Common Respiratory Infections PDF

 Common Respiratory Infections Classification of respiratory infections: Respiratory infections are classified according to the level of the respiratory tract most involved: Upper respiratory tract infection...

 Common Respiratory Infections Classification of respiratory infections: Respiratory infections are classified according to the level of the respiratory tract most involved: Upper respiratory tract infection Laryngeal/tracheal infection Bronchitis Bronchiolitis Pneumonia. Croup laryngotracheobronchitis Mucosal inflammation and increased secretions affecting the airway, and the edema of the subglottic area. Viral croup accounts for over 95% of laryngotracheal infections. Croup occurs from 6 months to 6 years of age but the peak incidence in 2nd year of life. It is commonest in the autumn. Etiology: Clinical Features: Examination: Diagnosis: Parainfluenza viruses Low Fever and Vital signs Clinical Human metapneumovirus coryza - Tachycardia, tachypnea, low ox Diagnostic test rarely Respiratory syncytial virus RSV Barking cough conc needed. Influenza Harsh stridor Oral cavity✘ not favorable “more Neck X ray: steeple sign Rhinovirus Hoarseness damage Chest examination Adenovirus - inspection: accessory muscle use, respiratory distress, cyanosis (if sever), tired/ fatigue. - - Auscultation: stridor (from upper airway lower unaffected) DDx: Management: Minimizing agitation in a symptomatic child can help improve symptoms. Placing the child in a comfortable position may help improve the evaluation and treatment process. Self-limited disease. But?? but there is a risk of upper airway obstruction and that’s why you need to manage the patient, so every patient that comes to the ER with croup should receive oral steroid ! Dexamethasone 0.15 0.6 mg/kg: faster resolution of symptoms, and decreased return to medical care. MOA: Corticosteroids are thought to work by decreasing laryngeal mucosal edema through their anti- inflammatory effects. You can also give prednisolone for 5 days but in classical teaching we give Dexamethasone. A single dose of nebulized budesonide (2mg) is indicated in children with mild-to-moderate or moderate- to-severe croup. Some give nebulized budesonide with dexa. Humidified Air Nebulized Racemic epinephrine: causes vasoconstriction in the mucosa of the subglottic area and reduces airway edema, providing symptomatic relief for the duration of its action ( 5years: Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae, S.aureus (MRSA) At all ages Mycobacterium tuberculosis should be considered. Pathophysiology: Pneumonia develops when the normal defensive mechanisms in the lower respiratory tract are impaired and invaded or overwhelmed by a pathogen. Pathogen proliferate in the lower respiratory tract immune and inflammatory process resultant accumulation of fluid, white blood cells, cellular debris in the alveoli. This leads to a reduction in pulmonary compliance, collapse of alveoli, and pulmonary ventilation- perfusion mismatch, giving rise to the symptoms and signs of pneumonia. 4  Clinical Features: Fever Vital signs Febrile, tachycardic, tachypneic and low oxygen saturation if patient sick Difficulty in breathing Nasal flaring, grunting, suprasternal and subcostal Cough retraction. Lethargy ‘unwell’ child. dullness on percussion Irritability, restlessness, Inspiratory respiratory coarse crackles over the Poor feeding affected area Localized chest, abdominal pain pleural irritation decreased breath sounds o Sharp pain bronchial breathing headache, sore throat, myalgias* Wheezing with atypical Pneumonia *Summarize Atypical Pneumoniae : causes Mycoplasma & Chlamydia pneumoniae years school age headache, sore throat, myalgias Systemic manifestations wheezes no consolidation in x ray. Diagnosis: Chest X ray first thing to do o White spots in the middle of lung o or fissure separates lobes in round pneumonia Full blood count WBCs high usually in pneumococcal pneumonia Acute- phase reactant ESR or CRP Chemistry panel Na (hyponatremia) ADH manifestation Sputum CS/ blood CS Blood culture if patient is sick Because with S. pneumonia -> septicemia/ Bacteremia Nasopharyngeal aspirate Chest US Management: Outpatient Vs hospital management Supportive management re-examine the patient within 48 to 72 hours after the initiation of antibiotic treatment Indications for admission: Age Respiratory distress Dehydration Toxic appearance Underlying cardiac, pulmonary, metabolic, immunologic, hematologic or neoplastic disease. children who worsen clinically despite appropriate outpatient therapy. Family is not able to provide appropriate observation Anti-Microbial Therapy: Outpatient: Inpatient Antibiotics: newborn: broad spectrum Abx - clindamycin, vancomycin - School age: macrolide Or amoxicillin - Duration 5 days > macrolide, 7-10 days > amoxicillin Antiviral If viral > influenza > give Tamiflu 5 Prognosis: The majority of otherwise healthy children with community-acquired pneumonia in developed countries recover without any long-term sequelae. Complications: Parapneumonic effusion Empyema Lung abscess bacteremia/septicemia Hyponatremia Prevention: Breastfeeding good hand washing /good personal respiratory hygiene Vaccination (pneumococcal, Hib, and influenza) 6