小儿呼吸疾病(英文ppt).ppt

Infection Diseases of Respiratory Infection Diseases of Respiratory System in ChildrenSystem in ChildrenIntroductionIntroductionn High Morbidity RateHigh Morbidity Raten High Mortality RateHigh 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 tractUpper respiratory tract nose,paranasal sinuses,pharynx,eustachian tube,epiglottis,larynxLower respiratory tractLower respiratory tract:trachea,bronchi,bronchioles,alveolus Anatomy Anatomy Anatomy Anatomy Upper respiratory tractUpper respiratory tract ShortShortNasalpassages,nasolacrimalductandeustachiantubeNasalpassages,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 mucosaNasal mucosaIs softIs softMore vascularMore vascular Nasal cavity Nasal cavity is short and is short and narrow narrow Anatomy Anatomy Narrowed airwayNarrowed airwayNarrowed airwayNarrowed airwaySoft mucous menbraneSoft mucous menbraneSoft mucous menbraneSoft mucous menbraneMore vascularMore vascularMore vascularMore vascularSofter and more compliantSofter and more compliantSofter and more compliantSofter and more compliantClinicalsignificance:Easytobecomehyperemia,edema,andcongestionEasytobecomehyperemia,edema,andcongestionwhichwillinduceinfectionwhichwillinduceinfectionComplication:PulmonaryemphysemaandatelectasisComplication:PulmonaryemphysemaandatelectasisLower Lower respiratory respiratory tracttractPhysiologyPhysiologyThe younger the child The younger the child The quicker the frequencyThe quicker the frequencyThe less regular the rhythmThe less regular the rhythmVital capacity(VC)Vital capacity(VC)Tidal volumeTidal volumeTotal lung capacity(TLC)Total lung capacity(TLC)Respiratory frequency and rhythm：The respiratory frequency is inversely related to ageThe 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 coldCommon coldCommon cold”Acute Upper Respiratory InfectionIntroductionl80-90%proportionofvisittoclinic.lspreadtonearbyorgansandtissues(otitismedia,conjunctivitis,lymphadenitis,lymphadenitisandpneumonia)lBronchialasthma,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 symptomMild symptomMild symptom Nasal congestion,Nasal congestion,rhinorrhearhinorrhea,sneezing,sore throat sneezing,sore throatSevere symptomSevere symptomSevere symptomSevere symptom High fever,convulsion,High fever,convulsion,anorexia,frequency cough anorexia,frequency coughClinical ManifestationSymptoms of URI in children of different ages3 yr）more often affectedlFeatures include:A high temperature that lasts 45 days,pharyngitis,conjunctivitis,cervical lymphadenopathy,and rhinitis.lDuration of illness is usually 1-2 weeksPharyngoconjunctival FeverOtitismediaCervicallymphadenitisBronchitisPneumoniaSepticemiaComplication Viral Infection Viral Myocarditis Viral EncephalitisBacterial Infections（streptococcus)Acute Nephritis Rheumatic FeverDiagnosisDiagnosislSymptoms lsighslThedifferentialdiagnosisoftheURlincludesotheracuteinfectiousdisease.lInpatientwithInpatientwithfebrileconvulsion,centralnervoussystemInfectionsshouldalsoconsidered.lPatientswithabdominalpainmayhaveacuteabdomen.Differential diagnosisDifference Between Mesenteric Lymphadenitis Difference Between Mesenteric Lymphadenitis and and Acute appendicitisAcute appendicitisClinicalManifestationMesentericlymphadenitisAcuteappendicitisSymptomofURIexistabsentFeverandAbdominalPain1stpresentwith:feverFollow:pain(mild)1stpresentwith:pain(severe)Follow:LowgradefeverAbdomensignsDiffusetendernessNoreboundtendernessandguardingProgressivelocalizedabdominaltendernessWithreboundtendernessandguardingBloodroutineWBCisusuallynormalorelevatedWBCiselevatedhigherlevelofneutrophilsProphylaxislIncreaseoutdooractivities.lImprovephysicalfitness.lEnhanceimmunityfunction.lPatientsincollectiveinstitutionsshouldbeisolated.lGeneraltreatment Etiologicaltreatment Anti-virus：Ribavirin AvoidtheabuseofantibioticslSymptomatictreatment 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.SummarySummarylAcute bronchitis is inflammation of the tracheobronchialepithelium.lTracheaisusuallyinvolved，soacutebronchitisisalsocalledacutetracheobronchitis.lAcute bronchitis is commonly secondary to an acute viralinfection,orjustonemanifestationofacuteinfectiousdisease.Acute BronchitislInfectious factors：viral,bacterial or otherpathogeninfectionslCharacters of respiratory tract of infants:Themucous become edema and hyperemia whichmakethebronchusnarrowerwheninflammation.lOther factors：immunodeficiency,nutritionaldiseases,specificbodyconstitution.EtiologyClinical ManifestationlBeginsasanURIlCoughisasignificantsigns nonproductivecoughproductivelThesystemicsymptomsisusuallysevereininfantsincludingfever,vomitinganddiarrhealMedical examination：RespiratoryrudenessDiffuseorscatteredralesNodyspnealCXR: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.SummarylPneumonia 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 rateEpidemiologyEpidemiologyClassified 