Lower Respiratory Tract Infections in Children Flashcards
What are common bacterial agents that cause infections?
strep pneumoniae, Haemophilus influenzae, Moraxella catrrhalis, Mycoplasma pneumoniae, chlamydia pneumoniae,
What are comon viral agents that cause infection?
RSV, parainfleunza III, influenze A and B, adenovirus
What are the principles of management of a LRTI?
Make a diagnosis, Asess the patient (oxygenation, hydration, nutrition), to treat or not to treat
What is tracheitis?
it is croup which doesnt get better, inflammation of the trachea.
What are the symptoms of tracheitis?
Barking cough, stridor, fever and sickness
Fever, sick child
Swollen tracheal wall, narrowed tracheal lumen, luminal debris
What bacteria causes tracheitis?
Staph or strep
What is an endobronchial infection?
An infection inside the airway
What are the symptoms of bronchitis?
loose rattly cough started off with an URTI with an end of the cough there is vomit (post tussive vomit)
What bacteria cause bronchitis?
Pneumococcus and Haemophilus
What is the mechanism of bacterial bronchitis?
Distrubed mucociliary clearance, lack of social inhibition, bacterial overgrowth is secondary.
How are bacterial infections transmitted during winter?
The respiratory virus is picked up, mucociliary escalator switches off for up to 4 weeks, cough and rattle, mucociliary escalator slowly recovers.
What is the natural history of bacterial bronchitis?
It follows URTI, lasts 4 weeks, 60-80% respond to antibiotics.
What URTI does bronchitis follow?
Rhinovirus
How does the cough morbidity vary with each winter?
First winter - bad, second winter better, Third winter - fine
What is the diagnosis for bacterial bronchitis?
Make a diagnosis, Reassure (parents and grandparents), Do not treat
How does bronchitis differ from bronchiolitis?
Bronchitis is the infection of the large airways and bronchiolitis is the infection of the small airways
What is bronchiolitis?
It is a LTRI of infants
What percentage of infants does bronchiolitis affect?
30 - 40%
What are the common viruses that cause bronchiolitis?
Respiratory syncytial virus, parainfluenza, human metanuma virus
What are the symptoms of bronchiolitis?
Stiuffy nose, tachypnoae, poor feeding
Why do infants feed poorly when they have bronchiolits?
They’ve only got one orifice through which they feed and breath with a nose block and that is their mouth.
What might you hear during an examination of a infant that has bronchiolitis?
Crackles +/- wheezes
What are the management techniques of bronchiolitis?
Maximal observation, minimal intervention
What are the investigations carried out during bronchiolitis?
NPA
Oxygen saturation
What is a lower respiratory tract infection often characterised by?
48-hour history of fever, SOB, cough and often grunting
What does wheeze rule out in LRTIS?
Wheeze makes the bacterial cause unlikely.
What are the infective agents of LRTIs
Virus and commensal bacteria/bacterium, mycoplasma, Chlamydia.
When are you allowed to call in pneumonia?
Signs are focal in one area (Left lower zone)
Craputations
High Fever (otherwise call it a LRTI)
What are the management methods for pneumonia?
Nothing if the symptoms are mild
Oral Amoxycillin first line
Oral Macrolide second choice
Only for iv if vomiting
What are the benefits of oral antibiotics?
Shorter hospital stay, Cheaper
What vaccination do to the risk and severity of pertussis?
It reduces the risk and severity
What is pertussis characterised by?
• Coughing fits, vomiting and color change
What is empyema?
• The complication of pneumonia, extension of the infection into pleural space.
What are the treatments for empyaema?
• Antibiotics +/- drainage
What is the treatment for tracheitis?
Augmentin
What the most common cause of LRTI in infancy?
Bronchiolitis
What 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 relevant investigations for bronchiolitis?
Nasopharyngel aspiration, Oxygen saturasion to determine severity
What does 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
How can you confirm a lower respiratory tract infection?
Reduced or bronchial breath sounds
What are the possible investigations for community acquired pneumonia?
CXR and inflammatory makers NOT routine
What is the management forcommunity 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 exist
What is the treatment for empyema?
Antibiotics and drainage
