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Peds - Jesse > Resp infections > Flashcards

Resp infections Flashcards

1
Q

Resp infections in children (5)

A 
Epiglottitis
Croup Syndrome (Laryngitis, Laryngotracheitis, Laryngotracheobronchitis)
Bronchiolitis
Pneumonia
Acute Otitis Media
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2
Q

Critical points of airway obstruction:

A

Junction of tongue and posterior pharynx
Supraglottic area
Subglottic area

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3
Q

Upper airway obstruction gives ______

Lower airway obstruction gives ______

A

inspiratory stridor

expiratory wheeze

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4
Q 
Resp pathogens:
Viruses (5)
Mycoplasma (1)
Chlamydia (3)
Bacteria (5)
A 
Viruses
RSV
Rhinovirus
Parainfluenza
Adenovirus
Influenza

Mycoplasma
M. pneumoniae

Chlamydia
C. trachomatis
C. pneumoniae
C. psittaci

Bacteria
S. pneumoniae (Pneumococcus)
H. influenzae
M. catarrhalis
Staphylococcus
M. tuberculosis
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5
Q
  • Croup syndrome triad

- Caused by ____ (3 classes)

A

Stridor, cough, hoarseness
Infectious (Epiglottitis, Laryngitis, Laryngeal Diphtheria, Laryngo-tracheitis, L-T-bronchitis, L-T-B-pneumonia), mechanical (foreign body, trauma), allergic (Acute angioneurotic edema)

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6
Q

Epiglottitis:

  • usually caused by which pathogen?
  • pathogenesis?
  • child’s appearance?
  • sign on resp exam?
A
  • H. influenzae B (Hib) (rarely seen today due to immuniz’n)
  • Colonization of nasopharynx –> bacteremia –> seeding of epiglottis –> supraglottic edema obstruction due to ball-valve effect
  • Abrupt onset in < 24 hours; Child insists on sitting, leaning forward, hyperextension of the neck, anxious, drooling, toxic-looking
  • Stridor may or may not be present
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7
Q

Laryngotracheitis (Viral Croup):

  • ages?
  • which viruses? (4)
  • pathogenesis?
  • Tx?
A
  • Ages 3 months to 3 years
  • Parainfluenza 3 (1 or 2), RSV, Influenza, Adenovirus
  • Diffuse URTI –> spreads to larynx, trachea, bronchi, vocal cords –> expansion of inflamed tissue inward –> stridor, hoarse voice, and cough
  • Tx: Goal is to reduce inflammation: Cool mist; cold air; Hydration; Systemic steroids (dexamethasone); Racemic epinephrine (closely observe for rebound obstruction)
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8
Q

Bacterial tracheitis:

  • pathogenesis?
  • Sx? (3)
  • may resemble _____
  • which bacteria? (4)
  • Tx?
A

Sequela of injury to trachea (post-intubation; post- viral URI)
Acute onset of fever, stridor and copious amounts of purulent sputum (adults)
May resemble epiglottitis
Bacterial etiology: S. aureus, Group A strep, Pneumococcus, H. influenza
Medical emergency: ICU admission, probable intubation and antibiotics

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9
Q

Acute bronchitis:

  • Sx/findings (3)
  • pathogenesis?
  • Tx?
A
  • Fever, cough, and rhonchi
  • Viral URI with distal spread resulting in inflammation and damage to trachea and bronchi. Mycoplasma rarely implicated, but even so response to therapy is not impressive.
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10
Q

Bronchiolitis:

  • ages?
  • Sx/findings (3)
  • seasons?
  • main virus?
  • pathogenesis?
  • Tx (6)
A

-Disease of infancy
-rhinorrhea, expiratory wheezes, cough
-Occurs in winter and spring
-RSV is the major cause
-Walls of small bronchi and bronchioles become edematous, occluded with mucous, +/- bronchospasm
-Mortality almost exclusively seen in infants with underlying cardiac/pulmonary disease
Tx: O2, supportive care, fluids, Suctioning as needed, +/- inhaled bronchodilators, epinephrine

High risk infants: monthly Synagis (Palivizumab = monoclonal RSV antibody) during RSV season

