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12lower Respiratory Tract Infection

The document discusses pneumonia and acute bronchiolitis. Pneumonia is an inflammation of the lungs that can be caused by various infectious and non-infectious factors. Acute bronchiolitis is predominantly caused by respiratory viruses and is characterized by bronchiolar obstruction. Both conditions require supportive treatment and hospitalization may be needed for severe cases with respiratory distress.

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75 views44 pages

12lower Respiratory Tract Infection

The document discusses pneumonia and acute bronchiolitis. Pneumonia is an inflammation of the lungs that can be caused by various infectious and non-infectious factors. Acute bronchiolitis is predominantly caused by respiratory viruses and is characterized by bronchiolar obstruction. Both conditions require supportive treatment and hospitalization may be needed for severe cases with respiratory distress.

Uploaded by

mehdikhalid09
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Pneumonia and acute bronchiolitis

PNEUMONIA
Pneumonia is an inflammation of the

parenchyma of the lungs


 There are several noninfectious causes, which
includes
 Aspiration of food or gastric acid

foreign bodies, hydrocarbons, & lipoid substances


 Hypersensitivity reaction
 Drug-or radiation-induced pneumonitis
 Most cases of pneumonia are caused by microorganisms.
o Viruses
common
RSV, parainfleunza ,influenza,adenoviruses,
humanmetapneumo virus
Bacteria
Common
 S.pneumoniae
 GBS, GAS, M.pneumoniae, C.pneumoniae
 C.trachomatis
 gram negative enteric bacilli
 mixed anarobes

Uncommon
 HIB, S.aureus, M.catarrhalis, legionella species
FUNGAL
Histoplasma capsulatum, Aspergillus species

Cryptococcus neoformans, Pneumocystis jiroveci


Neonates(<3 wk)
 GBS, Escherichia coli, other Gram-negative bacilli

3 wk-3 mo
 RSV, other respiratory viruses,
 S. pneumoniae, HIB (type b, nontypeable)
 Chlamydia trachomatis if patient is afebrile
4 mo-4 yr
 RSV, other respiratory viruses,
 S. pneumoniae, HIB (type b, nontypeable)

Mycoplasma pneumoniae, GAS


≥5 yr
 M. pneumoniae, S. pneumoniae, Chlamydophila

pneumoniae, HIB (type b, nontypeable), viruses,


Legionella pneumophila
 Pneumonia is a significant cause of mortality which
causes approximately 4 million deaths among children
worldwide
 Pneumonia contributes 28% of under five mortality in

Ethiopia (the leading causes of U5 mortality)


 Children who are immunosuppressed or who have

underlying illness are at risk for specific pathogens,


such as pseudomonas in patients with cystic fibrosis.
 Risk increases in children with
 Lung diseases-asthma, Cystic Fibrosis, pulmonary
congestion
 Anatomic problems
 GERD
 Neurologic disorders
 Immunosuppression
 Environmental risks
Recurrent pneumonia is defined as
 2 or more episodes in a single year or 3 or more

episodes ever, with radiographic clearing between


episodes.
 An underlying disorder should be considered
HEREDITARY DISORDERS
 Cystic fibrosis, Sickle cell disease

DISORDERS OF IMMUNITY
 HIV/AIDS, congenital immunodeficiency

DISORDERS OF CILIA
 Immotile cilia syndrome

ANATOMIC DISORDERS
 GERD, Foreign body, Bronchiectasis
 Tracheoesophageal fistula (H type)
 Aspiration (oropharyngeal incoordination)
Respiratory defense mechanisms
Mucocilliary escalator
Mucosal secretion & secretary IGA
Cough reflex
Alveolar macrophage
 The pathologic process varies according to the
invading organism
 S.pneumoniae- characteristic focal lobar involvement
 Group A streptococcus
 Necrosis of tracheobronchial mucosa
 Formation of large amount of exudate ,edema ,and

local hemorrhage with extension into the intralveolar


septa
 Involvement of lymphatic vessels & increased

likelihood of pleural involvement.


 S. aureus- broncopneumonia
 Hemorrhagic necrosis & irregular areas of cavitations
of the lung parenchyma, resulting in pneumatoceles,
empyema.
Typical pneumonia
 Preceding symptoms of URTI
 Tachypnea-consistent manifestation
 Increased work of breathing

IC/SC retraction
suprasternal retraction
Nasal flaring, grunting
 Severe infection may be accompanied by cyanosis and

lethargy, especially in infants.


