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What are 2 categories of bacterial infections?
Pneumonia, pertussis
What are the most common bacterial agents that cause pneumonia in kids?
S. pneumoniae H. influenzae C. pneumoniae M. pneumoniae Pseudomonas
What is a common viral infection in children?
What 4 other disease fall in the category of bronchiolitis?
RSV Croup/Parainfluenzae Adenovirus Influenza
What is the main cause of pneumonia?
What are 5 common pediatric pulmonary problems?
Asthma CF Foreign body aspiration Obstructive sleep apnea Premature lung disease
What is the single best way to protect both yourself and your child from getting sick?
hand washing
Many newborn infections are transmitted by the ____ in a process called _____ transmission
What are the most common causes of CAP in children from birth to 20 days old?
Escherichia coli Group B streptococci Listeria monocytogenes
What are the most common causes of CAP in children age 3 weeks to 3 months?
Bacteria- Chlamydia trachomatis S. pneumoniae Viruses- Adenovirus Influenza virus Parainfluenza virus 1, 2, and 3 Respiratory syncytial virus
What are the most common causes of CAP in children age 4 months to 5 years
Bacteria- Chlamydia pneumoniae Mycoplasma pneumoniae S. pneumoniae Viruses- Adenovirus Influenza virus Parainfluenza virus Rhinovirus
What are the most common causes of CAP in children age 5 years to adolescence?
C. pneumoniae M. pneumoniae S. pneumoniae
What are the symptoms of community acquired pneumonia?
worsening productive cough, SOB, chest pain, fever, sweats/shaking chills/"rigor". May begin suddenly.
CAP is most often in what age group?
<2 and >65
What bug most frequently causes CAP?
S. pneumoniae (50% of cases)
What are the symptoms of atypical pneumonia (walking pneumonia)?
Low-grade fever, non-productive cough, insidious onset. May see myalgias, fatigue, skin rash
What bugs most commonly cause walking pneumonia?
Mycoplasma & chlamydophila
What are the symptoms of nosocomial (hospital acquired) pneumonia?
Be suspicious if new fever develops with or without cough
What bug most commonly causes nosocomial pneumonia?
Why are we seeing an increase in atypical or walking pneumonias?
Because of prevnar or pneumovax, there is less strep pneumo going around, which increases the prevalence of atypical pneumonia.
What will you see on the PE for a child with pneumonia?
Altered/decreased breath sounds, +/- crackles (rales), bronchial breath sounds
What lab tests should you order to test for pneumonia?
WBC (CBC), CRP, No sputum culture, consider viral or FA panel
What will CBC values show?
WBC may be elevated, with potential left shift
What will CRP values show?
What imaging should you order?
What will CXR show for CAP?
lobar consolidation +/- effusion in CAP
What will CXR show for atypical?
segmental/unilateral/lower lobe more common in mycoplasma.
What will CXR show for viral pneumonia?
Streaky/patchy pattern more common in viral
Why should you not do a sputum culture in kids?
Kids have so much oral bacteria that it can skew the results
What bug is a gram positive diplococci?
Streptococcus Pneumoniae
How many different serotypes does strep pneumo have?
How is strep pneumo transmitted?
Through the air from respiratory droplets
What are the most common seasons for strep pneumo?
winter & early spring
What is the incubation period for strep pneumo?
1-3 days
What are the vaccines that are available to treat strep pneumo?
Prevnar, pneumovax
How many strains does prevnar cover vs. pneumovax?
Who is eligible for pneumovax?
Kids with chronic illnesses- this one is better, but you have to be indicated for it
What diseases is strep pneumo associated with?
meningitis, pneumonia, OM, sinusitis
What is penicillin resistance for strep pneumo?
What should you treat strep pneumo with?
can start with amox and add a clindamycin if no improvement, or can start with a macrolide (azith)
What is a gram negative obligate intracellular bacteria?
Chlamydia (chlamydophila) pneumoniae
How is chlamydia pneumoniae transmitted?
respiratory droplets
What are symptoms of chlamydia pneumoniae infection?
insidious onset of cough, can start with pharyngitis, may/may not have fever
What diseases can chlamydia pneumoniae cause?
laryngitis, OM, sinusitis
Chlamydia is _____ to test for and can have possible ____ sequelae
What is a gram-negative rod/bacilli that is an obligate parasite present on mucous membranes?
