Pediatric Infectious disease Flashcards
- age less than 2 years
- inflammation of the bronchioles–> small airways
- bronchioles are obstructed with mucus and edema–> air trapping–> wheezing
bronchiolitis
viral etiology of bronchiolitis?
- Respiratory synctial virus (most common)
- rhinovirus
- parainfluenza virus
- influenza virus
- human metapneumovirus
- bocavirus
- coronaviruses
- Lower respiratory tract illness in young children (URI in older)
- most children have had it by 2 years of age
- most have only URI symptoms (but significant morbidity in infants (especially premature) and those with underlying lung disease or cyanotic heart diseaes
- mild URI followed in 1-3 days with wheezing, worsening cough and dyspnea
- usually winter/early spring
- rapid diagnostic testing–> nucleic acid testing)
RSV bronchiolitis
RSV management of healthy infants
- no routine CXR
- no continuous pulse ox
- no bronchodilators
- no steroids
- no chest physiotherapy
- supplemental oxygen as needed, saline nose drops and suctioning as needed
when to hospitalize for community acquired pneumonia in peds?
- hypoxemic- O2 < 90%
- age < 6 months
- toxic appearance
- respiratory distress
- known pathogen with increased virulence (e.g, staphylococcus aureus, recently group A strep)
- uncertain adherence to treatment at home
what are signs of respiratory distress?
- Tachypnea, breaths per minute
- dyspnea (difficulty breathing)
- retractions (suprasternal, intercostal, or subcostal muscle use)
- grunting
- nasal flaring
- apnea
- pulse oximetry < 90% on room air
What is considered tachypnea based on age?
0-2 months: > 60
2-12 months: > 50
1-5 years: > 40
> 5 years: > 20
how does meningitis look in infants vs. older children?
Infant
- Constant or weak crying
- increased sleeping/ lethargic
- vomiting
- bulging fontanelle- but not always
Older child/adolescent/adult
- Severe headache
- stiff neck
- nausea/ vomiting
- decreased appetite, photophobia
what are the most common etiologies of bacterial meningitis based on age?
- < 1 month of age: Ecoli, group B streptococcus, listeria monocytogenes
- > 1 month to < 10 years: S. pneumoniae and N. meningitidis; rarely- listeria
- > 10 years, N. Meningitidis - rarely listeria
most common microbes for pnemuonia in a 3week- 3 month old
chlamydia
trachomatis
RSV
HMPV
strep. pneumo
B. pertussis
Tachypnea, may have no fever (chlamydia, viral)
most common microbes for pnemuonia in a 3montth- 4 year old?
- RSV
- HMPV
- Influenza
- strep pneumo
- mycoplasma
Viral- prominant URI symptoms; wheezes on exam
most common microbes for pnemuonia in a 5/yo to teenager?
Strep pneumo
mycoplasma
chlamydophila
pneumoniae
often atypical: gradual onset, lowe fever, cough, clinically may look well
parapneumonic effusion that becomes infected
leaky pleura–> proteins, wbc, bacteria
empyema (pneumonia complication)
labs or bacterial meningitis?
- CBC- elevated white blood cell count with bandemia
- blood cultures positive in 50%
- CSF: elevated wbc, low glucose, elevated protein, gram stain =polymorphonuclear cells, CSF culture (DO NOT WAIT to give antibiotics if LP is delayed
- rapid multiplex PCR testing now available
Bacterial meningitis treatment (>1 month of age)
- empiric tx directed at N. meningitidis and S.pneumoniae
- empiric tx with Vancomycin and ceftriaxone
- narrow the spectrum once organism is known
- uncomplicated S. pneumoniae- 10 days (usually penicillin or ceftriaxone)
- N.meningitidis- 5 to 7 days of ceftriaxone
recommend hearing test after illness resolves
