LRTI in Children Flashcards
What are 5 bacterial infective agents?
Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Mycoplasma pneumoniae Chlamydia pneumoniae
What are 4 viral infective agents?
RSV
Parainfluenza III
Influenza A and B
Adenovirus
What is tracheitis?
Croup which does not get better - obstructed airways due to narrowing
Features of tracheitis
Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris
What can tracheitis present with?
Fever
Inspiratory stridor
What bacteria causes tracheitis?
Staph or strep
What can be used to treat tracheitis?
Augmentin
What is bronchitis?
Common endobronchial infection
What are the symptoms of bronchitis?
Loose rattly cough with URTI
Post-tussive vomit
No wheeze/creps
What bacteria can cause bronchitis?
Haemophilus
Pneumococcus
How is bronchitis treated?
It is self-limiting, no antibiotics
What is the mechanisms of bronchitis?
It disturbs the mucociliary clearance from UTRI causing difficulty to remove bacteria
Causes minor airway malacia
Can last up to 4 weeks
What usually precedes bronchitis?
URTI
What is the criteria for persistent bacterial bronchitis?
Wet cough
More than 1 months
Remission occurs with antibiotics
What are the 3 steps to be taken with persistent bacterial bronchitis?
Diagnosis should be made
Parents reassured
No treatment given
What percentage of children does bronchiolitis affect?
30-40%
What is the causative bacteria in bronchiolitis?
RSV
Others include:
Paraflu III
HMPV
What is the clinical presentation of bronchiolitis?
Nasal stiffness
Tachypnoea
Poor feeding
Crackles +/- wheeze
Who does bronchiolitis usually affect?
< 12 months old
Is bronchiolitis a recurrent infection?
No, it is a one off
What is the management of bronchiolitis?
maximal observation
Minimal intervention
Oxygen saturations according to severity
Investigation for bronchiolitis?
NPA (cohering)
O2 saturations
What are the general signs for LRTI in children?
Pyrexia (> 38.5C) SOB Cough Grunting Wheeze makes bacterial cause unlikely Reduced or bronchial breath sounds
Infective agents in LRTIs
Viruses in <35%
Bacteria: pneumococcus, mycoplasma, chlamydia
Mixed infection in <40%
When is it pneumonia and not a LRTI?
Signs are focal
Crepitations
High fever
Otherwise call it LRTI
Investigation for community acquired pneumonia
CXR and inflammatory markers not routine
Management of community acquired pneumonia
Nothing is symptoms are mild
1st: oral amoxycillin
2nd: oral macrolide
Only administered through IV if vomiting
When to use oral over IV antibiotics
Antibiotics are indicated
In non-severe LTRI
When child not vomiting
What are the benefits of oral antibiotics over IV?
Shorter hospital stay
Cheaper
Fewer for a few more hours
What is pertussis?
Whooping cough - coughing fits lasting over two weeks, vomiting and colour change
What can reduce the risk and severity of pertussis?
Vaccinations
What is empyaema a complication of?
Pneumonia - spread of infection into pleural space causing pus formation
Symptoms of empyaema?
Chest pain and very unwell
What is the management of empyaema?
IV Antibiotics +/- drainage
What is the prognosis on empyaema in children?
Good prognosis (in contract with adults)
Can bronchitis be treated with antibiotics?
No
What antibiotic is used to treat pneumonia and first antibiotic given in for general LTRIs?
Oral amoxycillin
Is there an antibiotic for bronchiolitis?
No
What is the first step in management in LTRIs before administering antibiotics (if appropriate)?
Oxygenation
Hydration
Nutrition
Then think about antibiotics
