management of LRTI

Question 1

5 bacterial causes of LRTIs?

Answer 1

• Strep pneumoniae
• H Influenzae
• Morazella Catarrhalis
• Mycoplasma Pneumoniae
• Chlamydia Pneumoniae

Question 2

4 viral causes of LRTIs?

Answer 2

• RSV
• Parainfluenzae 3
• Influenzae A & B
• Adenovirus

Question 3

What’s the most common LRTI in infants?

Answer 3

Bronchiolitis

Caused mostly by RSV or sometimes parainfluenzae 4 or HMPV

Question 4

How does Tracheitis present?

common or uncommon?

Answer 4

Uncommon
“croup which does not get better”
Fever, sick child

inflamed pus laden trachea

Question 5

cause of tracheitis?

Answer 5

Staph or Strep invasive infection

Question 6

treatment of tracheitis?

Answer 6

Augmentin

Question 7

what happens to airway in tracheitis?

Answer 7

Swollen tracheal wall
Narrowed tracheal lumen
Luminal debris

makes it hard to breath

Question 8

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?

Answer 8

Bronchitis

Tend to see:

• Mostly well kid
• 6months to 4 yrs
• Relapsing remitting pattern
• Loose Rattyl Cough
• Post-tussive Vomit (“glut”)
• No wheeze/creps

Question 9

mechanism of bacterial bronchitis?

Answer 9

Disturbed mucociliary clearance
Minor airway malacia
RSV/adenovirus

Bacterial infection/overgrowth is secondary

Question 10

treatment of bacterial bronchitis?

Answer 10

make diagnosis
reassurance
waiting- no treatment

Question 11

natural history of bacterial bronchitis

Answer 11

Following URTI
Lasts 4 weeks
60-80% respond 
First winter bad
Second winter better
Third winter fine
Pneumococcus/H flu

Question 12

What causes bronchitis?

Answer 12

Usually a viral infection e.g. RSV disturbs the mucocilliary escalator leading to a secondary bacterial infection with:

• Haemophilus Influenzae
• Pneumococcus

RIP

Question 13

how would you expect bronchiolitis to present?

Answer 13

<12 months old

One off episode of: 
- Nasal stuffiness (e.g. common cold) 
- ~3day h/o progressive tachypnoea
 feeding problems
crackles +/- wheeze

Question 14

How would you investigate and treat an infant with bronchiolitis?

Answer 14

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)

Question 15

Bronchiolitis causes?

Answer 15

Usually RSV, others include paraflu III, HMPV

Question 16

Kid comes in with mum complaining of a 2 day history of Fever, SOB & Coughing, what do we call that?

Answer 16

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

Question 17

How do you investigate and treat a LRTI/chest infection/pneumonia?

Answer 17

Mild = no meds

- Worse? = Oral amoxycillin –> Oral Macrolide 2nd line –> IV if vomiting

Question 18

when is it pneumonia?

Answer 18

Signs are focal, ie in one area (LLZ)
Creps
High fever

Otherwise call it LRTI

Question 19

use iv or oral abs? when use oral or iv?

Answer 19

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

Question 20

What is the difference between LRTI and bronchiolitis?

Answer 20

LRTI:
In all ages
More rapid onset of symptoms
Fever

bronchiolitis:
Aged <12 months
3 days before reach peak
Fever rarely >38oC

Question 21

What characterizes Pertussis?

Answer 21

Whooping cough:

• “coughing fits”
• vomiting
• Colour change

Question 22

how does Empyaema present?

Answer 22

Complication of pneumonia
Extension of infection into pleural space
Chest pain and very unwell
Antibiotics+/- drainage
Good prognosis (in contrast with adults)