Respiratory Tract Infections

Question 0

What are life threatening upper respiratory Tracy infections in children?

Answer 0

Acute epiglotitis (harmophilus influenzae)
Croup (acute vital obstructive laryngo-tracheo-bronchitis)
Look out for stridor!

Question 1

What is quinsy?

Answer 1

A peritonsillar abscess that:
Follows tonsillitis, presents with a unilateral sore throat, painful swallow, systemic upset, ‘hot potato voice’, is of bacterial cause. Treated with surgical incision and drainage and antibiotics

Question 2

What to do if acute epiglotitis is suspected? (Fever, drooling, stridor in a child)

Answer 2

Do not examine the throat!! Otherwise risk of acute fatal upper airway obstruction. Admit to hospital immediately.

Question 3

What to do about acute bronchitis? (H.influenzae or s.pneumoniae are the usual organisms)

Answer 3

Treatment only if underlying lung disease eg COPD as antibiotics shown to have a similar effect to placebo’s. But if antibiotics give: amoxycillin or clarithromycin.

Question 4

What is pneumonia?

Answer 4

• acute respiratory illness involving lung alveoli, often bacterial
• alveoli fill with organisms and inflammatory exudate, causing lung consolidation (seen as shadow on CXR)
• potentially serious because of impaired gas exchange (hypoxia) and risk of bacteraemia
• can be a pointer that there’s an underlying disease

Question 5

What are the signs of pneumonia?

Answer 5

Breathlessness
Tachypnoea
Pleuritic pain
New focal signs in the chest
Esp if systematically unwell (fever, rigor, tachycardia, sweating)

Question 6

How can the organism in pneumonia be identified? (Treatment usually started before the organism is known)

Answer 6

Sputum culture (high sensitivity, low specificity)
Blood culture (high specificity, low sensitivity)
Bronchoalveolar lavage/percutaneous aspirate
Antibody titres

Question 7

What’s the best clue to find out the causative organism in pneumonia?

Answer 7

The circumstance in which the infection occurs:

• community acquired
• hospital acquired
• aspiration pneumonia
• in the immunocompromised host

Question 8

What’s the organism in community acquired pneumonia? And the antibiotic used to treat it?

Answer 8

Streptococcus pneumoniae
Ab: penicillins: benzylpenicillin or amoxycillin are most active against s.pneumoniae and macrolides (eg erythromycin or clarithromycin) are also active against atypical organisms

Question 9

What’s the organism and the antibiotic given to treat hospital acquired pneumonia?

Answer 9

Organisms: gran neg bacilli, staph aureus
Ab: anti-pseudomonas beta-lactam by iv. +- aminoglycoside by iv

Question 10

What are the bacterial flora of the mouth?

Answer 10

90% anaerobes

10% aerobes mainly gran positive cocci

Question 11

What are the antibiotics in aspiration pneumonia?

Answer 11

Benzylpenicillin and flucloxacillin.

Or: co-amoxiclav

Question 12

What are the complications of pneumonia?

Answer 12

• empyema (pus in pleural cavity) needs surgical drainage
• lung abscess (collection of pus in lung) needs prolonged antibiotics
• bacteraemia (positive blood culture) risk of multi organ failure

Question 13

Key clinical questions:

Answer 13

Is the infection in the upper or lower respiratory tract? Is it pneumonia?
What’s the causative organism?
Is treatment needed? Antibiotic? Supportive therapy? Admission?

Question 14

What resp infections are notifiable?

Answer 14

TB, legionella infection

Question 15

Which disease are upper and which are lower respiratory?

Answer 15

Upper: tonsillitis, pharyngitis, sinusitis common coke etc
Lower: bronchitis, pneumonia