Lower respiratory tract infection - children

Question 1

What are some examples of LRTIs?

Answer 1

Tracheitis
Pneumonia
Bronchitis
Bronchiolitis
Empyema

Question 2

Give some common infective bacterial agents?

Answer 2

Strep. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, mycoplasma pneumoniae, chlamydia pneumonia

Question 3

Give some common infective viral agents?

Answer 3

RSV, parainfluenza III, influenza A and B, adenovirus

Question 4

What are the principles for management?

Answer 4

Make a diagnosis
Assess the patient - oxygenation, hydration and nutrition
To treat and not to treat is the dilemma

Question 5

Explain symptoms of tracheitis

Answer 5

Fever, sick child, miserable, barking cough

Question 6

What causes tracheitis?

Answer 6

Staph or strep invasive infection

Question 7

What is the treatment for tracheitis?

Answer 7

Augmentin

Question 8

Explain the symptoms of bronchitis

Answer 8

Loose rattily cough with URTI
Post-tussive vomit - glut
Chest free of wheeze/creps and cackles
Mostly self-limiting and child presents well

Question 9

Describe bronchitis

Answer 9

Very common
endobronchial infection
Haemophilus/ Pneumococcus

Question 10

Describe bacterial bronchitis mechanism

Answer 10

Disturbed mucociliary clearance - secretion pulls in airways and has to be brought up
Is a bacterial infection or overgrowth is secondary to normal commensal

Question 11

Describe the cycle in winter and clearance working?

Answer 11

Respiratory virus causes mucous ciliary escalator to turn off for 4 weeks
Cough and rattle - parent worries
Clearance almost removed then cycle repeats
Can happen 4x in winter for children

Question 12

What is the duration of the cough?

Answer 12

Most children have cough that lasts 10 days
20% of children have a cough for 2 weeks

Question 13

What is the natural history of bacterial bronchitis?

Answer 13

Lasts 4 weeks following URTI
First winter is bad then second is better and third is fine/normal level of cough
Due to pneumococcus/H flu

Question 14

What are the steps for managing bacterial bronchitis?

Answer 14

1. Make a diagnosis
2. Reassure
3. Do not treat as child is well but may sound bad

Question 15

What are the symptoms for bronchiolitis?

Answer 15

Nasal stuffiness, tachypnoea, poor feeding as short of breath because breathing and feeding from same hole
Crackles are heard and sometimes wheeze

Question 16

What are the common causes for bronchiolitis?

Answer 16

Usually RSV, others include paraflu III and HMPV

Question 17

Describe the duration of bronchiolitis on illness index

Answer 17

Child will have 3 days of worsening and stabilise on the 5th day
After 7 days recovery begins
Usually recovered by 14 days

Question 18

When does RSV peak?

Answer 18

During winter months

Question 19

What age can you get bronchiolitis?

Answer 19

Above 12 months old and is a one off so is not recurrent

Question 20

What is the management for bronchiolitis?

Answer 20

Maximal observation and minimal intervention

Question 21

What investigations are needed in bronchiolitis?

Answer 21

NPA - nasopharyngeal airway is an alternative airway device for treating soft tissue upper airway obstruction
Oxygen saturation measures severity
No need for CXR, bloods or bacterial cultures

Question 22

What medications are proven to work in bronchiolitis?

Answer 22

None

Question 23

What symptoms are seen in a lower respiratory tract infection?

Answer 23

Fever, shortness of breath, cough, grunting to keep airways open
Reduced or bronchial breath sounds
Infective agents - virus plus commensal bacteria

Question 24

When would you call a LRTI pneumonia?

Answer 24

If signs are focal so in one area like left lung zone
Creps
High fever

Question 25

What investigations are needed for community acquired pneumonia?

Answer 25

CXR and inflammatory markers are not routine

Question 26

What is the management for community acquired pneumonia?

Answer 26

Nothing if symptoms are mild so if 02 and hydration are fine
Oral amoxycillin is the first line
Oral macrolide is allergic so second choice
IV if vomiting

Question 27

When is oral antibiotics used?

Answer 27

When antibiotics are indicated (48hrs)
In non-severe LRTI
When child is not vomiting

Question 28

Why are oral antibiotics are better than IV?

Answer 28

Shorter hospital stay and cheaper
Increase fever a few hours longer

Question 29

What are the differences between LRTI and bronchiolitis?

Answer 29

LRTI - in all ages, more rapid onset of symptoms and fever
Bronchiolitis - aged more than 12 months, 3 days before peak is reached and fever is rarely higher than 38

Question 30

What are the guidelines for prescribing in upper and lower resp. tract infection?

Answer 30

Antibiotics are not indicated
Tonsillitis consider penicillin

Question 31

Explain pertussis

Answer 31

Very common
Whooping cough - coughing fits, vomiting and colour change, loud breathing noise after coughing fit

Question 32

Describe vaccines and pertussis

Answer 32

Vaccination reduces risk and severity but child can still get it

Question 33

What is Empyema?

Answer 33

Is collection of pus in cavity
Complication of pneumonia - extension of infection into pleural space
Chest pain and very unwell

Question 34

Does empyema need antibiotics?

Answer 34

Yes, IV antibiotics
Maybe need drainage of fluid

Question 35

What are 3 things to observe in a child with LTRI?

Answer 35

Oxygenation, hydration and nutrition