Respiratory diseases

Professor Ali Aboelmagd

The respiratory system include: 1- Air ways 2- Lungs 3- Pleura

Respiratory infections

The most frequent infections of childhood. Responsible for

1-More than 50 % of cases in outpatient clinics

2- 25% of admissions to Hospitals.

3- 30 % of deaths in children

1-Acute Rhinitis (Common Cold)

Rhinitis means inflammation of the nasal mucosa.

-The commonest human disease .

-The commonest respiratory infection in children .

• Young healthy children have ( 3 years or less ) have An average

of 6-8 colds per year

(Some children have 12 colds per year )

• Older children have about 1 – 2 colds per year in

Etiology : A viral disease

1- Rhinoviruses ( Responsible for about 50 % of cases) 2-Other

viruses

Clinical manifestations
I- Respiratory manifestations

1-Rhinorrhea (Nasal discharge)

First it is clear or mucoid , After 2 days become thick and

discoloured
This discoloration should not be assumed to be a sign of bacterial

infection

2-Nasal congestion& obstruction (Leading to Feeding difficulty)

3- Others : -Sore throat and mild cough.

II- Systemic manifestations

Usually minimal . Pyrexia usually mild or Absent except infants

Course.
The condition is usually self limited 2-5 days ( Up to 14 days )

Complications : Sometimes
1- Otitis media 2- Acute sinusitis

Differential diagnosis
Other causes of rhinorrhea

1-Influenza 2- Allergic rhinitis 3 – Sinusitis 4- Vasomotor rhinitis 5 -

Rhinitis medicamentosa 6- Local cause

Treatment
I- Supportive Care

A-Maintaining adequate oral hydration and nutrition

B- Relieve nasal obstruction

1-Blowing the nose (Older children )

2-Topical nasal saline may temporarily remove secretions

3- Nasal suctioning (Suction pump )

II- Medications

Analgesics antipyretics (Only in the prescence of Fever , Sore

throat or Otalgia.
Paracetamol or Ibuprofen can be used

Topical decongestants should be avoided to prevent Rhinitis

medicamentosa.

Systemic decongestants (Pseudoephrine) are contraindicated

2-AcuteTonsilopharyngitis
Acute pharyngitis (inflammation of the pharyngeal mucosa ) , Acute

Tonsillitis (inflammation of the tonsils ). Usually both conditions

occur together

Etiology : Viral or Bacterial

I-Viral

The most common type (70% of cases) this includes : Adenovirus ,

EBS virus .Coxsackievirus ,Influenza viruses and Other viruses

(corona viruses ,rhinoviruses, respiratory syncetial virus )

II- Bacterial

1. Group A beta hemolytic streptococci

a- Isolated b- Scarlet fever

2-Others
Clinical manifestations
A- Streptococcal tonsilopharyngitis

Symptoms

-High grade fever

-Sore throat

- Others (fever, Dysphagia, rhinorrhea , cough ).

Signs

1-Elevated body temperature

2-Posterior pharyngeal wall : Red and swollen, mucous

3- Tonsils : enlarged , Follicles of pus

4- Cervical lymph nodes : May be enlarged and tender

Streptococcal Tonsilo- pharyngitis

Signs
The tonsils are
1- Enlarged

2- Erythematous

3- Follicles of pus
on the surface
B-Viral Tonsilopharyngitis

I- General manifestations

1-Sore throat mild

2-Age younger

3-Onset gradual

4- fever Mild

II- specific viral pharyngitis

1- Epstein bar virus

2-Adeno virus

3- Coxakie virus

Viral pharyngitis

The pharyngeal wall is

- Erythematous
(Red in colour )

-Swollen
 Diagnosis
A- Clinical ( Symptoms & signs )

B-Laboratory

Not needed in most cases . Occasionally needed For :

Suspected streptococcal infection

1- Rapid antigen-detection tests (RADTs)

2- Throat culture

Suspected Diphtheria

Differential diagnosis
Other causes of sore throat

1- Throat abscess

2-Gengivostomatitis

Complications
Only in streptococcal Tonsilopharyngitis

A- Spread of infection: Retro pharyngeal abscess , Otitis

media, Sinusitis
B- Immunological: Rheumatic fever and Glomerulonephritis

Treatment
1-Antibiotics (Only For bacterial Tonsilopharyngitis)

