Upper and Lower Respiratory Tract Infections in Children Flashcards
What are some important examples of upper respiratory tract infections?
Rhinitis Tonsilitis Otitis media Pharyngitis Laryngitis Epiglottitis
If you see a child with an upper respiratory tract infection how would you try determine if they need treated?
Try determine where in it’s natural history the disease is
If you suspect the infection is self limiting and will improve you give the parents a list of symptoms to look for and a time period to observe over, if the child gets worse tell them to come back
How common is rhinitis? How should it be treated?
Very common, get 5-10 per year
Usually a self limiting condition but may be a prodrome to more serious illness. Would only really be worried if symptoms get significantly worse or they last for more than 2.5 weeks ish
What is otitis media? How does it appear on otoscopy?
Infection of the middle ear that causes inflammation and a buildup of fluid behind the eardrum
The TM will appear red instead of translucent and the TM will be bulging
Wouldn’t last longer than 1.5 weeks
How should you treat otitis media infection?
Analgesia** (main treatment as main symptom is pain)
- Antibiotics may help a bit but don’t seem to help significantly so wouldn’t recommend
- Antibiotics only work after 24 hours which is usually the main window of pain
What is the main dilemma regarding treatment for tosilitis and pharyngitis?
Determining if the infection is viral or bacterial
Viral you don’t treat, bacterial (strep throat) you give 10 days penicillin (not amoxycillin)
Duration is usually around 2-3 days
What are some hints as to whether the cause of tonsilitis / pharyngitis is viral or bacterial?
Bacterial (strep throat) tends to present with:
- Scarlet fever (faint pink rash)
- Pallor around the mouth
What is croup? How does it present? How is it treated?
Laryngotracheobronchitis
Presents with runny nose followed by stridor, barking cough and hoarse voice (usually lasts 1/2 days)
Treated with dexamethasone
What causes epiglottitis? How serious is it?
Haemophilus infleunza (vaccine history important)
Very serious condition - swelling of the epiglottis obstructs breathing
How does epiglottitis present? How is it treated?
Presents with difficulty swallowing (patient often drooling), stridor and trouble breathing
Treated with intubation and antibiotics
What are some examples of lower respiratory tract infections?
Tracheitis Pneumonia Bronchitis Empyaema Bronchiolitis
What are some bacteria that are not seen in health but may cause pathological infection?
Pertussis (whooping cough)
Bacteria causing TB
How does tracheitis tend to present?
“Croup that doesn’t get better”
- Barking cough
- Stridor
- Fever
- Child will be unwell
Which organisms tend to cause tracheitis? What is the treatment for the condition?
Staph or strep invasive infection
Augmentin (always give antibiotic)
How does bronchitis tend to present? What organisms cause it?
Loose, rattly cough with URTI
Post tussive vomit (post coughing - sputum evac)
Chest free of wheeze / crepitations
Caused by viral infection followed by secondary bacterial invasion due to reduced mucociliary clearance
What is the natural history of bronchitis like? What accounts for this?
Cough that resolves or nearly resolves, then recurrs
For the first 2 winters or so the child might get it very often, but after around their 3rd winter they develop some immunity
Accounted for by the fact that the viral infection inhibits the mucociliary escalator, allows for bacterial infection, finally gets cleared, and then the child gets another virus
How should bronchitis be treated?
Reassure the parents and don’t treat, the child is well enough they are just taking long to clear their mucus
What is bronchiolitis?
Infection of the small airways
Who tends to get bronchiolitis? What organism causes it?
Infants (affects 30-40% of infants) - so less than 1 year olds, peaks at around 3 months
Usually caused by RSV (can be paraflu III / HMPV)
How does bronchiolitis present?
Nasal stuffiness
Tachypnoea
Poor feeding
Crackles +/- wheeze
What is the natural history of bronchiolitis like? When should you admit to hospital?
Condition gets worse progressively for about 5 days, then stabilizes for a couple days and then resolves over about a week
If you see a child early on (day 2/3) and their oxygenation and nutrition isn’t great then admit to hospital, if they’re doing alright at around day 5 they shouldn’t get much worse
Investigations for bronchiolitis? Treatment?
NPA - nasophrayngeal aspirate (identify the virus) Oxygen saturations (determine severity)
Can treat with antibiotics or bronchodilators, but want to try keep treatment to a minimum
What is the general presentation of LRTI like?
48 hours in
Fever (>38.5 degrees)
SOB, coughing, grunting
Reduced bronchial breath sounds
If wheeze is seen in a LRTI what does this indicate?
That bacterial cause for infection is unlikely
What are the characteristics of pneumonia?
Signs are focal (eg. in left lower zone)
Crepitations present
High fever
What investigations may be done for pneumonia?
CXR and inflammatory markers
Not usually done because don’t impact the treatment course
Management of pneumonia?
(No treatment with mild symptoms)
Oral amoxycillin is first line **
Oral macrolide 2nd line
- IV only done if the child is vomiting
When is it better to use oral antibiotics rather than IV?
If the LRTI is not severe
If the child is not vomiting
What are some characteristics that differentiate LRTI and bronchiolitis?
Bronchiolitis occurs in infants (<12 months)
3 days until symptom peak for bronchiolitis, more rapid in other LRTI
Bronchiolitis rarely presents with fever
How does vaccination against pertussis affect the chance of getting whooping cough?
Reduces the chance of getting it, but it is still common even in vaccinated children
Vaccination also tends to reduce severity
How does whooping cough present?
Child coughs continuously (fit) until they can’t cough anymore (out of breath)
They then may vomit or wretch
The loud inhale after the coughing fit is the “whoop”
What is empyaema? How does it present?
Complication of pneumonia where the infection spreads into the pleural space
Presents with chest pain and the child being very unwell in general
How is empyaema managed? What is the prognosis like?
IV Antibiotics +/- drainage for treatment
Prognosis is good in children, unlike in adults
Which antibiotic is used for tracheititis?
For LRTI / pneumonia?
Tracheitis - augmentin
LRTI / pneumonia - oral amoxycillin
