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Flashcards in LRT Infections in Kids Deck (55):
1

Define lower respiratory infection?

any sublaryngeal airway infection is LRT

2

Define pneumonia:

-inflammation or infection of the lungs - especially the gas exchange units (terminal and respiratory bronchioles and interstitium)

3

most common cause of pneumonia (a LRT infection) in children (<1 year old?

viral

4

number 1 cause (organism) of bacterial/pyogenic pneumonia through childhood?

strep pneumo

5

How does pneumonia happen?

-deposition and replication of viral/bacterial agents on resp tract mucosa or the lung can be seeded hematogenously during bacteremia (from the blood to lungs)

6

How do bacteria often cause pneumonia?

-colonize the respiratory tract

7

how do viruses cause pneumonia?

-viral infections impair HOST DEFENSES = secondary bacterial pneumonias

8

Host defenses:

ALL MUST WORK
-nasopharyngeal air filtration
-laryngeal protection of the airway
-mucociliary clearance
-normal cough reflexes and strength
-normal anatomy
-unobstructed airway drainage
-normal cellular and humoral immune function

9

-3 main findings of pneumonia??? -Which symptom is most specific for pneumonia?

-fever
-cough
-tachypnea --> MOST **SENSITIVE** AND SPECIFIC SIGN OF PNEUMONIA IN INFANTS!

10

Clinical findings of pneumonia in children on physical exam?

-refusal to eat
-grunting
-rales
-rhonchi
-dec breath sounds
-normal breath sounds (less mass so the sounds distribute better throughout chest so may be normal sounding)
-cyanosis
-pallor
-accessory muscle use/retractions

11

Global health standards for pneumonia if youre out in the world?

need to have tachypnea and retractions to diagnose pneumonia

12

Bordatella pertusis- info:

WHOOPING COUGH
-pertussis=intense cough
-gram NEG pleomorphic
-humans only host
-transmission=droplet from cough
-very contagious
-incubation 6 days

13

3 phases of whooping cough:

1) catarhal phase
-1-2 weeks
-rhinorrhea
-conjunctival injection
-mild cough
-wheezing
-low grade fever
2) Paroxysmal phase
-2-4 weeks coughing inc in frequency and intensity
-WHOOP** - uncommon in child <6mo
-POST TUSSIVE EMESIS***
-hypoxia and fatigue from constant cough
-apnea
3) Convalescent phase
-1-2 weeks
-cough and vomit dec in frequency
-cough may continue for weeks

14

Pertusis testing/lab results

-leukocytosis (HIGH ABS LYMPH COUNT --> DIFFERENT BC THIS ISNT VIRAL BUT LYMPHS ARE UP!!!)
-CXR=perihilar infiltrates, atelectasis or emphysema
-nasopharyngeal swabs for PCR

15

Pertusis TX in child:

-hospitalize (if infant)
-oxygen & IV fluids
-erythromycin 40mg/kg divided q 6hrs for 14 days
-isolate patient for 5 days to prevent spread

16

Antibiotic of choice for pertussis in child?

-erythrmycin

17

influenza - info

RNA orthomyxovirus
-A, B, and C types - A and B causing epidemics
-H1N1 predominated last year
-H3N2 have greater mortality

18

Type A influenza surface antigens:

-surface antigens hemagglutinin (HA) and neuraminidase

19

3 types of hemagglutinin types:

H1 H2 and H3

20

2 types of neuramidase types:

N1 and N2`

21

Major changes of hemagglutinin type is called? Minor?

-antigenic shift = major
-antigenic drift = minor

22

influenza - spread?

-large droplets

23

influenza - who gets? when?

-school age children
-community outbreaks occur in winter and peak within 2 weeks of onset and last 4-8 weeks

24

influenza - infectious?

-infectious > 10 days after the onset of symptoms
-severely immunocomp patients shed virus for weeks to months

25

influenza - symptoms

-1-4 days onset (ABRUPT)
-mimics bacterial sepsis
-fever
-coryza (perfuse runny nose)
-myalgia
-headache
-malaise
-conjunctivitis
-pharyngitis
- dry cough
-can localize anywhere in resp tract = URI, croup, bronchiolitis, pneumonia

26

most common secondary bacterial infection due to influenza?

