小儿呼吸疾病(英文)

InfectionDiseasesofRespiratorySysteminChildrenIntroduction

HighMorbidityRate

HighMortalityRateEachyear,respiratoryinfectiondiseasescauseabout15milliondeathsamongchildrenyoungerthanage5yearthroughtheworld.Pediatricpulmonaryinfectionaccountsforabout63.89%ofallhospitalizationsofchildren,inwhich44.6percentarepneumonia.CricoidcartilageUpperrespiratorytract

nose,paranasalsinuses,pharynx,

eustachiantube,epiglottis,larynxLowerrespiratorytract:

trachea,bronchi,bronchioles,alveolus

AnatomyAnatomyUpperrespiratorytract

ShortNasalpassages,nasolacrimalductandeustachiantubeSignificance:Thesecharactersmakenasalcavityeasytobecomehyperemia,edema,andcongestionwhichwillinduceinfection.Localinfectioncanspreadtonearbyorgansandtissueseasilyandcausedyspnea,hoarsenessandapnea.NasalmucosaIssoftMorevascular

NasalcavityisshortandnarrowAnatomyNarrowedairwaySoftmucousmenbraneMorevascularSofterandmorecompliant

Clinicalsignificance:Easytobecomehyperemia,edema,andcongestionwhichwillinduceinfectionComplication:PulmonaryemphysemaandatelectasisLowerrespiratorytractPhysiologyTheyoungerthechildThequickerthefrequencyThelessregulartherhythmVitalcapacity(VC)

TidalvolumeTotallungcapacity(TLC)

Respiratoryfrequencyandrhythm：Therespiratoryfrequencyisinverselyrelatedtoage

.⑴neonate:40～50bpm；6～12mo:30-35bpm；

1-3

yr:25～30bpm；4～9yr:20-25

bpm；

8-14

yr:18～20bpm。(2)Someyounginfantspresentwithirregularrhythmorapneaduetoimmaturerespiratorycenter.SmallImmuneSystem

LowlevelofsIgA,IgGonRespiratoryMucosa

LowlevelofTh1functionAcuteUpperRespiratoryTractInfection

“Commoncold”

AcuteUpperRespiratoryInfectionIntroduction

80-90%proportionofvisittoclinic.

spreadtonearbyorgansandtissues(otitismedia,conjunctivitis,lymphadenitis,lymphadenitisandpneumonia)Bronchialasthma,nephritis,myocarditis,measlesandpertussismayalsofollowAURI90%ofAURIarecausedbyviralinfectionEtiology

RhinovirusEchovirusCoxsackievirusParainfluenzaInfluenzaAdenovirusRSV(RespiratorySyncytialVirus)PneumococcusMoraxelle

catarrhalis

HaemophilusinfluenzaeStaphylococcusaureusBacteriaMycoplasmaChlamydiaOtherMicroorganismsOthersMildsymptom

Nasalcongestion,rhinorrhea,sneezing,sorethroatSeveresymptom

Highfever,convulsion,anorexia,frequencycoughClinicalManifestation

SymptomsofURIinchildrenofdifferentages<3moInfantsAdolescentsSystemicsymptomUsuallymildLowgradefeverUsuallysevereHighfeverConvulsionIrritabilityUsuallymildLowgradefeverRespiratorySymptomsNasalcongestionDyspneaAbsentormildorsevereNasalcongestionRhinorrheaSneezingSorethroatGastrointestinalSymptoms

DiarrheaVomitingDiarrheaVomitingAnorexiaAbdominalPainThepharynxisredRetropharyngealfolliculosisErythematousenlargedtonsilsEnlargedlymphnodesEnterovirusillnessesmaybeassociatedwithawidevarietyofskinrashesPhysicalSign

HerpanginaCoxsackievirusAMostoftenoccursinsummerandautumnMoreoftenininfants（0-3yrofage）Characterizedbysuddenonsetoffever,sorethroatanddysphagiaCharacteristiclesions,presentontheposteriorpharynx,arediscretevesiclesandulcersDurationofillnessisusually7days

