Lower Respiratory Tract Infections in Children Flashcards
What is tracheitis?
Inflammation of the trachea
What is the incidence of bronchiolitis?
20% of children will get admitted to hospital with this
Incidence of LRTI
What are the common infective agents?
•Bacterial
–Strep pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae
•Viral
–RSV, parainfluenza III, influenza A and B, adenovirus
What is the description of tracheitis?
•“croup which does not get better”
What are the symptoms of tracheitis?
•Fever, sick child
What are the common causative agents for tracheitis?
Staoh or strep
What is the treatment for tracheitis?
Augmentin
Is bronchitis common?
Yes, very
What are the symptoms of bronchitis?
Loose rattly cough with URTI
Post-tussive vomit - ‘glut’
Chest free of wheeze and creps
Mostly self - limiting
What are the common causes of bronchitis?
Haemophilus/Pneumococcus
What is the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance
- minor airway malacia
- RSV/adenovirus
Why do people get recurrent colds in winter?
What does bacterial bronchitis usually follow on from?
URTI
What is Bronchioloitis defined as?
A lower respiratory tract infection of infants
What is usually 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
What is the most common cause of LRTI in infancy?
Bronchiolitis
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
Why does feeding have complications during the course of bronchiolitis?
It is essentially excersize 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 managent of bronchiolitis?
Maximal Observation
Minimal Intervention
What are the relevant investigations for bronchiolitis?
Nasopharyngel aspirate
Oxygen saturasion to determine severity
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
Is there any need for
–CXR
–Bloods
–Bacterial cultures ?
NO
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 woud you consider antibiotics for an LRTI?
After 48 hour history exists
LOOK
What is the only thing that causes coughing fits?
Pertussis
What are the symptoms of pertussis?
Vomiting and colour change
Is pertussis common?
Yes
Where can empyema arise from?
Complications of pneumonia
What is the treatment of empyema?
Antibiotics and drainage
To treat or not to treat
