小儿呼吸疾病(英文ppt).ppt

Infection Diseases of Respiratory System in ChildrenIntroductionn High Morbidity Raten High Mortality RatelEach 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 cartilageUpper respiratory tract Upper respiratory tract nose,paranasal sinuses,pharynx,eustachian tube,epiglottis,larynxLower respiratory tract Lower respiratory tract:trachea,bronchi,bronchioles,alveolus Anatomy Anatomy Upper respiratory tract Upper respiratory tract Short ShortNasalpassages,nasolacrimalductandeustachiantube Nasalpassages,nasolacrimalductandeustachiantubeSignificance: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 dyspnea,hoarseness and apnea.Nasal mucosa Nasal mucosaIs soft Is softMore vascular More vascular Nasal cavity Nasal cavity is short and is short and narrow narrow Anatomy Narrowed airway Narrowed airwaySoft mucous menbrane Soft mucous menbraneMore vascular More vascularSofter and more compliant Softer and more compliantClinicalsignificance:Easytobecomehyperemia,edema,andcongestion Easytobecomehyperemia,edema,andcongestionwhichwillinduceinfection whichwillinduceinfectionComplication:Pulmonaryemphysemaandatelectasis Complication:PulmonaryemphysemaandatelectasisLower Lower respiratory respiratory tract tractPhysiologyThe younger the child The younger the child The quicker the frequency The quicker the frequencyThe less regular the rhythm The less regular the rhythmVital capacity(VC)Vital capacity(VC)Tidal volume Tidal volumeTotal lung capacity(TLC)Total lung capacity(TLC)Respiratory frequency and rhythm：The respiratory frequency is inversely related to age The respiratory frequency is inversely related to age.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.SmallImmuneSystem lLow level of Low level of sIgAsIgA,IgGIgG on on Respiratory Mucosal Low level of Low level of Th1 functionAcute Upper Respiratory Tract Infection Acute Upper Respiratory Tract Infection“Common coldCommon cold”Acute Upper Respiratory InfectionIntroductionl80-90%proportionofvisittoclinic.lspreadtonearbyorgansandtissues(otitismedia,conjunctivitis,lymphadenitis,lymphadenitisandpneumonia)l Bronchialasthma,nephritis,myocarditis,measles andpertussis mayalsofollowAURI 90%of AURI are caused by viral infectionEtiology RhinovirusEcho virusCoxsackievirusParainfluenzaInfluenzaAdenovirusRSV(Respiratory Syncytial Virus)PneumococcusMoraxelle catarrhalis Haemophilus influenzaeStaphylococcus aureusBacteriaMycoplasmaChlamydia Other MicroorganismsOthersMild symptomMild symptom Nasal congestion,rhinorrhea,sneezing,sore throatSevere symptomSevere symptom High fever,convulsion,anorexia,frequency coughClinical ManifestationSymptoms of URI in children of different ages 3 mo Infants AdolescentsSystemicsymptomUsuallymildLowgradefeverUsuallysevereHighfeverConvulsionIrritabilityUsuallymildLowgradefeverRespiratory SymptomsNasalcongestionDyspneaAbsentormildorsevereNasalcongestionRhinorrheaSneezingSorethroat Gastrointestinal SymptomsDiarrheaVomitingDiarrheaVomitingAnorexiaAbdominalPainl Thepharynxisredl Retropharyngealfolliculosisl Erythematousenlargedtonsilsl Enlargedlymphnodesl EnterovirusillnessesmaybeassociatedwithawidevarietyofskinrashesPhysical SignHerpanginal CoxsackievirusAl Most often occurs in summer andautumnl Moreoftenininfants（0-3yrofage）l Characterized by sudden onset of fever,sorethroatanddysphagial Characteristic lesions,present on theposterior pharynx,are discrete vesiclesandulcersl Durationofillnessisusually7daysTwo Special Typesl Occurs typically with type 3,7 adenovirus l Most often occurs in spring and summerl Children（3 yr）more often affectedl Features include:A high temperature that lasts 45 days,pharyngitis,conjunctivitis,cervical lymphadenopathy,and rhinitis.l Duration of illness is usually 1-2 weeksPharyngoconjunctival FeverOtitismediaCervicallymphadenitisBronchitisPneumoniaSepticemiaComplication Viral Infection Viral Myocarditis Viral EncephalitisBacterial Infections（streptococcus)Acute Nephritis Rheumatic FeverDiagnosislSymptoms lsighsl ThedifferentialdiagnosisoftheURlincludesotheracuteinfectiousdisease.lInpatientwithInpatientwithfebrileconvulsion,centralnervoussystemInfectionsshouldalsoconsidered.l Patientswithabdominalpainmayhaveacuteabdomen.Differential diagnosisDifference Between Mesenteric Lymphadenitis Difference Between Mesenteric Lymphadenitis and and Acute appendicitis Acute appendicitisClinicalManifestationMesentericlymphadenitis AcuteappendicitisSymptomofURI exist absentFeverandAbdominalPain1stpresentwith:feverFollow:pain(mild)1stpresentwith:pain(severe)Follow:LowgradefeverAbdomensigns DiffusetendernessNoreboundtendernessandguardingProgressivelocalizedabdominaltendernessWithreboundtendernessandguardingBloodroutine