Haemophilus Influenzae
How many known serotypes are there of haemophilus influenzae?
6 (a thru f)
What type of haemophilus influenzae is associated with meningitis, pneumonia, and epiglotitis?
Type B, encapsulated
What is the vaccine available for h. influenzae type B?
What diseases are the unencapsulated h. influenzae bacteria associated with?
OM, sinusitis, pneumonia
What bug does not react to a gram stain?
Mycoplasma pneumoniae
Mycoplasma lack a cell wall and so are resistant to...
PCNs and beta-lactams
Mycoplasma inhibit ___ function which causes ______ ______
ciliary/paroxsysmal cough
What is the most common age group for mycoplasma infection?
5-20 yrs
What is the treatment of choice for mycoplasma?
Macrolides (azith)
What is a gram-negative, rod-shaped & polar flagella bacteria?
Pseudomonas is an ______ pathogen
Pseudomonas tends to smell...
How does pseudomonas resist abx?
They have efflux pumps that "pump" out abx before they can act
On CXR, a blurred mass with no visible heart border would indicate consolidation of what lobe?
right middle lobe
What is the proper pneumonia treatment for someone from birth to 20 days?
Admit- amp and gent with or without cefotaxime (claforan)
What is the proper pneumonia treatment for someone 3 weeks to 3 months?
Afebrile: macrolide, amoxil/clavulanate, 3rd gen cephalosporin Febrile: admit. Macrolide + 3rd gen cephalosporin
What is the proper pneumonia treatment for someone 4 months to adolescence?
High dose amoxil, amoxil/clavulanate, macrolide or 3rd gen cephalosporin
3rd Generation cephalosporins cover what?
gram+, gram-, and mycoplasma
Define bronchiolitis
The swelling/mucous buildup in the smallest airways (bronchioles), usually due to a viral infection
What age group is bronchiolitis in?
<2 yo
What are the symptoms of bronchiolitis?
nasal congestion, cough (wet), wheezing, cyanosis, decreased apetite, fever
What is the granddaddy of all viruses?
Respiratory synctial virus (RSV)
What is the #1 cause of hospitalizations in children <1 year
T/F: almost all children will be infected with RSV by their 2nd birthday
What does RSV cause?
A thick mucous build up in the lungs and nasal passages making air exchange difficult
How is RSV spread?
VERY CONTAGIOUS- spread mostly through hand contact, exposure to other children.
Who is more susceptible to RSV?
males, those who are not breastfed, and those living in crowded conditions
What is the biology of RSV?
negative-sense, enveloped RNA virus
What is the contagious period for RSV?
3-8 days, but as long as 4 weeks- can live on desk surfaces for hours
What is the seasonal cycle for RSV?
ramps up mid-october, hits the peak in dec-jan, then tapers down and is gone by mid-april
What will a baby with RSV look like?
Skin retraction sucking into chest Wet cough Wheezing Not eating Apnea spells
What diagnostic tests are available for RSV?
Nasal rinse for antigen detection, +/- cell culture in young kids, PCR assays (esp for older kids), typically no other labs
What will CXR imaging show for RSV?
scattered areas of atelectasis/mucus plugging/inflammation "c/w bronchiolitis"
When would a chest x-ray be indicated?
If you are also worried about pneumonia
What is treatment for RSV?
Tylenol, saline/bulb suction, etc
There is a potential link between RSV and ...
In more severe cases, treatment is:
oxygen, apnea monitoring, IVF, mechanical ventilation, +/- bronchodilators, steroids (unknown effects)
What are ways to prevent the spread of RSV?
handwashing wipe down surfaces cover nose/mouth when sneezing try to avoid childcare in the winter avoid kissing the child avoid sharing items avoid exposure to congested areas/children breastfeed
A very expensive RSV preventive medicine is...
Palivizumab (synagis)
What are the 2 factors that a child <2 must meet to qualify for synagis (never given to kids >2)?
