LRTI Flashcards
all types of LRTI we need to know
- acute bronchitis
- COPD exacerbations
- pneumonia (major one) + its complications
- bronchiectasis
Major LRTI in children
- laryngotracheobronchitis (croup)
- bacterial tracheitis/epiglottis
- bronchiolitis
- bordetella pertussi (whooping cough)
- bronchitis
- LRTI/pneumonia in children
- empyema
- viral induced wheeze
acute bronchitis
- inflammation of bronchi lasting around 2-3 weeks
- cold symptoms (cough+sputum)
- usually viral causes
- only need treatment if persistent, changes in sputum color, or have underlying conditions
COPD exacerbations
- change in sputum color
- fevers
- increased SOB
organisms associated with COPD exacerbations
- strep penumoniae
- H. influenza
- moraxella catarrhalis
- viral
treatment of COPD exacerbations
- steroids
- nebs
- antibiotics (amoxicillin, doxycycline, co-trimoazole, clarithromycin)
pneumonia characteristics
- inflammation of lung parenchyma (gas exchange structures)
- consolidation seen in CCX *this is the main way of confirming that it is pneumonia
- fever, malaise
- cough + sputum + haemoptysis
- pleuritic chest pain
- dyspnoea
risk factors of pneumonia
- smoking
- drinking (alcohol increases chances of exacerbations)
- extremes of age (not mobile –> aspirations, and immunocompromised)
- preceding viral illness/lung disease
- chronic illness
- IVDU (introduces pathogens to the body)
- prior hospitalizations
signs of pneumonia
- tachypnoea/tachycardia
- reduced expansion
- dull percussion
- increased vocal resonances (because sound is louder while going through solid structure)
- bronchial breathing where it should be vesicular (discontinuous)
- crepetations
investigations carried out for pneumonia
- CXR (main diagnosis)
- blood cultures (CRP, FBC, serum biochem)
- sputum culture + microbiology
- viral throat swab
- legionella urine antigen (bacterial antigen in urine)
differential diagnosis for pneumonia
- TB
- lung cancer
- pulmonary embolism
- pulmonary edema
- pulmonary vasculitis (inflammation of the lung vessels)
top 5 microbes that causes pneumonia
- pneumococcal pneumoniae
- chlamydia penumoniae (CAD)
- (tied with CAD) viral cause
- mycoplasma pneumoniae
- H influenza
- legionalle pneumophillia
CURB65
severity scoring of pnuemonia (0-5 points)
C-confusion
U- blood urea>7mmol/L
R- RR>30/min
B- systolic BP<90mmHg, diastolic <60mmHg
65- age >65
* be careful because in younger ppl, the numbers that we should start worrying about is much less than this
causes of bronchiectasis
- idiopathic
- childhood infection or CF
- ciliary dyskinesia (poorly functioning cilia –> retention of secretions and easily infected)
- hypogammaglobulinaemia: impaire immune system from not having enough gamma globulins produced in the blood
- allergic broncho-pulmonary asperillosis (ABPA): hypersensitivity to fungus.