TwoSpecialTypesOccurstypicallywithtype3,7adenovirusMostoftenoccursinspringandsummerChildren（>3yr）moreoftenaffectedFeaturesinclude:Ahightemperaturethatlasts4–5days,pharyngitis,conjunctivitis,cervicallymphadenopathy,andrhinitis.Durationofillnessisusually1-2weeksPharyngoconjunctivalFeverOtitismediaCervicallymphadenitisBronchitisPneumoniaSepticemiaComplicationViralInfection

→ViralMyocarditisViralEncephalitisBacterialInfections（streptococcus))

→AcuteNephritis

RheumaticFeverDiagnosisSymptomssighsThedifferentialdiagnosisoftheURlincludesotheracuteinfectiousdisease.Inpatientwithfebrileconvulsion,centralnervoussystemInfectionsshouldalsoconsidered.Patientswithabdominalpainmayhaveacuteabdomen.

DifferentialdiagnosisDifferenceBetweenMesentericLymphadenitisandAcuteappendicitisClinicalManifestationMesentericlymphadenitisAcuteappendicitisSymptomofURIexistabsentFeverandAbdominalPain1stpresentwith:feverFollow:pain(mild)1stpresentwith:pain(severe)Follow:LowgradefeverAbdomensignsDiffusetendernessNoreboundtendernessandguardingProgressivelocalizedabdominaltendernessWithreboundtendernessandguardingBloodroutineWBCisusuallynormalorelevatedWBCiselevatedhigherlevelofneutrophilsProphylaxis

Increaseoutdooractivities.Improvephysicalfitness.Enhanceimmunityfunction.Patientsincollectiveinstitutionsshouldbeisolated.TreatmentUpperrespiratoryinfectionisthemostcommondiseaseinchildhood,mostofwhicharecausedbyviralinfections.Theseverityofclinicalmanifestationsisrelatedtoageofthepatients.Infantspresentmildlocalsymptomsandseveresystemicsymptoms,whileolderchildrenpresentonthecontrary.Astuffy,congestednosemayexistininfantsyoungerthan3monthsofage.Treatmentforthecommoncoldshouldbemainlysymptomatic.Antibioticsshouldnotbeusedunlessinthoseyoung,infantpatientswhicharesuspectedtocomplicatebacterialinfections.SummaryAcutebronchitisisinflammationofthetracheobronchialepithelium.Tracheaisusuallyinvolved，soacutebronchitisisalsocalled‘acutetracheobronchitis’.Acutebronchitisiscommonlysecondarytoanacuteviralinfection,orjustonemanifestationofacuteinfectiousdisease.

AcuteBronchitisInfectiousfactors：viral,bacterialorotherpathogeninfectionsCharactersofrespiratorytractofinfants:Themucousbecomeedemaandhyperemiawhichmakethebronchusnarrowerwheninflammation.Otherfactors：immunodeficiency,nutritionaldiseases,specificbodyconstitution.EtiologyClinicalManifestation

BeginsasanURICoughisasignificantsigns

nonproductivecough→productiveThesystemicsymptomsisusuallysevereininfantsincludingfever,vomitinganddiarrheaMedicalexamination：RespiratoryrudenessDiffuseorscatteredrales

NodyspneaCXR:maybenormal

orthickeninglungmarkings

Acutebronchitisisaninflammationofthemajorconductingairwayswithinthelungwhichcausedbyviralorbacteria,andismostoftenininfants.Coughisthemostsignificantclinicalmanifestation.Fever,vomitinganddiarrheaarefrequentininfants.Respiratorysoundsareroughandscatteredralesareheardonauscultation.

Radiographicexaminationofthechestmayshowamildincreaseinbronchovascularmarkings.

Antibioticsareindicatedifabacterialinfectionoftheairwayissuspectedorproven.Corticosteroidsarerecommendedinseverecases.Summary

Pneumoniaisaninflammationoftheparenchymaofthelungs.

