestants
Ampicillin, amoxycillin, oral cephalosporins
What are the differential diagnosis’ of stridor?
acute:
- viral laryngotracheobronchitis (croup)
- epiglottis
- bacterial tracheitis
- reteropharyngeal abscess
chronic (congenital):
- laryngomalacia
- vascular ring
- laryngo or tracheal web, cyst or haemangioma
chronic (acquired):
- post traumatic tracheal stenosis
- mediastinal mass e.g. tumour
non-infectious:
- angioedema
- anaphylaxis
- foreign body
croup (infection of the laryngotracheabronchial airway)
incidence - 3 months to 6 years of age but the peak incidence is in the second year of life. It is commonest in the autumn
aetiology - 95% viral-parainfluenza. RSV and influenza, can produce a similar clinical picture.
clinical presentation - there is mucosal inflammation and increased secretions affecting the airway, but it is the oedema of the subglottic area that is potentially dangerous in young children because it may result in critical narrowing of the trachea. The typical features are a barking(seal bark) cough, harsh stridor and hoarseness, usually preceded by fever and coryza. The symptoms often start, and are worse, at night
investigation - mild, moderate, severe, impending respiratory failure. consider the need for hosp. admission
management - moderate: corticosteroid immediately and advice (symptoms usually resolve within 48hrs). severe: O2,corticosteroi
Epiglottitis (intense swelling and surrounding tissues associated with septicaemia)
acute is life-threatening.
incidence - common in 1-6yrs but affects all
aetiology - H. influenzae type b
clinical presentation - high fever, intense painful throat, drooling, not speaking, soft inspiratory stridor, respiratory difficulty, open mouth
investigation - don’t examine throat!! blood cultures to isolate H. influenzae
management - emergency, urgent endotracheal intubation, IV AB’s (ceftriaxone)
it is important to distinguish between croup and epiglottitis. list some of the differences
croup: -onset over days -proceeds coryza -severe barking cough -able to drink -no drooling -look unwell fever <38.5oC -harsh, rasping stridor -hoarse voice/cry
Epiglottitis:
- acute onset
- doesn’t proceed coryza
- no cough
- not able to drink
- drooling
- toxic, very ill appearance
- temp >38.5
- soft whispering stridor
- muffled and reluctant to speak
tracheitis
aetiology - parainfluenza, respiratory syncytial, influenza, adenovirus
In adults: hoarseness; retrosternal pain In children: dry cough; inspiratory stridor (croup)
bronchiolitis
incidence - commonest serious respiratory infection of infancy. 2–3% of all infants are admitted to hospital with the disease each year during annual winter epidemics; 90% are aged 1–9 months (bronchiolitis is rare after 1 year of age).
aetiology - respiratory syncytial virsus (RSV) is pathogen in 80% cases. rememnder by adenovirus, influenza virus, human metapneumovirus, parainfluenza, rhinovirus and mycoplasma pneumoniae
clinical presentation - coryzal symptoms precede dry cough and increasing dyspnoea. feeding difficulties. recurrent apnoea. laboured breathing, tachypnoea (nasal flares). expiratory grunting, use of accessory muscles, esp. scm, retraction of chest wall
investigations - identify respiratory virus by PCR analysis of nasopharyngeal secretions. CXR normally unnecessary but shows hyperinflation of lungs due to small airway obstruction, air trapping. resp exam show laboured breathing, hyperinflated chest, chest recession, hyper resonant percussion, fine crackles in all zones, wheeze may/may not be present
management - supportive. humidified O2 via nasal cannulae, monitor for apnoea, mist AB’s, steroids and nebulised bronchodilators (salbutamol or ipratropium), fluids, ventilation may be required, infectious control measures
what symptoms/signs are indicative of immediate referal to hospital in child with bronchiolitis?
apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis persistent oxygen saturation of less than 92% when breathing air.
pneumonia
incidence - infancy and old age
aetiology - viral (most common in younger children) and bacterial (most common in older children)
clinical presentation - fever and difficulty in breathing, usually preceding URTI. may have cough, poor feeding. localised chest, abdo or neck pains indicative of bacterial infection
investigation - resp. exam. may show clubbing, reduced chest movements on affected side, rapid/shallow breaths, dull percussion, bronchial breathing, crackles
management - supportive; O2, analgesia, fluids, AB
pathogens causing pneumonia vary according to childs age. discuss
New-born – organisms from the mother’s genital tract, particularly group B streptococcus, but also Gram-negative enterococci
Infants and young children – respiratory viruses, particularly RSV, are most common, but bacterial infections include Streptococcus pneumoniae or Haemophilus influenzae. Bordetella pertussis and Chlamydia trachomatis can also cause pneumonia at this age. An infrequent but serious cause is Staphylococcus aureus.
Children over 5 years – Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia pneumoniae are the main causes.
At all ages Mycobacterium tuberculosis should be considered
there has been marked reduction in the incidence of pneumonia from Haemophilus influenza type B since the introduction of what?
Hib immunisation
What are the chest signs of asthma in children?
reduced but hyperinflated movements, use of accessory muscles, chest wall retraction. hyper resonant percussion, auscultation
