Pediatric Respiratory Infections and Conditions

Classified in Medicine & Health

Written at January 4, 2024 on English with a size of 19.56 KB.

Acute Pharyngitis

Why Children get sick more often:

I-Physiological!

Anatomical
Nasal canal Narrow+short
Eustacian tube is short, Soft Mucosa
Pharynx may be narrow
Larynx is funnel shape
Lower Airway
More vasculature

Immature immune:

-No Humeral Immunity up to 3 M (IgA, IgG/IgM)

Immune weaker

Poor mucosal immunity

IgA Low in Bronchi

Endogenous Factors:

Cystic Fibrosis

Anatomic defect

Alpha1 antitrypsin Inhib Def!

Rickets

Preterm

Acute Cold:

Etiology:

Viral infection

Prominent sx Rhinorrhea+Nasal Obstruction

Rhinovirus+Coronavirus

CF:

Develop 1 to 3 days after viral infection

Nasal obstruction

Rhinorrhea

Sore or "scratchy" throat

Non-productive cough

Fever can be present

Colds usually persist about 1 week, although 10% last 2 weeks.

I-Lab Studies:

Nasal Smear for Eosinophil

Tx:

No Specific Therapy:

Management of Sx therapy:

If fever >38°C, antipyretic drugs can be used,
Acetaminophen may reduce symptoms of sore throat.
First-generation antihistamines reduce rhinorrhea
Antitussive drugs can be used in case of dry

Complication:

Otitis Media Most Common

Bacterial sinusitis

Fever, Facial Pain, Swelling

Acute Rhinosinusitis:

Etiology:

Sinusitis is supportive Infection of paranasal sinus

Bacteria:

S. PN
Moraxella atarhallis
Influenza
S Auerus

CF:

Typical symptoms:

Persistent, mucopurulent,

Nasal stuffiness

Cough, especially at night

Less common symptoms:

Nasal quality to the voice

Halitosis (bad breath)

Facial swelling

Facial tenderness and pain

Headache

Sinusitis may exacerbate asthma.

Complication:

Orbital cellulitis (spread of bacteria into the

Orbit through the wall of the infected sinus)

Otitis media

Epidural or subdural empyema

Brain abscess

Tx:

I-Acute sinusitis:

Penicillin /Amoxillin

Ceguroxin

II-Chronic Sinusitis:

Amoxicillum

Cefuroximum

**Acute Pharyngitis!

Etiology:

Many infectious agents can cause pharyngitis:

Group A streptococci

Group C beta-hemolytic streptococcus;

Chlamydophila pneumoniae

M. pneumoniae

Many viruses cause acute pharyngitis:

Adenoviruses

Coxsackie A

Rhinoviruses

CF:

High temperature

Tonsils red, puffy

Sore throat; throat pain, when swallowing

Regional lymph node reaction

Vomiting

Cough

Intensive redness of throat, tonsils; very painful swallowing

Tonsils with purulent exudate

High T - up to 40,5 C with chills

Nausea, vomiting

Possible skin rash

Tx:

Benzylpenicillin IV, phenoxymethylpenicillin per os

Neo-macrolides (clarythromycin, azytromycin)

I - II generation of cephalosporins – good penetration

Bronchitis:

Etiology:

Bronchitis refers to nonspecific bronchial inflammation and is associated with a number of childhood

Usually viral in origin+cough as a prominent feature.

Causing :influenza/pertussis/Diphtheria/Pn/S Aureus!

Acute:

Is when Trachea is Involved!

CF:

Rhinitis

3-4	5-10
Malaise Slight fever, chills Back and muscle pain Frequent, dry, hacking cough Purulent sputum Chest pain exacerbated by coughing	Mucus thins, cough abates Low grade fever Upper respiratory signs: nasopharyngitis, conjunctivitis, and rhinitis As the syndrome progresses: (cough worsens, breath sounds become coarse). Chest radiographs are normal or may have increased bronchial markings.

DX:

Clinical Feature+ Hx!

Some Test To Rule out Pn/ASthma:

(chest x-ray)

(blood tests)

(pulse oximetry)

(sputum and nasal discharge cultures

(pulmonary function tests from 5-7 years

(bronchoscopy)

(CT scan)

Tx:

No specific Therpay !

Use Humidifier if air is dry

Shit position

Cough suppressant

Antihistamine

Expectorant!

Child Pn :

Gx:

Pneumonia is an inflammation of the parenchyma of the lungs.

Cause=Bacteria

epidemiology:

High Morbidity!

Etiology:

Streptococcus pneumoniae (pneumococcus)

Chlamydia pneumoniae and Mycoplasma pneumoniae.

