《儿科学精品教学资料》5 儿童呼吸系统感染性疾病课件

Respiratory Infectious Respiratory Infectious Diseases in ChildrenDiseases in Children Yi-Xiao BAO, MD. PhD. Department of Pediatrics, Xinhua hospital School of Medicine, Shanghai Jiaotong University Introduction Acute Upper Respiratory Tract Infection Acute Bronchitis Pneumonia PrevalencePrevalence High Mortality RateHigh Mortality Rate 15 million deaths/year among 3 yr children Disease duration is usually 1-2 wks Features include: PharyngoconjunctivalPharyngoconjunctival Fever Fever Otitis media Cervical lymphadenitis Bronchitis Pneumonia Septicemia Complications 1. Viral Infections Viral myocarditis Viral encephalitis 2. Bacterial Infections (streptococcus) Acute nephritis Rheumatic fever DiagnosisDiagnosis DifferentialDifferential Symptoms Symptoms Signs Signs other acute infectious diseases should be differentiated. In patients with febrile convulsion, CNS infections should be considered. Patients with abdominal pain may have acute abdominal diseases. Mesenteric Mesenteric lymphadenitislymphadenitis Acute appendicitisAcute appendicitis URI symptomsexistabsent Fever & abdominal pain Fever present firstly Mild pain following Severe pain present firstly Low grade fever following Abdomen signs Diffuse tenderness No rebound tenderness and guarding Progressive localized abdominal tenderness with rebound tenderness and guarding Blood test Usually normal or elevated WBC Elevated WBC Higher level of neutrophils TreatmentTreatment Severe nasal obstruction Irritability-restlessness High fever Pharyngeal portion ulcer Conjunctivitis Anti-virus: Ribavirin Avoid the abuse of antibiotics 2. Etiological treatment 1. General treatment 3. Symptomatic treatment ProphylaxisProphylaxis Increase outdoor activities Improve physical fitness Enhance immunity function Patients should be isolated from public places AURI is the most common disease in childhood. Most cases are caused by viral infections. Disease severity is related to patients age. SummarySummary Infants present with mild respiratory and severe systemic symptoms, while older children on the contrary. 60 bpm, increased pulmonary rales Tachycardia that can not be explained by high fever or tachypnea, HR180 bpm Irritability and cyanosis Gallop rhythm or dull heart sound , distension of jugular vein and enlarged cardiac Increased liver with tenderness 1.5cm Oliguria or anuria accompanied with edema of eyelid or lower extremities Myocardial failure ComplicationComplication Empyema of pleura Purulent pneumothorax Bullae of lung Septicemia Purulent pericarditis Other complications Lab FindingsLab Findings Etiological exam Bacteriological exam: bacterial culture Virological exam: viral isolation Mycoplasma exam: specific immunity exam Peripheral blood test White cell count CRP (C-reactive protein) Nitroblue tetrazolium test PathogenPathologyDurationSeverity Viral Bacteria Mycoplasma Broncho Lobar Interstitial Acute ( 3mo) Mild Severe ClassificationClassification Pathogen Pathology Streptococcus pneumoniae Haemophilus influenzae 1. 1. Bronchopneumonia (Lobular pneumonia)Bronchopneumonia (Lobular pneumonia) Hyperemia and edema of bronchiolar wall Exudation of pulmonary lobule Bronchiolar obstruction scattered surround bronchus - More common in infants, aged or weak people Hyperpyrexia Cough Tachypnea Dyspnea Clinical manifestation Chest X-ray Increase lung markings Diffuse bilateral patchy infiltrates and consolidation scattered throughout both lungs Atelectasis, hyperinflation, bullae of lung and pyothorax A segmental atelectasis at the right superior lobe. The transverse fissure is displaced by the airless lobe. There is a sector of high density shadow with the apex toward the hilum of lung. The diaphragm is elevated and the mediastinum is shifted to the involved side. Segmental Segmental atelectasisatelectasis 2.2. Lobar pneumoniaLobar pneumonia PathogenPathogen streptococcus pneumoniae (mainly) PathologyPathology Inflammation infiltrates throughout a whole lobe or segment of the lung Clinical manifestation Clinical manifestation Hyperpyrexia, cough and rusty sputum - More common in adolescence, rare in young children A consolidation within the transverse fissure and oblique fissure can be seen at the middle lobe of right lung. Changes in CXR follow the onset of clinical presentation. Chest X-rayChest X-ray It mainly affects infants of 2-6 months old. It is caused by viruses, RSV (85%) Pathological changes include swelling and distension of bronchioles and secretions blockage, leading to airway obstruction 3. 