LRTI in children Flashcards
name 5 LRTI
pneumonia tracheitis bronchitis emyaema bronchiolitis
common bacterial infective agents for LRTI
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Chlamydia pneumoniae
common viral infective agents for LRTI
RSV
parainfluenza III
influenza A and B
adenovirus
principles of management of LRTI
diagnosis
assess patient - oxygenation, hydration, nutrition
treat or not treat?
tracheitis disease profile
swollen tracheal wall with narrowed tracheal lumen and luminal debris
uncommon
a child will present with a fever
it’s a staph or strep invasive infection
what antibiotic is used to treat tracheitis?
augmentin
bronchitis disease profile
common endobronchial infection loose rattly cough with URTI post cough vomit - 'glut' no wheeze haemophilus/pneumococcus mostly self-limiting
bacterial bronchitis mechanism of infection in children
disturbs mucociliary clearance lack of social inhibition- child doesn't cover mouth etc infection secondary (due to treatment of something else or changes in immune system)
natural history of bacterial bronchitis
following a URTI
lasts 4 weeks
cough morbidity gets better in repeated infection
what should happen with persistent bacterial bronchitis?
make the diagnosis
reassure patient
but don’t treat
bronchiolitis
LRTI of infants
30-40% of all infants affected
usually RSV (Respiratory syncytial virus)
nasal stuffiness, tachypnoea - rapid breathing
poor feeding
crackles but no wheeze
how many days after the start of a cough should you seek medical attention for an infant
5 days after start of cough
bronchiolitis diagnosis
under 12 months one off (NOT recurrent)
management of bronchiolitis
maximal observation
minimal intervention
investigations done for bronchiolitis
NPA - nasopharyngeal aspirate- collects specimen using nasal tube
oxygen saturations
which medications have been proven not to work at treating bronchiolitis
salbutamol adrenalin steroids ipratropium bromide antibiotics
LRTI
48 hours, fever, SOB, cough, grunting
wheeze means bacterial cause unlikely
reduced or bronchial breath sounds
when would you call it pneumonia and not a LRTI?
if signs are focal
creps
high fever
British thoracic society guidelines for community acquired pneumonia
nothing if symptoms are mild
Oral Amoxycillin first line
Oral Macrolide second choice
Only for iv if vomiting
what are not routinely used investigations for community acquired pneumonia
CXR and inflammatory markers are NOT routine
why are oral antibiotics preferred choice for treatment of pneumonia over IV
shorter hospital stay
cheaper
although you may have fever for longer
pertussis (whooping cough)
common!
vaccination reduces risk and severity
coughing fits
vomiting and colour change
empyaema
complication of pneumonia
extension of infection into pleural space
chest pain and very unwell
IV antibiotics used to treat