Virus pneumonia: influenza, para influenza, RSV, etc

Bacterial pneumonia:

(pneumococci, H.influenza, staphylococci, pseudomonas)

Atypical pneumonia: mycoplasma pneumonia, Chlamydia, legionella

Parasitic pneumonia: toxocara, ascarides

Fungal pneumonia: candida, aspergilus

Classification

Clinical types:

Community acquired

Hospital acquired

Other types (aspirative, necrotizing, opportunistic)

Typical/atypical

Acute/chronic

Other types: lobat/multilobar, bronchial, interstitial

Non complicated/complicated

Community Acquired Pn :

Children Pn:

CF:

High temperature

Cough

Wheezing

Respiratory distress

Auscultation: bronchial breathing,a

Locally altered percussion sound

Chest pain or abdominal pain

Dx:

XRay:

Pulmonary parenchymal infiltration

During first few days of illness radiological changes may not appear

Repeating x-ray is necessary just for complicated pneumonia (

Lab Test:

Pulse oximetry: in suspicion of respiratory distress (SpO2 > 92%)

Blood gas analysis (Sa02, pO2, pCO2, PH) will be more appropriate when SpO2 is

CBC and CRP

Procalcitonin concentration: for pneumonia with sepsis

Microbiological investigation:

Blood cultures: for children with severe bacterial pneumonia

Nasopharyngeal aspirates (children

Sputum microbiology test

When pleural fluid is present, should be aspirated for diagnostic purposes

Tx:

Depends on the Cause+ Pts

If not Hospitalization---->amoxilin(80-90 mg/kg24)

Hospitalized empiric x is

Cefuroxin 150mg/kg)/Cetriaxone

C pneumonia--------->Macrolide

If Staph bacteria suspected---->Vanco/Condamycin

Adolescence---->Fluoeuoilone For Atypical pm

Viral ----->No Ax!

Atypical Pn :

Caused by

pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Mycoplasma pneumonia is a type of atypical pneumonia. It is caused by the bacteria M.

pneumoniae.

Pneumonia due to chlamydia-related bacteria occurs year round and accounts for 5 - 15% of all

Pneumonia due to mycoplasma / chlamydophila:

Gets worse during the first 4 - 6 days, and then

Improves over 4 - 5 days.

Even though symptoms will improve, it may take a while for them to go away

The most common symptoms of pneumonia are:

Chills

Cough (with Legionella pneumonia, you may cough up bloody mucus)

Fever, which may be mild or high

Shortness of breath

Confusion, especially in older people or those with Legionella pneumonia

Headache

Loss of appetite, low energy, and fatigue

Dx:

Complete blood count (CBC)

Blood cultures

Blood tests to identify the bacteria

Bronchoscopy (rarely needed)

CT scan of the chest

Open lung biopsy

Sputum culture

Tx:

I- home:

Control fever with aspirin,

(NSAIDs, or acetaminophen.)

Drink plenty of fluids to help loosen secretions and bring up phlegm.

Get a lot of rest.

II-Antibiotics are used to treat atypical pneumonia.

Azithromycin

Clarithromycin

Erythromycin

Fluoroquinolones and their derivatives (such as levofloxacin)

Tetracyclines (such as doxycycline)

III-Hospital:

Antibacterial :

Empiric at the beginning, later according to culture results and antibioticogram

Antiviral : if there are doubt of presence of influenza or other virus infection

TB:

Gx:

Chronic infection with latency period!

Lungs is the organ

Sx( Productive cough/ chest pain /Dyspnea)

Active TB:Sx are active (Fever Weight Loss, Night Sweats, Productive cough)Can spread by blood to other organs!You can expect to find Xray changesLatent TB:Only found out by Tb Skin Test or IGRA !If Tx Decrease Risk of Active TB

Dx:(exclusion)

Chest x-ray

Tuberculin skin test

Acid-fast stain and culture

When available, DNA-based testing

-Sputum Examination

-Drug suspectility Test

-------->Tubeclin skin test=GOLDSTANDRD!!!!(myocobacteriun antigen into Forarm , 5-10 cm below elbow)( 5 TB unites)

Dx For High Risk :>5 mm Diamater induration

Dx for Normal children:>10 mm---->(-) Result DOES Not Rule out TB

^IGRAfor TB(interpheron gamma)is blood test----->which is run trouh seroogy analysis in lab ... searching for TB antigens !!..Dont Go into details No need to know that much!!!!!!just know both test tuberclin + IGRA both can be used for confirming TB infection BUT NOT DIEsASES!!!!!!^^Tx:- Send child to TB clinic with pediatric expertise- Confer with local health department and pediatric TB consultant- Four drug empiric therapy using directly observed therapy DOT- DOT: non family member observes patient taking medication- DOT : can increase completion rates to 90% range

