Post on 08-Jun-2019
Infec'ons of the respiratory system in childhood
Theprinciplesofdiagnosisandtreatment
• Variedagents–Bacteriaandviruses• Clinicalpicturemayvarywithe;ologicalagent• Maybepresentinnormalpeoplebutmaycausediseaseinonlyfew.
Epidemiology
INTRODUCTION
• Upperandlowerrespiratorytractseparatedatbaseofepiglo@s• Upperrespiratorytractconsistsofairwaysfromthenostrilstothevocalcordsinthelarynx,includingtheparanasalsinusesandthemiddleear• Thelowerrespiratorytractcoversthecon;nua;onoftheairwaysfromthetracheaandbronchitothebronchiolesandthealveoli• Thechildren<5yrsofagegetanaverageofthreetosixepisodesofARIsannuallyregardlessofwheretheyliveorwhattheireconomicsitua;on• TheseverityofLRIsinchildrenunderfiveisworseindevelopingcountries
Acute respiratory infec'ons
Ø ARIRESPONSIBLEFOR20%OFCHILDHOOD(<5YEARS)DEATHS(INWHICH90%FROMPNEUMONIA)
Ø ARImortalityhighestinchildren§ HIV-infected§ Under2yearofage§ Malnourished§ Weanedearly§ Poorlyeducatedparents§ Difficultaccesstohealthcare
Ø Out-pa;entsvisits§ 20-60%
Ø Admissions§ 12-45%
• Maycausetheinflamma;onofrespiratorytractanywherefromnosetoalveoli.• Maybeclassifiedas–AURI–AcuteUpperRespiratoryInfec;on(commoncold,pharyngi1s,epiglo41s,&o11smediaetc.)
orALRI–AcuteLowerRespiratoryInfec;on(laryngi1s,layngotrachei1s,bronchi1s,bronchioli1s&pneumonia)
Acute respiratory infec'ons
UPPER RESPIRATORY TRACT INFECTIONS
• Diseasesofthenoseandsinuses:• RHINITIS(COMMONCOLDORCORYZA)-RHINOVIRUSES,ENTEROVIRUSES,CORONAVIRUSES• SINUSITIS-VIRAL/BACTERIAL
• ACUTEPHARYNGITIS• ADENOVIRUS,ENTEROVIRUS,RHINOVIRUS,GROUPABETAHEMOOLYTICSTREPTOCOCCUS(olderchildren)
• LARYNGITIS:• ACUTEINFECTIOUSLARYNGITIS-VIRAL/DIPTHERIA• CROUP• Inflamma;onofthelarynxtracheaandbronchi• ACUTEEPIGLOTTITIS(SUPRGLOTTITIS)
• EARINFECTIONS(ACUTEOTITISMEDIA)-VIRUSES,PNEUMOCOCCUS,HEMOPHILUSINFLUENZA,MORAXELLACATARRHALIS
• TONSILLITIS• GROUPABETAHEMOLYTICSTREPTOCOCCI,EBV
• Childrenaverage8episodesperyear,adults3episodesperyear• E;ologies:
• Rhinoviruses30to35%• Coronavirusesabout10%• Miscellaneousknownvirusesabout20%• Influenzaandadenovirus-30%• Undiscoveredvirusesupto35%• GroupAstreptococci5%to10%
• Parainfluenzawasthefirstrespiratoryvirusisolated(1955)• Seasonalvaria;on
• Rhinovirusearlyfall• Coronavirus-winter
Common Cold- RHINITIS
• Commonsymptomsaresorethroat,runningnose,nasalmucosaconges;on,sneezing,some;mesaccompaniedbyconjunc;vi;s,myalgias,fa;gue• Incuba;onperiod12-72hours• Nasalobstruc;on,sneezing,scratchythroat• Mediandura;on1weekbut25%canlast2weeks• Pharyngealerythemaiscommonerwithadenovirusthanwithrhinoorcoronavirus