mainly, the causes is anything that results in: dilatation of the bronchi, loss of mucous, LRTI
secondary causes of pneumonia
- influenza (staph aureus)
- aspiration pneumonia (in stroke, MS, oesophageal disease)
- immunocompromised people (HIV, fungi, viruses)
- MRSA
treatments of pneumonia (based on CURB65 scores)
0-1: amoxcillin, (clarithromycin or doxycycline in penicillin allergic patients), duration 5 days
2: amoxicillin + clarithromycin, (levofloxacin), 5-7 days
3-5: co-amoxiclav + clarithromycin, (levofloxacin or co-trimoxazole), 7-10 days
also consider supportive treatments like O2, ventilation, intubation, atipyretics, NSAIDS, fluids
pneumonia complications/exacerbations
- sepsis
- acute kidney injury (less perfusion to the kidneys because the blood is directed to other infected body parts)
- parapnuemonic effusion
- empyema
- lung abscesses
- swinging fever
- weight loss
- disseminated infection
- failure to improve or persistently high WCC/CRP
3 types of pneumonia based on spread of disease
- bronchopneumonia (patches across the lungs)
- lobar pneumonia (the whole lobe affected)
- interstitial pneumonia (wipes out the whole lung, less about infection, more about inflammation)
typical microbes that causes pneumonia
pneumococcal pneumoniae
Haemophilus influenzae
mycoplasma pneumoniae (diarrhoea, stomach pain, etc)
atypical microbes that causes pneumonia
legionella pneumophilia chlamydia pneumoniae(CAD), chlamydia psittaci (birds) coxiella burnetti (livestock) moraxella catorrhalis virus
hospital acquired microbes that cause pneumonia
enterobacteria staph aureus pseudominas aerugionosa klebsiella pneumoniae clostridia anaerobes TB
what antibiotic to give in aspiration pneumonia?
amoxicillin + metronidazole
what is the name of the virus that is associated with HIV and immunocompromise as a secondary cause of pneumonia, and what is the drug used against it?
pneumocystis jiroveci pneumoniae
co-trimoxazole
what is the drug used against MRSA
vancomycin
empyema as complications of pneumonia
- pus in the pleural cavity
- detected by thoracic ultrasound
- the lower the pH of the pus, the more metabolic activity, meaning more infection. Low pH may need draining, but otherwise would go away by itself
- prolonged antibiotics or surgery in severe cases
lung abscesses in pneumonia
- appears rounded in CXR
- do bronchoscopy to make sure that it is not lung cancer
- haemoptysis + foul smelling sputum
differences btw LRTI in children and adults
- fever pretty common and not concerning unless persistent
- deteriorate quickly
- LRTI common in children 3/10 will have it, and 9/10 kids will face viral infections –> weakened immunity –> opportunistic bacterial infection
- red flag feature is persistent fever in children < 6 months
common infective bacteria in children
- strep pneumoniae
- HI
- moraxella catarrhalis
- klebsiella pneumoniae
- myocplasmia pneumoniae
- chlamydia pneumoniae
common infective virus in children
- RSV
- parainfluenze III
- influenza A/B
- human metapneumovirus
common LTRI in children
- bronchitis
- bronchiolitis
- laryngoltracheobronchitis (croup)
- tracheitis
- epiglottis
- bordetella pertussis (whooping cough)
- empyema
- LRTI/pneumonia
- viral induced wheeze
symptoms of croup + key feature
- viral infection of large airways –> narrowing
- common (6 months - 6 yrs)
- persistent cough that sounds like barking seal
- inspiratory stridor
- hoarseness of voice
- respiratory distress
- KEY FEATURE: worse at night (9 pm)
symptoms that indicate moderate and severe croup
moderate: barking seal cough + inspiratory stridor
severe: barking seal cough + inspiratory stridor + lethargy/agitation
management of croup
- supportive care, safe netting, advice
- oral once off dose of dexamethasone (steroid) 0.15ml/kg
- admission for moderate and severe symptoms
- oxygenation + a little steroid
- nebulized adrenaline
epiglottis symptoms
- swollen epiglottis that blocks off airway
- rare, medical emergency
- can be vaccinated against, which is why it is rare
- high fever
- hypoxic
- drooling, sore throat, leaning forward
can we examine child with epiglottis?
NO
sticking something down a completely blocked off throat can make it worse
trancheitis symptoms
- swollen tracheal wall and narrow tracheal lumen
- croup like symptoms, except it does not get better
- fever
causative organism for epiglottis and treatment
- H. influenzae
- this can be vaccinated against, which is why it is rare
causative organism for tracheitis and treatment
- staph or strep infection
- co-amoxiclav
corisal define
watery eyes and runny nose
describe seesaw breathing
when the airway is mostly blocked and the child breathes by lifting the chest and sucking in abdomen
when to admit a child?
