Makindo Medical Notes

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Viral lower respiratory tract infections (LRTI) are more common than bacterial infections in children under 2 years of age. It is important to ensure follow-up for those children if symptoms persist after discharge, to monitor recovery and detect any complications early.

Causes

• Bacterial Causes:
  • Pneumococcus: A major cause of bacterial pneumonia in children, often leading to severe infection if untreated.
  • Mycoplasma: Often causes atypical pneumonia with a gradual onset and prolonged symptoms.
  • Haemophilus Influenzae: Known for causing pneumonia, especially in unvaccinated children.
  • Staphylococcus: Can cause severe, rapidly progressing pneumonia, especially in immunocompromised children.
  • Tuberculosis (TB): An important cause in regions where TB is prevalent, often presenting with a chronic cough and weight loss.
• Viral Causes:
  • Respiratory Syncytial Virus (RSV): The leading viral cause of LRTI in children under 2 years old, commonly leading to bronchiolitis.
  • Influenza A and B: Seasonal viral infections that can cause severe illness, especially in young children.
  • Parainfluenza Virus: Commonly associated with croup and bronchiolitis.
  • Adenovirus: Can cause both upper and lower respiratory tract infections, presenting with severe symptoms.
  • Human Metapneumovirus: Another important viral pathogen associated with pneumonia in young children.
  • Coronavirus (other than COVID-19): Known to cause seasonal respiratory illnesses in young children.

Signs and Symptoms

• General Symptoms:
  • Fever: Often presents with elevated body temperature (T°), indicating infection.
  • Malaise: General feeling of discomfort and fatigue.
  • Poor feeding: Common in infants and young children, as they may be too unwell to eat properly.
• Respiratory Distress:
  • Tachypnoea: Rapid breathing, indicating difficulty in breathing and potential respiratory failure.
  • Cyanosis: A bluish tint to the skin or lips, indicating low oxygen levels in the blood.
  • Grunting: A sign of respiratory distress, as the child tries to keep the airways open.
  • Intercostal recession: Indrawing of the chest between the ribs, showing difficulty in breathing.
  • Use of accessory muscles: Use of the neck and chest muscles to assist in breathing.
• In Older Children:
  • Lobar pneumonia signs: Pleural pain, crackles on auscultation, and bronchial breathing, indicating localized infection in the lung.

Monitoring

• Temperature (T): To assess fever and monitor for signs of infection.
• Pulse rate (P): Monitoring for tachycardia, which can indicate respiratory distress or fever.
• Respiratory rate (R): An elevated respiratory rate is a key indicator of respiratory distress.
• SpO₂ (Oxygen Saturation): To assess the oxygen levels in the blood and ensure they are adequate for the child’s well-being.

Admission Criteria

• Admit if:
  • SpO₂ < 92%, indicating hypoxemia.
  • Signs of severe respiratory distress (e.g., cyanosis, tachypnoea, grunting).

Investigations

• Consider:
  • Chest X-ray (CXR): To assess the presence of consolidation, effusion, or signs of pneumonia.
  • Full Blood Count (FBC): To check for signs of infection (e.g., elevated white blood cell count).
  • Blood and sputum cultures: Particularly in cases of severe pneumonia, to identify the causative organism.
• Not Required:
  • Investigations are generally not necessary for community-acquired pneumonia (CAP) in children being discharged home if they are stable.

Management

• Viral Lower Respiratory Tract Infections (LRTI):
  • More common than bacterial infections in children under 2 years of age.
  • Mild cases can typically be managed without antibiotics.
  • Ensure follow-up if symptoms persist or worsen after discharge to monitor for complications.
• First-line Treatment for Bacterial Infections:
  • Amoxicillin: A broad-spectrum antibiotic effective against common bacterial causes like Pneumococcus.
• Alternatives for Resistant Cases or Specific Pathogens:
  • Co-amoxiclav: A combination of amoxicillin and clavulanic acid, used for more resistant infections.
  • Azithromycin: Often used for Mycoplasma or atypical pneumonia.
  • Clarithromycin: Another alternative for Mycoplasma and other atypical pathogens.