Cold
• Mainchallengeistodis;nguishbetweenuncomplicatedcoldandstreptococcalpharyngi;sorbacterialsinusi;s• Goodexamina;on
• Markedexudateorpharyngealerythemasuggests• Streptococcalinfec;on• Adenovirus• Diphtheria
• Rapidan;gentestsforgroupAstreptococcus• Rapidtechniquesforinfluenza,RSV,parainfluenza
Diagnosis and treatment
Cold- treatment
• Reduc;onofmucosaledemaandexcessivesecre;onofmucus:• properhydra;onchild• airhydra;on• nasallavagewithsalinesolu;on,seawater• suc;onofsecre;onsininfants• decongestants(nasalsympathomime;cseg.xylometazoline,oxymetazoline)inolderchildren
• Communityacquiredbacterialsinusi;s• S.pneumoniae• H.influenzae• S.pyogenes
• Nosocomialsinusi;s• Seenincri;callyill,mechanicallyven;lated
• S.aureus• Pseudomonasaeruginosa• Serra1amarcescens
• fungal
Sinusi's
Sinusi's
• Acute-dura;onto12weeks• Clinicaldiagnosisonly
• conserva;vetreatment• Sinusx-rayifthesuspectedpresenceoffluid
• Chronic-dura;on>12weeksdiagnosis:interview+imagingtest• anatomicalchangesinthesinuses• CT,X-raybays• invasivetreatment
• Clinicalfeatures• Sneezing• Nasaldischarge• Facialpressure• Fever• Purulentdrainage• Headache
• Sinusimagingnotrou;nelyrecommended
Acute sinusi's
• Maxillary:usuallyuncomplicated• Ethmoid:cavernoussinusthrombosis-serious• Frontal:osteomyeli;soffrontalbone;cavernoussinusthrombosis;epidural,subdural,orintracerebralabscess;orbitalextension• Sphenoid:Rare,riskoftoextensiontointernalcaro;dartery,cavernoussinuses,pituitary,op;cnerves;commonmisdiagnosesincludeophthalmicmigraine,asep;cmeningi;s,trigeminalneuralgia,cavernoussinusthrombosis
Acute sinusi's: complica'ons
Acute ethmoid sinusi's
• theearliestdevelopingsinusinflamma;on• possibleinyoungerchildren,infants• theseveresymptomsprogressesrapidly• theinflammatoryprocessintheorbital;ssue(especiallyininfants)• highriskofintracranialcomplica;ons-CT• absolutelynecessaryhospitaliza;on,consulta;onophthalmology
Acute maxillary sinusi's
• -Complica;onofacuteinfec;onsupperrespiratorytract,childhoodinfec;ousdiseases,odontogenic• -Over5-6yearsofage• -Bilateralorunilateral• -Headache,dila;on,painaggravatedby;l;ngthehead,cough,nasalpurifica;on
Acute frontal sinusi's
• -Usuallycoexistswithinflamma;onofthemaxillaryandethmoidsinuses,upperrespiratorytractinfec;on• -Olderchildren• -Severeheadache,painintheprojec;onofthesinuses,during;l;nghead
Symptoma'c treatment:
• NSAIDs• mucoly;cs• Inhala;ons• Drugsdecongestants• nasallavagewithsalinesolu;on• Ensuringthecomfortofthechild(lyingdownwithheadheldhigh,non-smokingenvironment),• adequatehydra;on
