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    Acute Lower Respiratory Infections

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    As Minhas Origens
    This document provides information on acute lower respiratory infections in children, including laryngitis, bronchiolitis, and pneumonia. It describes the symptoms, risk factors, diagnosis, and treatment for each condition. For laryngitis, it notes the most common causes are viral infections like parainfluenza. Bronchiolitis symptoms include cough, wheezing and difficulty breathing, often caused by RSV. Pneumonia can be viral or bacterial, with different symptoms, treatments and chest x-ray findings depending on the cause. The document provides detailed clinical guidance on evaluating and managing these common pediatric respiratory illnesses.

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    Acute Lower Respiratory Infections

    Uploaded by

    As Minhas Origens
    24 views28 pages
    This document provides information on acute lower respiratory infections in children, including laryngitis, bronchiolitis, and pneumonia. It describes the symptoms, risk factors, diagnosis, and treatment for each condition. For laryngitis, it notes the most common causes are viral infections like parainfluenza. Bronchiolitis symptoms include cough, wheezing and difficulty breathing, often caused by RSV. Pneumonia can be viral or bacterial, with different symptoms, treatments and chest x-ray findings depending on the cause. The document provides detailed clinical guidance on evaluating and managing these common pediatric respiratory illnesses.

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    Acute-Lower-Respiratory-Infections (1)

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    This document provides information on acute lower respiratory infections in children, including laryngitis, bronchiolitis, and pneumonia. It describes the symptoms, risk factors, diagnosis, and treatment for each condition. For laryngitis, it notes the most common causes are viral infections like parainfluenza. Bronchiolitis symptoms include cough, wheezing and difficulty breathing, often caused by RSV. Pneumonia can be viral or bacterial, with different symptoms, treatments and chest x-ray findings depending on the cause. The document provides detailed clinical guidance on evaluating and managing these common pediatric respiratory illnesses.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views28 pages

    Acute Lower Respiratory Infections

    Uploaded by

    As Minhas Origens
    This document provides information on acute lower respiratory infections in children, including laryngitis, bronchiolitis, and pneumonia. It describes the symptoms, risk factors, diagnosis, and treatment for each condition. For laryngitis, it notes the most common causes are viral infections like parainfluenza. Bronchiolitis symptoms include cough, wheezing and difficulty breathing, often caused by RSV. Pneumonia can be viral or bacterial, with different symptoms, treatments and chest x-ray findings depending on the cause. The document provides detailed clinical guidance on evaluating and managing these common pediatric respiratory illnesses.

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    © All Rights Reserved
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    of 28

    Acute Lower Respiratory

    Infections
    Madalena Sales Luís
    Eduarda Sousa

    Pediatric lesson
    2019
    Acute Lower Respiratory Infections

    • Laryngitis
    • Bronchiolitis
    • Pneumonia
    Laryngitis
    • Laryngothracheobronchitis, laryngotracheitis (croup)
    • Common cause of stridor in children
    • Autumn and winter
    • 6 months – 4 years (usually)
    • Benign course

    • Etiology:
    • Viral: parainfluenza 1, 2, 3 (75%); influenza A, B; Adenovirus; RSV
    • Mycoplasma Pneumoniae
    Laryngitis
    • Symptoms
    • Stridor
    • Laryngeal cough (“barking cough”)
    • Hoarseness (cry or voice)
    • Fever

    Symptoms worse at night, with agitation and crying Improve with cool
    Laryngitis
    • Physical examination
    • Hoarse voice, stridor, polypnea
    • PA: normal breath sounds, wheezing, crackles (eventually)
    • Important: DO NOT use a spatula to observe the oropharynx → Spasm of
    the larynx

    • Complication – Airway obstruction (↓ with age)


    Laryngitis
    • Differential Diagnosis
    • Epiglottitis (clinic, Hib)

    • Parapharyngeal/retropharyngeal abcess (CT scan)

    • Aspiration/ingestion of a foreign body (clinical history, chest radiography,


    bronchoscopy)

    • Anomalies of the upper airway (laryngomalacia, subglottic stenosis)


