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Respiratory tract infectious
Respiratory tract infectious
Upper LowerCommon cold Bronchitis Pharyngitis BronchiolitisLaryngitis PneumoniaAcute otitis media
Acute sinusitis
Upper respiratory tract infection
• Etiology:Viruses: e.g rhinoviruses, adenoviruses, RSV,
enteroviruses, EBV,Bacteria: e.g Streptococcus. Pnumococcus,
Hemophilus influezna,moraxella catarrhalisFungi: e.g Candida albicans,
Common cold -coryza
• Viral ethiology• Clear or mucopurulent nasal discharge or
nasal blockage• Fever may occur • Other symptoms : tiredness , headache, • Treatment : paracetamol, ibupropfen,
Pharyngitis
Symtoms: Throat pain, Fever Physical exam: Inflammed,red pharynx ,
lymph nodes can be enlarged Etiology: 2/3 viral, 1/3 bacterial
Viral Bacterialdrops of dew- likedrops of dew- like pharynx distinctly pharynx distinctly
redred
accompanying accompanying coryzacoryza
coryzacoryza
lymph nodes lymph nodes slightly enlarged or slightly enlarged or not enlargednot enlarged
lymph nodes lymph nodes prominently prominently enlarged and enlarged and tendertender
Laboratory testLaboratory test
Usually low Usually low CRP,WBC, CRP,WBC,
LymphocyteLymphocyte in in Blood filmBlood film
High CRP,High CRP,
WBC low or highWBC low or high
Neutrophil Neutrophil granulocytegranulocyte
Viral
Bacterial
Tonsilitis
• Fever• red and/or swollen tonsils • white or yellow patches on the tonsils • tender, stiff, and/or swollen neck(swollen lymph
nodes)• painful or difficult swallowing• Sore throat• Abdominal pain , vomiting• Antibiotic should be given (penicillin, macrolid)
Tonsilitis
Mononucleosis(glandular fever)• fever• tonsilitis (sometimes causing airway narrowing)• prominent lymphadenopathy (Neron’s neck)• hepatosplemomegaly• a maculopapullar rash• no positive reaction to antibiotic• most commonly contracted by adolescents and
young adults ages
• Etiology: mostly EBV
Mononucleosis
Scarlet fever• acute, bacterial, rash disease of childhood• caused by β hemolytic streptoccoccus, group
B• incubation period 1-7 days ( average-3 days)
acute onset, fever,vomiting, abdominal pain,• pharyngitis , tonsilitis• rash appears on 1 or 2 day- macular ,punctate
intensively red• characteristic location on face- paleness
around mouth, spreading downwords
Scarlet fever
• characteristic tongue ( white strawberry tongue→ red strawberry tongue
• haemorrhagic lesions in articular fossae ( Pastia lines)
• Desquamation begins after a week from face to limbs
Acute infection of the middle ear
• fever , pain in ear, irritation, loss of appetite
• examination of tympanic membrane: loss of normal light reflection, bulging, red membrane
acute infection of the middle ear
Complications:• mastoiditis• meningitis
Reccurent ear infection may cause chronic secretory otitis media( glue ear), leading to hearing loss
Sinusitis• Sinusitis is inflammation of the paranasal
sinuses Most cases are due to a viral infection • Pain, swelling, tendreness over a cheek, nasal
blockage, headache• Treatment: antibiotics, histamine blockers,
decongestants,
Laryngitis• Symptoms• Hoarseness or no voice at all • Dry, sore burning, throat • Coughing, barking cough• stridor• Difficulty swallowing • Sensation of swelling in the area of the larynx • Cold or flu-like symptoms • Swollen lymph nodes• Fever • Difficulty breathing (mostly in children) • Difficulty eating • Increased production of saliva in mouth
Comparison of clinical features of subglottic laryngitis and epiglottitis
• Subglottic Subglottic laryngitislaryngitis
EpiglottitisEpiglottitis
OnsetOnset over daysover days over hoursover hours
Preceding Preceding coryzacoryza
++ --
CoughCough severe, barkingsevere, barking slight or absentslight or absent
Ablity to Ablity to swallowswallow
++ --
Drooling Drooling salivasaliva
-- ++
AppearenceAppearence unwellunwell toxic, very illtoxic, very ill
FeverFever <38,5<38,5 >38,5>38,5