Treatment
• Inpa;entswithmildormoderatecourseofacutesinusi;s,las;nglessthan7-10daysappliesvigilantobserva;on• Theuseofan;bio;csisrecommendedwhen:
• Orofacialpain,feverabove39stC• Noimprovementaoer7-10days• Signsofdeteriora;onaoerini;alclinicalimprovement
• An;bio;c10-14days• Ilinetherapy:amoxicillin• IIlinetherapy:amoxicillinwithclavulanicacid• inhypersensi;vityreac;onstopenicillins-cefuroxime• Inthecaseofimmediatehypersensi;vitytobeta–lactams-macrolides:clarithromycin,azithromycin
Chronic sinusi's
• 1)An;bio;csmin.3weeks.• 2)Drugsdecongestants(eg.Oxymetazolinenasal,oralpseudoephedrine)• 3)Mucoly;c• 4)steroides(nasal,oral)• 5)salinetonose
• 2)surgicaltreatment-correc;onofanatomicalabnormali;es:adenoidectomy,adenotonsilectomy,correc;onofnasalseptum
• Inflammatorysyndromeofthepharynx• Mostcasesareviral• MostimportantbacterialcauseisStreptococcuspyogenes(15-20%)
• Presentswithsoreorscratchythroat• Inseverebacterialcasestheremaybeodynophagia,fever,headache
Acute pharyngi's
Acute pharyngitis- diagnosis
Congestion of the throat mucosa Vesicles Enlarged lumps of the throat back Pharyngitis usually coexists acute rhinitis Symptomatic treatment: - Antipyretics, analgesics - cough suppressants - Decongestant
Acute pharyngi's: physical examina'on
• Viral:edemaandhyperemiaoftonsilsandpharyngealmucosa-Rhinovirus,Coronavirus-coldsymptoms• Streptococcal:exudateandhemorrhageinvolvingtonsilsandpharyngealwalls• Epstein-Barrvirus(infec;ousmono):mayalsocauseexudate,withnasopharyngeallymphoidhyperplasia
• Inflammatorysyndromeofthepharynx• Mostcasesareviral• MostimportantbacterialcauseisStreptococcuspyogenes(15-20%)
• Presentswithsoreorscratchythroat• Inseverebacterialcasestheremaybeodynophagia,fever,headache
Acute pharyngi's
Cause Symptoms
Rhinovirus,Coronavirus Coldsymptoms
Adenovirus Pharyngealerythemaandexudatemaymimicstreptococcalpharyngi;sConjunc;vi;s(follicular)presentin30-50%ofcases;commonlyunilateralbutbilateralin25%ofcases
Ebstein-Barrinfec;on Fever,swollenlymphnodes,swollentonsilswithexudation
Enterovirus-e.g.Coxsackievirus(Herpangina) Small,1-2mmvesiclesonthesoopalate,uvula,andanteriortonsillarpillarswhichrupturetoformsmallwhiteulcersVomi;ngOccursmainlyinchildren
HSV-1 Severe,blisters,ulcera;onofthemucousmembranes,pain,profusesaliva;on,lackofappe;te
q Tonsilli;siscausedbyavarietyofcontagiousviralandbacterialinfec;ons.
q Itisspreadbyclosecontactwithotherindividualsandoccursmoreduringwinterperiods.
q Themostcommonbacteriumcausingtonsilli;sisstreptococcus.