3. BronchiolitisBronchiolitis Clinical ManifestationClinical Manifestation Chest radiographic findingsChest radiographic findings Expiratory wheezing Tachypnea, nasal flaring Cyanosis Fine rales Emphysema Disease duration of 4-7 days Hyperexpansion (common) Peribronchial cuffing Increased interstitial markings Patchy infiltrates The most common - Escherichia coli Main in young infants 1 week 4. Newborn pneumonia4. Newborn pneumonia PathogenPathogen staphylococcus aureus hemolytic streptococcus Systemic toxic symptoms Clinical ManifestationClinical Manifestation Difficult milk-feeding Drowsiness Poor response Tachypnea Cyanosis, foaming at mouth, nodding respiration and apnea may be present in severe cases. Some cases only have systemic toxic symptoms. Fever and respiratory manifestation (cough, rales) are rare. Chest X-ray: patchy shadows and infiltrates 5. Adenovirus pneumonia5. Adenovirus pneumonia PathogenPathogen SusceptibleSusceptible Clinical Clinical manifestationmanifestation Type 3,7 adenovirus Young children（6 mo-2 yr ） Sudden onset of high fever, toxic symptoms and pale face Cardiac dysfunction and nervous system involved sometimes Respiratory symptoms: severe cough, dyspnea and wheezing Fine rales occur after 3-4 days CXR diffuse interstitial and patchy alveolar infiltrates Peribronchial thickening Focal consolidation throughout both lung field Chest X-rayChest X-ray patchy infiltrates and consolidation with hyperinflation It is more common in neonates and infants. Disease onsets suddenly and progresses quickly. Clinical manifestation varies with disease stage. Consolidation of lung is obvious. Chest X-ray reveals infiltrates, abscess and bullae of lung. 6. Staphylococcal pneumonia6. Staphylococcal pneumonia Rash Severe toxic symptoms Digestive symptoms Convulsion Shock Abscess Multiple round high density shadow in both sides. Pulmonary Bulla Female, 7 day, hyperpyrexia and no crying Multiple giant air-containing cavity Pyopneumothorax Encapsulated pleural effusion It is common symptomatic pneumonia in older children. Fever, dry cough are frequent complaints. Extrapulmonary manifestation is not rare. 7. 7. MycoplasmaMycoplasma pneumonia pneumonia A 5-year-old boy complaints of fever and cough MP antibody (+) CXR: Interstitial infiltrates Increased lung markings Diffuse patchy infiltrates Volume loss of both lower lobes Enlarged hilar shadow DiagnosisDiagnosis Differential Peak age of onset Clinical manifestation Lab findings Chest X-ray Others Acute bronchitis Pulmonary tuberculosis Foreign body in bronchus Symptomatic treatment TreatmentTreatment Antimicrobial treatment Complication treatment Supporting treatment physical treatment Nursing Immunity function enhancement Oxygen supply Conscious sedation Pyretolysis Cough Suppressants Eliminate sputum Principle of antibiotic treatmentPrinciple of antibiotic treatment Streptococcus pneumoniae penicilin Amoxicillin Bacillus influenzae Amoxicillin plus clavulanate 2nd or 3rd-generation cephalosporins Staphylococcus aureus Oxacillin sodium Vancocin Moraxelle catarrhalisAmoxicillin plus clavulanate Mycoplasma PneumoniaErythromycin Macrolide SensitiveSensitiveEarlyEarlySufficientSufficientCombinedCombined A Antiviral ntiviral treatment treatment Ribavirin Interferon (IFN) Immunoglobulin No ideal antiviral drugs are available. Traditional Chinese medicine Yuxingcao, Double coptis Severe toxic symptoms Increased secretions and bronchial spasm Complicated pleural effusion in early period Indications of systemic corticosteroidsIndications of systemic corticosteroids