Acute respiratory infections (Croup (LARYNGOTRACHEOBRONCHITIS.…
Acute respiratory infections
LARYNGOTRACHEOBRONCHITIS. Inflammation of the mucosa in the area causes swelling and oedema of the subglottic area. Children have narrow trachea - easily obstructed
Responsible for >95% of LARYNGOTRACHEAL infections in children.
Most commonly due to
viruses. Also RSV influenza etc.
Between the ages of 6mo - 6yrs.
PEAK 2 years old.
Commonest in the AUTUMN.
Fever (not particularly high) and coryza >>
barking cough, harsh stridor, hoarseness
Depends on severity - mild or severe.
oral steroids - prednisolone, dexamethasone or nebulised budesonide.
Single dose ORAL DEX is first line at 0.15mg/kg, REGARDLESS OF SEVERITY
reduces severity and duration of croup. Reduces need for hospitalisation. Many fewer children need intubation since introduction of steroids.
Mild - managed at home, dependent highly on parents understanding and confidence/capability, low threshold to bring in or admit if <12mo old because v narrow trachea anyway.
SEVERE - ADMIT
- may need intubation, need closer monitoring by anaesthetist. Give
WESTLEY croup severity scoring
Based on 5 domains - air entry, stridor, cyanosis, retractions and level of consiciousness. Helps guide management - whether to admit or not and whether to give steroids and/or adrenaline
Bacterial tracheitis (aka pseudomembranous croup)
Similar to severe croup. Child has a HIGH fever, appears toxic, rapid airway obstruction due to
thick airway secretions
IV abx, intubation and ventilation if required
Exceedingly rare in the UK now Hib vaccine introduced (>99% reduction)
Intense swelling of epiglottis and surrounding tissues associated with septicaemia
Very quick onset and deterioration >> ONSET over HOURS.
Cough is SILENT - they aren't able to speak or drink,
HIGH FEVER, toxic and unwell
stridor = soft-whispering
(compare to harsh of croup)
SECURE THE AIRWAY - if suspected, intubate under GA.
Afterwards, blood can be taken for cultures
- given for 3-5 days
Intubation kept in for 24h
Most children recover well and within 2-3 days with appropriate treatment.
offered to household contacts for prophylaxis
Annual winter epidemics - 2-3% of children admitted to hospital for this. Mostly infants
Caused by RSV in >80% of cases. Also human metapneumovirus, rhino, parainfluenza, flu, adeno, Mycoplasma pneumoniae.
Dual infection with RSV and human metapneumo associated with
Coryzal followed by SOB and dry cough
• Subcostal and intercostal recession
• Hyperinflation of the chest:
– Prominent sternum
– Liver displaced downwards
• Fine end-inspiratory crackles
• High-pitched wheezes – expiratory > inspiratory
• Cyanosis or pallor.
Diagnosis of RSV
: PCR of respiratory secretions from nose
humidified o2 via nasal cannulae
Fluids via NG or IV sometimes necessary
May require NIV - CPAP or full ventilation in some cases
Bordetella pertussis. Highly infectious.
Endemic, outbreaks every 3-4 years.
Infants that haven't had 2, 3, 4 month jabs yet are particularly susceptible.
1 week of
Characteristic paroxysmal/spasmodic coughs. Come in
. (not always, especially in infants - may just have apnoea)
During the coughing - so severe that child may become red/blue in the face.
Violence of coughing can cause vomiting or nosebleeds, subconjunctival haemorrhages
Paroxysmal phase usually lasts 3-6 weeks. Can last for months.
include pneumonia, bronchiectasis, convulsions. Rare.
Pernasal swabs + culture of organism
LYMPHCYTOSIS on blood film
Abx can shorten duration and severity of infection if administered early in course of illness. (i.e. within first 7 days)
But usually people present later than that - in paroxysmal phase.
MACROLIDE abx still recommended if within 21 days of illness starting
Should be given to infants and children - based on clinical suspicion not lab results (takes time)
If < 1mo give azithromycin? Unclear over uptodate vs CKS NICE whether azithro or clarithro...
Associated with increased risk of pyloric stenosis?
Otherwise - just pain relief and hydration (largely supportive). No symptomatic recommended for cough
Pneumonia. Always consider TB at all ages if high risk
Newborn: birth canal organisms = group B strep, gram -ve enterococci
Infants and young children - usually viral. RSV. Can be strep pneum, Hib, Bordetella pertussis and Chlamydia trach. Staph A
Older children >5 = mycoplasma pneumoniae, strep pneum, chlamydia pneum (bacteria)