OM and lower resp infections Flashcards
etiology of AOM
usually viral- rhino, paraflu, flu, entero
may lead to bacterial superinfection: strep pneumo, H flu, M catarrhalis. pneumococcal vaccine helps.
When do you treat OM
if child under 2. if child is over 2 but has otorrhea or bilateral AOM. If over and severe disease (fever over 39).
if you decide to watch and wait and kid isn’t better within 72 hrs.
give antibiotics
complications of OM
eustachian tube dyfunction/recurrent infections
TM rupture
cholesteatoma
acute mastoiditis (brain infection, deep necak abcess, lateral sinus thrombosis)
Olser’s triad
endocarditis, meningitis, S. pneumo pneumonia
presentation of acute bronchitis
persistent cough for 1-3 weeks, often w/ sputum production
fever and constitutional symptoms are uncommon
wheezing might be present.
etiology of acute bronchitis
usually flu, paraflu, RSV (others like rjhino, corona, adeno possile)
atypical bacteria also can cause acute bronchits: mycoplasma, chlamydia, pertussis
typical bacteria DON’T cause acute bronchitis
Diagnosis and treatment of acute bronchitis
clinical presentation. labs should be normal. CXR only warrented if the clinical picture is weird (fever) or you have focal exam findings. No sputum culture needed.
supportive treatment. no abx unless pt is old, immunocompromised, or has pertussis
clinical presentation of bronchiolitis
kid under 2 with wheezing and airway obstruction from infection. May be hard to distinguish from a triggered astham attach. Peak is age 2-6mo in winter. leading cause of hospitalization in kids under 2. kids are tachypnic with increased use of intercostal muscles and retratctions. Expiratory wheeze with prolonged expiratory phase. crackles and mild hypoxemia. hyperventilation and peribronchial coughing.
2 major causes of acute brionchiolitis
RSV and human metapneumovirus
bronchiolitis pathophysiology
virus infects the airway epithelial cells leading to damage and inflammation of small airways. this yeilds edema, mucus, sloughed epithelial debris. You see obstruction and air trapping
What are the risks of severe disease with bronchiolitis?
prematurity, low birth weight, age under 6-12 wks, chronig pulmonary disease, congenital heart disease, immunodeficiency.
Brionchiolitis treatment
supportive. Maybe bronchodilators? No abx. Riaviran may be used in severe case, but it is inhaled, hard to use, and teratogenic
briochiolitis prevention
palivizumab: monocolonal Ab against RSV fusion glycoprotein. given once per month in RSV season among premies
community acquired vs. hospital acquired pneumonia
community acquired: found in people who haven’t had hospital care or long term care in last 14 days. If in hospital less than 72 hrs and become ill during hospital stay, this is also considered community acquired. hospital acquired is seen in people who have been in the hospital within the last 14 days.
5 ways to gain access to the lung parenchyma
- aspiration (S. pneumo, H flu, gram neg rods, S aureus, actinomyces)
- infection of the upper airway with subsequent spread (RSV, chlamydia, mycoplasma
- direct inhalation of infection in lungs: TB, flu, fungi
- hematogenous: VZV, CMV, S aureus, septic pulmonary emboli
- contiguous spread from adjacent infection:
