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Lower respiratory tract infections in children

Lower respiratory tract infections in children. Mostafavi SN. MD Pediatric infectious disease departement Isfahan University of Medical Science. Lower respiratory tract infections. Pneumonia: Viral Bacterial Afebrile Atypical Aspiration Nosocomial Bronchiolitis Empyema. Case 1.

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Lower respiratory tract infections in children

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  1. Lower respiratory tract infections in children Mostafavi SN. MD Pediatric infectious disease departement Isfahan University of Medical Science

  2. Lower respiratory tract infections • Pneumonia: • Viral • Bacterial • Afebrile • Atypical • Aspiration • Nosocomial • Bronchiolitis • Empyema

  3. Case 1 • A 6 months old boy brought with high fever and cough. On physical exam tachypnea and bilateral coarse rales were found. What’s your diagnosis?

  4. Diagnosis of pneumonia • What's suggestive symptoms and signs of pneumonia? • Which patient has definite diagnosis of pneumonia?

  5. Symptoms/signs of pneumonia • All respiratory infections: fever, cough, • Lower respiratory involvement: respiratory distress, tachypnea, cyanosis • Pneumonia: fine rales, decreasing breath sounds, bronchophonia, … • Definite: new pulmonary infiltration in CXR

  6. Case 1-1 • A 6 months old boy brought with high fever and cough. On physical exam tachypnea and bilateral coarse rales were found. What’s your diagnosis?

  7. Case 1-2 • A 6 months old boy brought with high fever and cough. On physical exam tachypnea and bilateral coarse rales were found. What’s your diagnosis?

  8. Case 1-2 • Has the infant need admission?

  9. Admission criteria in pneumonia • Inability to intake fluid or medications • Cyanosis( o2 sat< 92%) • Severe respiratory distress( apnea, …) • Toxic appearance • Pleural effusion • Sometimes < 1 year

  10. Case 1-2 • Has the patient need antibiotic?

  11. Case 1-3 • A 6 months old boy brought with high fever and cough. On physical exam tachypnea and bilateral coarse rales were found. If he need any antibiotic?

  12. Case 1-2 • A 6 months old boy brought with high fever and cough. On physical exam tachypnea and bilateral coarse rales were found. If he need any antibiotic?

  13. Which antibiotic should be prescribed for the infant?

  14. Case 1-2 • What's the clinical course of the patient?

  15. Clinical course of bacterial pneumonia • Improve in fever and respiratory signs in 48-72 hours • Clearing CXR in 4-8 weeks

  16. Case 2 • A 7 years old girl brought with high fever, malaise, protracted cough, mild diarrhea since 5 days ago. On PE she had bilateral fine rales without significant respiratory distress. She received coamoxiclave since 72 hour ago. Whats your diagnosis?

  17. Atypical pneumonia • What's the suggestive symptoms and signs of atypical pneumonia?

  18. Atypical pneumonia • Age 5-15 yr • Severe constitutional signs: high fever, prolonged fever, anorexia, malaise • Mild respiratory signs: coryza, protracted prolonged cough, no/mild distress, bilateral mild rales • Prominent extrapulmonary signs: rash, diarrhea, abdominal pain, CNS, … • Prominent x ray abnormalities: bilateral interstitial, lobar infiltrates specially in lower lobes • No response to beta-lactams and dramatic response to azithromycine, clarithromycine, erythromycine

  19. Case 3 • A 2 month old boy brought with severe cogh since two days ago and coryza and mild cough since five days ago. His mother has signs of URTI since 7 days ago. On PE RR=70/min, mild cyanosis and diffuse wheezing were found. What's your diagnosis?

  20. Main clues in bronchiolitis • Age:<1 yr ( 2-6 mo), peak admission: 1-3 mo • Epidemic in Day to Farvardin months • Initially coryza, cough then severe cough, wheezing, dyspnea • Sometimes fever • Hyperinflation, perihilar infiltration in x ray

  21. Case 3- x ray

  22. Case 3 • A 2 month old boy brought with severe cogh since two days ago and coryza and mild cough since five days ago. His mother has signs of URTI since 7 days ago. On PE RR=70/min, mild cyanosis and diffuse wheezing were found. Has the patient need admission?

  23. Admission in bronchiolitis • O2 saturation< 90-92 • Age< 6 wk • Reduced intake • Underlying heart, lung, immunological disease • Severe respiratory distress including apnea

  24. What's the outpatient management of bronchiolitis?

  25. Out patient management of bronchiolitis • No effect of salbutamol, theophylline G, corticosteroids, cough suppressants • Supine position with the head elevated • Small frequent feeding • Nose drops and clearing • Warning signs • Mist therapy

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