Respiratory Disease Flashcards
Name six important viral pathogens causing respiratory infection in childhood
1) Respiratory syncytial virus
2) Rhinoviruses
3) Parainfluenza
4) Influenza
5) Human Metapneumovirus (hMPV)
6) Adenoviruses
Name six important bacterial causes of respiratory infection in childhood
1) Streptococcus pneumoniae
2) Other strep infections
3) Haemophilus influenzae
4) Moraxella catarrhalis
5) Bordetella pertussis
6) Mycoplasma pneumoniae
Which pathogen remains important cause of resp infections globally? (as opposed to in the UK)
Mycobacterium tuberculosis
What condition does bordetella pertussis cause?
Whooping cough
What factors cause an increased risk of respiratory infection? (x7)
1) Parental smoking (espec maternal)
2) Poor socioeconomic status - large family size, overcrowding, damp housing.
3) Poor nutrition
4) Underlying lung disease such as bronchopulmonary dysplasia, CF, asthma
5) Male gender
6) Haemodynamically significant congenital heart disease
7) Immunodeficiency
How is respiratory infection classified?
According to the level of the respiratory tract most involved.
Working your way down: URTI, laryngeal/tracheal infection, bronchitis, bronchiolitis and pneumonia.
Give an example of an infection affecting the laryngeal/tracheal region.
Croup
Causes a barking cough and occurs most commonly in children 1-3 yrs old.
What pathogens most commonly cause coryza/common cold?
Rhinoviruses, coronaviruses and RSV
Which bacterial infection is a common cause of pharyngitis and tonsillitis in older children?
Group A beta-haemolytic streptococcus
Only a third of cases of tonsillitis are caused by bacteria so antibiotics are often not necessary. When antibiotics are indicated, which antibiotic is best avoided and why?
Amoxicillin - because it may cause a widespread maculopapular rash if the tonsillitis is due to infectious mononucleosis (EBV)
What criteria is used to assess the likelihood of whether pharyngitis/tonsillitis is caused by Group A beta-haemolytic streptococci? Give the name and explain it.
The centor criteria. The 4 criteria are:
1) Presence of tonsillar exudate.
2) Presence of tender anterior cervical lymphadenopathy or lymphadenitis.
3) History of fever.
4) Absence of cough.
The presence of three or four of these clinical signs (Centor score 3 or 4) suggests that the person may have GABHS (40–60% chance) and may benefit from antibiotics treatment.
At what age is acute otitis media most likely to occur in children?
6-12 months
Why are young children prone to acute otitis media?
Because their Eustachian tubes are short, horizontal and function poorly.
Describe the appearance of the tympanic membrane in acute otitis media
The tympanic membrane is bright red and bulging with the loss of normal light reflection
Which pathogens most commonly cause acute otitis media?
RSV, Rhinoviruses, Pneumococcus, H.influenzae and Moraxella Catarrhalis
What serious complications can result from acute otitis media
Mastoiditis and meningitis (but they are now uncommon)
What antibiotic is widely used for acute otitis media?
Amoxicillin
What % of childhood respiratory infections are caused by viruses?
80-90%
What can recurrent ear infections lead to?
Otitis media with effusion (OME) also known as glue ear
How does otitis media with effusion present?
Hearing loss (which may present as behavioural problems) - children are otherwise asymptomatic.
Describe the appearance of the eardrum in otitis media with effusion (OME)
The ear drum is seen to be dull and retracted and often there is a fluid level visible
What type of hearing loss does OME result in?
Conductive hearing loss
How can you confirm a diagnosis of OME in
a) Children > 4 years?
b) Children
a) A flat trace on tympanometry in conjunction with evidence of conductive hearing loss on pure tone audiometry
b) Reduced hearing on a distraction hearing test in younger children
In which age range is OME very common?
2-7 years (peak incidence 2.5 to 5 years)
What adverse consequences may result from conductive hearing loss caused by OME?
Interference with normal speech development and and learning difficulties
What can be done for children with chronic glue ear?
- Insertion of ventilation tubes i.e. grommets. This is what happens in practice.
- Research suggests adenoidectomy would provide more long term benefit
What is done for children with glue ear if the problems recur after grommet extrusion?
Reinsertion of grommets with adjuvant adenoidectomy
Name the three indications for tonsillectomy
1) Recurrent severe tonsillitis
2) A peritonsillar abscess (quinsy)
3) Obstructive sleep apnoea (adenoids will also be removed)
Name the three indications for removal of tonsils and adenoids
1) Recurrent OME & hearing loss, where it gives significant additional long term benefit.
2) Obstructive sleep apnoea (an absolute indication)
What is the other name for croup?
Laryngeotracheobronchitis
What treatment should be given to all children with croup, regardless of severity?
A single dose of dexamethasone (0.15mg/kg)