WBCisusuallynormalorelevatedWBCiselevatedhigherlevelofneutrophilsProphylaxislIncreaseoutdooractivities.lImprovephysicalfitness.lEnhanceimmunityfunction.lPatientsincollectiveinstitutionsshouldbeisolated.l Generaltreatment Etiologicaltreatment Anti-virus：Ribavirin Avoid the abuse ofantibioticsl Symptomatictreatment SeverenasalobstructionIrritability-restlessnessHighfeverPharyngealportionulcerConjunctivitisTreatmentl Upper respiratory infection is the most common disease in childhood,most of which are caused by viral infections.l The severity of clinical manifestations is related to age of the patients.Infants present mild local symptoms and severe systemic symptoms,while older children present on the contrary.A stuffy,congested nose may exist in infants younger than 3 months of age.l Treatment for the common cold should be mainly symptomatic.Antibiotics should not be used unless in those young,infant patients which are suspected to complicate bacterial infections.Summaryl Acute bronchitis is inflammation of the tracheobronchialepithelium.l Trachea is usually involved，so acute bronchitis is also calledacutetracheobronchitis.l Acute bronchitis is commonly secondary to an acute viralinfection,orjustonemanifestationofacuteinfectiousdisease.Acute Bronchitisl Infectious factors：viral,bacterial or otherpathogeninfectionsl Characters of respiratory tract of infants:Themucous become edema and hyperemia whichmakethebronchusnarrowerwheninflammation.l Other factors：immunodeficiency,nutritionaldiseases,specificbodyconstitution.EtiologyClinical Manifestationl BeginsasanURIl Coughisasignificantsigns nonproductivecoughproductivel Thesystemicsymptomsisusuallysevereininfantsincludingfever,vomitinganddiarrheal Medical examination：RespiratoryrudenessDiffuseorscatteredralesNodyspneal CXR:maybenormal orthickeninglungmarkings Acute bronchitis is an inflammation of the major conducting airways within the lung which caused by viral or bacteria,and is most often in infants.Cough is the most significant clinical manifestation.Fever,vomiting and diarrhea are frequent in infants.Respiratory sounds are rough and scattered rales are heard on auscultation.Radiographic examination of the chest may show a mild increase in bronchovascular markings.Antibiotics are indicated if a bacterial infection of the airway is suspected or proven.Corticosteroids are recommended in severe cases.Summaryl 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.Acute PneumonialSeason of onsetSeason of onset lAge of onsetAge of onsetlMorbidity rateMorbidity ratelMortality rateMortality rateEpidemiologyClassified according to the infecting organism:Classified according to the infecting organism:Viralpneumonia,bacterialPneumonia,mycoplasmaPneumonia.Classified according to Pathology:Classified according to Pathology:Bronchopneumonia,lobarpneumonia,interstitialpneumonia.Classified according to duration of disease:Classified according to duration of disease:Acutepneumonia(3mo).Classified according to severity of disease:Classified according to severity of disease:Mildpneumoniaandseverepneumonia.CategoryBacteria BacteriaStreptococcus pneumoniae,Haemophilus influenzae,Staphylococcus aureus,Escherichia coli,Pseudomonas pyocyaneaVirusesRespiratory Syncytial Viruses,adenovirus,influenza,parainfluenzaothersIncidence rate of Chlamydia pneumoniae and Mycoplasma pneumoniae are increasing recent years.EtiologyAge More often in infantsDiseaseEnvironmentMalnutrition,Congenital heart disease,Immunodeficiency diseasewetness,stuffiness and crowding.InducementPatients 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 lungPathologyfevercoughtachypneaRalesClinical ManifestionPneumonia PneumoniaApartfromthegeneralfeaturesofbronchopneumonia,Apartfromthegeneralfeaturesofbronchopneumonia,severepneumoniaalsopresentwith severepneumoniaalsopresentwithl l systemictoxicsymptomsinrespiratory systemictoxicsymptomsinrespiratorysystem systeml lcirculatorysystem circulatorysysteml lnervoussystem nervoussysteml ldigestivesystem digestivesystemSevere PneumoniaCirculatory systemMyocarditis,heart failureMicrocirculation disturbanceDigestive systemGastrointestinal dysfunction,enteroplegiaAlimentary tract hemorrhageNervous systemIntracranial hypertensionEncephaledemaWater-Electrolyte BalanceMixed acidosis,dehydrationHyponatremiaExtrapulmoanry presentationsl Suddenlyonsetoftachypnea,R60bpm,increasedpulmonaryrales.l Tachycardiathatcannotbeexplainedbyhighfeverortachypnea,HR180bpml Irritabilityandcyanosisl Galloprhythmordullheartsound,distensionofjugularveinandenlargedcardiacl Increasedliverwithtenderness,1.5cm.l