- severe resp symptoms/distress
- child has other associated symptoms/underlying conditions, other risk factors
- subcostal recession, seesaw breathing, tripod position (signs of severe resp distress)
- child is systemically unwell, lethargy, agitation
- O2 sat < 95%
- tachypnoea (RR>50/min)
- cathode ray tube > 2secs
- less than 6 months old
- pleuritic chest pain (empyema?)
- bad social circumstances
what is NPA
nasopharyngeal airway/nasal trumpet/nose hose - tube inserted into nasal passageway to secure open airway
brodetella pertussi (whooping cough) symptoms and diagnosis
- common in 2-5 years cycle
- vaccination reduces risk and severity
- coughing fit that goes on and on
- vomiting due to cough
- inspiratory whooping sound
cause of whooping cough
bacterial infection
treatments for whooping cough (3 antibiotics)
can be treated in 3 weeks with marcolides
1. erythromycin (usually this one)
2. clarythromycin
3. azithromycin
pregnant women in their 16-32 weeks and children <3 weeks old should be immunized for this
bronchitis symptoms and characteristic
- very common
- loose, rattly cough
- is actually a UTRI
- vomiting
- examination of the chest will turn out fine, no wheeze or crepetations
- the child is usually well, condition self limiting, no need to treat the infection in normal cases.
causative organism of bronchitis
haemophilus/pneumococcus
mechanism of infection of bronchitis
stage 1. mucociliary clearance in minor airways has problems –> minor airway malacia/tracheomalacia (collapse of airway when exhaling), caused by RSV/adenovirus –> hard to breathe + coughing
stage 2. this collapse of the mucociliary clearance opens for opportunistic secondary bacterial infections
differences and similarities btw empyema in children vs adults
- offer antibiotics and drainage if needed in both cases
- children have better prognosis and more likely to recover in contrast to adults
steps in treating LRTI in children
- oxygen, nutrition, hydration (this is normally enough, if it doesn’t work then think about step 2)
- antibiotics
- review treatment if needed
which LRTI in children needs antibiotics?
- bacterial tracheitis: co-amoxiclav
- bordetella pertussis: marcolides (mainly erythromycin)
- empyema: IV antibiotics
- pneumonia: oral amoxicillin
which LRTI in children does not need antibiotcis? (are mostly self-limiting)
- laryngealtracheobronchitis(croup)
- bronchitis
- broncholitis
- viral induced wheeze
bronchiolitis symptoms
- very common in < 2yrs
- inflammation
- congestion in bronchioles
- cold symptoms (corisal)
- mild fever
- followed by coughing, wheezing, tachypnnoea
- easily spread and reinfected
- long symptoms (days and weeks)
causative organism of bronchiolitis
RSV (respiratory syncytial virus)
management of bronchiolitis
- supportive care
- admission
- oxygenation and NPA as needed
- NO CXR needed, clinical diagnosis
LRTI/pneumonia symptoms in preschool, infants, and neonates
preschool: COUGH, fever pain
infants: COUGH, tachypnoea, irritable, lethargy, poor feeding, preceding UTRI, grunting
neonates: grunting, tachypnoea, resp distress, poor feeding, lethargy, coughing (unlike the other 2, coughing is not the main symptom)
how to tell that is a LTRI
- preceded with UTRI
- fever >39 Celsius
- chest recession and raised RR (tachypnoea) in resp distresses
- wheeze is less common in children and adults
treatment of pneumonia in children
- if symptoms are mild, leave them alone, but safe net
- oral amoxicillin is the first choice
- oral macrolide is the second choice
- use IV if there is vomiting, but otherwise, always go for oral
empyema in children
children has good prognosis for this compared to adutls
viral induced wheeze in children
- if child between 6 months - 5 yrs have a wheeze, think of viral induced wheeze before asthma (it could actually be asthma, but the child is too young to know for sure anyway, only when it keeps happening over 5 years would you call it asthma )
- use bronchodilators
