1、小儿呼吸疾病（英文ppt）lEach year, respiratory infection diseases cause about 15 million deaths among children younger than age 5 year through the world.l Pediatric pulmonary infection accounts for about 63.89% of all hospitalizations of children, in which 44.6 percent are pneumonia.Cricoid cartilage nose, pa
2、ranasal sinuses,pharynx, eustachian tube, epiglottis, larynxtrachea bronchi bronchioles alveolusSignificance :These characters make nasal cavity easy to become hyperemia, edema, and congestion which will induce infection. Local infection can spread to nearby organs and tissues easily and cause dyspn
3、ea, hoarseness and apnea. Clinical significance: Respiratory frequency and rhythm ： neonate : 4050 bpm；612mo: 30-35 bpm； 1-3 yr : 2530 bpm；49 yr : 20-25 bpm； 8-14 yr :1820 bpm。(2) Some young infants present with irregular rhythm or apnea due to immature respiratory center. SmallImmune SystemRespirat
4、ory Mucosal Th1 function l 80-90% proportion of visit to clinic.l spread to nearby organs and tissues (otitis media, conjunctivitis, lymphadenitis, lymphadenitis and pneumonia)l Bronchial asthma, nephritis, myocarditis, measles and pertussis may also follow AURI 90% of 90% of AURI are AURI are cause
5、d by caused by viral viral infectioninfectionEtiology Etiology RhinovirusEcho virusCoxsackievirusParainfluenzaInfluenzaAdenovirusRSV(Respiratory Syncytial Virus)PneumococcusMoraxelle catarrhalis Haemophilus influenzaeStaphylococcus aureusMycoplasmaChlamydia Other MicroorganismsNasal congestion, rhin
6、orrhea,Nasal congestion, rhinorrhea, sneezing, sore throat sneezing, sore throatHigh fever, convulsion,High fever, convulsion, anorexia, frequency cough anorexia, frequency cough lThe pharynx is red lRetropharyngeal folliculosislErythematous enlarged tonsils lEnlarged lymph nodeslEnterovirus illness
7、es may be associated with a wide variety of skin rashes HerpanginaHerpanginal Coxsackievirus Al Most often occurs in summer and autumnl More often in infants（0-3 yr of age）l Characterized by sudden onset of fever, sore throat and dysphagia l Characteristic lesions, present on the posterior pharynx,
8、are discrete vesicles and ulcersl Duration of illness is usually 7 days l Occurs typically with type 3,7 Occurs typically with type 3,7 adenovirus adenovirus l Most often occurs in spring and Most often occurs in spring and summersummerl Children Children （3 yr 3 yr ） more often more often affecteda
9、ffectedl Features include: Features include: A high temperature that lasts A high temperature that lasts 45 days, pharyngitis, 45 days, pharyngitis, conjunctivitis, cervical conjunctivitis, cervical lymphadenopathy, and rhinitis. lymphadenopathy, and rhinitis. l Duration of illness is usually 1-2 Du
10、ration of illness is usually 1-2 weeksweeksOtitis mediaCervical lymphadenitisBronchitisPneumoniaSepticemiaViral Infection Viral Myocarditis Viral EncephalitisBacterial Infections（streptococcus) Acute NephritisRheumatic FeverlSymptoms lsighsl The differential diagnosis of the URl includes other acute
11、 infectious disease.febrile convulsion, central nervous system Infections should also considered.l Patients with abdominal pain may have acute abdomen.l Increase outdoor activities.l Improve physical fitness.l Enhance immunity function.l Patients in collective institutions should be isolated.l Gener
12、al treatment Etiological treatment Anti-virus：Ribavirin Avoid the abuse of antibioticsl Symptomatic treatment Severe nasal obstruction Irritability-restlessness High fever Pharyngeal portion ulcer Conjunctivitisl Upper respiratory infection is the most common disease in Upper respiratory infection i
13、s the most common disease in childhood,childhood, most of which are caused by viral infections. most of which are caused by viral infections. l The severity of clinical manifestations is related to age of The severity of clinical manifestations is related to age of the patients. the patients. Infant
14、s present mild local symptoms and severe systemic Infants present mild local symptoms and severe systemic symptoms, while older children present on the contrary. symptoms, while older children present on the contrary. A stuffy, congested nose may exist in infants younger than A stuffy, congested nos
15、e may exist in infants younger than 3 months of age. 3 months of age. l Treatment for the common cold should be mainly symptomatic. Treatment for the common cold should be mainly symptomatic. Antibiotics should not be used unless in those young, infant Antibiotics should not be used unless in those
16、young, infant patients which are suspected to complicate bacterial patients which are suspected to complicate bacterial infections.infections.l Acute bronchitis is inflammation of the tracheobronchial epithelium .l Trachea is usually involved，so acute bronchitis is also called acute tracheobronchiti