Oliguriaoranuriathatpresentwithedemaofeyelidorlowerextremities.Myocardial failurelEmpyemaofpleuralPurulentpneumothoraxlBullaeoflunglSepticemialPurulentpericarditisComplicationlPeripheralbloodexaminationWhitecellcount CRP(C-reactiveprotein)NitrobluetetrazoliumtestlEtiologicalexamination Bacteriologicalexamination：BacterialcultureVirologicalexamination：ViralisolationExamination ofmycoplasma：Specificimmunityexamination Laboratory ExaminationLobular pneumonia(Bronchopneumonia)l Pathogen Streptococcuspneumoniae Haemophilusinfluenzael PathologyPathological changes such as hyperemia and edema ofbronchiolarwall,exudationofpulmonarylobule,andbronchiolarobstructionarescatteredsurroundbronchus.l Clinical manifestation Hyperpyrexia,cough,tachypnea anddyspnea Morecommonininfants,agedpeopleandweakpeoplel lIncreaselungmarkings Increaselungmarkingsl lDiffusebilateralPatchyinfiltratesand DiffusebilateralPatchyinfiltratesandconsolidationscatteredthroughoutboth consolidationscatteredthroughoutbothlungs lungslAtelectasis,hyperinflation,bullaeoflungandpyothoraxChest radiographic findings in bronchopneumoniaChest radiographic findings in bronchopneumoniaFrontalviews:Patchy infiltrates and consolidation at the inner zone and middle zone of bilateral lower lobes,with or without hyperinflationSegmental atelectasisFrontal views:It is a segmental atelectasis at the right 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:mailystreptococcuspneumoniael Pathology:inflammtion infiltrates infiltrates throughout throughout a a whole whole lobe lobe or orsegmentofthelung.segmentofthelung.l Mainclinicalmanifestation:l Morecommoninadolescence,rareinyoungchildren.l Hyperpyrexia,cough,andrustysputuml X-rayfindingsChangeafterchangesofclinicalsymptoms.Lobar pneumonia at middle lobe of right lungFrontalviews:A consolidation within the transverse fissure and oblique fissure can be seen at the middle lobe of right lung,l viraldisease,RSV(85%).l aged2-6months.l airwayobstructionisduetopathologicalchangesincludeswelling and distension ofbronchioles,secretionsblockage.Bronchiolitisllexpiratorywheezingexpiratorywheezinglltachypneatachypnea,nasalflaring,nasalflaringllCyanosisCyanosisllfinefineralesralesllemphysemaemphysemallThedurationofillnessis47daysThedurationofillnessis47daysClinical ManifestationllHyperexpansionHyperexpansion is commonly present is commonly present llPeribronchialPeribronchial cuffing cuffingllIncreased interstitial markingsIncreased interstitial markings llPatchy infiltrates Patchy infiltrates Chest radiographic findingsChest radiographic findingsFrontal views of CXR:Ground-glass opacity Decreased lung markingsPatchy infiltrates in innner and middle zoneAcquired hyperinflationRSV Pneumonial Escherichiacoliisthemostcommonpathogeninneonate.Inyounginfants1week,mainlypathogenarestaphylococcusaureusandhemolyticstreptococcus.l l Some patients may present only with signs of generalized Some patients may present only with signs of generalized toxicity.toxicity.Patientuausllypresentnocoughorfever.Ralesareseldomheardonausculation.Clinicalmanifestationmaybemilk-resistant,drowsiness,lowresponse,andtachypnea.l Cyanosis,foamingatmouth,noddingrespirationorapneamaypresentinseverecases.l Respiratorysignsisrare.Pneumonia of newbornChest X-rayFrontalviews:There is patchy shadows and infiltrates at right lung field.Adenovirus pneumonial Type3,7adenovirusl Youngchildren（6mo-2yr）aremoreoftenaffectedl Acuteonsetofhighfever,toxicsymptomsandpaleface.Sometimespresentwithcardiacdysfunctionandsymptomofnervoussystem l Severecough,dyspneaandwheezing l Respiratorysignssuchasfineralesoccurafter3-4daysl Patchyinfiltratesandconsolidationwithhyperinflation.Adenovirus pneumoniaFrontalviews:Chest radiographs revealsdiffuseinterstitialandpatchyalveolar infiltrates,peribronchialthickening,andfocal consolidationthroughoutbothlungfield.Staphylococcal pneumonial l Morecommoninneonateandinfants Morecommoninneonateandinfantsl l Presentasuddenonsetandprogressquickly Presentasuddenonsetandprogressquicklyl l Signsinclude:Signsinclude:rashes,severe toxicsymptoms,digestivesymptoms,convulsionandshockl Signsvarywithstageofdiseasel Consolidationoflungisobviousl ChestX-rayrevealsinfiltrates,abscessandbullaeoflungAbscessoflungFrontal views:Multiple round high density shadow in both sidesPyopneumothoraxEncapsulatedpleuraleffusionPulmonaryBullaFemale，7 day，hyperpyrexia and no cryingCXR:multiple giantair-containing cavity l Commoncauseofsymptomaticpneumoniainolderchildrenl Fever,drycougharecommonsymptomsl Extrapulmonarycomplicationssometimesoccurl Chestradiographsareuntypical,usuallydemonstrateinterstitialorbronchopneumonicinfiltrates Mycoplasma pneumoniaInterstitial infiltrates in Inters