respiratory tract infectious. respiratory tract infectious upper lower common cold bronchitis...

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,