1- Penicillin

- Oral for 10 days - Intramuscular single dose

 2- Amoxicillin Oral for 10 days (50 - 90mg / kg daily)

In case of Penicillin allergy

1-Cephalexin (50 mg/kg/day two divided doses for10 days ) or

2-Azithromycin ( 12mg / kg first day and then 6mg / kg for 4 days

once daily

2-Antipyretic/analgesic

Paracetamol 10-15 mg/kg (Can be repeated every 6 hours )

Ibuprofen 8-10 mg/kg (Can be repeated every 8 hours )

3 - Fluids

4- Diet

3-Acute Otitis media

Acute onset

- High fever

- Otalgia

-Ear discharge (Otorrhea)

Diagnosis

Ear examination ( Otoscopy )

Reveals a congested bulging eardrum.

 4-Acute sinusitis

A-Viral
The commonest usually a part of acute rhinitis

B- Bacterial
Usually on top of rhinitis

Suspected in a child with a cold

1- Does not improve by 10–14 days

2- Worsens after 5–7 days of recovery

Manifestations may include

- Purulent nasal discharge

-High fever

-Postnasal discharge

- Facial tenderness

- Headache

5-Laryngeal infections
Laryngitis means inflammation of the larynx . Croup is a clinical term

includes group of diseases characterized by haking (barking) cough

with or without stridor. This includes

1- Laryngotracheobronchitis ( Viral croup )

Inflammation of the larynx usually with inflammation of the trachea

and bronchi

Etiology predominantly viral infection

I-The Para influenza viruses account for about 75% of cases;

II-Other viruses

Clinical manifestations
Symptoms

I- Prodrome of upper respiratory tract infection for 2-3 days

II- followed by Haking cough , Stridor hoarsence of voice and

respiratory difficulty

Haking cough means week cough with hoarse character .

Stridor means respiratory sound usually heard during inspiration due

to airway obstruction above the thorathic inlet and signify

extrathorathic obstruction

Signs

1 Temperatures Variable , Usually here is low-grade fever

( Sometimes temperatures may reach 39– 40°C)

2-Respiratory distress

In most cases there is no or slight distress, Rarely severe

respiratory distress

Course : Symptoms usually resolve completely within a week.

Treatment
1- Supportive therapy ( Oxygen , antipyretics )

2- Drugs

a-Dexamethasone

intramuscular or Oral 0 .2 - 0.6 mg/kg one dose

b-Nebulized epinephrine

c- Nebulized Budenoside

3-Hospitalization

Symptoms did not resolve within 3 hours and or -impending

respiratory failure

Acute Epiglottis (Bacterial croup)

Etiology bacterial

1- Homophiles Influenza type b 2- Others ( Staphylococci ,

Streptococci ,

Clinical Manifestation

Sudden onset of High fever ,Dysphagia, Drooling of saliva, Muffled

voice ,Respiratory distress and may be Cyanosis. Stridor and Haking

cough are late manifestations

Course : Rapidly Progressive

Treatment
1-Hospitolizotion

2-Patent airways (Suction of secretions, Endotracheal tube

3- Antibiotics : Third generation cephalosporin (Ceftriaxone or

Cefotaxime )
Laryngeal infections differential diagnosis of

Other cuses of stridor

I-Congenital

1- Laryngomalacia (commonest)

2- Subglottic stenosis

3- Others

Laryngeal web

Laryngeal cyst

Laryngeal hemangioma

Laryngeal papilloma

II-Acquired

1- Croup( viral, epiglottis etc )