1. some kind of hemodynamically significant disease 2. premature birth
What are risk factors for RSV?
prematurity, congenital HD, chronic lung disease, neuro disease, daycare attendance, exposure to smoke or poor air quality, older school-age kids
What is the presentation of croup?
Mild URI that leads to barking cough (seal bark), stridor- caused by swelling around the vocal cords and windpipe
More severe cases of croup can include...
retractions, cyanosis, air hunger
What causes croup?
Mainly human parainfluenza virus (type-1 and less often type 2). Type 3 associated with bronchiolitis/pneumonia. Others- adenovirus, RSV, Influenza
What is the most common age group for croup?
children between 3 months and 5 years old (severe cases mostly in kids <3)
What is the seasonal progression of croup?
begins during the last week of august, and ends in mid-late december
Type 1 parainfluenza causes ____, type 3 causes ____.
croup, pneumonia
Type 3 pneumonia is typically during what seasons?
spring-early summer
What is the typical duration for croup?
peaks 2-3 days after onset and lasts less than a week
What lab tests would you order for croup?
can test for antigen on nasal secretions by ordering a viral FA panel, rarely can do a lateral neck film
What is the sign that could be present on lateral neck film?
Steeple sign- swelling inside the larynx
What is treatment for croup?
Palliative therapy: Rest, Hydration, Calm your child Steroids- single dose Dexamethasone IM or oral (0.6mg/kg). Effects can last for up to 4 days. (can shorten the virus) Nebulized epinephrine- quick relief
How can you prevent croup?
Infection-control practices Pearl: Researchers are developing vaccines against HPIV-1 and -3 infections. Passively acquired maternal antibodies may play a role in protection from HPIV types 1 and 2 in the first few months of life, highlighting the importance of breast-feeding.
A child with epiglottitis will present with...
profuse drooling, respiratory distress, and fever
Is epiglottitis a medical emergency?
What test is used to confirm epiglottitis?
Lateral neck x-ray
Why should you not instrument an airway in a potential epiglottitis case?
It may cause spasm and throat closing
What is the primary causative agent for epiglottitis?
H. Flu type b (prevented by the Hib vaccine)
What is the most common cause of the common cold?
Picornaviruses (200+ can cause it)
What are other examples of viruses that cause colds?
(rhinovirus- 100 serotypes) and coronaviruses, Also- parainfluenza virus, RSV, Adenovirus and Influenza.
What are symptoms of a cold?
scratchy throat, runny nose/congestion, cough, HA
How long does a cold typically last?
1-2 weeks
The common cold typically occurs in what seasons?
usually fall/winter
How may colds do adults get? Children? Children in daycare?
2-3/yr 6-10/yr Up to 14/yr
What is treatment for the common cold?
palliative: saline for the nose, steamy bathroom, elevate mattress, fluids, tylenol PRN, OTC not recommended for children <6 yo
What is prevention for a cold?
Hand washing, perhaps zinc, echinacea, vit C
When is influenza season?
Begins in late winter
How is flu spread?
What is the hallmark for the fl?
Sudden onset with high fever
What are the symptoms of the flu?
Sudden onset high fever (>102), fatigue, HA, sore throat, runny nose, body aches +/- diarrhea and vomiting
What labs should be ordered for flu?
Rapid flu test (for A & B), or viral FA panel
What is the flu shot?
IM. Inactivated virus. Covers type A and B strains AND H1N1- ideally the ones that will be prevalent each winter. Indicated for people 6mos and up. Contraindicated in egg allergy.
What is fluMist?
live attenuated vaccine (type A&B&H1N1). Nasal spray. Indicated for people 2-49yrs without asthma. Contraindicated in people who have had allergic rxn to eggs, gentamycin, gelatin and those who are using aspirin therapy.
Relenza and Tamiflu need to be started within what time frame of symptom onset?
48 hours
Relenza and tamiflu work against what strains of the flu?
A & B
What is relenza? Who is it contraindicated in?
Relenza is an inhaled powder-given 2 inhalations BID x 5 days / people with lung problems
What is tamiflu?
an oral medication (pill or liquid)

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