Pneumonia, Bronchiolitis Flashcards

1
Q

How are pneumococcal infections spread?

A

1) Strep pneumonia is often carried in the nasopharynx of healthy children.
2) Asymptomatic carriage is very prevalent amongst young children -> transmission of pneumococcal disease via droplet spread.

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2
Q

What conditions caused by pneumococcal infections?

A

1) Pharyngitis, sinusitis, conjunctivitis, otitis media.

2) Invasive disease such as pneumonia, sepsis, meningitis.

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3
Q

Who is at increased risk from pneumococcal infections?

A

1) Young infants as their immune system is not as strong, hence it responds poorly to encapsulated pathogens such as Strep pneumoniae. (Pneumococcal vaccine has reduced incidence of invasive disease in UK)
2) Hyposplenism (sickle cell disease) or nephrotic syndrome - should be given daily prophylactic penicillin (to cover strains not covered by vaccine)

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4
Q

What is pneumonia?

A

It is the inflammation of the substance of the lung - an acute lower respiratory tract infection caused by bacteria, but also can be caused by viruses and fungi.

This is usually due to infection affecting distal airways + alveoli with the formation of an inflammatory exudate.

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5
Q

Epidemiology of pneumonia?

A

Incidence peaks in infancy and old age, viruses are more common in younger children and bacteria is more common in older children.

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6
Q

Aetiology of pneumonia?

A

Newborn - organisms from mum’s genital tract:

1) Group B Streptococci
2) Gram-negative enterococci

Infants and young children:
MAINLY Viruses: RSV, Influenza A+B, Parainfluenza
Bacterial infections: Streptococcus Pneumoniae, Haemophillus influenzae, Bordatella pertusis, Staph aureus (RARE but serious).

Children over 5 years:

1) Mycoplasma pneumoniae
2) Streptococcus pneumoniae
3) Chlamydia pneumoniae

(Vaccinations against streptococcus pneumoniae and Haemophilus influenzae type B (HiB) into routine immunisation schedule has reduced incidence of pneumoniae caused by these pathogens)

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7
Q

Clinical presentation of pneumonia?

A

Usually preceded by an URTI:

1) Common cold - coryza
2) Sore throat - pharyngitis, tonsillitis
3) Acute otitis media
4) Sinusitis

Followed by:

1) Fever (>37.5 degrees) and difficulty breathing are most common features.
2) Cough, lethargy, poor feeding and an ‘unwell child’
3) Localised chest, abdomen or neck pain is a sign of pleural irritation - suggests bacterial infection.
4) Respiratory distress - nasal flaring, tachypnoea, intercostal recession, chest indrawing, cyanosis
5) Consolidation with dullness on percussion, decreased breath sounds and bronchial breathing over that area are often absent in children.

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8
Q

Differential diagnosis of pneumonia?

A

1) TB - suspect if overseas contacts, HIV positive or odd CXR.
2) Bordatella pertussis (whooping cough):
Apnoea, bouts of coughing ending with vomitting +/- cyanosis, worse at night or after feeds.
‘Whoops’ not always heard - caused by inspiration against a closed glottis.

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9
Q

Diagnosis of pneumonia?

A

1) Increased respiratory rate - best clinical sign of pneumonia
2) CXR - confirms diagnosis:
Lobar consolidation is indicative of Streptococcus pneumonia.
For other types CXR is unable to differentiate between bacterial and viral pneumonia.
In some cases, pleural effusion may be present causing blunting of the costophrenic angle.
3) Nasopharyngeal aspirate in younger children can be useful to identify viral causes.
4) FBC/CRP not useful in differentiating between bacteria or viral causes.

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10
Q

Treatment of pneumonia?

A
1) Most cases can be managed at home, hospital indications: 
severe tachypnoea, 
O2 sats <93%, 
grunting, 
apnoea, 
difficulty breathing,
not feeding.

2) Supportive O2 for hypoxia and analgesia for pain.
3) IV fluids if necessary.
4) Older infants: 1st line antibiotic - oral amoxicillin, 2nd line - macrolides - Clarithromycin or Oral Co-Amoxiclav if unresponsive.
5) Children >5yrs - Oral amoxicillin or clarithromycin.

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11
Q

What is bronchiolitis?

A

An acute viral infection of the lower respiratory tract - acute bronchiolar inflammation that occurs primarily in the VERY young.
Self-limiting illness, management most supportive.

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12
Q

Epidemiology of bronchiolitis? (RSV 80%)

A

Commonest serious respiratory infection of infancy.
90% of admissions are aged 1-9 months, bronchiolitis is rare after 1 year.
RSV is the pathogen in 80% of cases.

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13
Q

Aetiology of bronchiolitis:

A

1) RSV (respiratory syncytial virus)

2) Parainfluenza, influenza, rhinovirus, human metapneumovirus.

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14
Q

Risk factors for severe bronchiolitis?

A

1) Under 1 years
2) Premature with bronchiopulmonary dysplasia
3) Cystic fibrosis
4) Congenital heart disease

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15
Q

Clinical presentation for bronchiolitis?

A

1) Coryza
2) Sharp, dry cough
3) Tachypnoea
4) Intercostal and subcostal recession
5) Hyperinflation of chest - prominent sternum, liver displaced downwards
6) Cyanosis or pallor
7) Fine-end inspiratory crackles
8) High pitched WHEEZE + EXPIRATORY
9) Tachycardia
10) Inadequate feeding (less than 50% intake in past 24 hours) + increasing dyspnoea
11) Apnoea (temporary cessation of breathing especially in sleep seen in <4months)

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16
Q

Differential diagnosis for bronchiolitis:

A

1) Viral induced wheeze (if wheeze no crackles)
2) Pneumonia (consider if temp above 40 degrees, wheeze not common in pneumonia)
3) Asthma

17
Q

Diagnosis for Bronchiolitis?

A

1) Pulse oximetry and blood gas analysis to monitor hypoxia
2) CXR unnecessary in simple cases - would show hyperinflated lungs
3) PCR analysis of nasopharyngeal secretions to help identify RSV

18
Q

Treatment for Bronchiolitis?

A

1) Humidified oxygen given via nasal cannula (% determined via pulse oximetry)
2) IV fluids or NG feeds
3) Monitor for apnoea
4) Steroids, antibiotics or bronchodilators not recommended
5) Assisted ventilation may be required in severe cases via nasal or facemask, CPAP or full ventilation.
6) Severe bronchiolitis, immunocompromised or heart/lung disease: Antiviral e.g. nebulised Ribavirin

19
Q

Preventing Broncholitis?

A

1) RSV highly contagious so use good hand hygeine to prevent cross-infection.
2) Monoclonal antibody to RSV e.g. IM Palavizumab (monthly administration) - given to high risk pre-terms