Paediatric Lower Respiratory Tract Infections Flashcards
What are examples of lower respiratory tract infections in children?
- Tracheitis
- Pneumonia
- Bronchitis
- Bronchiolitis
- Empyema
What are the common bacterial infective agents?
- Strep pneumoniae
- Haemophilus influenzae
- Marxella catarrhalis
- Mycopasma pneumoniae
- Chlamydia pneumoniae
What are the common viral infective agents?
- RSV
- Parainfluenza III
- Influenza A and B
- Adenovirus
What is tracheitis?
- Inflammation of the trachea
- Croup that does not get better
What organisms cause tracheitis?
Staph or strep
How is tracheitis treated?
Augmentin
How does tracheitis present?
- Fever
- Sick child
- Barking cough
- Stridor
What is bronchitis?
Endobrachial infection
What organisms cause bronchitis?
- Haemophilus
- Pneumococcus
How does bronchitis present?
- Loose rattly cough with URTI
- Post-tussive vomit- ‘glut’
- Child very well
- Sounds like Darth Vader
What is the chest free of inn bronchitis?
Wheeze and creps
What is the mechanism of bacterial bronchitis?
- Disturbed mucociliary clearance
- Minor airway malacia
- RSV/adenovirus
- Infection secondary
- Lack of social inhibition
What is the normal duration of bronchitis cough?
A couple of weeks
What is the natural history of bacterial bronchitis?
- Following URTI
- Lasts 4 weeks
- Improves with successive Winters
What is the criteria for persistent bacterial bronchitis?
- Wet cough
- More than 1 month
- Remission with antibiotics
What are the 3 steps to ‘treating’ bacterial bronchitis?
- Make the diagnosis
- Reassure
- Do not treat
What is bronchiolitis?
A LRTI affecting infants primarily
What is the prevalence of bronchiolitis?
Affects 30-40% of infants
What is the presentation of bronchiolitis?
- Nasal stuffiness
- Tachypnoea
- Poor feeding
- Crackles with/without wheeze
What usually causes bronchiolitis?
- RSV
- Paraflu III
- HMPV
When is RSV most prevalent?
Over the Christmas period
Who does bronchiolitis affect?
Under 12 months old
What is the pattern of bronchiolitis?
- It is a one off
- Does not recur
What is the progression of bronchiolitis?
- Child gets rapidly worse about day 2-5
- Child stabilises but does not get better 5-7
- Child recovers 7 days plus
How is bronchiolitis managed?
- Maximal observation
- Minimal intervention
What investigations can be carried out for bronchiolitis?
- Nasopharyngeal aspirate
- Oxygen saturations
What investigations can be done but are quite frankly unnecessary?
- Chest X-ray
- Bloods
- Bacterial cultures
Why is a NPA carried out?
To identify the responsible organism so all patients can be place in one ward to minimise staff exposure
What medications are proven to work with bronchiolitis?
NONE
What medications do we know not to work on bronchiolitis?
- Salbutamol
- Ipratropium bromide
- Adrenalin
- Steroids
- Antibiotics
- Nebulised saline
What are the typical symptoms of lower respiratory tract infections?
- 48hrs
- Fever-
- Shortness of breath
- Cough
- Grunting
- Reduced or bronchial breath sounds
What symptom makes a bacterial cause unlikely?
Wheeze
What are the common infective agents in LRTIs?
- Viruses
- Bacteria pneumococcus
- Mycoplasma
- Chlamydia
- Mixed infection
When should it be called pneumonia?
- Signs are focal
- Creps
- High fever
What should you call it if its not pneumonia?
LRTI
What investigations are not routine in pneumonia?
- Chest X-ray
- Inflammatory markers
How should pneumonia be managed?
- Nothing if symptoms are mild
- Oral amoxicillin first line
- Oral macrolide second choice
- Only IV if vomiting
What is pertussis characterised by?
Coughing fits with vomit and colour change
Why is pertussis common despite vaccination?
Vaccination only reduces risk and severity but doe not prevent
What is empyema?
A complication of pneumonia where there is an extension of infection into the pleural space
How does a child with empyema present?
Chest pain and very unwell
How is empyema treated?
IV Antibiotics +/- drainage
How should most LRTIs be managed?
Maintenance of oxygenation, hydration and nutrition
