Childhood Respiratory Infections
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Transcript Childhood Respiratory Infections
Dr. S. Benson
GPSTI
Infections
URTI
Croup
Epiglottitis
Whooping Cough
Bronchiolitis
Pneumonia
TB
URTI
Coryza – Usually rhinovirus, coronavirus, RSV
Pharyngitis – viral or Group A beta-haemolytic strep
Tonsillitis – Group A beta-haemolytic strep and EBV
Acute Otitis Media – viruses, pneumococcus, strep,
haemophilus, moraxella catarrhalis
Sinusitis – viral or bacterial
URTI
Children often present with:
Sore throat
Fever (inc febrile convulsions)
Blocked Nose
Nasal Discharge
Earache
Wheeze
URTI
Thorough examination is needed
Exclude serious infections
Address feeding and hydration
Consider possible bacterial causes for:
Otitis Media (discharge, ruptured drum, red and bulge)
Tonsillitis (exudative with pus)
Mainstay of treatment is paracetamol and ibuprofen
URTI
Antibiotics – to prescribe or not to prescribe?
Recommend if tonsilitis or acute OM
Tonsilitis – Give Penecillin V (avoid amoxicillin as maybe
caused by EBV – rash)
Acute OM – Coamoxiclav is a suitable choice
Take throat swabs before treatment
Most URTI are viral
Croup
Viral laryngotracheobronchitis
Mucosal inflammation of respiratory tract
Usually caused by RSV, parainfluenza and influenza
Usually children are 6 months to 6 years old
Presents as stridor and difficulty breathing
Croup
Can be managed at home if mild
Give humidified air
Give steroids (reduces severity and duration of croup)
oral prednisolone (2mg/kg) for 3 days
nebulised budesonide (2mg stat)
Nebulised adrenaline provides transient relief
If severe or desaturating will need admission
Acute Epiglottitis
Life threatening swelling of the epiglottis
Can cause septicaemia
Caused by haemophilus influenza type B
Mostly in children 1-6yo
DO NOT examine the throat
Keep the child calm
Acute Epiglottitis
Management is in ITU
ET intubation often required
7-10 days of 3rd gen cephalosporin
Rifampicin prophylaxis for close contacts
Croup vs Epiglottitis
Croup
Epiglottitis
Time Course
Days
Hours
Prodrome
Coryza
None
Cough
Barking
None
Feeding
Can drink
None
Mouth
Closed
Drooling
Toxic
No
Yes
Fever
<38.5
>38.5
Stridor
Rasping
Soft
Voice
Hoarse
Weak / Silent
Whooping Cough
Caused by bordatella pertussis
Three stages of illness
Catarrhal (1-2 weeks) – fever, cough, coryza
Paroxysmal (2-6 weeks) – barking cough
Convalescent (2-4 weeks) – lesser symptoms which
resolve
The barking cough has a characteristic paroxysmal
nature with an inspiratory whoop
Whooping Cough
Investigations:
Eyes – Subconjunctival haemorrhages are indicated
CXR
FBC – Leucocytosis and lymphocytosis
Nasal swab for pertussis
As part of the work up, we need to ensure this is not
pneumonia.
Treatment is with erythromycin / clarythromycin
These have limited effect on cough
Whooping Cough
Admission required if:
Apnoeas
Cyanosis
Paroxysms
Risk of seizures
Patients should isolated for 5 days
Immunize close contacts under the age of 7
Only 90% effective and wanes as child ages
Prophylactic antibiotics to close contacts
Bronchiolitis
Most commonly due to RSV
Also can be caused by influenza, parainfluenza,
adenovirus, rhinovirus and C and M Pneumoniae
Causes problems by:
Invading nasal and pharyngeal epithelium
Spreading to lower airways
Increasing mucus production, desquamation and
obstruction
Net effect is hyperinflation and atelectasis
Bronchiolitis
History
Winter months
Coryzal illness
Dry cough
Worsening SOB
Wheeze
Feeding problems
Apnoeic episodes
Bronchiolitis
Examination findings
Cyanosis or pallor
Dry cough
Tachypnoea
Subcostal and intercostal recession
Chest hyperinflation
Prolonged expiration
Respiratory pauses
Wheeze
Crackles
Bronchiolitis
Treatment mainly supportive
Keep oxygen saturations above 92%
If tachypnoeic when feeding consider NG tube
Bronchodilators (salbutamol, atrovent, adrenaline)
Mechanical ventilation if severe
Reserve antivirals for immunodeficient patients
Prophylaxis is available for preterm or babies with
chronic lung problems
Pneumonia
Lower respiratory tract infection
Mostly bacterial
Common pathogens shown below
Age
Pathogen
Neonate
Group B strep
E. Coli
Klebsiella
Listeria
Infants
Strep pneumoniae
Chlamydia
School age
Strep pneumoniae
Staph aureus
Group A strep
Bordatella
Mycoplasma pneumoniae
Pneumonia
Symptoms and Signs
High temp
Productive cough
Tachypnoea (>50)
Grunting
Recession
Cyanosis
Lethargy
Focal signs / bronchial breathing
Pneumonia
Investigations
NPA
FBC
Microbiology
CXR (not of mild and uncomplicated)
Pleural fluid if effusion may be indicated
Pneumonia
Follow local guidelines for treatment
Recommended treatments are
Amoxicillin
Coamoxiclav
Cefuroxime
Antipyretics can also be helpful
IV fluids
Oxygen as required
Physiotherapy is not all that helpful in children
Tuberculosis
Consider in at risk groups
Mantoux test
CXR
Specialist referral
Summary
URTI
Croup
Epiglottitis
Whooping Cough
Bronchiolitis
Pneumonia
TB