Peds LRTIs Flashcards
Where does the LRT begin?
Sublaryngeal
What are the major LRTIs?
Bronchiolitis Larnygotracheobronchisits Tracheitis Bronchitis Pneumonia
What is the definition of pneumonia?
Infection of the lung parenchyma, specifically the gas exchange unit
What percent of all pediatric deaths result from pneumonia?
18%
What accounts for most LRTIs in children?
Viruses (90%)
What is the main bacterial cause of LRTIs?
Strep pneumoniae
What is the pathophysiology of pneumonia? (2)
Deposition of and subsequent replication of viral or bacterial agents in the respiratory tract mucosa or the lung can be seeded hematogenous spread
How do viral infections predispose to the development of pneumonia?
Impair host defenses, leading to secondary bacterial pneumonia
Recurrent pneumonias should be suspicious for what?
Immune disease or change in physiology
What are the 3 major signs of pneumonia?
Fever
Cough
Tachypnea
What is the most sensitive and specific sign of pediatric pneumonia? How sensitive/specific?
Tachypnea–really, really sensitive, but not so specific
What are the lung findings of pneumonia?
-Rales and rhonchi
Decreased breath sounds
What is the best non-verbal finding of pneumonia? Why?
Refusal to eat d/t breathing problems
How is it kids can have pneumonia, but have normal sounds?
Hearing sounds from the other side
What are the two best signs of pneumonia in kids younger than 5 yo?
Tachypnea
Retractions
Post tussive emesis = ?
Bordetella pertussis
True or false: humans are the only known host of Bordetella pertussis
True
What is the gram stain and morphology of Bordetella pertussis?
Gram negative pleomorphic bacilli
What is the incubation period of Bordetella pertussis?
6 days
What are the three stages of Bordetella pertussis?
- Catarrhal phase (non-specific ssx)
- paroxysmal phase (coughing)
- Convalescent phase (decreasing coughing)
How do you diagnose Bordetella pertussis?
Clinical picture
Leukocytosis with absolute lymphocytosis
What are the CXR findings of Bordetella pertussis?
Perihilar infiltrates
Atelectasis
Emphysema
How do you confirm Bordetella pertussis?
Nasopharyngeal swab for PCR
When should you hospitalize pts with Bordetella pertussis?
- If less than 6 mo
- IVF or oxygen needed
What is the treatment for Bordetella pertussis?
Erythromycin 40 mg/kg q 6 hours for 14 days
How long should you isolate patients for with Bordetella pertussis?
5 days
What are the ssx of influenza?
- High fever
- Myalgias
- Non-productive cough
- HA
What is the viral family of influenza?
RNA orthomyxovirus
What age group is most affected with the flu?
School ages children
How long are children infectious for after ssx appear? What about immunocompromised children?
10 days
weeks to months if immunocompromised
Is the flu abrupt or gradual onset?
Abrupt
How often do febrile seizures occur in children hospitalized for the flu?
20%
What is the most common complication of the flu?
Strep pneumoniae
What is Reye syndrome?
Systemic disorder of mitochondrial function that occurs during of after a viral illness
What are the two viruses that can set off Reyes syndrome?
Flu
varicella
What is the treatment for Reyes syndrome?
Supportive
What are the metabolic changes with Reyes syndrome?
Hypoglycemia
Hyperammonemia
LFTs increased
How do you diagnose the flu?
Rapid nasal swab
How do you treat the flu?
Supportive
True or false: you should vaccinate ALL children with underlying chronic disease for the flue
True
What age is appropriate for the flu?
6 months and older
What are the ssx of bronchiloitis (RSV)?
Rhinorrhea
Sneezing
Sudden worsening of a cough
What viral family is RSV?
Paramyxoviridae
What are the two proteins on RSV virus and what are their functions?
G protein -attachment
F- fusion protein
What is RSV?
Bronchiolitis
By what age are virtually all children have an infection with RSV?
2 years
How long can RSV survive on fomites?
12 hours
What are the signs of RSV?
Tachypnea rhinorrhea
Low grade fever
OM
What is the pathognomonic finding of a CXR with RSV?
Segmental atelectasis
Air trapping
What is the treatment for RSV?
Maintain nasal airway
Supportive
What is the only thing you should do with RSV?
Supportive
no CXR, albuterol, viral swabs etc
Cough, tachypnea, bilateral conjunctivitis, without fever under 4 months of age = ?
Chlamydia trachomatis
What percent of children born to mothers with chlamydia infections will get pneumonia?
30-50%
What is the usual presentation of chlamydia trachomatis (age, ssx)?
1-3 months old
Cough, tachypnea, NO fever
What are the CXR findings with chlamydia trachomatis?
Hyperinflation, but no significant findings
What are the CBC findings with chlamydia trachomatis?
WNL but with peripheral eosinophilia
What is the treatment for chlamydia trachomatis?
Oral Erythromycin
High fever, cough, lethargy, tachypnea, low oxygen sat, L shift CBC, = ?
Strep Pneumoniae
What does the CXR show with strep pneumonia in kids?
Lobar or segmental consolidation
“round” pneumonia
What does the CBC should with pneumonia?
Leukocytosis with a L shift
What is the treatment for strep pneumonia in children?
Ampicillin
When are IV abx indicated for strep pneumonia?
If severe
What are the ssx of mycoplasma pneumonia? What age?
Mild LRTI ssx
Usually school age
How common is mycoplasma pneumonia in children less than 3-4 yo?
Rare
How do you diagnose mycoplasma pneumoniae?
Cold agglutinins test
Mycoplasma titers
What is the most common symptom with mycoplasma pneumonia?
Intractable nonproductive cough
What is the abx of choice for mycoplasma pneumonia? Why?
Macrolides
lack a cell wall
Why treat mycoplasma pneumonia with a macrolide and cephalosporin?
Macrolide for mycoplasma
Cephalosporin for strep pneumonia