Tonsili's
Streptococcal pharyngi's (tonsili's)- symptoms • suddenonset• fever>38.5°C,headache,malaise• sorethroataggravatedbyswallowing• ooenabdominalpain,nausea,vomi;ng• thepeakincidence:5-15yearsofage• especiallyinwinter,spring• e;ology:β-hemoly;cstreptococcusgroupA(Streptococcuspyogenes)• includesthethroatandtonsils(tonsilli;s)• some;mes-rush-Scarletfever
• Enlarged,redtonsilswithexudatefoci• loosenessandrednessofthethroat• hypertrophyoffolliclesbackofthethroat• painandswollenlymphglandsintheneckfrontandsubmandibular• petechiaeonthepalate
Physical examina'on
Streptococcal pharyngi's - diagnosis
• Symptomsandsigns• Physicalexamina;on• Rapidtest-Streptest• ASO,throatswabculture
Treatment • Fenoxymetylopenicilinpo100000–200000j.m./kg/24h2xfor10days(bw<40kg)2-3mlnj.m./24h2xfor10dni(childrenbw>40kg)• Benzylpenicylinbenzathineim1x• 600000j.m.(children<40kg),1,2mlnj.m.(children>40kg)• Cefadroxil30mg/kg1xfor10days(children<40kg)1g1xdzfor10dni(children>40kg)• macrolides:clarithromycin,azithromycinIncasesoffrequentrecurrence:clindamycinoramoxicillinclavulanate
Complica'on aJer tonisili's
• Systemic:• Acuterheuma;cfever(heart,joints,skin,CNS)• Acutepost-streptococcalglomerulonephri;s• Myocardi;s
• Local:• Peritonsillarabscess(afewdaysaoerthere-anginafever,sorethroatononeside)• Recurrentpharyngi;s,o;;smedia,sinusi;s
• Vincent’sangina:anaerobicpharyngi;s(exudate;foulodortobreath)• Ludwig’sangina-poten;allylife-threatening,rapidlyexpanding,diffuseinflamma;onofthesubmandibularandsublingualspaces,dentalorigin• Quinsy:peritonsilli;s/peritonsillarabscess.Medialdisplacementofthetonsil;ooenspreadofinfec;ontocaro;dsheath
Vincent’s angina and Quinsy
• S.pneumoniaeandH.influenzaetheleadingcausesinallagegroups)• Moraxellacatarrhalis:10%ofcases• Somecasesmaybeviral(RSV,influenza,enteroviruses)• Mycoplasmapneumoniae:inflamma;onofthetympanicmembrane
Acute o''s media
Acute o''s media
§ Themostcommonconsequenceofaprolongedinfec;onofthenasopharynxunderfavorableanatomicalcondi;ons:§ Dysfunc;onoftheEustachiantube§ Hypertrophytonsils§ Adenoidhypertrophy
§ Cri;calroleofEustachiantubeasconduitbetweennasopharynx,middleear,andmastoidaircells
§ Childrenhaveshorter,widerEustachiantubesthanadults
• earpain(throbbing)• hearingproblems• coexis;ngsymptomsofcatarrhalinfec;ons• aversiontofood(infants)• irritability• inchildren<3yearsofagenonspecificsymptoms:anxiety,vomi;ng,slightfever/fever,cryingatnight,conjunc;vi;s,poorappe;te,rubbingtheear
Symptoms
Otoscopic examina'on
Acuteo;;smedia-signstheeardrumis:§ bulging§ cloudiness§ redness
O''s media with effusion
O;;smediawitheffusion(OME)-serouso;;smedia(SOM)orsecretoryo;;smedia(SOM)§ Presenceoffluidinthemiddleear§ Thefluidmaytakeweekstoresolve
Differen'al diagnosis- AOM
• inflamma;onofthecervicallymphnodes• pharyngi;sandtonsilli;s• mumps• diseasesoftheteeth,temporomandibularjoint• boilintheexternalauditorymeatus• foreignbodyintheearcanal
AOM- complica'ons
• mastoidi;s• meningi;s• venoussinusesthrombosis• brainabscess• VIInervepalsy• labyrinthi;s• recurrento;;smedia• lossofhearing!!!
Treatment
• Acuteo;;smediawithpainintheini;alperiodshouldbetreatedwithibuprofenoracetaminophen.