    Laryngitis
    • Diagnosis

    • The diagnostic is clinical, no need for exams

    • Blood tests, chest radiography and other exames ONLY if other diagnosis is
    suspected
    Laryngitis
    • Treatment
    • Oral fluids
    • Antipyretics → Paracetamol, Ibuprofen
    • Humidified air (steam or cool mist)→ ↓ edema
    • Child should be calm, avoid crying

    • Dexamethasone 0,15 - 0,6 mg/Kg oral or IM single dose → reduces the duration of
    symptoms

    • Nebulization with epinephrine 1 mL + saline 3 mL → moderate or severe disease;


    effect in 30 minutes with 2h duration

    • Hospitalization – severe presentation


    Acute Bronchiolitis
    • Bronchiolar obstruction with edema, mucus and cellular debris
    • Main cause of wheezing before 2 years old
    • Winter (November to April)
    • Transmission: cough and sneeze
    • Prognosis is usually good
    • Complications → Pneumonia, Atelectasis, Acute Respiratory Failure

    • Etiology:
    • Viral: RSV (85%); Parainfluenza 1, 2, 3; Influenza A e B; Adenovirus;
    Rhinovirus; Metapneumovirus
    Acute Bronchiolitis
    • Risk Factors

    • < 12 weeks of age


    • Prematurity
    • Congenital heart disease
    • Chronic Pulmonary disease
    • Neuromuscular disease
    • Immunodeficiency
    • Exposure to tobacco smoke
    Acute Bronchiolitis • Cough
    • Wheezing
    • Signs and symptoms
    • Polypnea, nasal flaring, subcostal and
    intercostal retractions
    • Rhinorrhea • Thoracic hyperinflation
    • Nasal obstruction
    • Cough • Apnea
    • Fever • Difficulty feeding
    • Anorexia • PA: normal/decreased breath sounds,
    • Conjunctivitis wheezing, crackles, prolongation of the
    expiratory phase of breathing
    day 1-3
    day 3-7
    Acute Bronchiolitis
    • Disease severity

    Mild Moderate Severe


    • RR < 50 cpm • RR 50 – 70 cpm • RR > 70 cpm
    • Mild to moderate • Moderate chest • Global retractions
    chest retractions retractions • Cyanosis
    • Bilateral wheezing • Bilateral wheezing • Dehydration
    • Sat O2 > 92% • Sat O2 88-92% • Sweating
    • Hydration • Tiredness
    • Oral tolerance • Bilateral wheezing
    • Sat O2 < 88%

    Ambulatory Emergency department observation → Hospitalization


    Acute Bronchiolitis
    Hospitalization 5 – 10 %

    • Indications:
    • Age < 6 weeks
    • Moderate to severe respiratory difficulty (Sat O2 ≤ 92 %)
    • Vomits or refuse to eat
    • Risk factors in past medical history
    • Parents inability to provide care

    IMPORTANT - Family and health professional's hand washing


    Acute Bronchiolitis
    Diagnosis is essentially clinical

    • Pulse oximetry for oxygen saturation • Blood tests only if:


    (severity) ▪ Severe disease
    ▪ Prolonged evolution
    ▪ Suspicion of bacterial infection
    • Chest radiography only if:
    ▪ Severe disease • Etiologic investigation only if:
    ▪ Prolonged evolution ▪ Hospitalization
    ▪ Localized changes in PA
    ▪ Personal history of cardiac or
    pulmonary disease
    Acute Bronchiolitis
    • Treatment

    • Saline to clear nasal congestion


    • Cool-mist humidifier
    • Elevate headboard (30º)
    • Oral fluids
    • Reduce and divide meals
    • Antipyretics → Paracetamol, Ibuprofen
    Acute Bronchiolitis
    • Treatment

    • Oxygen therapy if Sat O2 ≤ 92%

    • Feeding with nasogastric tube

    • Not to use routinely:


    • Nebulizer epinephrine (only in Hospital)
    • Nebulizer bronchodilator
    Pneumonia
    • Fever and/or lower respiratory tract signs and symptoms associated to chest
    radiography with parenchymal infiltrates

