Pneumonia and bronchiolitis Flashcards
what is the common organisms causing neonatal pneumonia?
what about infants and adolescents?
- GBS
- E.Coli
- gram neg bacilli
- chlamydia
- Viral (40%): (para)influenza, adenovirus
- bacterial (60%):
strep pneumoniae mostly, staph aureus, h influenza
what bacteria cause aspirational pneumonia?
the non-immunised?
- gram -ve enteric bacteria
- strep pneumonia, staph aureus
- H. influenza, b.pertussis, measles
what about the immunocompromised?
- viral: CMV, VZV, HZV, measles, adenovirus
- bacterial: pneumocystis carinii, TB
what kind of questions would you ask apart from general respiratory ones in a child? (2)
what can be seen on X-ray to make you think bacterial or viral?
- vomiting post cough
- poor feeding
- bacterial, localised consolidation
- viral, diffuse consolidation
why might you do a urine dip in pneumonia?
what organism causes RBC agglutination on blood film?
what Abx for a mild pneumonia? severe?
- legionnaires antigen
- mycoplasma
- oral amoxicillin or erythromycin
- IV cefuroxime +/- erythromycin or metronidazole
what is the prognosis?
do they need follow up CXR?
- most resolve within 1-3 weeks
- no, only done in adults as underlying cancer suspected
what is bronchiolitis most commonly caused by?
less common causes?
what age group does it occur in?
- respiratory syncytial virus (RSV)
- hMPV, adenovirus and parainfluenza
- 2-6 months, by 2 years 80% will have had it
what are the risk factors for bronchiolitis?
- older siblings, nursery
- passive smoking
- prematurity
- congenital heart disease
- DM
- Downs Syndrome
what clinical features does this cause?
what are the signs of respiratory distress in an infant?
- respiratory symptoms
- decreased feeding, irritability
- apnoea
- signs of sepsis
- recession, nasal flaring
- head bobbing, tracheal tug
what investigations would you do for bronchiolitis?
- clinical diagnosis
- Pa02
- Nasopharyngeal aspirate: RSV and other viral cultures
- CXR not recommended
- routine bloods, cultures, ABG
what is the management of bronchiolitis?
- mostly self limiting (7-10 days)
- give fluids, managed at home
when should you refer to hospital in bronchiolitis ?
- poor feeding
- lethargy
- apnoea
- RR >70
- ARDS
- cyanosis
- Sats <94%
who gets vaccinated against RSV?
- premature babies, those with lung heart or neuro disease
what is the prognosis for bronchiolitis?
- most will make a full recovery
- most deaths occur in those with congenital problems