• Immediatean;bio;ctreatmentisrecommended:1. Inchildrenunder6monthsofage2. Inchildrenwithahighfeverandvomi;ng3. Inchildrenunder2yearsofagewithbilateralo;;smedia4. Inpa;entswithleakagefromtheear
Treatment
• Amoxicillin75-90mg/kg/dayin2doses(<40kg),1500-2000mgevery12hours(>40kg),treatment;me10daysinchildren<2r.ż5daysinchildren>2r.ż.• Second-linean;bio;cs:amoxicillinwithclavulanicacid,cefuroximeaxe;l,cefaclor,ceoriaxone• Inthecaseofallergytopenicillin:macrolides
Larynx diseases
• Acutediffuseinflamma;onofthelarynx(laryngi;sacutadiffusa)• Acuteinflamma;onoftheepiglo@s(epiglo@;sacuta)• Acutecroup(laryngi;sacutasubglo@ca)• Acuteinflamma;onofthelarynx,tracheaandbronchi(laryngotracheobronchi;s)• Acutemalignantinflamma;onofthelarynx,tracheaandbronchi(laryngotracheobronchi;smaligna)
Larynx disease signs
• Withoutstenosisofthelarynx:• hoarseness• aphonia• barkingcough
• Withnarrowingofthelarynx• hoarseness• aphonia• Inspiratorystridor• Laryngealdyspnea(inspiratory,inspiratory-expiratory)• workofaccessorymuscles
• Life-threa;nginfec;on• Occursmostlyinwinters• Peakincidence:-1–6years• Maleaffectedmore• Bacterialinfec;on(Hemophilusinfluenzatypeb)• Concomitantbacteremia,pneumonia,o;;smedia,arthri;sandotherinvasiveinfec;onscausedbyH.influenzatypebmaybepresent
ACUTE EPIGLOTTITIS
• Clinicalfeatures• Highfever,sorethroat,dyspnea,rapidlyprogressingrespiratoryobstruc;on• Pa;entmaybecometoxic,difficultswallowing,labouredbreathing,drooling,hyperextendedneck• Cyanosis,coma,death• Stridorisalatefinding
ACUTE EPIGLOTTITIS
• Donotexaminethethroat• Assessmentofseverity
• Degreeofstridor• Respiratoryrate• Heartrate• Levelofconsciousness• Pulseoximetry
EXAMINATION
• DIAGNOSIS:• “CHERRYRED”APPEARANCEOFEPIGLOTTISONLARYNGOSCOPY• THUMBSIGNONLATERALNECKRADIOGRAPH
ACUTE EPIGLOTTITIS
• NEEDTOBEMANAGEDWITHENDOTRACHEALINTUBATION• HELPFROMANAESTHETIST• BLOODCULTURES• FLUIDANDELECTROLYTESUPPORT• INTRAVENOUSAMPLICILLIN100mg/kg/dayORCEFTRIAXONE100mg/kg/day.• OTHEROPTIONS
• (CEFUROXIMEORCEFOTAXIME)TOTALTREATMENT:-7-10DAYS
• RIFAMPICINPROPHYLAXISTOCLOSECONTACTS
TREATMENT - ACUTE EPIGLOTTITIS
• VIRALINFECTIONLEADINGTOMUCOSALINFLAMMATIONOFTHEGLOTTICANDSUBGLOTTICREGIONS• COMMONLYDUETOINFLUENZA(TYPEA),PARAINFLUENZA(1,2,3)ANDRSV• AGE:-6MONTHS–6YEARS
Laryngi's acuta subgloUca (VIRAL CROUP)
• INITIAL:-RUNNINGNOSE,MILDCOUGH,FEVER(LOWGRADE)• LATER(24-48HOURS):-
• BARKINGCOUGH• HOARSENESSOFVOICE• NOISYBREATHING(MAINLYONINSPIRATION)
• SYMPTOMSWORSENATNIGHTANDONLYINGDOWN• CHILDRENPREFERTOBEHELDUPRIGHTORSITINBED• SYMPTOMSRESOLVEWITHINAWEEK
CLINICAL FEATURES
• HOARSEVOICE• NORMALTOMODERATELYINFLAMMEDPHARYNX• SLIGHTLYINCREASEDRESPRATEWITHPROLONGEDINSPIRATIONANDINSPIRATORYSTRIDOR• DIAGNOSIS
• MAINLYACLINICALDIAGNOSIS
EXAMINATION
• TREATMENT• MOISTORHUMIDIFIEDAIR• COLDNEBULISATION–0,9NaCl• LOWTEMPERATURE18-20stC• Treatmentoffever• Fluids• STEROIDS
• REDUCETHESEVERITYANDDURATION/NEEDFORENDOTRACHEALINTUBATION• dexametazon 0,15 - 0,6 mg/kg mc im. lub iv.)