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11
Q

Microbial Agents that cause pneumonia (6 categories; incl 3 bacteria)

A 
Viral
Bacterial (S. pneumococcus, H. influenzae, M. catarrhalis)
Mycoplasma (> 5 years old)
Chlamydia
TB
Fungal
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12
Q

Pneumonia:

  • Pathophysiology?
  • Clinical manifestations (3)
A
  • Pathophysiology: (1) Aspiration, (2) Contiguous spread, (3) Secondary to poor host defenses (Cystic Fibrosis, smoke inhalation), (4) Hematogenous spread
  • Clinical manifestations: usually fever, tachypnea, +/- other findings (e.g. crackles)
  • Tx dep on age, distribution of disease, status of child
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13
Q

Acute otitis media pathogenesis

A

-Viral URTI –> Edema of mucosal surfaces –> obstruction of Eustachian tube –> Stasis of fluid in the middle ear –> Bacterial superinfection

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14
Q

Acute otitis media Dx (3)

A
  1. Sudden onset of symptoms
  2. Signs of inflammation (e.g. pain, bulging tympanic membrane, erythema of TM)
  3. Signs of effusion (e.g. immobile TM, air-fluid level, loss of the bony landmarks behind the TM—especially the short process of the malleus) - Effusion can persist for weeks to months = OM with effusion/“glue ear”
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15
Q
  • Acute otitis media microbiology

- Always Tx with antibiotics?

A 
S. pneumo (36%)
No growth (25%)
H. flu (22%)
M. cat (14%)
GAS (3%)

-if minimal Sx, 92% will resolve on their own.

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16
Q

AAP otitis media Tx guidelines

A
  • Treat with antibiotics for children under 6 months
  • If 6 - 24 months, not too sick and diagnosis is uncertain, could choose to observe for 48 - 72 hrs
  • If older than 24 months and not too sick, could observe for 48 – 72 hrs, even if diagnosis is certain
  • Should make sure follow-up available, caregivers reliable
  • Should always treat the pain!
17
Q

CPS otitis media Tx guidelines (wrt observation)

A

Observe 48 to 72 hrs if :
> 6 months of age
No immunodeficiency, chronic cardiac or pulmonary disease, anatomical abnormalities of head/neck or history of complicated otitis media, or Down sydrome. (? Aboriginal children?)
Illness is mild (mild otalgia, fever < 39)
Parents are capable of recognizing signs of worsening illness and can readily access medical care if child does not improve

18
Q

Otitis media spontaneous resolution is pathogen-dependent; 3 main pathogens and their % spontaneous resolution?

A

S. pneumoniae 19% spont. resolution
H. influenzae 48% spont. resolution
M. catarrhalis 79% spont. resolution

19
Q
  • Otitis media antibiotic Tx (first- and second-line)

- Risk factors for resistance? (2)

A

First-line:
Amoxicillin: excellent middle-ear penetration, well- tolerated, relatively narrow antimicrobial spectrum
-Recommendation now is to start with high dose amoxicillin for everyone (80-100 mg/kg/day); If it fails, likely due to B-lactamase production, so switch to amoxicillin-clavulinic acid (can give high-dose)

Second-line:
Amoxicillin-clavulinic acid: inhibition of B-lactamase
Also 2nd/3rd generation cephalosporins, macrolides
-If fails high dose amoxicillin-clavulinic acid, consider intravenous Ceftriaxone (3rd generation cephalosporin) for 3 days

Risk factors: Day care, recent antibiotic use (past 1 -3 months)

20
Q

How the 3 main otitis media pathogens each devel resistance

A

S. pneumoniae: Change in penicillin-binding site

H. influenzae & M. catarrhalis: Production of B-lactamase

21
Q

Length of antibiotic Tx for otitis media (2 groups)

A 
10 days:  
Children younger than 2 years old
Children with frequent recurrent AOM 
Children with perforated TM
Children who failed their initial treatment

5 days:
Everybody else!

22
Q

Which common bacterial pathogen does NOT make B-lactamase?

A

S. pneumoniae

Peds - Jesse (5 decks)

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