17、s.l Acute bronchitis is commonly secondary to an acute viral infection, or just one manifestation of acute infectious disease.l Infectious factors：viral, bacterial or other pathogen infectionsl Characters of respiratory tract of infants: The mucous become edema and hyperemia which make the bronchus
18、narrower when inflammation.l Other factors：immunodeficiency, nutritional diseases, specific body constitution.lBegins as an URIlCough is a significant signs nonproductive cough productivelThe systemic symptoms is usually severe in infants including fever, vomiting and diarrhealMedical examinationMed
19、ical examination： Respiratory rudeness Diffuse or scattered rales No dyspnealCXR : CXR : may be normal or thickening lung markingsAcute bronchitis is an inflammation of the major Acute bronchitis is an inflammation of the major conducting airways within the lung which caused by viral or conducting a
20、irways within the lung which caused by viral or bacteria, and is most often in infants. Cough is the most bacteria, and is most often in infants. Cough is the most significant clinical manifestation. Fever, vomiting and significant clinical manifestation. Fever, vomiting and diarrhea are frequent in
21、 infants. Respiratory sounds are diarrhea are frequent in infants. Respiratory sounds are rough and scattered rales are heard on auscultation.rough and scattered rales are heard on auscultation. Radiographic examination of the chest may show a mild Radiographic examination of the chest may show a mi
22、ld increase in bronchovascular markings.increase in bronchovascular markings. Antibiotics are Antibiotics are indicated if a bacterial infection of the airway is indicated if a bacterial infection of the airway is suspected or proven. Corticosteroids are recommended in suspected or proven. Corticost
23、eroids are recommended in severe cases.severe cases. l Pneumonia is an inflammation of the parenchyma of the lungs. l Most cases of pneumonia are caused by microorgnanisms, but there are several noninfectious causes, which include aspiration of food or gastric acid, foreign bodies and so on. Viral p
24、neumonia, bacterial Pneumonia, mycoplasma Pneumonia. Bronchopneumonia, lobar pneumonia,interstitial pneumonia. Acute pneumonia( 3mo). Mild pneumonia and severe pneumonia.Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus,Escherichia coli, Pseudomonas pyocyaneaVirusesRespiratory
25、Syncytial Viruses, adenovirus, influenza, parainfluenzaothersIncidence rate of Chlamydia pneumoniae and Mycoplasma pneumoniae are increasing recent years. More often in infantsDiseaseEnvironmentMalnutrition, Congenital heart disease, Immunodeficiency diseasewetness, stuffiness and crowding. Patients
26、 with the following problems are particularly predisposed to this disease: l Hyperemia, edema and inflammatory infiltration of lung tissuesl Alveolar exudate l Patchy Inflammation focus, and consolidation l Atelectasis and emphysema of lungCirculatory systemMyocarditis, heart failureMicrocirculation
27、 disturbanceDigestive systemGastrointestinal dysfunction, enteroplegiaAlimentary tract hemorrhageNervous systemIntracranial hypertensionEncephaledemaWater-Electrolyte BalanceMixed acidosis, dehydrationHyponatremia l Suddenly onset of tachypnea, R60 bpm, increased pulmonary rales. l Tachycardia that
28、can not be explained by high fever or tachypnea, HR180 bpml Irritability and cyanosisl Gallop rhythm or dull heart sound , distension of jugular vein and enlarged cardiacl Increased liver with tenderness, 1.5cm.l Oliguria or anuria that present with edema of eyelid or lower extremities.lEmpyema of p
29、leuralPurulent pneumothoraxlBullae of lung lSepticemia lPurulent pericarditis lPeripheral blood examination White cell countCRP (C-reactive protein) Nitroblue tetrazolium testlEtiological examination Bacteriological examination ：Bacterial culture Virological examination： Viral isolation Examination
30、of mycoplasma： Specific immunity examination Lobular pneumonia Lobular pneumonia (Bronchopneumonia)(Bronchopneumonia)l PathogenPathogen Streptococcus pneumoniae Haemophilus influenzael PathologyPathology Pathological changes such as hyperemia and edema of bronchiolar wall, exudation of pulmonary lob
31、ule, and bronchiolar obstruction are scattered surround bronchus.l Clinical manifestationClinical manifestation Hyperpyrexia, cough, tachypnea and dyspnea More common in infants, aged people and weak peoplelAtelectasis, hyperinflation, bullae of lung and pyothoraxChest radiographic findings in bronc
32、hopneumoniaChest radiographic findings in bronchopneumoniaFrontal views :Patchy infiltrates and consolidation at the inner zone and middle zone of bilateral lower lobes, with or without hyperinflationSegmental atelectasisSegmental atelectasisFrontal views :It is a segmental atelectasis at the right