 Bacterial pneumonia in adults and older children
typically begins suddenly with high fever, cough, and
chest pain.
 Auscultatory findings- crackles, BBS, wheezing,

decreased breath sounds


Atypical pneumonia syndrome; may have
extrapulmonary manifestations, LG, patchy diffuse
infiltrates, poor response to β-lactam antibiotics, and
negative sputum Gram stain
Clinical manifestation
 Inc. WBC
 CXR
 Blood culture
 Age <6 mo
 Multiple lobe involvement
 Immunocompromised state
 Toxic appearance
 Moderate to severe respiratory distress
 Requirement for supplemental oxygen
 Complicated pneumonia
 Dehydration
 Vomiting or inability to tolerate oral fluids or

medications
 No response to appropriate oral antibiotic therapy
 Social factors (e.g., inability of caregivers to administer

medications at home or follow-up appropriately)


TREATMENT
 Treatment of suspected bacterial pneumonia is based

on the presumptive cause & the clinical appearance of


the child.
 Out patient- po amoxicillin, Macrolides for Atypical

pneumonia
 Inpatient-IV penicillin or cephalosporin
 Supportive- oxygen, nutrition, rehydration
COMPLICATIONS
 Result of spread of bacterial infection with in the

thoracic cavity
Pleural effusion, empyema & pericarditis
 Result of bacteremia & hematologic spread;

Meningitis, suppurative arthritis & osteomyelitis


 Meningitis, suppurative arthritis & osteomyelitis
results from infection with HIB & pneumococcal
organisms.

 S. aureus, S. pneumoniae, and S. pyogenes are the most


common causes of parapneumonic effusions and of
empyema .
ETIOLOGY
 Streptococcus pneumoniae
 Staphylococcus aureus
 Haemophilus influenzae
 GAS
 Gram-negative organisms
 Tuberculosis
 Fungi
 Lung abscess into the pleural space
 Trauma or thoracic surgery
 Mediastinitis
 Intraabdominal abscesses.

 It occurs in 5-10% of children with bacterial

pneumonia and in up to 86% of children with


necrotizing pneumonia.
 Empyema has three stage
Exudative, Fibrinopurulent, organizational
 The initial clinical feature is that of pneumonia
 Worsening of clinical symptoms of pneumonia after

initiation of therapy
 Dullness and decreased air entry on the affected side
1. CXR
 Homogeneous density obliterating the normal

markings of the underlying lung.


 Small effusions may cause obliteration of only the

costophrenic or cardiophrenic angles


2.Ultrasonographic examinations are useful and may
guide thoracentesis if the effusion is loculated.
3. thoracentesis
Empyema
 Protein level >3.0 g/dL
 Pleural fluid protein: serum protein ratio >0.5
 Pleural fluid LDH values >2/3 upper limit of normal

for LDH
 Pleural fluid : serum LDH ratio >0.6
 PH <7.1
 Glucose <40 mg/d
 Cells often >50,000, PMN cell predominence
 Gram staining occasionally positive
 Gross appearance .. cloudy or purulent
Local CX
 BPF- bronchopleural fistula
 Pyopneumothorax
 Purulent pericarditis
 Pulmonary abscesses
 Peritonitis
 Osteomyelitis of the ribs.

Septic Cx
Meningitis, arthritis, and osteomyelitis
 Systemic antibiotics and
 Thoracentesis and chest tube drainage
 fibrinolytic agent;
 VATS- video assisted thoracic surgery is indicated
 Open decortications

 Systemic antibiotic therapy is required for 3-4 wk.


 Acute bronchiolitis is predominantly a viral disease.
 RSV is responsible for more than 50% of cases.
 Others parainfluenza, adenovirus, rhinovirus, and

Mycoplasma.
 Emerging pathogens include

 human metapneumovirus and human bocavirus,


 Acute bronchiolitis is characterized by bronchiolar
obstruction with edema, mucus, and cellular debris.
 exposure to an older contact with a minor respiratory
syndrome within the previous week
 The infant first develops a mild URTI with sneezing

and clear rhinorrhea.


 Diminished appetite and fever of 38.5-39°C
 Gradually, respiratory distress ensues, with paroxysmal

wheezy cough, dyspnea, and irritability.


 The infant is often tachypneic,
tachypneic which can interfere
with feeding.
 Apnea particularly with very young infants (<2mo old)

or former premature infants


 Clinical particularly in a previously healthy infant
presenting with a 1st-time wheezing
 Chest radiography can reveal hyperinflated

lungs with patchy atelectasis but is not indicated in


all patients with bronchiolitis.
 Viral testing….
Hospitalization
 Infants with acute bronchiolitis who are experiencing

respiratory distress (hypoxia, inability to take oral


feedings, apnea, extreme tachypnea)
 The mainstay of treatment is supportive.
 Hypoxemic children should receive cool

humidified oxygen.
 Sedatives are to be avoided
 Suctioning of secretions is an essential part of the
treatment of bronchiolitis
 adjunctive therapies for bronchiolitis. Bronchodilators
 Infants with acute bronchiolitis are at highest risk
for further respiratory compromise in the 1st 48-72
hr after onset of cough and dyspnea; the child may be
desperately ill with air hunger, apnea, and
respiratory acidosis.
 The case fatality rate is <1%,

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