StridorStridor harsh, harsh, raspingrasping
soft,whisperingsoft,whispering
Voice,cryVoice,cry hoarsehoarse Reluctant to Reluctant to speakspeak
Treatment of suglottic laryngitis
Nebulised steroids and 0,9 % NaClsaline Systemic steroids Oxygen therapy Usually no antibiotics are neededEtiology: mostly viral or allergens
Epiglottic laryngitis
Etiology: Haemophilus influenzae HIB, rare after HIB vaccinations
Treatment of epiglottitis• In intensive care unit• Intubation• Antibiotic (cephalosporin II, III generation)
LTRI
• Bronchitis (acute, obturative)• Bronchiolitis• Pneumonia
Bronchitis
• Bronchitis is inflammation of the mucous membranes of the bronchi
• Etiology:• Viruses ( Parainfluenzae, Adenovirus, RS-virus,
Rhinovirus)• Bacteria (Haemophilus influenzae,
Streptococcus pneumoniae, Staphylococcus aureus)
• Atopy
Symtoms of bronchitis
• non-productive cough• productive cough• dyspnoe (due to obturation)• fever• vomiting• wheezing• dry rale• coarse rattling
Treatment mucolitycs (eg cysteine derivates, Ambroksol) bronchodilating drugs- Beta Agonist, Ipratropii
bromidum SteroidsAntibiotics- mainly used in newborns and small
chlildren when bacterial infection is suspected (eg Amoxicilline, Cephalosporin antibiotics I, II generation- Cefalotin, Cefuroxim)
Broncholitis
Etiology:• viruses (RS virus, Parainfluenzae, Influenzae,
Adenovirus)
One of the most danger LRTI due to lifethreatening respiratory insufficiency
Bronchiolitis
• Typical childhood infection• Most often in infancy• Cough,expiratory dyspnoe, fever• Involvment of bronchioli• Respiratory insufficinecy• Wheezing , crackles
Bronchiolatis
• Oxygen therapy, • Bronchodilators- Berodual, Ventolin, Atrovent• Steroids-nebulized and/or systemic• Nebulized epinephrine• Nebulized hypertonic saline (3%)
dyspnoe
• Sternal, subcostal and intercostal recession• Nasal flaring• Hyperinflation of chest
(sternum prominent, liver displaced downward)
• Dyscoordination of chest and abdomen movment
Pneumonia
• Pneumonia is an inflammation of the lungs. It is a serious infection in which air sacs in the lungs fill with pus and other liquid.
• Pneumonia may be lobar or bronchial • Pneumonia is most common in winter and
spring. • About 10 to 15 percent of children with a
respiratory infection have pneumonia.
Pneumonia
• The pathogens causing pneumonia vary according to the child's age:
• Newborn - organisms from the mother's genital tract, particularly group B streptococcus, but also Gram-negative enterococci
Pneumonia• Infants and young children -mostly
respiratory viruses, particularly RSV, are most common, but olso bacterial infections include Streptococcus pneumoniae or Haemophilus influenzae. Bordetella pertussis and Chlamydia trachomatis can also cause pneumonia at this age. An infrequent but serious cause is Staphylococcus aureus
• Children over 5 years - Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia pneumoniae are the main causes.
• At all ages Mycobacterium tuberculosis should be considered
Pneumonia-symptoms:• fever and cough are the first to develop • persistent cough that may last three to four
weeks • severe cough that may produce some mucus • chest or stomach pain • decrease in appetite • chills • breathing fast or hard • vomiting • headache• not feeling well
Pneumonia
• tachypnoea,• nasal flaring• chest indrawing • crackles over the affected area • dullness on percussion,• decreased breath sounds• bronchial breathing
Pneumonia-diagnosis
• chest x ray- segmental involvement,diffuse peribronchiolar densities,effusion
• blood tests- e.g. blood cell count, CRP, • sputum culture• pulse oximetry
Treatment
• antibiotics • Increased fluid intake • oxygen therapy • frequent suctioning of your child's nose and
mouth (to help get rid of thick secretions) • medication for cough• sometimes bronchdilators
Pneumonia
Complications:• most common: abscesses, empyema• less common: peritonitis, pericarditis,