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Respiratory Infections in Children

Respiratory Infections in Children. 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

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Respiratory Infections in Children

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  1. Respiratory Infections in Children Dr. S. Benson GPSTI

  2. Infections • URTI • Croup • Epiglottitis • Whooping Cough • Bronchiolitis • Pneumonia • TB

  3. 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

  4. URTI • Children often present with: • Sore throat • Fever (inc febrile convulsions) • Blocked Nose • Nasal Discharge • Earache • Wheeze

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Acute Epiglottitis • Management is in ITU • ET intubation often required • 7-10 days of 3rd gen cephalosporin • Rifampicin prophylaxis for close contacts

  11. Croup vs Epiglottitis

  12. 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

  13. 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

  14. 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

  15. 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

  16. Bronchiolitis • History • Winter months • Coryzal illness • Dry cough • Worsening SOB • Wheeze • Feeding problems • Apnoeic episodes

  17. Bronchiolitis • Examination findings • Cyanosis or pallor • Dry cough • Tachypnoea • Subcostal and intercostal recession • Chest hyperinflation • Prolonged expiration • Respiratory pauses • Wheeze • Crackles

  18. 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

  19. Pneumonia • Lower respiratory tract infection • Mostly bacterial • Common pathogens shown below

  20. Pneumonia • Symptoms and Signs • High temp • Productive cough • Tachypnoea (>50) • Grunting • Recession • Cyanosis • Lethargy • Focal signs / bronchial breathing

  21. Pneumonia • Investigations • NPA • FBC • Microbiology • CXR (not of mild and uncomplicated) • Pleural fluid if effusion may be indicated

  22. 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

  23. Tuberculosis • Consider in at risk groups • Mantoux test • CXR • Specialist referral

  24. Summary • URTI • Croup • Epiglottitis • Whooping Cough • Bronchiolitis • Pneumonia • TB

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