Lower respiratory tract infection - children Flashcards
What are some examples of LRTIs?
Tracheitis
Pneumonia
Bronchitis
Bronchiolitis
Empyema
Give some common infective bacterial agents?
Strep. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, mycoplasma pneumoniae, chlamydia pneumonia
Give some common infective viral agents?
RSV, parainfluenza III, influenza A and B, adenovirus
What are the principles for management?
Make a diagnosis
Assess the patient - oxygenation, hydration and nutrition
To treat and not to treat is the dilemma
Explain symptoms of tracheitis
Fever, sick child, miserable, barking cough
What causes tracheitis?
Staph or strep invasive infection
What is the treatment for tracheitis?
Augmentin
Explain the symptoms of bronchitis
Loose rattily cough with URTI
Post-tussive vomit - glut
Chest free of wheeze/creps and cackles
Mostly self-limiting and child presents well
Describe bronchitis
Very common
endobronchial infection
Haemophilus/ Pneumococcus
Describe bacterial bronchitis mechanism
Disturbed mucociliary clearance - secretion pulls in airways and has to be brought up
Is a bacterial infection or overgrowth is secondary to normal commensal
Describe the cycle in winter and clearance working?
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
What is the duration of the cough?
Most children have cough that lasts 10 days
20% of children have a cough for 2 weeks
What is the natural history of bacterial bronchitis?
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
What are the steps for managing bacterial bronchitis?
- Make a diagnosis
- Reassure
- Do not treat as child is well but may sound bad
What are the symptoms for bronchiolitis?
Nasal stuffiness, tachypnoea, poor feeding as short of breath because breathing and feeding from same hole
Crackles are heard and sometimes wheeze
What are the common causes for bronchiolitis?
Usually RSV, others include paraflu III and HMPV
Describe the duration of bronchiolitis on illness index
Child will have 3 days of worsening and stabilise on the 5th day
After 7 days recovery begins
Usually recovered by 14 days
When does RSV peak?
During winter months
What age can you get bronchiolitis?
Above 12 months old and is a one off so is not recurrent
What is the management for bronchiolitis?
Maximal observation and minimal intervention
What investigations are needed in bronchiolitis?
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
What medications are proven to work in bronchiolitis?
None
What symptoms are seen in a lower respiratory tract infection?
Fever, shortness of breath, cough, grunting to keep airways open
Reduced or bronchial breath sounds
Infective agents - virus plus commensal bacteria
When would you call a LRTI pneumonia?
If signs are focal so in one area like left lung zone
Creps
High fever
What investigations are needed for community acquired pneumonia?
CXR and inflammatory markers are not routine
What is the management for community acquired pneumonia?
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
When is oral antibiotics used?
When antibiotics are indicated (48hrs)
In non-severe LRTI
When child is not vomiting
Why are oral antibiotics are better than IV?
Shorter hospital stay and cheaper
Increase fever a few hours longer
What are the differences between LRTI and bronchiolitis?
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
What are the guidelines for prescribing in upper and lower resp. tract infection?
Antibiotics are not indicated
Tonsillitis consider penicillin
Explain pertussis
Very common
Whooping cough - coughing fits, vomiting and colour change, loud breathing noise after coughing fit
Describe vaccines and pertussis
Vaccination reduces risk and severity but child can still get it
What is Empyema?
Is collection of pus in cavity
Complication of pneumonia - extension of infection into pleural space
Chest pain and very unwell
Does empyema need antibiotics?
Yes, IV antibiotics
Maybe need drainage of fluid
What are 3 things to observe in a child with LTRI?
Oxygenation, hydration and nutrition