    • Etiology: (more frequent)


    • Virus (80 a 85%)
    • Streptococus Pneumoniae; Mycoplasma Pneumoniae (above 5 years old)

    Newborn (< 1 month) 1 to 3 months 3 months to 5 years > 5 years


    Streptococcus group B Respiratory syncytial virus Respiratory syncytial virus M. Pneumoniae
    E. Coli Parainfluenza Parainfluenza S. Pneumoniae
    S. Pneumoniae Adenovirus Influenza C. Pneumoniae
    H. Influenzae (type B) S. Pneumoniae Adenovirus Streptococcus pyogenes
    S. Aureus S. Pneumoniae
    C. Trachomatis S. Aureus
    H. Influenzae (type B) M. Pneumoniae
    Pneumonia – signs and symptoms
    Clinic Viral pneumonia Bacterial pneumonia Atypical pneumonia

    Beginning Insidious Suddenly Insidious


    Fever 38-39ºC > 39ºC 38-39ºC
    Rhino pharyngitis, conjunctivitis, Cough, thoracalgia
    Asthenia, headache, dry
    Other symptoms myalgias, exanthema, abdominal pain (lower lobe
    cough
    diarrhea pneumonia)
    Family context ocasional rare frequent
    General condition well feels unwell well
    Generalized crackles Focal crackles, asymmetry of breath Unspecific
    Auscultation
    wheezing sounds, dullness on percussion Crackles in lower lobe
    Alveolar, consolidation
    Intersticial
    Chest Radiography Interstitial, atelectasis Pleural effusion, abscess,
    Clinic-radiologic dissociation
    pneumatoceles
    Lymphocytosis Leukocytosis Unspecific
    Laboratory tests
    CRP N / ↑ CRP ↑↑ CRP N / ↑

    CRP – C-reactive protein


    Pneumonia
    • Diagnosis is essentially clinical

    • Evaluation:
    • Pulse oximetry for oxygen saturation (severity of the disease) - IMPORTANT
    • Chest radiography – indicated in severe cases and if there is suspicion of
    complications
    • Laboratory tests – if hospitalization; can be helpful for etiologic diagnosis
    • Blood culture – Always before starting antibiotic
    • Thoracic US or CT – only if suspicion of complications

    • Different patterns suggest etiologic diagnosis


    Pneumonia
    • Treatment:
    1st line:
    • Amoxicillin 80-100 mg/Kg/day 8/8h oral 7-10 days
    • Ampicillin 150 mg/Kg/day 6/6h IV – if hospitalization

    Atypic pneumonia
    • Azithromycin 10 mg/Kg/day once daily 5 days or Clarithromycin 15 mg/Kg/day
    12/12h 14 days

    • Antipyretics → Paracetamol, Ibuprofen


    • Drink plenty of fluids
    • IV fluids
    • Oxygen therapy if SpO2 ≤ 92%
    Pneumonia – Chest Radiography
    Normal
    Pneumonia – Chest Radiography lateral view
    Right lung Left lung
    Pneumonia – Chest Radiography
    Lobar consolidation
    Pneumonia – Chest Radiography
    Retro-cardiac consolidation
    Pneumonia – Chest Radiography
    Interstitial pattern Round pneumonia
    Pneumonia - complications
    Right consolidation with pleural effusion Atelectasis
    Pneumonia - complications
    Consolidation with pneumatoceles Staphylococcic pneumonia
    References
    • J. M. V. Amaral “Tratado de Clinica Pediátrica” 2ª edição
    ed Abbott Laboratórios, Lda - Amadora,2013

    • J. Palminha, E. M. Carrilho – “Orientação diagnóstica em Pediatria” ed Lidel –


    edições técnicas, Lda – Lisboa 2003

    • M. A. Costa, M. C. Lemos, F. Durães, J. M. Palminha – “Terapêutica Pediátrica em


    Ambulatório” 3ª edição.
    Lidel – edições técnicas, Lda – Lisboa 2017

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