• NEBULIZEDADRENALINE(EPINEPHRINE)5mg
Treatment
Acute diffuse inflamma'on of the larynx
• Inmostcases-adults,schoolchildrenandolderchildren• E;ology–viral,misuseofvoice,otherirritantssubstances• Symptoms:hoarseness,drycough,scratching,burninginthethroat,shortnessofbreathinyoungerchildren• Accompanyingsymptoms:runnynose,conjunc;vi;s• Treatment-symptoma;c:Savingvoice,nebulisa;onwithsaline,mucoly;cs
• BRONCHITIS• BRONCHIOLITIS• PNEUMONIA
LOWER RESPIRATORY TRACT INFECTIONS
BRONCHITIS ACUTA
• Cause• Viral-Parainfluenzae,Adenovirus,RSV,Rhinovirus• Bacteria
• Primary:Bordetellapertusis,Mycoplasmapneumoniae• Secondarytoviralinfec;on:H.influenzae,S.pneumoniae,S.aureus
• Symptoms:• drycoughprecededbyinflamma;onoftheURTI(2-3days)• drycough,thenwetcough• short-termfeverorfeverless• vomi;ng• expiratorydyspnea• coughinguptoseveralweeks
BRONCHITIS ACUTA
Clinicalexamina4on• Lungshyperinfla;on/disten;on• percussion-hyper-resonantsound,lungslimitsarelower,• asculta;on:wheezing,rales,mediumandcoarsecracles,• dyspneafeatures:tachypnea,respiratoryeffort,prolongedexpiratoryphase
Addi4onalexamina4on• onlynecessaryinsevereorpersistentcases• ChestX-ray-withoutpulomonaryconsolida;on,distensionperipheralpartsofthelungs• gasanalysis• measurementofoxygensatura;on• TestsforChlamydiapneumoniae,Mycoplasma,RSV
BRONCHITIS ACUTA -TREATMENT
• humidity,lowtemperature,properhydra;on• an;pyre;cs• symptomsofobstruc;on-nebulizedbronchodilators• bacterialsuperinfec;on-empirican;bio;c-amoxicillin;alterna;vely-cefuroxime,amoxicillinwithclavulanicacid,macrolide
• Oneofthemostcommondiseasesininfantsandyoungchildren;typically<2yearsofage(mostinfants>6monthsofage)
• Inflammatorydiseaseofthebronchioles• Peakageofonset:6months
• Some;messeverecourseoflife-threateningrespiratoryfailure
• Mostcommonagent:RSV-respiratorysyncy;alvirus,• Other-parainfluenzavirus,influenza,adenovirus,metapneumoviruses
• Male:female:-2:1• Occursmostlyinautumn/spring
• transmissionbydropletsandbydirectcontact
BRONCHIOLITIS
• Twophases:1. 2-3daysofinflamma;onURTI2. Rapiddeteriora;onofgeneralcondi;on:
• Dyspnea-insipratory-expiratory,respiratorycyanosis,• Dry,paroxysmalcough,some;mescausingvomi;ng• Loud,wheezingbreath• Irritability,feedingdifficulty• Episodesofapnoea
CLINICAL FEATURES
• Rapidshallowbreathing(60-80/min)• Centralcyanosis/pallor• Useofaccessorymusclesofrespira;on
Subcostal/intercostalrecessions,Flaringofalaenasi
• Expiratorywheeze/grun;ng• Prolongedexpira;on,tachypnoe• Hyper-resonantpercussionnotes• Chesthyperinfla;on• Ausculta;on:finecracklesatthetopoftheinhala;onandexhala;onbeginning,wheezing,silenceoverthelungs!!!(extremehyperinfla;on)
EXAMINATION FINDINGS IN BRONCHIOLITIS
