Download - Dr. S. Benson GPSTI. Infections URTI Croup Epiglottitis Whooping Cough Bronchiolitis Pneumonia TB.

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Dr. S. BensonGPSTI

InfectionsURTICroupEpiglottitisWhooping CoughBronchiolitisPneumoniaTB

URTI Coryza – Usually rhinovirus, coronavirus,

RSVPharyngitis – viral or Group A beta-

haemolytic strepTonsillitis – Group A beta-haemolytic strep

and EBVAcute Otitis Media – viruses, pneumococcus,

strep, haemophilus, moraxella catarrhalisSinusitis – viral or bacterial

URTIChildren often present with:

Sore throatFever (inc febrile convulsions)Blocked NoseNasal DischargeEaracheWheeze

URTIThorough examination is neededExclude serious infectionsAddress feeding and hydrationConsider possible bacterial causes for:

Otitis Media (discharge, ruptured drum, red and bulge)

Tonsillitis (exudative with pus)

Mainstay of treatment is paracetamol and ibuprofen

URTIAntibiotics – to prescribe or not to prescribe?Recommend if tonsilitis or acute OM

Tonsilitis – Give Penecillin V (avoid amoxicillin as maybe caused by EBV – rash)

Acute OM – Coamoxiclav is a suitable choice

Take throat swabs before treatmentMost URTI are viral

CroupViral laryngotracheobronchitisMucosal inflammation of respiratory tractUsually caused by RSV, parainfluenza and

influenzaUsually children are 6 months to 6 years oldPresents as stridor and difficulty breathing

CroupCan be managed at home if mildGive humidified airGive steroids (reduces severity and duration

of croup) oral prednisolone (2mg/kg) for 3 days nebulised budesonide (2mg stat)

Nebulised adrenaline provides transient relief

If severe or desaturating will need admission

Acute EpiglottitisLife threatening swelling of the epiglottisCan cause septicaemiaCaused by haemophilus influenza type BMostly in children 1-6yo

DO NOT examine the throatKeep the child calm

Acute EpiglottitisManagement is in ITUET intubation often required7-10 days of 3rd gen cephalosporinRifampicin prophylaxis for close contacts

Croup vs EpiglottitisCroup Epiglottitis

Time Course Days Hours

Prodrome Coryza None

Cough Barking None

Feeding Can drink None

Mouth Closed Drooling

Toxic No Yes

Fever <38.5 >38.5

Stridor Rasping Soft

Voice Hoarse Weak / Silent

Whooping CoughCaused by bordatella pertussisThree stages of illness

Catarrhal (1-2 weeks) – fever, cough, coryzaParoxysmal (2-6 weeks) – barking coughConvalescent (2-4 weeks) – lesser symptoms

which resolveThe barking cough has a characteristic

paroxysmal nature with an inspiratory whoop

Whooping CoughInvestigations:

Eyes – Subconjunctival haemorrhages are indicated

CXRFBC – Leucocytosis and lymphocytosisNasal swab for pertussis

As part of the work up, we need to ensure this is not pneumonia.

Treatment is with erythromycin / clarythromycinThese have limited effect on cough

Whooping CoughAdmission required if:

ApnoeasCyanosisParoxysmsRisk of seizures

Patients should isolated for 5 daysImmunize close contacts under the age of 7

Only 90% effective and wanes as child agesProphylactic antibiotics to close contacts

BronchiolitisMost commonly due to RSVAlso can be caused by influenza,

parainfluenza, adenovirus, rhinovirus and C and M Pneumoniae

Causes problems by:Invading nasal and pharyngeal epitheliumSpreading to lower airwaysIncreasing mucus production, desquamation

and obstruction

Net effect is hyperinflation and atelectasis

BronchiolitisHistory

Winter monthsCoryzal illnessDry coughWorsening SOBWheezeFeeding problemsApnoeic episodes

BronchiolitisExamination findings

Cyanosis or pallorDry coughTachypnoeaSubcostal and intercostal recessionChest hyperinflationProlonged expirationRespiratory pausesWheeze Crackles

BronchiolitisTreatment mainly supportiveKeep oxygen saturations above 92%If tachypnoeic when feeding consider NG tubeBronchodilators (salbutamol, atrovent,

adrenaline)Mechanical ventilation if severeReserve antivirals for immunodeficient patientsProphylaxis is available for preterm or babies

with chronic lung problems

PneumoniaLower respiratory tract infectionMostly bacterialCommon pathogens shown below

Age PathogenNeonate Group B strep

E. ColiKlebsiellaListeria

Infants Strep pneumoniaeChlamydia

School age Strep pneumoniaeStaph aureusGroup A strepBordatellaMycoplasma pneumoniae

PneumoniaSymptoms and Signs

High tempProductive coughTachypnoea (>50)GruntingRecessionCyanosisLethargyFocal signs / bronchial breathing

PneumoniaInvestigations

NPAFBCMicrobiologyCXR (not of mild and uncomplicated)Pleural fluid if effusion may be indicated

PneumoniaFollow local guidelines for treatmentRecommended treatments are

Amoxicillin CoamoxiclavCefuroxime

Antipyretics can also be helpfulIV fluidsOxygen as requiredPhysiotherapy is not all that helpful in children

TuberculosisConsider in at risk groupsMantoux testCXRSpecialist referral

SummaryURTICroupEpiglottitisWhooping CoughBronchiolitisPneumoniaTB