33、superior lobe. The transversa fissure is displaced toward the airless lobe. There is a sector high density shadow with the apex toward the hilum of lung. The diaphragm is elevated and the mediastinum is shifted to the side of involvement. Lobar pneumonial Pathogen: maily streptococcus pneumoniael Pa
34、thology : inflammtion l Main clinical manifestation: l More common in adolescence, rare in young children.l Hyperpyrexia, cough, and rusty sputuml X-ray findings Change after changes of clinical symptoms.Frontal views :A consolidation within the transverse fissure and oblique fissure can be seen at
35、the middle lobe of right lung, l viral disease, RSV (85%). l aged 2-6 months. l airway obstruction is due to pathological changes include swelling and distension of bronchioles, secretions blockage.lexpiratory wheezingl tachypnea, nasal flaringlCyanosisl fine ralesl emphysemalThe duration of illness
36、 is 4 7 days lHyperexpansion is commonly present lPeribronchial cuffinglIncreased interstitial markings lPatchy infiltrates Frontal views of CXR:Ground-glass opacity Decreased lung markingsPatchy infiltrates in innner and middle zoneAcquired hyperinflationl Escherichia coli is the most common pathog
37、en in neonate. In young infants 1 week, mainly pathogen are staphylococcus aureus and hemolytic streptococcus.Patient uauslly present no cough or fever. Rales are seldom heard on ausculation. Clinical manifestation may be milk-resistant, drowsiness, low response, and tachypnea.l Cyanosis, foaming at
38、 mouth, nodding respiration or apnea may present in severe cases.l Respiratory signs is rare.Frontal views :There is patchy shadows and infiltrates at right lung field. l Type 3,7 adenovirusl Young children（6 mo-2 yr ）are more often affectedl Acute onset of high fever, toxic symptoms and pale face.
39、Sometimes present with cardiac dysfunction and symptom of nervous system l Severe cough, dyspnea and wheezing l Respiratory signs such as fine rales occur after 3-4 daysl Patchy infiltrates and consolidation with hyperinflation.Frontal views :Chest radiographs reveals diffuse interstitial and patchy
40、 a l v e o l a r i n f i l t ra t e s , peribronchial thickening, and f o c a l c o n s o l i d a t i o n throughout both lung field. rashes, severe toxic symptoms, digestive symptoms, convulsion and shockl Signs vary with stage of diseasel Consolidation of lung is obviousl Chest X-ray reveals infil
41、trates, abscess and bullae of lungAbscess of lungFrontal views :Multiple round high density shadow in both sidesEncapsulated pleural effusionPulmonary BullaFemale，7 day，hyperpyrexia and no cryingCXR: multiple giantair-containing cavity lCommon cause of symptomatic pneumonia in older children lFever,
42、 dry cough are common symptoms lExtrapulmonary complications sometimes occurlChest radiographs are untypical, usually demonstrate interstitial or bronchopneumonic infiltrates Mycoplasm A 5-year-old boycomplain of fever and cough.MP antibody (+)Frontal views of CXR:Increased lung markingsDiffuse patc
43、hy infiltratesVolume loss of lower lobes of bilateral lungEnlarged hilar shadowPeak age of onsetClinical manifestationLaboratory examinationX-ray examinationOtherssupporting therapysupporting therapyl Symptomatic treatmentSymptomatic treatment Oxygen supply Conscious sedation Pyretolysis Cough suppr
44、essants Eliminate sputum l Antimicrobial therapy Antimicrobial therapy l Treatment of complicationTreatment of complicationl Enhance immunity functionEnhance immunity functionl physical treatmentphysical treatmentl Sensitivel Early treatmentl Sufficiencyl Drug combinationAntimicrobial treatment Anti
45、microbial treatment Antibiotic treatmentAntibiotic treatmentl Ribovirinl interferon (IFN)l Human Immunoglobulin l Traditional chinese drug therapy Yuxingcao, Double coptistoxic symptom that include shock, ultrahyperpyrexia and toxic encephacopathysecretionsbronchial spasmpleural effusion l Heart fai
46、lurecardiotonic, sedative diuresis and oxygen supplyl Respiratory Failuresuctioning, oxygen supply intubation and artificial respiratorl Toxic encephacopathyanti-infection, oxygen supplY, correct acidosis l Fever, cough, tachypnea and fine rales are four major symptoms of pneumonia. l Besides, sever
47、e pneumonia present circulatory, neurological and digestive symptoms l Diagnosis mainly depends on clinical manifestations and X-ray examination.l According to the characteristics of clinical symptoms, signs and auxiliary examination, we classify different type and severity. l Treatment should emphasize comprehensive treatment. l Choose different antibiotics according to different pathogens.l Pay attention to the importance of nursing, supporting therapy, and symptomatic therapy.