• ChestX-ray• Hyperinfla;on,increasedlucencyandincreasedbronchovascularmarkingsandmildinfiltrates
• arterialbloodgas(hypercapnia,hypoxemia,acidosis)• completebloodcount,CRP• Pulseoximetry• Nasopharyngealswabs(viralculture)• Viralan;bodytests
BRONCHIOLITIS
AchestX-raydemonstra;nglunghyperinfla;onwithaflazeneddiaphragmandbilateralatelectasisintherightapicalandleobasalregionsina16-day-oldinfantwithseverebronchioli;s
• COMPLICATIONS• Pneumonia• Pneumothorax• Dehydra;on• Respiratoryacidosis• Respiratoryfailure• Heartfailure• Prolongedapneicspellsàdeath
BRONCHIOLITIS
• Mainlysuppor;ve-humidifytheair,appropriateplacementofthechild,assistedevacua;onofsecre;onsfromthenose• Nebulisa;onshypertonic3%sodiumchloridesolu;on• nebulizedadrenaline• Oxygeninhala;on(achieveO2>92%)• Iftachypneic,limittheoralfeedsanduseangtubeforfeeding• Parenteralfluidstolimitdehydra;on• Correctrespacidosisandelectrolyteimbalance• Mechanicalven;la;on(severerespdistressorapnoea)
• Notrou;nelyrecomended:β-agonists,an;cholinergics,Ribavirin,steroids• Notusedrou;nely:Immunoglobulinan;-RSV
BRONCHIOLITIS - treatment
Inflamma;onofthelungparenchymaandisassociatedwiththeconsolida;onofthealveolarspacesDevelopedworld
Viralinfec;onsLowmorbidityandmortality
Developingworld-commoncauseofdeathBacteriaandPCPin65%
PNEUMONIA
• Varyaccordingto• Age,immunestatus,wherecontracted
• Developedcountries• Viruses:RSV,Adenovirus,Parainfluenza,Influenza• MycoplasmapneumoniaeandChlamydiapneumoniae• Bacteria:5-10%
• Developingcountries• S.pneumoniae,H.influenzae,Saureus• Viruses40%• Other:Mycoplasma,Chlamydia,Moraxella
E'ology
ETIOLOGY ACCORDING TO AGE
AGEGROUP CAUSATIVEORGANISM
NEONATES GROUPBSTREPTOCOCCUSE.COLIKLEBSIELLASTAPHAUREUS
INFANTS RSV,parainflenza,adenovirus,infleunzavirusgrypy,enterovirus,rhinovirus,HSVPNEUMOCOCCUSCHLAMYDIAH.INFLUENZATYPEb
CHILDREN1TO5YRS RESPIRATORYVIRUSESPNEUMOCOCCUSH.INFLUENZATYPEbC.TRACHOMATISM.PNEUMONIAES.AUREUSGPASTREPTOCOCCUS
CHILDREN5TO18YRS M.PNEUMONIAEPNEUMOCOCCUSC.PNEUMONIAEH.INFLUENZATYPEb
Pneumonia
Pneumonia
Community-AcquiredPneumonia
Atypicalpneumonia
(mycoplasma;c,chlamydia,viral)
Typicalpneumonia(bacterial)
Nosocomialpneumonia
Aspira;onpneumonia
Pneumonia- diagnosis
ü Fever ü Cough ü Dyspnea expiratory- inspiratory, ü Tachypnoe And … +Typical sounds during auscultation + typical changes in X-ray • ThebasisofdiagnosisisachestX-ray• Lungconsolida;onoftheonesegmentallobe• Inters;;alchangesNOTE:intheearlystagesofthediseasex-raymaybenormal
• Signofrespiratorydistress;nasalflaring&chestindrawing
• Youngerthan2months• Decreasedlevelofconsciousness• Stridorwhencalm
• Severemalnutri;on• Associatedsymptoma;cHIV/AIDS
Danger Signs
Bacterial pneumonia -symptoms