1-Isoniazid : daily dose in mg/kg/dose : 10-15 (300mg)- Twice weekly : 20-30 (900 mg)-Course of treatment : initial phase 2 months , continuation phase 6 months

2- Rifampin : daily dose in mg/kg/dose:10-20 (600mg)-Twice weekly:10-20(600 mg)- Course of treatment : same as isoniazid

1-Isoniazid : daily dose in mg/kg/dose : 10-15 (300mg)- Twice weekly : 20-30 (900 mg)-Course of treatment : initial phase 2 months , continuation phase 6 months2- Rifampin : daily dose in mg/kg/dose:10-20 (600mg)-Twice weekly:10-20(600 mg)- Course of treatment : same as isoniazid3- Pyrazinamide: daily dose in mg/kg/dose: 20-40 (2 grams)-Twice weekly:50 (2 grams)- Course of treatment :Initial phase : 2 months4 Ethambutol: daily dose in mg/kg/dose:15-25 (2.5 grams)After 2 M the Regiment can be Changed!^^PRevention:-Treat and cure adults with smear positive TB-Always try to identify the index case- BCG vaccination:- Weakend mycobacterium bovis- Intradermal injection- given at birth- Protects against sever forms of TB , eg : TB meningistis , military TB

**Otitis Media:

-2nd infection

^^Cause:

-S Pn

-H influenza

-Morzxalla

-S arueus

^^PX:

-bacteria enter through Tube

-Meatus

-hematogenous!

^^CF:

Ear pain

-Fever

-Otorrhea

^^Dx:

-Otoscopy

-Radiology

^^TX:

Ax(amoxillin for 39X!!

for 2 Days

Then Add Clavulanic!

-Antipyretic

-Antihstamine

-Decongestions!

***Adenoid Hypertrphy :Enlarge when infectted^^CFI- Acute adenoiditis:- Prolonged rhinitis and mucoid- purulent nasal discharge- Difficulty breathing through nose- Leakage of posterior pharyngeal wall (posterior rhinorrhea)- Fever from subfebrile → febrile- CoughII- Chronic:- Prolonged cough at night- Recurrent bronchitis- Recurrent otitis- Impaired hearing^^Tx:Adenolectomg if(perisitent mouth Breathing)(adenuod Face)(Recurrent chronic otitis)(Recurrent bronchtiis2-wash nose3-Ax(peniccilin)**PEDIATRIC ASTHMA:^^Gx:-Chronic inflmmation-Bronchi hyperresponsive of Bronchi-Episodic exacerbation +reversible airflow obstruction''the MAIN symptomns is intermittent Dyspnea''^^Causes:-allergic asthma=typical for children-Non allergic for Adults!Allergic(children)-Main RF= Atopy!-pollen,dusmutes,Animals^^CF:-Intermittent duspnea(Main)-High Pitched Wheezing-Coughing-Improve with Anti Asthmaitc X

Mild	Severe
-Persistant Dry cough(night/ excercise)-Dyspnea-Chest tightness	-Severe dysnea-Hypoxemia-accesory muslce use

^^Dx:1-PFT=SPIROMETRY = GOLD STANDARD!(MILD----->80%)(Moderate--------->50-80%)(SEVERE 2-allergy Test3-Sensitiz4-Asculatation (prolonged exp with wheezing)^^Tx:I-Avoid X /No Smoking/Inform ParentsII-Short Term:-SABA(Albutarol)----> within 5-10 min for 4-6 H-Anticholinergic------>Relives cosntirction by decrease mucous production-Oral CS (1mg/kg/d)--------->3-10 days for asthma exacerbationIII-Long :-Inhaled CS-------->Chronic athma-Leukotrien modifiers-LABA(salmetrol)-------Omalizumab--->anti -IgE-Anti histamines***ExacerbationSteps1-O2+SABA (alberatol) evey 20 min2-Low Dose ICS3-Low Dose ICS + LABA /Meduim Dose ICS4-Medeuim dose ICS + LABA5-High Dose ICS+ LABA / Omalizumab6-High Dose ICS+LABA+ OMALIZUMABSum up:-O2 -SABA (albuterol) every 20min-CS oral IV----> Improve outcome-Anticholinegice are added to SABA every 6 H-Mg Sulfate--->Severe-Epinephrinne in asthma !(anaphylaxis)

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