Lower respiratory tract infections Flashcards
How does tracheitis present?
How would you differentiate it from croup (LTB)?
Tracheitis has the same symptoms as croup:
- coryza
- barking cough
- stridor
- fever & unwell
Tracheitis is bascially croup that doesnt get better
What microorganisms cause tracheitis?
How is it treated?
Staph or strep
Think staph aureus is most common
Augmentin
What is bronchitis?
How does it present?
Endobronchial infection - very common
Presentation:
- Productive ‘loose’ rattly cough
- Post-tussive vomiting
- Follows an URTI
May have several episodes of this over the winter
If you listened to the chest of a child with bronchitis - what would you expect to hear?
Nothing
No wheeze / crackles / crepitations
What microorganisms cause bronchitis in children?
Haemophilus
Pneumococcus
Describe the mechanism behind bacterial bronchitis
1) Primary viral infection (RSV/adenovirus) turns mucocilliary escalator off
Mucus etc pools up…
2) Bacterial infection occurs secondary to this
How long does bronchitis tend to last?
Most fine by 10 days - but can last for up to 4 weeks
How do you treat bronchitis in children?
You dont
What is bronchiolitis?
Describe its epidemiology
Infection of the bronchioles (smaller airways)
Affects infants (peak 3-6 months)
Most common serious LRTI of infants with 30-40% being affected at some point
Like most - its most common in winter
What microorganism causes bronchiolitis?
RSV (respiratory syncytial virus)
Parainfluenza III
Human metapneumovirus
May be seoncdary bacterial infection too
How does bronchiolitis typically present?
<1 year old with ~5 days history of:
- coryzal symptoms (nasal stuffiness, sneezing)
- cough
- tachypnoea
- poor feeding
- ~fever
If you listened to the chest of someone with bronchiolitis - what would you be looking for?
Fine inspiratory crackles / crepitations
+/- Wheeze
Usually bilateral
How do you treat bronchiolitis?
How long does it take for bronchiolitis to resolve?
You don’t*
Typically fine by 14 days
*If really bad - supportive (low sats = oxygen, no feeding = NG tube etc)
What investigations would you do for a child with bronchiolitis?
NPA
Oxygen sats
NPA - nasopharyngeal aspirate
Although bronchitis/bronchiolitis are lower respiratory tract infections - LRTI is a diagnosis in itself
Clinically, what is a lower respiratory tract infection?
Rapid onset (<48hrs) hrs of fever, SOB, coughing, grunting
If you have a kid with a suspected LRTI - what would a wheeze indicate to you about the cause?
Wheeze = bacterial cause unlikely
What additional features would be required for a LRTI to be called pneumonia?
If focal lung signs
Crepitations
High fever
Describe the management of LRTI (or pneumonia) in a child
If symptoms mild - nothing
If treatment required:
Oral amoxycillin - 1st line
Oral macrolide (eg clarithromycin)
IV if vomiting
Briefly compare the presentations for LRTI & bronchiolitis
How can you differentiate them?
LRTI:
- any age
- rapid onset (<48hrs)
- fever - one of main features
Bronchiolitis:
- age <12 months
- slower onset (>3 days before peak)
- fever rarely >38*
Compare the possible findings on auscultation of chest for a) bronchitis, b) bronchiolitis & c) LRTI
a) Bronchitis - fuck all
b) Bronchiolitis:
- wheeze
- fine inspiratory crepitations
c) LRTI / pneumonia:
- wheeze
- reduced or bronchial breath sounds
- crepitations (pneumonia)
LRTI & bronchiolitis very similar findings - history is more important to diff
What is pertussis?
How does it present?
Pertussis - aka Whooping cough or the 100 day cough
Caused by bordetella pertussis
Characterised by coughing fits which may be followed by vomiting
Lasts bloody ages (hence the name)
A child has an LRTI / pneumonia
Their condition deteriorates and they begin to experience severe chest pain and become very unwell
What has likely happened?
Describe the condition
Pleural empyema
Complication of pneumonia in which the infection extends into the pleural space - which fills with puss
Main symptoms are chest pain, cough, dysnpnoea, fever & not feeling at your best
How is a pleural empyema treated?
Antibiotics +/- surgical drainage
Complete da table
For all these diseases - before you would consider antibiotic treatment - what must you look at first
Oxygenation
Hydration
Nutrition
