Lower Respiratory Tract Infections in children Flashcards
What is acute bronchitis?
Self limiting infection leading to inflammation of trachea and major bronchi (and is therefore associated with oedematous large airways and production of sputum)
How long does bronchitis tend to take to resolve?
3 weeks (cough may go on for longer through)
What is the leading cause of acute bronchitis?
Viruses
When does acute bronchitis tend to happen?
Most cases in Autumn or winter
How does acute bronchitis tend to present?
Cough - productive/non-productive (tends to be loose and rattly) sore throat Rhinorrhoea Wheeze Usually normal chest examination
How can you differentiate acute bronchitis from pneumonia?
History - sputum, wheeze and SoB may b absent in acute bronchitis, but tends to be present in pneumonia
Examination - no focal chest signs (e.g. dullness to percussion, creps, bronchial breating) in acute bronchitis
Systemic features, e.g. malaise, myalgia, fever usually absent in bronchitis and present in pneumonia
How is acute bronchitis diagnosed?
Clinically - does not require investigations
What tends to cause acute bronchitis in kids?
H. influenzae/pneumococcus
What is considered persistent bacterial bronchitis?
Wet cough persisting for over 1 month
Treat with antibiotics
How is acute bronchitis managed normall?
Analgesia
Good fluid intake
Antibiotics (amoxicillin) may be considered if systemically unwell, if they have pre-existing co-morbs, CRP >100
What is bronchiolitis?
Condition characterised by bronchiolar inflammation
What pathogen causes bronchiolitis in 75-80% of cases?
RSV
When is the incidence of bronchiolitis highest?
Winter
What is the most common cause of serious LRTI in <1 year olds?
Bronchiolitis
What can provide infants with protection against bronchiolitis?
Maternal IgG
What are less common causes of bronchiolitis?
Mycoplasma
Adenoviruses
May be secondary bacterial infection
In which infants is bronchiolitis infection more serious?
If they have bronchopulmonary dysplasia (e.g. premature), congenital heart disease or CF
What are features of bronchiolitis?
Corzyal symptoms (incl. mild fever) precede: Dry cough Increasing SoB Wheezing, fine inspiratory crackles Feeding difficulties with increased SoB
When should infants be taken into hospital by ambulance with bronchiolitis?
Apnoea (reported/observed)
Child looks seriously unwell to a healthcare professional
Severe resp distress, e.g. grunting, marked chest recession, RR>70/min
Central cyanosis
Persistent O2 sats <92% on air
For what infants with bronchiolitis should referral to hospital be considered?
If any of the following apply:
RR >60/min
Difficulty breastfeeding/inadequate oral intake (50-75% usual)
Clinical dehydration
How is bronchiolitis managed?
Supportive - humidifed O2 if sats <92%
NG feeding if child unable to take enough fluid/feed by mouth
Suction for excessive upper airway secretions
At what age do people tend to get bronchiolitis?
<1 year
At what age do people tend to get VIW?
6m-4y
At what age do people tend to get asthma?
> 2 years
What are features of LRTIs in kids?
48h hx of fever (>38.5C), SoB, cough, grunting
Reduced/bronchial breath sounds
What are common pathogens causing LRTIs in kids?
Viruses <35% Pneumococcus Mycoplasma Chlamydia Mixed infection
How do you tell if its a LRTI or a pneumonia?
Focal signs, creps and high fever = pneumonia, otherwise = LRTI
How should CAP be managed in children?
NB CXR and inflammatory markers not routine
Nothing if mild - review
1st line - amoxicillin, oral macrolide second line
Only IV if vomiting
