LRTI Children Flashcards
Where do LRTI occur
Below the voice box
Name 5 LRTI
Tracheitis Pneumonia Bronchitis Empyema Bronchiolitis
How many hospital admission where there in 2013/14 due to LRTI in 0-14 year olds
27,326
How many hospital admission where there in 2010/11 due to LRTI in 0-14 year olds
22,008
What type of agents can cause LRTI
Bacteria
Viruses
What type of bacterial agents are known to be able to cause LRTI
Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumoniae Chlamydia pneumoniae
What type of viral agents are known to be able to cause LRTI
RSV
Parainfluenza III
Influenza A and B
Adenovirus
What is tracheitis
Croup which does not get better
What does tracheitis cause
Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris
What will a child with tracheitis present with
Fever
Biphasic stridor
Sick child
What is the causative agent of tracheitis
Strep
Staph
What can be used to treat tracheitis
Augmentin
What is bronchitis
A very common endobronchial infection
What does bronchitis cause
Loose rattily cough in the URT
Post-tussive vomit (glut)
Chest is free of wheeze/creps
What causes bronchitis
Common respiratory commensals Haemophilus/Pneumococcus
How is bronchitis treated
It is mostly self-limiting
Child will be very well
What mechanism does bacterial bronchitis use
It disturbs the mucociliary clearance
Causes minor airway malacia
What tends to precede bacterial bronchitis
URTI
How long does bacterial bronchitis last
About 4 weeks
What are the first 3 winters with bacterial bronchitis like
1st = bad 2nd = better 3rd = fine
What is the criteria for a persistent bacterial bronchitis
Wet cough
Present for over a month
Remission occurs with antibiotics
What are the 3 steps to be taken with persistent bacterial brochitis
Diagnosis should be made
Parents reassured
No treatment given
How many infants does bronchiolitis affect
30-40%
What causes bronchiolitis
Mainly RSV
Sometimes parainfluenza III or HMPV
Is memory produced against RSV
No
It removes the intracellular membrane
How many nuclei does RSV have
More than one
What signs and symptoms does bronchiolitis have
Nasal stuffiness
Tachypnoea
Poor feeding
The child may have some crackles or wheeze.
What can bronchiolitis be classified as
Wheezy bronchitis
Asthmoid bronchitis
Viral associated wheeze
Asthma
At what age is the peak of bronchiolitis seen
Around 3 months
State 3 features of bronchiolitis
Disease of under 12 months
One of condition
Has a typical history
How many days does it take to recover from bronchiolitis
7 days
How should bronchiolitis be managed
Maximal observation
Minimal intervention
What investigations can be done for bronchiolitis
Nasopharyngeal aspirate (cohorting) Oxygen saturations (severity)
What investigations are not required for bronchiolitis
CXR
Bloods
Bacterial cultures
What medication is available for bronchiolitis
None
What medication has been proven not to work for bronchiolitis
Salbutamol Ipratropium bromide Adrenalin Steroids Antibiotics Nebulised saline
How long do LRTI present for
48 hours
State 5 features of LRTIs
Fever (over 38.5˚C) SOB Cough Grunting Reduced or bronchial breath sounds
How many cases of LRTIs are caused by viruses
35% (higher in younger children)
How many cases of LRTIs are caused by a mixed infection
40%
What bacterial agents can cause LRTIs
Bacteria Pneumococcus
Mycoplasma
Chlamydia
When should a LRTI be called pneumonia
When:
Signs are focal
Creps
High fever
What are the steps to treat pneumonia
Hydration
Oxidation
Nutrition
Antibiotics
What is not a routine part of investigations for community acquired pneumonia according to BTS guidelines
CXR
Imflammatory markers
How should community acquired pneumonia be managed according to BTS guidelines
Nothing if the symptoms are mild (review if things get worse)
Oral amoxycillin first line
Oral macrolide 2nd choice
IV if vomiting
Should IV or oral antibiotics be used when antibiotics are indicated in a non-severe LRTI when the child is not vomiting
Oral
Why is oral antibiotics preferred
Shorter stay in hospital
Cheaper
Child will have fever for a few more hours
Give 5 conditions where antibiotics are not indicated
Bronchiolitis Croup Acute LRTI Otitis media Pharyngitis/tonsillitis
How does vaccination benefit pertussis (whooping cough)
Risk is reduced
Severity of illness is reduced
State 2 symptoms of pertussis
Coughing fits
Vomiting and colour change
What is empyema
Pus in the body cavity
A complication of pneumonia which occurs when the infection extends into the pleural space
What does empyema cause
Chest pain
Child will be very unwell
What treatment is given for empyema
Antibiotics
May require drainage
What is the prognosis of empyema in children
Good in contrast with adults
Does tracheitis require antibiotics
Yes
What antibiotic does tracheitis require
Augmentin
Does bronchitis require antibiotics
No
Does LRTI/pneumonia require antibiotics
Usually when there is a fever for over 2 days, cough and focal signs
Does bronchiolitis require antibiotics
No
Does empyema require antibiotics
Yes
What antibiotic does LRTI/pneumonia require
Oral amoxycillin
What antibiotic does empyema require
IV antibiotics
