Disease
Causative Agent
Facts
S&S
PE
Bronchitis
*Viral >90%
*Bacterial
1. Common: Influenza,
parainfluenza, RSV,
coronavirus, adenovirus,
rhinovirus
2. Atypical: Bordetella
pertussis, mycoplasma
pneumoniae, chlamydia
pneumoniae
*Can be acute or
chronic
*SARS & H1N1:
Dangerous, associated
w/ bronchitis
symptoms may
include:
*cough
(productive or
nonproductive)
sputum
*DOE
*wheezing,
rhonchi, or other
signs of
obstruction
*accompanying
cold symptoms
(fever, sore
throat, nasal
congestion,
runny nose)
HEENT:
*may have rhinitis or
pharyngitis
*may have conjunctivitis or
otitis media with adenoviral
infection
Neck:
*may have
lymphadenopathy
Lungs:
*wheezing, rhonchi,
prolonged expiratory phase
or other obstructive signs
may be present, but patient
may have no signs of
bronchospasm
A. Acute
*Symptomatic
*Avoid ABX (Atypical bacteria controversy)
*Non-traditional therapies (ie. Herbal)
1. Bronchodilators (if bronchospasm)
2. Anti-inflammatory agents
3. Nasal sprays
4. Anti-tussive agents
5. Combination meds w/pain meds
6. Smoking cessation
B. Chronic
1. Smoking cessation
2. Bronchodilators
3. Oxygen therapy
4. Antibiotics
*Post-TX fever, increased sputum production
& chest pain requires re-eval
1. RSV - MC
2. Adenovirus
*Common infection in
infants & children
*typical bronchiolitis
presents as seasonal
respiratory illness in
children < 2 years old
with fever, tachypnea
wheezing, increased
respiratory effort
(grunting, nasal
flaring, and intercostal
and/or subcostal
retractions)
*rhinitis, fever,
dry cough, and
wheezing
*more severe
disease may
include grunting,
nasal flaring, and
intercostal
retractions
reflecting the
increased effort
to breathe(
General:
*assess for tachypnea,
retractions, fever,
tachycardia
Lungs:
*wheezing, crackles,
prolonged expiratory phase
intercostal or subcostal
retractions
*Treatment geared toward underlying disease
*Prognosis dependent on severity of
underlying disease and acute illness
1. Acute in children: Supportive care
*+/- steroids, albuterol
2. Adults with Constrictive
*Little benefit of oral steroids
3. Adults with Proliferative
*Prednisone 1mg/kg/day x 1-3 months, then
tapered to 20-40mg/day for 3-6 months
Bronchiolitis
Types
1. Constrictive (aka
Obliterative): Chronic
inflammation, concentric
scarring, and smooth
muscle hypertrophy
2. Proliferative:
Intraluminal exudate
obstructing the lumen,
leads to pneumonia
(cryptogenic, organizing
pneumonitis (COP)
Other Causes
1. History of URI
symptoms
2. Irritants (aerosols,
dust, fume, mold)
3. Aspiration
4. Change in lifestyle
5. Smoking
TX
Dx: routine CXR NOT usually
warranted
1
Influenza
*Three strains: A, B, C
*A&B are similar
*C has short duration
*Strain A most likely to
lead to pandemic
(Pandemic flu 1918)
*H5N1 Avian flu: Fierce
spread potential
(H5N1:Hemagglutinin
type 5 neuramindase
Type 1: surface antigens
on the virus structure)
*Now H7N9 strain (2013
Acute
Epiglottitis
*Haemophilus influenzae
type b
*beta-hemolytic
streptococci - groups A,
B, C
*Highly contagious
*Early 1900's strain
thought to have
caused all outbreaks
since
*No other strain has
been so virulent since
*Lasts 1-7 days
*Prognosis excellent
in young healthy
adults
*abrupt onset of
epiglottic edema
* Risk factors:
smoking and not
receiving Flu vaccine
1. Fever
2. Malaise
3. Chills
4. HA
5. Myalgias
6. Nasal
congestion
7. Nausea
8. Coryza, nonproductive
cough, sore
throat,
conjunctiva
redness
*stridor
*hoarse or
muffled voice
*fever
*sore throat
*dysphagia
*cervical
adenopathy
*drooling
Labs
1. Leukopenia
2. Nasal swab influenza A&B
(rapid)
3. Throat swabs in some labs
Prevention
*Hallmark for care
*Proper hand washing in
schools and work
Vaccinate
1. Patients >age 50
2. Nursing home patients
3. Children over 6 months
4. Chronic lung disease
5. Pregnant in 2 or 3 trimes.
6. Health care workers
General physical:
*body posture may signal
partial airway obstructiontripod position (sitting and
leaning forward on
outstretched arms)
*mouth open
*neck fully extended
*protruding chin
*protruding tongue
*stridor (a late finding)
*toxic appearance (common
in children)
*drooling
*muffled
*The earlier the better—1st S&S
*Rest/fluids/analgesia/anti-tussives
1. Zanamifir (Relenza): 2, 5mg inhal. qd x5
days
*Contraindicated in asthma patients
2. Oseltamivir (Tamiflu): 75mg BID x 5 days
3. Peramivir IV (only admin by CDC
themselves)
*Meds costly
*Marketed to reduce days being ill &
severity
*Caveat: TX w/in 1-2 days onset
Complications
1.
2.
3.
4.
5.
6.
7.
Co-morbid illness
Viral Pneumonia
CHF
Diabetes
Renal failure
Heart disease
Pulmonary illness
◦ admit to intensive care unit
◦ endotracheal/nasotracheal intubation or
tracheostomy may be necessary;
prophylactic intubation (not waiting
for impending airway obstruction)
recommended in childre)
*broad-spectrum second- or third-generation
cephalosporins for 7-10 days is typical empiric
therapy until C&S results available
*Supplemental O2
*IVF
*Hib drug of choice - cefotaxime or
ceftriaxone
2
Pertussis
*Bordetella pertussis small fastidious gramnegative coccobacillus
bacteria produces
toxins which
◦ immobilize cilia
◦ damage respiratory
epithelium
◦ induce mucus
release
cause inflammatory
cells to enter lumen of
respiratory tract
*Atleast 2 doses of
vaccine needed for
protection
*prolonged
cough (> 2
weeks)
*paroxysms of
coughing
*inspiratory
"whoop"
*posttussive
vomiting
*nonspecific URI
s/s prodrome
phonation/dysphonia
*hot potato voice
Neck:
*cervical adenopathy
*tenderness over hyoid
bone
Imaging
*lateral necy x-ray : thumb
sign, soft tissue swelling,
pencil-thin airway
*low grade fever
*spasmodic cough may be
present with characteristic
inspiratory "whoop" in
infants and children
DX
*GOLD STANDARD: culture
positive for Bordetella
pertussis
*positive PCR on
nasopharyngeal sample
(swab or aspirate)
*antibiotics recommended if within 6 weeks
of cough onset in infant < 1 year old, or within
3 weeks of cough onset if > 1 year old
*azithromycin preferred in infants < 1 month
old
*first-line antibiotics for patients ≥ 1 month
old are macrolides
azithromycin
clarithromycin
erythromycin
*alternative for patients ≥ 2 months old is
trimethoprim-sulfamethoxazole
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