Lower Respiratory Tract Infections in Children Flashcards
What are the clinical features of acute bronchitis?
Cough (often productive with mucus), wheezing, shortness of breath, and chest tightness.
Low-grade fever, fatigue, malaise, and sometimes sore throat.
Rhonchi and rales may be heard on auscultation.
Common Cause: Often viral (e.g., rhinovirus, influenza, parainfluenza, coronavirus).
Bacterial infections (e.g., Mycoplasma pneumoniae, Chlamydia pneumoniae) can also occur but are less common.
What are the clinical features of pneumonia?
Fever, chills, productive cough (often with purulent or blood-tinged sputum), pleuritic chest pain, dyspnea.
Tachypnea, hypoxia, and tachycardia.
Crackles or dullness on percussion, increased tactile fremitus on auscultation.
Common causes:
Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus (bacterial).
Influenza virus, respiratory syncytial virus (RSV) (viral).
What are the clinical features of bronchiolitis?
Cough, wheezing, labored breathing, tachypnea, and nasal flaring.
Respiratory distress, including grunting, retractions.
Low-grade fever, irritability, poor feeding (especially in infants).
Seen mainly in infants and young children, often caused by respiratory syncytial virus (RSV), though can be due to parainfluenza or adenovirus.
What are the common bacterial and viral organisms causing lower respiratory infections?
Bacterial Causes:
Streptococcus pneumoniae (most common cause of community-acquired pneumonia).
Haemophilus influenzae (causes pneumonia, especially in those with comorbidities).
Mycoplasma pneumoniae (typically causes atypical pneumonia, more common in younger people).
Staphylococcus aureus (including MRSA causing severe pneumonia).
Klebsiella pneumoniae (can cause necrotizing pneumonia and lung abscesses).
Pseudomonas aeruginosa (more common in immunocompromised individuals).
Viral Causes:
Influenza virus (can lead to viral pneumonia).
Respiratory syncytial virus (RSV) (common cause of bronchiolitis in infants).
Parainfluenza virus (can lead to pneumonia and croup).
Adenovirus (can cause pneumonia and bronchiolitis).
What is the role of supportive therapy in the management of lower respiratory infections?
Hydration: Ensures adequate fluid balance and helps loosen mucus.
Oxygen therapy: Administered for hypoxia (low oxygen levels) if required, especially in pneumonia or severe bronchiolitis.
Rest: Encouraged to support immune function and recovery.
Pain and fever management:
Paracetamol or ibuprofen for fever and chest pain relief.
Cough relief:
Expectorants like guaifenesin to thin mucus (for bronchitis).
Cough suppressants (e.g., dextromethorphan) can be used for severe, dry cough.
Inhaled bronchodilators: For wheezing and bronchospasm in bronchiolitis or asthma exacerbations (e.g., albuterol).
When are antimicrobial therapies used in lower respiratory infections?
Bacterial Pneumonia:
Streptococcus pneumoniae: First-line treatment with amoxicillin or penicillin.
Haemophilus influenzae: Amoxicillin-clavulanate or cephalosporins.
Atypical pneumonia (e.g., Mycoplasma pneumoniae): Treated with macrolides (e.g., azithromycin) or doxycycline.
**Severe pneumonia (e.g., MRSA) or Pseudomonas aeruginosa: Vancomycin or linezolid for MRSA; piperacillin-tazobactam or cefepime for Pseudomonas.
Viral Infections:
Influenza: Oseltamivir or zanamivir within 48 hours of symptoms to reduce severity and duration.
RSV: Supportive therapy is the mainstay, but ribavirin may be used in severe cases.
Antibiotics are generally not used for viral infections unless there is a secondary bacterial infection.
