Transcript Document
Respiratory Diseases
Lin Guangyu Department of Pediatrics, The Second Affiliated Hospital to Medical College, Shantou University
General Introduction
Respiratory disorders important as They account for 50
%
of consultations with general practitioners for acute illness in young children and a third of consultations in older children Respiratory illness leads to 20-35
%
of acute paediatric admissions to hospital, some of which are life threatening Asthma is the most common chronic illness of childhood in the world
Acute Upper Respiratory Infection (AURI)
Introduction
AURIs are the most frequently occurring illness in children. On average, children acquire three to eight AURIs every year. AURIs are generally caused by the viruses.
There are little difference in the incidence of colds by sex, race, or geograhpic region.
Environmental factors that increase the likelihood of acquiring cold include attendance at child care facilities, smoking, passive exposure to smoke, low income, crowding and psychologic stress.
Etiology
Viruses
Cold viruses may be transmitted by three routes:
Large-particle droplets, which can travel a short distance to directly inoculate another person
Small-particle aerosols, which can travel longer distances and deposit directly in alveoli of other individuals
Secretion, which are transmitted by direct physical contact
Etiology
Common viruses that usually cause common colds
Rhinoviruses Parainfluenza or influenza viruses Respiratory Syncytial Virus (RSV) Coronaviruses
Adenovirus
Enteroviruses
Coxsackie Virus and ECHO Virus
Reoviruses
Etiology
The common cold has over 200 known viral causes:
30% are rhinoviruses.
40% are unknown.
15% are influenza or parainfluenza viruses.
10% are coronaviruses.(20% in adult.)
5% are enteroviruses.
Etiology
Parainfluenza viruses (types 1
～
4) often produce lower respiratory disease but, particularly in reinfections, the symptoms may present as uncomplicated AURIs.
RSV often begins in infants as a AURI but spreads to the lower respiratory tract.
Etiology
Bacteria
A bacteral infection is secondary.
The most common bacteria:
Streptococcus hemolyticus
Influenza Bacillus
Streptococcus Pneumoniae
Mycoplasma Pneumoniae
Etiology
Other causes
Characteristic of respiratory anatomy and physiology in children
Characteristic of respiratory immunity in children
Body states:Deficiency of vitamins and trace elements malnutrition
Environmental factors
Pathogenesis
The offending virus invades the epithelial cells of URT.
Inflammatory mediators are released.
They alter the vascular permeability and cause tissue edema and stuffiness.
Stimulation of cholinergic nerves in the nose and URT leads to increased mucus production (rhinorrhea) and occasionally to bronchocontriction
Injury to cilia in the nasal epithelial cells may decrease ciliary function and impair clearance of nasal secretions.
Clinical Manifestations
Symptoms of Respiratory System
Nasal obstruction
Rhinorrhea
Sneezing
Coughing
Pharyngodynia
Clinical Manifestation
General Symptoms
Sudden onset
Anorexia
Fever
Vomiting
Diarrhea
Restlessness, Convulsion
Abdominal pain
Clinical Manifestations
Signs
Congestion of throat
Swelling of tonsil
Submaxillary lymphadenopathy and cervical lymphadenopathy
Skin rash
Clinical Manifestations
Symptoms of older children with URIs
The patients usually experiences a sudden onset of clear or mucoid rinorrhea, nasal congestion, and fever.
Mild sore throat, cough, sneezing, and eye irritation may develop.
Headache, malaise, myalgia, and decreased appetite usually occur.
The nose, throat, and tympanic membrane can appear red and inflamed.
Most systemic symptoms subside within 5
～
7 days.
Clinical Manifestations
Infants with URIs
Infants have a more general presentation .
High-grade fever
Irritable and restless
Feeding and sleeping difficult
Vomiting and diarrhea
Specific Types of URIs
Herpangina
Herpangina is caused by coxsackie A group viruses.
Herpangina is characterized by an acute onset of fever and oropharyngeal vesicles ( 3-4mm in size) and ulcers surrounded by an ery, and sometimes the characteristic lesions are found on the soft palate and uvula.
Dysphagia , vomiting , and anorexia also occur.
Symptoms disappear in 1 week.
Specific Types of URIs
Pharyngo-conjunctival fever
This disorder is caused by type 3 or 7 adenovirus.
Pharyngitis, conjunctivitis, fever and cervical lymphadenopathy are the main findings.
Symptoms disappear in 1
～
2 weeks.
Complications
Acute otitis media
Paranasal sinusitis
Neck lymphrnoditis
Retropharyngeal abscess
Laryngitis
Lower respiratory tract disease
Acute glomerulonephritis and rheumatic fever
Laboratory Test
White cell count
The viral infections is normal to low.
The bacterial infections or viral-bacterial infection is high. Laboratory diagnosis of viral infections
Antigen or nucleic acid detection
Serologic testing
Isolation of viruses by culture of the throat or nasopharynx
Use of monoclonal antibodies
Polymerase chain reaction (PCR)
Diagnosis and Differential Diagnosis
Diagnosis
According to symptoms and signs, AURIs are easily diagnosed.
A key decision in evaluating children with AURIs is to determine whether the illness is just a common cold or whether a secondary infection or complication is present.
Diagnosis and Differential Diagnosis
Differential Diagnosis
Influenza
Epidemiologic history
Severe general symptoms
Acute infectious diseases during early period
History Clinical manifestations
Laboratory findings
Acute appendicitis
Periumbilical abdominal pain, which then localizes to the right lower quadrant Higher white blood cell counts
Treatment
General treatment
Heteropathy
The treatment of AURIs is usually symptomatic
Etiological treatment
Antivirotic:Virazole Persantine
Antibiotics
Conclusive Discussion
The term URTI embraces a number of different conditions.
Common cold (coryza) Sore throat (pharyngitis, including tonsillitis) Acute otitis media Sinusitis (relatively uncommon)