LRTI Flashcards
Whooping cough (pertussis) Bronchitis Tracheitis Pneumonia Bronchiolitis
What is whooping cough?
An upper respiratory tract infection.
What are the signs of whooping cough?
Low grade fever Coughing fits - with periods of no coughing between (paroxysmal coughing) Loud inspiratory whoop Rhinorrhoea Post cough vomiting
What can happen in severe coughing, especially in children?
Pneumothorax
Faint
Vomit
What is a common presentation in infants?
Apnoea (temporary cessation of breathing) - instead of cough
Who gets the whooping cough vaccine?
Pregnant women
Infant
Children
Pre teens
What is the tests done to diagnose whooping cough>
Nasal swab culture - takes 2-3 weeks
If infection > 2 weeks - can test for anti pertussis immunoglobulin G
How is anti pertussis immunoglobulin G tested for?
5-16 yrs - in mouth saliva
>17 yrs - in blood
What is the management of whooping cough?
Notify public health
Macrolide antibiotics - clarithromycin, azithromycin or erythromycin - if cough begun within 21 days
Co-trimoxazole (alternative)
Prophylaxis antibiotics to vulnerable close contacts
What is the main complication from whooping cough?
Bronchiectasis
How long does whooping cough take to resolve?
8 weeks - can take longer
What are examples of macrolide antibiotics?
Clarithromycin
Erythromycin
Azithromycin
Roxithromycin
What is the cause of whooping cough?
Bordetella pertussis
What is the 1st line antibiotic for >1 month?
Azithromycin
What is the 2nd line antibiotic for >1 month?
Trimethoprim + sulfamethoxazole
What is bronchiolitis?
Infection and inflammation of the bronchioles, only seen in children <1yr.
When is bronchiolitis common?
In the winter
As a ONE OFF (not recurrent).
Most common before 6 months (average = 3 months).
How does bronchiolitis present?
runny nose sneezing poor feeding mild fever dyspnoea wheeze crackles tachypnoea
How many infants get bronchiolitis?
30-40%
What investigation is done for children with bronchiolitis?
Nasopharyngeal aspirate
What is the difference between bronchiolitis and bronchitis?
Bronchiolitis is an infection of the smaller airways whereas bronchitis is an infection of the larger airways.
What is the usual cycle of bronchiolitis?
- starts as URTI (1/2 get better and 1/2 develop chest symptoms)
- chest symptoms start 1-2 days after URTI symptoms
- symptoms are at their worst on days 3-4
- symptoms usually last 7-10 days total
Full recovery occurs within 2-3 weeks
When should you admit someone with bronchiolitis to hospital?
<3 months or any pre-existing condition ( prematurity, Downs syndrome or cystic fibrosis)
50 – 75% or less of their normal intake of milk
Clinical dehydration
RR 70
O2 sats 92%
deep recessions or head bobbing
Apnoeas
Parents not confident in their ability to manage at home or difficulty accessing medical help from home
What is the treatment for tracheitis, bronchitis, pneumonia/LRTI, bronchiolitis and empyema?
tracheitis = augmentin bronchitis = nothing bronchiolitis = nothing empyema = IV antibiotics LRTI/pneumonia = nothing OR oral amoxycillin
What is tracheitis?
A very rare disease which presents like croup.
How does tracheitis present?
Like croup but it doesn’t get better
Fever
Sick
High fever and rapidly progressing airway obstruction with thick airway secretions.
Most children with croup are otherwise well but children with tracheitis are very unwell
What is the main cause of tracheitis?
Staphylococcus aureus
what is the treatment for tracheitis?
Augmentin
usually IV
in bronchiolitis, how high is the fever?
the fever rarely reaches >38 degrees
What are the main features of bronchitis?
Its an infection of the larger airways, causes sputum production and does NOT require antibiotics.
Usually viral infection.
What is the most common cause of bronchitis?
Strep pneumoniae
haemophilus influenza
What are negative signs in bronchitis?
there is NO crackles or wheeze
What is the typical cycle of bronchitis?
child has a cough that’s nearly gone then it reoccurs.
How long does bronchitis last for?
usually up to 4 weeks
how does a bacterial infection occur after bronchitis?
When the mucociliary tract stops working then a bacterial infection can occur secondary to the bronchitis
what is the treatment for bronchitis?
NOTHING
What are the main signs of pneumonia?
Focal signs (in one part of the chest) crepitations High fever Productive cough Fever >38.5 tachycardia tachypnoea lethargy delirium dullness to percussion coarse crackles bronchial breathing
What are the most common causes of pneumonia?
Strep pneumonia
Most common virus: respiratory syncytial virus
How is pneumonia managed?
Amoxycillin (+ a macrolyde - erythromycin, clarithromycin and azithromycin)
Macrolide are used as monotherapy in patients with a penicillin injury
when should IV antibiotics be used?
Only if the child is vomiting
