Lower Respiratory Infection

Front 1

Bronchiolitis Definition

Back 1

-itis: acute inflammation +

edema, necrosis of epithelial cells of the small bronchioles

Front 2

Bronchiolitis Patho

Back 2

Mostly common RSV

then Adenovirus, parainfluenza, rhinovirus, influenza

Respiratory Syncytial Virus (<2yo)

Incubation: 4-6 days

Season: Late fall to early spring

Duration: 3-7 days

Front 3

Bronchiolitis Clinical Presentation

(commonly a/w preceding viral infection)

Back 3

1.) Fever, usually no higher than 102F, hx URI

2.) Decreased appetite

3.) Cough

5.) Large amount of clear rhinorrhea-

clear runny faucet nasal discharge!!!

Front 4

Bronchiolitis Physical Examination

ACL/AOM, washing machine

Back 4

1.) VS: Elevated T, HR, RR

2.) HEENT: mild conjunctivitis, pharyngitis, AOM,

respiratory distress

3.) Neck: anterior cervical lymphadenopathy

4.) Chest: coarse, scattered wheezing

"WASHING MACHINE"

5.) Abdomen: distended, palpable liver/spleen due to hyperinflation

Front 5

Bronchiolitis Diagnostic Tests

Back 5

1.) Rapid RSV: nasal swab

2.) Rarely CXR or CBC

but, CXR for 16 day old infant with severe bronchiolitis could look like....

Lung Hyperinflation, flattened diaphragm, b/l atelectasis in the R apical & L basal regions

Front 6

Bronchiolitis Differential Diagnosis

Back 6

1.) Asthma

2.) PNA

3.) Aspiration foreign body

4.) Croup

5.) Cystic Fibrosis

6.) Congenital Heart Dx

Front 7

Bronchiolitis Management

Back 7

MILD: sx care

Fluids, antipyretics

NS , nasal spray with suctioning

MODERATE to severe

<2mo/ older infant with respiratory distress

Hospitalize for supportive care

Reasons to hospitalize

1.) Stridor

2.) Apnea

3.) Tachypnea>60bpm at rest

4.) Hypoxia

5.) Poor feeding

6.) Decreased sensorium

7.) Parent unable to manage at home

Front 8

Bronchiolitis Education/ Prevention

Back 8

Not recommended:

1.) SABA (albuterol): not first line tx, but can try, can continue to have a good response

2.) Adrenaline

3.) Antibiotics

4.) Steroids

5.) Humidification or steam--> humidified air at home, moist get rid of nasal secretions

Education:

Course of illness: first 2-3 days are the worst

*Potential for recurring wheezing in childhood

*Increased risk of asthma going forward

Front 9

Bronchiolitis PREVENTION

Back 9

Palivixumab (synagis)

MONOCLONAL antibody to prevent RSV

*recommended for infants/premies/babies born in winter seasons or with congenital /

cardiac abnormality to prevent them from getting RSV

Front 10

Pertussis (whopping cough) Definition

Back 10

HIGHLY CONTAGIOUS

ACUTE RESPIRATORY ILLNESS

CAUSE: Bordetella pertussis

Front 11

Pertussis Clinical Presentation / Stages

Back 11

Incubation: 7-10 days after exposure,

but maybe up to 3 weeks

(i.e. kid in daycare is coughing, a week later, patient gets pertussis)

Three Stages:

1.) Catarrhal (inflammation of mucous membranes)- 1-2 weeks

2.) Paroxysmal (intensification of sx) 2-4 weeks

3.) Convalescent (recovery): 3 weeks-6 months

Front 12

Pertussis Clinical Presentation

Back 12

Pediatrics:

1.) URI, low grade temp

2.) Persistent Cough, Paroxysmal cough

3.) Posttussive emesis

4.) Cyanosis, sweating, prostration/exhaustion

after coughing

Adolescent/ Adult

PERSISTENT PAROXYSMAL COUGH

Front 13

Pertussis Physical Examination

Back 13

1.) HEENT:

*Mild injected conjunctivae with watery discharge

*Rhinorrhea

2.) CTA bilaterally (clear to auscultation)

3.) Skin: peteachial from coughing

Front 14

Pertussis Diagnostic Test

Back 14

1.) Culture with specimen from nasal swab

2.) Most reliable in the catarrhal stage (1-2wks)

Front 15

Pertussis Differential Diagnoses

Back 15

1.) PNA

2.) GERD
3.) Cystic Fibrosis

4.) Asthma

5.) Foreign Body

Front 16

Pertussis Management

Back 16

1.) Azithromycin

2.) Alternative Clarithromycin >1mo

MOST EFFECTIVE if tx in early stage, after that will decrease transmission, but not course of illness

Post exposure prophylaxis:

All close contacts, regardless of immunity status/

Exposed with risk factors

Front 17

Pertussis Prevention

Back 17

IMMUNIZATION!!

CHILDREN

Dtap series 6 weeks- 6yo

ADOLESCENTS

Single dose Tdap booster 11-12yo

Single dose of Tdap is recommended for older adolescent 13-18yo who have not yet received a dose of Tdap

ADULTS

Single dose of Tdap vaccine (adacel) to replace the next dose of adult Td vaccine

Critical targets: adults in contact with children

Health care (hospital and clinic), child care, education

Front 18

Cystic Fibrosis Definition

Back 18

Autosomal Recessive Disorder

Multi-systemic, Progressive illness

Manifests as :

COPD, GI disorder, exocrine dysfunction

Median Predicated Survival age in US: 36yo

Front 19

Cystic Fibrosis Patho

Back 19

AUTO-RECESSIVE

1.) Defect in CF transmembrane conductance regulator protein (CFTR) which is expressed in epithelial cell and blood cells

2.) CFTR defect causes defective ion transport, airway surface liquid depletion and defective mucocilliary clearance

aka don't clear mucus like normally would,

causing mucous plugs and other pulmonary problems

Front 20

Cystic Fibrosis Clinical Findings :

Pulmonary, GI, Endocrine

Back 20

Pulmonary:

1.) Lungs at birth are normal

2.) Marked impermeability to CHLORIDE/SODIUM reabsorption

3.) Mucous is vicious / leads to decreased motility

4.) Lung infections

GI:

1.) Meconium ileus (first 2 weeks of life)

2.) FTT due to pancreatic enzyme insufficiency

*ask- first passing of stool , was it delayed?*

Endocrine

1.) Recurrent acute pancreatitis

2.) DM

Front 21

Cystic Fibrosis Diagnosis

Back 21

You will suspect CF in any young child with :

FTT, Respiratory sx not responding to tx, or frequent respiratory infections

Sweat Test

Genetic Testing, newborn screening

Management: multi-disciplinary team

Front 22

Ciliary Dyskinesia

Back 22

AUTOSOMAL RECESSIVE

Impaired mucocilliary clearance

Defect in cillia in airway-->

Ciliary immobility aka "Ciliary dyskinesia"

will look like an asthma kid, don't clear their airways, lots of respiratory sx, cough, PNA

Front 23

Ciliary Dyskinesia Clinical Manifestations

Back 23

1.) Respiratory Infections

2.) Rhinosinusitis

3.) Nasal polyps

4.) Otitis Media

5.) SITUS INVERSUS 50% (heart on other side)
6.) Decreased fertility

7.) A/w transposition of the great vessels