Mostcasesofpneumoniaarecausedbymicroorgnanisms,butthereareseveralnoninfectiouscauses,whichincludeaspirationoffoodorgastricacid,foreignbodiesandsoon.AcutePneumoniaSeasonofonset

AgeofonsetMorbidityrateMortalityrateEpidemiologyClassifiedaccordingtotheinfectingorganism:

Viralpneumonia,bacterialPneumonia,mycoplasmaPneumonia.ClassifiedaccordingtoPathology:Bronchopneumonia,lobarpneumonia,interstitialpneumonia.Classifiedaccordingtodurationofdisease:Acutepneumonia(<1mo),persistentpneumonia(1-3mo)andchronicpneumonia(>3mo).Classifiedaccordingtoseverityofdisease:Mildpneumoniaandseverepneumonia.CategoryBacteriaStreptococcuspneumoniae,Haemophilus

influenzae,Staphylococcusaureus,

Escherichiacoli,PseudomonaspyocyaneaVirusesRespiratorySyncytialViruses,adenovirus,influenza,parainfluenzaothersIncidencerateofChlamydiapneumoniae

andMycoplasma

pneumoniaeareincreasingrecentyears.EtiologyAgeMoreoftenininfantsDiseaseEnvironmentMalnutrition,Congenitalheartdisease,Immunodeficiencydiseasewetness,stuffinessandcrowding.

InducementPatientswiththefollowingproblemsareparticularlypredisposedtothisdisease:Hyperemia,edemaandinflammatoryinfiltrationoflungtissuesAlveolarexudate

PatchyInflammationfocus,andconsolidationAtelectasisandemphysemaoflungPathologyfevercoughtachypneaRalesfoursymptomsClinical

ManifestionPneumoniaApartfromthegeneralfeaturesofbronchopneumonia,severepneumoniaalsopresentwith

systemictoxicsymptomsinrespiratorysystemcirculatorysystemnervoussystemdigestivesystemSeverePneumoniaCirculatorysystemMyocarditis,heartfailureMicrocirculationdisturbanceDigestivesystemNervoussystemIntracranialhypertensionEncephaledemaWater-ElectrolyteBalanceMixedacidosis,dehydrationHyponatremiaExtrapulmoanrypresentations

Suddenlyonsetoftachypnea,R>60bpm,increased

pulmonaryrales.

Tachycardiathatcannotbeexplainedbyhighfeverortachypnea,HR>180bpmIrritabilityandcyanosisGalloprhythmordullheartsound,distensionofjugularveinandenlargedcardiac

Increasedliverwithtenderness,>1.5cm.

Oliguriaoranuriathatpresentwithedemaofeyelidorlowerextremities.MyocardialfailureEmpyemaofpleuraPurulentpneumothoraxBullaeoflung

SepticemiaPurulentpericarditis

ComplicationLaboratoryExaminationLobularpneumonia(Bronchopneumonia)Pathogen

Streptococcuspneumoniae

Haemophilus

influenzaePathology

Pathologicalchangessuchashyperemiaandedema

ofbronchiolarwall,exudationofpulmonarylobule,andbronchiolarobstructionarescattered

surroundbronchus.Clinicalmanifestation

Hyperpyrexia,cough,tachypneaanddyspneaMorecommonininfants,agedpeopleandweakpeopleIncreaselungmarkingsDiffusebilateralPatchyinfiltratesandconsolidationscatteredthroughoutbothlungsAtelectasis,hyperinflation,bullaeoflung

andpyothoraxChestradiographicfindingsinbronchopneumoniaChestradiographicfindingsinbronchopneumoniaFrontalviews

:Patchyinfiltratesandconsolidationattheinnerzoneandmiddlezoneofbilaterallowerlobes,withorwithouthyperinflationSegmentalatelectasisFrontalviews

:Itisasegmentalatelectasisattherightsuperiorlobe.Thetransversafissureisdisplacedtowardtheairlesslobe.Thereisasectorhighdensityshadowwiththeapextowardthehilumoflung.Thediaphragmiselevatedandthemediastinumisshiftedtothesideofinvolvement.