• youngerchildrenooenatypicalsymptoms:• fever>38.5stC,chills• anxiety• gastro–intes;nalproblems• tachypnoe>50/min.• withoutcoughingearlyinthedisease
• inolderchildren(>6yearsofage)imageofatypical,similartothatobservedinadults:• cough,tachypnea• fever>38.5stC,chills• paininthechest
Bacterial pneumonia
Clinicalexamina4on• Percussion:thedullsoundovertheareaofinflamma;on• Tremorchestincreased• Ausculta;on:• -finecracles• -Tighteningofthefollicularmurmur• -Murmurbronchial
Addi4onaltests• X-rayCHEST:densityinflammatory:lobar,inters;;al
• LABORATORYTESTS:• -WBC(upto15-40thousand/mm3),thepredominanceofneutrophilsorWBC<5thousand/mm3(badprognosis)
• -Shiototheleoinasmearofwhitebloodcells,anemiainsevereinfec;ons(eg.Staphylococcal)
• -ArterialbloodgaspO2• -ESR,CRP• -Bacteriacultureofsputum,(chargeontopofthefever),pleuralfluid
Atypical pneumonia
• Thee;ologyofMycoplasmapneumoniae,Chlamydophilapneumoniae• schoolchildren• insidiousonset• moderatefever• jointpain,headache,cough,;ring,unproduc;ve,wheezing,• respiratoryratenormalorincreased• characteris;csofhyperinfla;on• X-ray:inters;;alinfiltrates,pleuraleffusion,lymphadenopathyinthehilumlung• Serologicaltests-an;bodies
Viral pneumonia
• E;ology:RSvirus,influenza,parainfluenza,adenovirus,measles,CMV,• Pneumoniaprecededbyinflamma;onoftheupperairways• Inolderchildrenmild,withoutcomplica;ons.Ininfantsandtoddlerscoursemaybesevereandlife-threatening.• Inthecaseofthee;ologyofRSV->wheezing,shortnessofbreath• Laboratorytests:leukocytosiswithlymphocytosis• X-ray:inters;;alchanges,hyperinfla;on
Treatment
• Thecool,moistair• Respiratoryphysiotherapy• Adequatehydra;on• Proceedingsan;pyre;c(non-pharmacologicalmethod,drugs)andanalgesic• An;bio;c
• An;tussives,an;histamines-notrecommended!!
An'bio'cs
• Children3week-thethirdmonthoflife-amoxicillinwithclavulanateorcefuroxime• Inseverecases-cefotaximeorceoriaxoneincombina;onwithcloxacillin.• Ifthee;ologyisatypical-macrolide• Children3months-5yearsold–ampicilinoramoxicillin• Children5-15yearsold-amoxicillinormacrolide,forsevereconcomitanttreatment->macrolideandamoxicillin
• Thedura;onoftreatment7to10dayswhenazitromicin5days• Inmilderformofdisease-5days
Preven'on
• VACCINATIONS:• vaccina;onagainstH.influenzaetypeB(vaccina;onrequired)(2mo,3-4mo,5-6mo,16/18mo)• vaccina;onagainstS.pneumoniae(vaccina;onrecommended)• influenzavaccina;on(vaccina;onrecommendedonceayear)
Bacterial• Poorlydemarcatedalveolaropaci;eswithairbronchograms• Lobarorsegmental• Opacifica;on
Viral• Peripheralstreaking,inters;;alchanges,• airtrapping
Radiology- chest X- ray
• Cluestootherspecificorganisms• Staphylococcus–areasofbreak-down• Klebsiella,anaerobes,H.influenzaorTB–cavita;ngorexpansilepneumonia• TB,S.aureus,H.influenza
• pleuraleffusionandempyema
Radiology