-strep pneumo (MOST COMMON)
-staph aureus ( ALSO COMMON)

27

What is Reye syndrome:

-affects brain and liver post viral (varicella) or influenza infection

28

Stages of Reye syndrome:

0=vomiting
1=vomit, confusion, lethargy
2=agitation, delirium, DECORTICATE (elbows flexed) posturing, hyperventilation
3=coma and DECEREBRATE (elbows extended) posturing
4=flaccidity, apnea, and dilated fixed pupils

Progression from stage 1 to 4 can happen in 24 hours
-worse outcome if younger

29

What inc risk of Reye syndrome during viral illness?

-salicylates (aspirin)

30

Diagnosis of reye syndrome:
Definitive diagnosis with?

-hypoglycemia
-hyperammonemia
-inc liver enzymes

Definitive with liver biopsy

31

Reye syndrome tx?

limited tx
-correct hypoglycemia and inc ICP

32

diagnosis of influenza:

-based on clinical presentation, time of year, and community surveillance
-rapid nasal swab tests of Influ A and B
-blood count short normal WBC or mild dec in leukocytes

33

Tx for influenza?

-supportive most - fluids, fever control, rest
-neuraminidase inhibitors (zanamivir & oseltamivir) in children if bad

34

Vaccination against influenza?

vaccinate everyone above 6mo
(2 doses)

35

RSV epidemic when?

winter

36

RSV transmission:

-resp droplets and fomites

37

classic finding in RSV?

-WHEEZING
-otitis media

38

recovery from RSV how long?

7-12 days

39

x-ray of RSV?

-air trapping
-segmental atelectasis
-inc interstitial markings

-DO NOT ORDER X-RAY

40

Tx for RSV bronchiolitis

-maintain patency of nasal airway
-maintain adequate hydration and nutrition
-optimize ventilation and oxygenation

41

Aim of tx of RSV bronchiolitis

-releive resp distress
-overcome airway obstruction
-enhance mucociliary clearance
-return child to normal resp status

42

tachypnea + rales heard but no wheezing, no fever, 6 weeks old, conjunctivitis - organism?

-chlamydia trachomatis pneumonia

43

presentation of chlamydia trachomatis?

-1-3 months (NONE OLDER THAN 4mo)****
-repetitive staccato cough, tachypnea, and absence of fever, wheezing some nasal stuffiness
-CXR no sig abnormalities or hyperinflation (shaggy heart sometimes)
-WBC usually normal with peripheral eosinophilia

44

chlamydia trachomatis - tx:

-macrolides (*ORAL AZITHROMYCIN for 5 days or ORAL ERYTHROMYCIN for 14days)
-tetracyclines
-quinolones
-sulfonamides

45

If there is evidence of chlamydial conjunctivits without pneumonia tx how?**

-still give oral erythromycin**

46

9mo female
sudent onset fever to 102.5
dec activity
cough
lethargy
hypoxemia?
hgih WBC count
left shift-inc bands

organisms?
what organism present similarly?

pneumonia - strep pneumo
(since its not viral strep pneumo is most common)

-influenza similar BUT RARELY has hypoxemia and doesnt have high WBC

47

CXR of strep pneumo?

-lobar or segmental consolidation

48

strep pneumo if child is untable symptoms?
What Tx?

-hypoxic
-resp distress
-hemodynamically unstable

-IV antibiotics - ampicillin / sulbactam, cefuroxime, ceftriaxone
-continueuntil patient stable then give 10 day course of oral antibiotics

49

strep pneumo if child is stable tx?

-oral antibiotics
-->amoxicillin/clavulanic acid, cefuroxime, or other 2nd gen ceph

50

mycoplasma pneumonia - info

-walking pneumonia
-most common in school age child
-RARE BEFORE AGE 3-4

51

presumptive diagnosis of m pneumo with what test?

cold agglutinins

52

definitive diagnosis of mycoplasma via?

-drawing mycoplasma titers

53

clinical manifestation of mycoplasma

-intractable nonproductive to mild cough ***
-squeaky door breathing
-chills
-pharyngitis
-rhinorrhea
-ear pain

54

Tx of choice for mycoplasma?

-macrolides

55

mycoplasma vs chlamydia pneumophilia:

-chlam has more pharyngitis followed by cough and high fevers