Respiratory Infections in Children

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Respiratory Infections in Children

• Dr. S. Benson
• GPSTI

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Infections

• URTI
• Croup
• Epiglottitis
• Whooping Cough
• Bronchiolitis
• Pneumonia
• TB

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URTI

• Coryza Usually rhinovirus, coronavirus, RSV
• Pharyngitis viral or Group A beta-haemolytic
  strep
• Tonsillitis Group A beta-haemolytic strep and
  EBV
• Acute Otitis Media viruses, pneumococcus,
  strep, haemophilus, moraxella catarrhalis
• Sinusitis viral or bacterial

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URTI

• Children often present with
• Sore throat
• Fever (inc febrile convulsions)
• Blocked Nose
• Nasal Discharge
• Earache
• Wheeze

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URTI

• Thorough examination is needed
• Exclude serious infections
• Address feeding and hydration
• Consider possible bacterial causes for
• Otitis Media (discharge, ruptured drum, red and
  bulge)
• Tonsillitis (exudative with pus)
• Mainstay of treatment is paracetamol and ibuprofen

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URTI

• Antibiotics 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 treatment
• Most URTI are viral

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Croup

• Viral laryngotracheobronchitis
• Mucosal inflammation of respiratory tract
• Usually caused by RSV, parainfluenza and
  influenza
• Usually children are 6 months to 6 years old
• Presents as stridor and difficulty breathing

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Croup

• Can be managed at home if mild
• Give humidified air
• Give 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

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Acute Epiglottitis

• Life threatening swelling of the epiglottis
• Can cause septicaemia
• Caused by haemophilus influenza type B
• Mostly in children 1-6yo
• DO NOT examine the throat
• Keep the child calm

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Acute Epiglottitis

• Management is in ITU
• ET intubation often required
• 7-10 days of 3rd gen cephalosporin
• Rifampicin prophylaxis for close contacts

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Croup vs Epiglottitis
Croup Epiglottitis
Time Course Days Hours
Prodrome Coryza None
Cough Barking None
Feeding Can drink None
Mouth Closed Drooling
Toxic No Yes
Fever lt38.5 gt38.5
Stridor Rasping Soft
Voice Hoarse Weak / Silent
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Whooping Cough

• Caused by bordatella pertussis
• Three stages of illness
• Catarrhal (1-2 weeks) fever, cough, coryza
• Paroxysmal (2-6 weeks) barking cough
• Convalescent (2-4 weeks) lesser symptoms which
  resolve
• The barking cough has a characteristic paroxysmal
  nature with an inspiratory whoop

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Whooping Cough

• Investigations
• Eyes Subconjunctival haemorrhages are indicated
• CXR
• FBC Leucocytosis and lymphocytosis
• Nasal swab for pertussis
• As part of the work up, we need to ensure this is
  not pneumonia.
• Treatment is with erythromycin / clarythromycin
• These have limited effect on cough

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Whooping Cough

• Admission required if
• Apnoeas
• Cyanosis
• Paroxysms
• Risk of seizures
• Patients should isolated for 5 days
• Immunize close contacts under the age of 7
• Only 90 effective and wanes as child ages
• Prophylactic antibiotics to close contacts

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Bronchiolitis

• Most commonly due to RSV
• Also can be caused by influenza, parainfluenza,
  adenovirus, rhinovirus and C and M Pneumoniae
• Causes problems by
• Invading nasal and pharyngeal epithelium
• Spreading to lower airways
• Increasing mucus production, desquamation and
  obstruction
• Net effect is hyperinflation and atelectasis

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Bronchiolitis

• History
• Winter months
• Coryzal illness
• Dry cough
• Worsening SOB
• Wheeze
• Feeding problems
• Apnoeic episodes

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Bronchiolitis

• Examination findings
• Cyanosis or pallor
• Dry cough
• Tachypnoea
• Subcostal and intercostal recession
• Chest hyperinflation
• Prolonged expiration
• Respiratory pauses
• Wheeze
• Crackles

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Bronchiolitis

• Treatment mainly supportive
• Keep oxygen saturations above 92
• If tachypnoeic when feeding consider NG tube
• Bronchodilators (salbutamol, atrovent,
  adrenaline)
• Mechanical ventilation if severe
• Reserve antivirals for immunodeficient patients
• Prophylaxis is available for preterm or babies
  with chronic lung problems

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Pneumonia

• Lower respiratory tract infection
• Mostly bacterial
• Common pathogens shown below

Age Pathogen
Neonate Group B strep E. Coli Klebsiella Listeria
Infants Strep pneumoniae Chlamydia
School age Strep pneumoniae Staph aureus Group A strep Bordatella Mycoplasma pneumoniae
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Pneumonia

• Symptoms and Signs
• High temp
• Productive cough
• Tachypnoea (gt50)
• Grunting
• Recession
• Cyanosis
• Lethargy
• Focal signs / bronchial breathing

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Pneumonia

• Investigations
• NPA
• FBC
• Microbiology
• CXR (not of mild and uncomplicated)
• Pleural fluid if effusion may be indicated

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Pneumonia

• Follow local guidelines for treatment
• Recommended treatments are
• Amoxicillin
• Coamoxiclav
• Cefuroxime
• Antipyretics can also be helpful
• IV fluids
• Oxygen as required
• Physiotherapy is not all that helpful in children

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Tuberculosis

• Consider in at risk groups
• Mantoux test
• CXR
• Specialist referral

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Summary

• URTI
• Croup
• Epiglottitis
• Whooping Cough
• Bronchiolitis
• Pneumonia
• TB