2- Laryngeal foreign body

3- Laryngeal angioedema

4- Hypocalcaemia

5-Vocal cord paralysis

6-Others

Spasmodic croup
-A mild benign condition

-Unknown Etiology and pathogenesis

- Most common in children 1–3 years old

Clinical manifestations
An attack of barking cough and stridor

1- Principally at night. 2- Usually- Moderate in severity 3- Lasts only

for several hours

4- may be recurrent at the nights of the second and third days or

later on

Treatment : Assurance of parents

Differential diagnosis : Other causes of stridor

Laryngomalacia

Congenital anomaly characterized by Collapse of the supraglottic

structures during inspiration

Clinical manifestations

Stridor

-Since birth

- Usually mild

- More evident with

. Crying

. Supine position

Diagnosis

1- Clinical

2- Laryngoscopy

Prognosis

Gradually subsides over several months or by the end of the second

year

Treatment
Assurance of parents

6-Bacterial tracheitis

-Caused by Staphylococcus aureus and others.

- On top of viral croup

- Very severe infection

- Manifestations similar includes brassy cough

-Rapidly progressive airways obstruction

7- Bronchitis
Means bronchial inflammation

A-Acute Bronchitis

Etiology viral infection

1- Isolated

2- Part of other respiratory infection or Exanthems )

Clinical manifestations
Symptoms

Cough
Early : it is dry After several days becomes productive Which

indicates leukocyte migration but not necessarily bacterial infection.

Many children swallow their sputum, and this may produce emesis

(Post tussive emesis)

Signs

-General condition Good

- Chest examination

1-Early findings Nothing

II- Later : coarse crepitations a scattered wheezing and scattered

wheezing

Course
The disease is self-limited The course usually lasts about 2- 3 weeks

Treatment
I-Symptomatic (Fluids , Antipyretics

III- Medications Usually not needed

Cough suppressants and mucolitics are ineffective and may be

dangerous

Differential diagnosis of acute cough

Common causes

1 – Bronchitis

2 Acute rhinitis

3- Whooping cough

4- Pneumonia

5-Foreign body inhalation

 B-Protracted bacterial bronchitis (PBB )

Bacterial infection of the conducting airways

Causative organisms

Haemophilus influenza, Streptococcus pneumoniae, Moraxella

catarrhalis and Staphylococcus aureus

Clinical diagnosis

-Chronic wet cough ( 4 weeks or more)

-Otherwise well child

- Recurrence

Treatment

Amoxicillin clavulinic acid for two weeks

Causes of chronic cough ( 4 weeks or more)

1- Protracted bacterial bronchitis (PBB)

2 Infection (TB )

3- Irritation ( Smoke , odours ...

4- Aspiration

5- Allergy

6 -Supurative lung disease & Bronciectasis

7- Habit cough ( somatic cough )

 8- Bronchiolitis
Inflammation of terminal bronchioles

Very common Affects 2–3% of all infants each year

Etiology It is a predominantly viral disease

1- Respiratory syncetial virus (RSV) is by far the most common

viral cause

2-Other viruses

Clinical manifestations

Age : First 2 years of life ( maximum around 1- 9 months )

Severity :Variable (Mild to very severe )

Symptoms

Rhinorrhoea for1–2 days Followed by acute onset of : wheezing,

Respiratory difficulty and mild cough

Wheeze means respiratory sound usually heard during expiration due

to airway obstruction below the thorathic inlet and signify

intrathorathic obstruction.

Signs

Chest examination reveals :

A- Inspection : Tachypnea and Respiratory distress

B-Percussion : Hyperresonance

C- Auscultation: prolonged expiration and wheezing

Course 7 - 10 days

Prognosis

Inspite of disease severity the disease is usually Self limited

Rarely ( respiratory failure and death )

Differential diagnosis

Other causes of acute wheezing

A-Acute Wheezing

1- Infections e.g. Bronchiolitis

2-Foreign body aspiration

3-Others

B-Recurrent Wheezing

1- Episodic viral wheeze (EVW)

2 -Multiple trigger wheeze (MTW)

3- Recurrent aspiration

4- Bronchial asthma

5- Others

Treatment

Most children with bronchiolitis are treated at home .

1-Hospitalization

a- Young infants (under 6 months of age

b- Marked respiratory distress.

c - feeding difficulty .

2- Supportive measures

• Oxygen ( the most important item)

• Fluids to maintain hydration

• Proper Feeding

• Suctioning of secretions
-