Lower respiratory tract infection in children Flashcards
What are common infective agents ?
Bacterial:
- strep pneumoniae
- haemophilus influenzae
- Moraxella catarrhalis
- mycoplasma pneumoniae
- chlamydia pneumoniae
Viral:
- RSV
- parainfluenzae III
- influenza A + B
- adenovirusWhat is tracheitis ?
Inflammation of the trachea
What is the description of tracheitis ?
Croup which doesn’t get better
What are the symptoms of tracheitis ?
Fever
Swollen tracheal wall
Narrow tracheal lining
Luminal debris
What are the common causative agents for tracheitis ?
Staph or strep infection
What is the treatment of tracheitis ?
Augmentin
How common is bronchitis ?
Very common
What are the symptoms of bronchitis ?
Loose rattily cough with URTI
Post-tussive vomit - ‘glut’
Chest free of wheeze and creps
Is bronchitis self-limiting ?
Yes
What is the causative agents for bronchitis ?
Haemophilus/Pneumococcus
What is the mechanism of bacterial bronchitis ?
Disturbed mucocilary clearance
- minor airway malacia - RSV/adenovirus
What does bacterial bronchitis usually follow on from ?
URTI
What is Bronchiolitis defined as ?
A lower respiratory tract infection of infants
What % of children are usually affected by bronchiolitis ?
30-40%
What is the cause of bronchiolitis ?
RSV (Respiratory Syncytial Virus)
Parainfluenza 3, HMPV (human metapneumovirus)
What are the symptoms of bronchiolitis ?
Nasal Stiffness
Tachypnoea
Poor feeding
Crackles +/- wheeze
When is the peak incidence of Bronchiolitis ?
3 months
What separates bronchiolitis from asthma ?
Bronchiolitis is a 2 week infection from start to finish, asthma is recurrent
What are the differences between LRTIs and bronchiolitis ?
LTRI:
- in all ages - more rapid onset of symptoms - fever
Bronchiolitis:
- ages <12 months - 3 days before reach peak - fever rarely >38°C
Why does feeding have complications during the course of bronchiolitis ?
It is essentially exercise for the baby who is unused to the idea of breathing through the mouth, nose is blocked
Feeding the baby now has complications
What is the management of bronchiolitis ?
Maximal observation
Minimal intervention
What does an NPA involve ?
A catheter (or tube) is inserted a short distance into your child’s nose (this should occur with minimal discomfort to your child)
Gentle suction is used to collect some mucus
The mucus is then sent to the laboratory for
testing
What tests are there no need for in bronchiolitis ?
CXR
Bloods
Bacterial cultures
What are the relevant investigations for bronchiolitis ?
Nasopharyngeal aspirate
Oxygen saturation to determine severity
Are there any medications proven to help bronchiolitis ?
No
What is the definition of a LRTI ?
48 hours of fever (above 38.5 degrees)
SOB
cough and grunting
What can you infer from wheeze ?
Bacterial cause is unlikely
How do you confirm a lower respiratory tract infection ?
Reduced or bronchial breath sounds
What are the infective agents for LRTI ?
Viruses in <35% (higher in younger)
Bacteria Pneumococcus, Mycoplasma, Chlamydia
Mixed infection in <40%
How can you tell if the LRTI is pneumonia ?
Signs are focal (one side of the chest)
Creps – fine crackles
High fever
What are the possible investigations for community acquired pneumonia ?
CXR -(rarely going to help) and inflammatory makers NOT “routine”
What is the management for community acquired pneumonia ?
Nothing if symptoms are mild (always offer to review if things get worse!) Oral Amoxycillin first line Oral Macrolide second choice Only for iv if vomiting
When would you consider antibiotics for an LRTI ?
After 48 hour history exists
What is the only thing that causes coughing fits ?
Pertussis
What is pertussis also known as ?
Whooping cough
What are the symptoms of pertussis ?
Vomiting
Colour change
Is pertussis common ?
Yes
What reduces the risk and severity of pertussis ?
Vaccination
What is empyema ?
Extension of infection into pleural space
Where can empyema arise from ?
Complications of pneumonia
What are the symptoms of empyema ?
Chest pain
Very unwell
What is the treatment of empyema ?
Antibiotics
Drainage
