Lower respiratory tract infections

Question 1

How does tracheitis present?

How would you differentiate it from croup (LTB)?

Answer 1

Tracheitis has the same symptoms as croup:

• coryza
• barking cough
• stridor
• fever & unwell

Tracheitis is bascially croup that doesnt get better

Question 2

What microorganisms cause tracheitis?

How is it treated?

Answer 2

Staph or strep

Think staph aureus is most common

Augmentin

Question 3

What is bronchitis?

How does it present?

Answer 3

Endobronchial infection - very common

Presentation:

• Productive ‘loose’ rattly cough
• Post-tussive vomiting
• Follows an URTI

May have several episodes of this over the winter

Question 4

If you listened to the chest of a child with bronchitis - what would you expect to hear?

Answer 4

Nothing

No wheeze / crackles / crepitations

Question 5

What microorganisms cause bronchitis in children?

Answer 5

Haemophilus

Pneumococcus

Question 6

Describe the mechanism behind bacterial bronchitis

Answer 6

1) Primary viral infection (RSV/adenovirus) turns mucocilliary escalator off

Mucus etc pools up…

2) Bacterial infection occurs secondary to this

Question 7

How long does bronchitis tend to last?

Answer 7

Most fine by 10 days - but can last for up to 4 weeks

Question 8

How do you treat bronchitis in children?

Answer 8

You dont

Question 9

What is bronchiolitis?

Describe its epidemiology

Answer 9

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

Question 10

What microorganism causes bronchiolitis?

Answer 10

RSV (respiratory syncytial virus)

Parainfluenza III

Human metapneumovirus

May be seoncdary bacterial infection too

Question 11

How does bronchiolitis typically present?

Answer 11

<1 year old with ~5 days history of:

• coryzal symptoms (nasal stuffiness, sneezing)
• cough
• tachypnoea
• poor feeding
• ~fever

Question 12

If you listened to the chest of someone with bronchiolitis - what would you be looking for?

Answer 12

Fine inspiratory crackles / crepitations

+/- Wheeze

Usually bilateral

Question 13

How do you treat bronchiolitis?

How long does it take for bronchiolitis to resolve?

Answer 13

You don’t*

Typically fine by 14 days

*If really bad - supportive (low sats = oxygen, no feeding = NG tube etc)

Question 14

What investigations would you do for a child with bronchiolitis?

Answer 14

NPA

Oxygen sats

NPA - nasopharyngeal aspirate

Question 15

Although bronchitis/bronchiolitis are lower respiratory tract infections - LRTI is a diagnosis in itself

Clinically, what is a lower respiratory tract infection?

Answer 15

Rapid onset (<48hrs) hrs of fever, SOB, coughing, grunting

Question 16

If you have a kid with a suspected LRTI - what would a wheeze indicate to you about the cause?

Answer 16

Wheeze = bacterial cause unlikely

Question 17

What additional features would be required for a LRTI to be called pneumonia?

Answer 17

If focal lung signs

Crepitations

High fever

Question 18

Describe the management of LRTI (or pneumonia) in a child

Answer 18

If symptoms mild - nothing

If treatment required:

Oral amoxycillin _{- 1st line}

Oral macrolide (eg clarithromycin)

IV if vomiting

Question 19

Briefly compare the presentations for LRTI & bronchiolitis

How can you differentiate them?

Answer 19

LRTI:

• any age
• rapid onset (<48hrs)
• fever - one of main features

Bronchiolitis:

• age <12 months
• slower onset (>3 days before peak)
• fever rarely >38*

Question 20

Compare the possible findings on auscultation of chest for a) bronchitis, b) bronchiolitis & c) LRTI

Answer 20

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

Question 21

What is pertussis?

How does it present?

Answer 21

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)

Question 22

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

Answer 22

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

Question 23

How is a pleural empyema treated?

Answer 23

Antibiotics +/- surgical drainage

Question 24

Complete da table

Answer 24

Question 25

For all these diseases - before you would consider antibiotic treatment - what must you look at first

Answer 25

Oxygenation

Hydration

Nutrition