Dr. S. Benson
GPSTI
Infections
 URTI
 Croup
 Epiglottitis
 Whooping Cough
 Bronchiolitis
 Pneumonia
 TB
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
URTI
 Children often present with:
 Sore throat
 Fever (inc febrile convulsions)
 Blocked Nose
 Nasal Discharge
 Earache
 Wheeze
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
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
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
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
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
Acute Epiglottitis
 Management is in ITU
 ET intubation often required
 7-10 days of 3rd gen cephalosporin
 Rifampicin prophylaxis for close contacts
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
<38.5
>38.5
Stridor
Rasping
Soft
Voice
Hoarse
Weak / Silent
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
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
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
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
Bronchiolitis
 History
 Winter months
 Coryzal illness
 Dry cough
 Worsening SOB
 Wheeze
 Feeding problems
 Apnoeic episodes
Bronchiolitis
 Examination findings
 Cyanosis or pallor
 Dry cough
 Tachypnoea
 Subcostal and intercostal recession
 Chest hyperinflation
 Prolonged expiration
 Respiratory pauses
 Wheeze
 Crackles
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
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
Pneumonia
 Symptoms and Signs
 High temp
 Productive cough
 Tachypnoea (>50)
 Grunting
 Recession
 Cyanosis
 Lethargy
 Focal signs / bronchial breathing
Pneumonia
 Investigations
 NPA
 FBC
 Microbiology
 CXR (not of mild and uncomplicated)
 Pleural fluid if effusion may be indicated
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
Tuberculosis
 Consider in at risk groups
 Mantoux test
 CXR
 Specialist referral
Summary
 URTI
 Croup
 Epiglottitis
 Whooping Cough
 Bronchiolitis
 Pneumonia
 TB