URTI & Stridor Flashcards
Frequency of URTI at each age according to WHO
up to 14 in the first yr of life
4 -10 yr. - 2–5 times per year
10 – 14 - 2.5–5 times per year
Adults – 1.7 times per year
How does the paediatric immune system differ to adults
Physiological hypogammaglobulimaenia during 4 –11 mo.
IgG is equal to adults - 7 – 8 yr IgM takes -1 yr. IgA - 6 – 7 yr. IgE - 6 – 7 yr NK - same as adults
Predominant lymphocytosis - 4 day – 4 yr
Relative neutropenia - 4 day – 4 yr
Complement maturity takes- 1 yr.
thymus largest at 2 yrs/ - shrinks by puberty
tonssillar enlarged for 2 – 4 yr.
How does the viral infection rate of children change according to age
Infants younger than 3 months have lower infectious rate – as they’re protected by maternal IgG antibodies
The infection rate increases from 3 to 6 months of age since their own IgG is low until 7/8
The viral infection rate increase during toddler, and preschool years d/2 increased social life of children and increased contact with immature igG
Hoe does the paediateic anatomy increase the likelihood of URTI
Smaller diameter of paediatric airways facilites rapid movement of pathogens
Which 7 factors contribute the the paediateic resistance from infections
⚫ Deficient immune system ⚫ Malnutrition ⚫ Anemia ⚫ Fatigue ⚫ Allergies ⚫ Asthma ⚫ Cardiac anomalies
How is the respiratory tract divided
Upper resp tract
1) nasal cavity
2) pharynx
3) larynx
Lowr resp tract
1) trachea
2) pulmonary bronchi
3) lungs
Types OF URTI
– Rhinitis
– Otitis media – Sinusitis
– Epiglottitis – Pharyngitis – Laryngitis
– Croup
– Tonsillitis
– Retropharengeal abscess Peritonsillar abscess
Non specific URTI
Common cold
Influenza
Adenoviruses
Gingivostomatitis
Enteroviruses
Herpangina
Hand, foot, and mouth disease
Pleurodynia
What is the common cold and how is it dg
• Etiology: more than 200 viruses – rhinoviruses 30-50% – coronaviruses 10-15% – influenza 5-15% – parainfluenza 5% – adenoviruses <5% – Enteroviruses <5% – unknown 20-30%
• Diagnosis: based on Classical Clinical features 1)clear or mucopurulent nasal discharge w/blockage 2)+/- fever
Management of the common cold
• educate parents that colds are self-limiting and have no specific cure
• Symptomatic rx regime:
Nasal blockage: Plenty of fluid intake, rest, humidified air, nasal aspiration
Pain: over-the-counter analgesics and antipyretics.
(paracetamol or ibuprofen)
- Antibiotics are of no benefit as the common cold has viral etio and super bacterial infection is very uncommon.
- assure parents Cough may persist for up to 4 weeks after a common cold.
Summarise influenza in 5 points
- Etiology: Influenza A & B
- Symptoms: Fever, myalgias, headache, rhinitis, malaise, nonproductive cough, sore throat
- Diagnosis: Influenza A &B antigen testing
- Treatment: Supportive care, tamiflue, amantidine
- Anti – influenza vaccines indication:
- children w/ chronic lung and heart diseases at school age
- children from 6 mo in USA, in EU from 2yrs
Summarise Adenoviral infection in 4 points
• Symptoms: Low grade fever,
Lymphadenomegaly , pharyngitis and NON PURULENT CONJUNCTIVITIS
• Diagnosis: based on clinical sx
• Treatment:
Adequate fluid intake, rest, humidified air, nasal aspiration and over-the-counter analgesics and antipyretics, no aspirin till 14 yr d/2 reyes syndrome
• Possible complication – pneumonia which requires Aggressive treatment
Summarise gongivostomatitis
HSV infection from 10mo - 3 years
• charac sx :
1) vesicular lesions on: lips, gums, anterior tongue and hard palate,which often progress to extensive, painful ulceration with/without bleeding
2) high fever and the child is very miserable. The illness may persist for up to 2 weeks.
3) painful eating and drinking (dysphagia), can cause dehydration.
• Management is symptomatic unless severe:
Diet – no salty and spicy food with normal ph
severe disease: intravenous fluids and aciclovir.
Summarise heorangina
mouth infection d/2 cocksackie virus
Sx:
General: Fever, ± loose stools
Specific: Vesicular and ulcerated lesions on the soft palate and uvula causing anorexia d/2 pain on swallowing
Rx:
• Severe cases need intravenous fluids, diet is the same as in gingivostomatitis
• No antibiotics, no acyclovir as its caused by cocksackie not HSV
Summary of enteroviruses
Enteroviruses are Common in Paeds
coxsackie viruses, echoviruses, and polioviruses
common cause of childhood infection.
• Transmission:
faecal–oral and respiratory droplet routes.
replication in the pharynx and gut, nthe virus spreads to infect other organs.
• Infections occur most commonly in the summer and autumn.
Sx:
• febrile illness, sometimes with a rash usually over the trunk
that is blanching or consists of fine petechiae.
• Some children have a history of loose stools or vomiting
