management of LRTI Flashcards
5 bacterial causes of LRTIs?
- Strep pneumoniae
- H Influenzae
- Morazella Catarrhalis
- Mycoplasma Pneumoniae
- Chlamydia Pneumoniae
4 viral causes of LRTIs?
- RSV
- Parainfluenzae 3
- Influenzae A & B
- Adenovirus
What’s the most common LRTI in infants?
Bronchiolitis
Caused mostly by RSV or sometimes parainfluenzae 4 or HMPV
How does Tracheitis present?
common or uncommon?
Uncommon
“croup which does not get better”
Fever, sick child
inflamed pus laden trachea
cause of tracheitis?
Staph or Strep invasive infection
treatment of tracheitis?
Augmentin
what happens to airway in tracheitis?
Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris
makes it hard to breath
Mom brings in her son saying he’s been going through episodes all winter of a rattly cough & post-coughing vomit that’s mucousy. What does it sound like?
what are symptoms of this disease?
Bronchitis
Tend to see:
- Mostly well kid
- 6months to 4 yrs
- Relapsing remitting pattern
- Loose Rattyl Cough
- Post-tussive Vomit (“glut”)
- No wheeze/creps
mechanism of bacterial bronchitis?
Disturbed mucociliary clearance
Minor airway malacia
RSV/adenovirus
Bacterial infection/overgrowth is secondary
treatment of bacterial bronchitis?
make diagnosis
reassurance
waiting- no treatment
natural history of bacterial bronchitis
Following URTI Lasts 4 weeks 60-80% respond First winter bad Second winter better Third winter fine Pneumococcus/H flu
What causes bronchitis?
Usually a viral infection e.g. RSV disturbs the mucocilliary escalator leading to a secondary bacterial infection with:
- Haemophilus Influenzae
- Pneumococcus
RIP
how would you expect bronchiolitis to present?
<12 months old
One off episode of: - Nasal stuffiness (e.g. common cold) - ~3day h/o progressive tachypnoea feeding problems crackles +/- wheeze
How would you investigate and treat an infant with bronchiolitis?
A NPA & O2 sats is all that’s needed
Focus on their oxygen, hydration & nutrition and most will recover on their own
(Remember it’s viral so it can’t be treated with Abx)
Bronchiolitis causes?
Usually RSV, others include paraflu III, HMPV
Kid comes in with mum complaining of a 2 day history of Fever, SOB & Coughing, what do we call that?
A LRTI or Chest Infection
Characterized by 48hrs of fever,
sob,
cough +/- wheeze,
reduced/bronchial breath sounds & creps
Don’t call it pneumoniae as it unnessarily scares parents
wheeze makes bacterial cause unlikely
How do you investigate and treat a LRTI/chest infection/pneumonia?
Mild = no meds
- Worse? = Oral amoxycillin –> Oral Macrolide 2nd line –> IV if vomiting
when is it pneumonia?
Signs are focal, ie in one area (LLZ)
Creps
High fever
Otherwise call it LRTI
use iv or oral abs? when use oral or iv?
Oral! use oral if: antibiotics are indicated (48 hours, etc, etc) in non-severe LRTI when child is not vomiting
oral:
Shorter hospital stay
Cheaper
Fever for a few more hours
only use iv if child vomitting
What is the difference between LRTI and bronchiolitis?
LRTI:
In all ages
More rapid onset of symptoms
Fever
bronchiolitis:
Aged <12 months
3 days before reach peak
Fever rarely >38oC
What characterizes Pertussis?
Whooping cough:
- “coughing fits”
- vomiting
- Colour change
how does Empyaema present?
Complication of pneumonia Extension of infection into pleural space Chest pain and very unwell Antibiotics+/- drainage Good prognosis (in contrast with adults)
