Lower Respiratory Tract Infections in Children Flashcards
List some common bacterial ‘infections’ which are common in health.
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydia pneumoniae
Name two bacteria which are not common in health and what they cause/.
Pertussis - whooping cough
Mycobacterium - tuberculosis.
List some viruses which cause LRTI.
RSV
Parainfluenza III
Influenza A and B
Adenovirus
What are the principles of management in children with LRTI’s?
Make a diagnosis (easy)
Assess the patient (easy)->oxygenation, hydration, nutrition
To treat or not to treat (grey)
What is tracheitis?
Infection of the trachea
Name some symptoms of children with tracheitis.
‘Croup which didn’t get better’
-Barking cough
-Fever
-Feeling sick
What is the tracheitis caused by?
Staph or strep over colonisation of the airways.
What is the treatment for tracheitis?
Augmentin
How is bronchitis charcaterized?
Child very well, parent very worried
What is bronchitis?
Infection of the inside of the airways
Endobronchial infection
What are the presenting symptoms of bronchitis?
Loose rattly cough started with URTI
Post-tussive vomit - “glut” -> vomiting after coughing for a long period of time
What’s the mechanism of bacterial bronchitis?
Disturbed mucociliary clearance-> cilia don’t work
How long can bacterial bronchitis last for?
Up to four weeks
Describe briefly the cycle of bacterial bronchitis.
Continuous cycle through winter- 4 or 5 cycles.
Child’s first winter- bad
Second- better
Third-fine
What is the management for persistent bacterial bronchitis?
- Make the diagnosis
- Reassure
- Do not treat
What is bronchiolitis?
Infection of the smaller airways
How common is bronchiolitis?
Very common
Which forms of viruses/bronchiolitis may an infant get soon after being born?
Usually RSV (respiratory sensitive virus), others include paraflu III, HMPV
What are the presenting symptoms of bronchiolitis?
Nasal stuffiness, tachypnoea, poor feeding
Crackles and sometimes wheeze in chest
How many days after the start of bronchiolitis does the child stabilise?
Five days
How long does the child remain at this stabilised worst period?
Two days
At what age does bronchiolitis occur?
<12months
Is bronchiolitis recurrent or one off?
One off
What is the management of bronchiolitis?
Maximum observation
Minimum intervention
What investigations take place for a clinical diagnosis of bronchiolitis?
NPA (nasal pharyngeal aspirin) to identify virus
Oxygen saturation
Name some medication which can help bronchiolitis.
Hehe none
…wait not hehe that makes me sound mean
If there is a wheeze in someone presenting w a LRTI, what kind of infection is it unlikely to be?
Bacterial
Name some characterisations of LRTI’s.
48 hrs, fever (>38.5oC), SOB, cough, grunting
What symptoms are common in pneumonia?
btw, if they have these symptoms, you are allowed to call it pneumonia. If they don’t, call it URTI as parents get terrified when they hear pneumonia.
Signs are focal, ie in one area (LLZ)
Creps
High fever
What are the treatment options for children w pneumonia?
Nothing if symptoms are mild (always offer to review if things get worse!)
Oral Amoxycillin first line
Oral Macrolide second choice
When might you use IV antibiotics/medications?
If the child is vomiting
Name some advantages of oral medication compared to IV.
Shorter hospital stay
Cheaper
Name a disadvantage of oral medication compared to IV
Child might have a fever for a couple of hours longer
What are the differences between LRTI and bronciolitis?
LRTI-
In all ages
More rapid onset of symptoms
Fever
Bronchiolitis-
Aged <12 months
3 days before reach peak
Fever rarely >38oC
What is the medical term for whooping cough?
Pertussis
Pertussis is still common despite being vaccinated. However, what does the vaccine do?
Reduces risk and severity of whooping cough
Name some symptoms of pertussis.
Coughing fits
Vomiting after coughing fit
What condition can be a complication of pneumonia?
Empyaema
In Empyaema, where does the infection spread?
Spreads to the pleural space
What may children with Empyaema expereince?
Chest pain and feeling generally unwell
What is the treatment for Empyaema?
Antibiotics with drainage of the fluid
What are the three most important things to sort when deciding if to give a child w a LRTI antibiotics or not?
Nutrition
Hydration
Oxygenation
Which LRTI’s should you give antibiotics to treat?
Tracheitis and Empyaema
What LRTI may you need to give antibiotics for and when?
Pneumonia if two days of fever, cough, focal signs