LobarpneumoniaPathogen:mailystreptococcuspneumoniaePathology:inflammtion

infiltratesthroughoutawholelobeorsegmentofthelung.

Mainclinicalmanifestation:Morecommoninadolescence,rareinyoungchildren.Hyperpyrexia,cough,andrustysputumX-rayfindingsChangeafterchangesofclinicalsymptoms.LobarpneumoniaatmiddlelobeofrightlungFrontalviews

:Aconsolidationwithinthetransversefissureandobliquefissurecanbeseenatthemiddlelobeofrightlung,viraldisease,RSV(85%).aged2-6months.airwayobstructionisduetopathologicalchangesincludeswellinganddistensionofbronchioles,

secretionsblockage.Bronchiolitisexpiratorywheezing

tachypnea,nasalflaringCyanosisfineralesemphysemaThedurationofillnessis4~7daysClinicalManifestationHyperexpansioniscommonlypresentPeribronchialcuffingIncreasedinterstitialmarkings

PatchyinfiltratesChestradiographicfindingsFrontalviewsofCXR:Ground-glassopacityDecreasedlungmarkingsPatchyinfiltratesininnnerandmiddlezoneAcquiredhyperinflationRSVPneumoniaEscherichiacoliisthemostcommonpathogeninneonate.Inyounginfants>1week,mainlypathogenarestaphylococcusaureusandhemolyticstreptococcus.

Somepatientsmaypresentonlywithsignsofgeneralizedtoxicity.

Patientuausllypresentnocoughorfever.Ralesareseldomheardonausculation.

Clinicalmanifestationmaybemilk-resistant,drowsiness,lowresponse,andtachypnea.Cyanosis,foamingatmouth,noddingrespirationorapneamaypresentinseverecases.Respiratorysignsisrare.PneumoniaofnewbornChestX-rayFrontalviews

:Thereispatchyshadowsandinfiltratesatrightlungfield.Adenoviruspneumonia

Type3,7adenovirusYoungchildren（6mo-2yr）aremoreoftenaffectedAcuteonsetofhighfever,toxicsymptomsandpaleface.Sometimespresentwithcardiacdysfunctionandsymptomofnervoussystem

Severecough,dyspneaandwheezing

Respiratorysignssuchasfineralesoccurafter3-4daysPatchyinfiltratesandconsolidationwithhyperinflation.AdenoviruspneumoniaFrontalviews:Chestradiographsrevealsdiffuseinterstitialandpatchyalveolarinfiltrates,peribronchialthickening,andfocalconsolidationthroughoutbothlungfield.Staphylococcalpneumonia

MorecommoninneonateandinfantsPresentasuddenonsetandprogressquicklySignsinclude:rashes,

severe

toxicsymptoms,digestivesymptoms,convulsionandshockSignsvarywithstageofdiseaseConsolidationoflungisobviousChestX-rayrevealsinfiltrates,abscessandbullaeoflungAbscessoflungFrontalviews:MultipleroundhighdensityshadowinbothsidesPyopneumothoraxEncapsulatedpleuraleffusionPulmonaryBullaFemale，7day，hyperpyrexiaandnocryingCXR:multiplegiantair-containingcavityMycoplasmapneumoniaInterstitialinfiltratesinMycoplasmapneumonia

A5-year-oldboycomplainoffeverandcough.MPantibody(+)FrontalviewsofCXR:IncreasedlungmarkingsDiffusepatchyinfiltratesVolumelossoflowerlobesofbilaterallungEnlargedhilarshadow

Peakageofonset

Clinicalmanifestation

Laboratoryexamination

X-rayexamination

OthersDiagnosisAcutebronchitisPulmonarytuberculosisForeignbodyinbronchusDifferentialDiagnosisTreatmentPrincipleofantibiotictreatment:

SensitiveEarlytreatmentSufficiencyDrugcombinationAntimicrobia