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.CategoryCategoryBacteriaBacteriaStreptococcus 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.EtiologyEtiologyAgeAge More often in infantsDiseaseEnvironmentMalnutrition,Congenital heart disease,Immunodeficiency diseasewetness,stuffiness and crowding.InducementPatients with the following problems are particularly predisposed to this disease:lHyperemia,edema and inflammatory infiltration of lung tissueslAlveolar exudate lPatchy Inflammation focus,and consolidation lAtelectasis and emphysema of lungPathologyfeverfevercoughcoughtachypneatachypneaRalesClinical ManifestionPneumoniaPneumoniaApartfromthegeneralfeaturesofbronchopneumonia,Apartfromthegeneralfeaturesofbronchopneumonia,severepneumoniaalsopresentwithseverepneumoniaalsopresentwithl l systemictoxicsymptomsinrespiratorysystemictoxicsymptomsinrespiratorysystemsysteml lcirculatorysystemcirculatorysysteml lnervoussystemnervoussysteml ldigestivesystemdigestivesystemSevere PneumoniaCirculatory systemMyocarditis,heart failureMicrocirculation disturbanceDigestive systemGastrointestinal dysfunction,enteroplegiaAlimentary tract hemorrhageNervous systemIntracranial hypertensionEncephaledemaWater-Electrolyte BalanceMixed acidosis,dehydrationHyponatremiaExtrapulmoanry presentationsl Suddenlyonsetoftachypnea,R60bpm,increasedpulmonaryrales.l Tachycardiathatcannotbeexplainedbyhighfeverortachypnea,HR180bpmlIrritabilityandcyanosislGalloprhythmordullheartsound,distensionofjugularveinandenlargedcardiacl Increasedliverwithtenderness,1.5cm.lOliguriaoranuriathatpresentwithedemaofeyelidorlowerextremities.Myocardial failurelEmpyemaofpleuralPurulentpneumothoraxlBullaeoflunglSepticemialPurulentpericarditisComplicationlPeripheralbloodexaminationWhitecellcount CRP(C-reactiveprotein)NitrobluetetrazoliumtestlEtiologicalexamination Bacteriologicalexamination：BacterialcultureVirologicalexamination：ViralisolationExamination ofmycoplasma：Specificimmunityexamination Laboratory ExaminationLaboratory ExaminationLobular pneumonia (Bronchopneumonia)lPathogen Streptococcuspneumoniae HaemophilusinfluenzaelPathologyPathological changes such as hyperemia and edema ofbronchiolarwall,exudationofpulmonarylobule,andbronchiolarobstructionarescatteredsurroundbronchus.lClinical manifestation Hyperpyrexia,cough,tachypnea anddyspnea Morecommonininfants,agedpeopleandweakpeoplel lIncreaselungmarkingsIncreaselungmarkingsl lDiffusebilateralPatchyinfiltratesandDiffusebilateralPatchyinfiltratesandconsolidationscatteredthroughoutbothconsolidationscatteredthroughoutbothlungslungslAtelectasis,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 pneumonialPathogen:mailystreptococcuspneumoniaelPathology:inflammtioninfiltratesinfiltratesthroughoutthroughouta awholewholelobelobeororsegmentofthelung.segmentofthelung.lMainclinicalmanifestation:lMorecommoninadolescence,rareinyoungchildren.lHyperpyrexia,cough,andrustysputumlX-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,lviraldisease,RSV(85%).laged2-6months.lairwayobstructionisduetopathologicalchangesincludeswelling and distension ofbronchioles,secretionsblockage.BronchiolitisBronchiolitisllexpiratorywheezingexpiratorywheezingll tachypneatachypnea,nasalflaring,nasalflaringllCyanosisCyanosisllfinefineralesralesllemphysemaemphysemallThedurationofillnessis47daysThedurationofillnessis47daysClinical ManifestationllHyperexpansionHyperexpansion is commonly present is commonly present llPeribronchialPeribronchial cuffing cuffingllIncreased interstitial markingsIncreased interstitial markings llPatchy infiltrates Patchy infiltrates Chest radiographic findingsChest radiographic findingsChest radiographic findingsChest radiographic findingsFrontal views of CXR:Ground-glass opacity Decreased lung markingsPatchy infiltrates in innner and middle zoneAcquired hyperinflationRSV PneumoniaRSV PneumonialEscherichiacoliisthemostcommonpathogeninneonate.Inyounginfants1week,mainlypathogenarestaphylococcusaureusandhemolyticstreptococcus.l lSome patients may present only with signs of generalized Some patients may present only with signs of generalized Some patients may present only with signs of generalized Some patients may present only with signs of generalized toxicity.toxicity.toxicity.toxicity.Patientuausllypresentnocoughorfever.Ralesareseldomheardonausculation.Clinicalmanifestationmaybemilk-resistant,drowsiness,lowresponse,andtachypnea.lCyanosis,foamingatmouth,noddingrespirationorapneamaypresentinseverecases.lRespiratorysignsisrare.Pneumonia of newbornChest X-rayFrontalviews:There is patchy shadows and infiltrates at right lung field.Adenovirus pneumonialType3,7adenoviruslYoungchildren（6mo-2yr）aremoreoftenaffectedlAcuteonsetofhighfever,toxicsymptomsandpaleface.Sometimespresentwithcardiacdysfunctionandsymptomofnervoussystem lSeverecough,dyspneaandwheezing lRespiratorysignssuchasfineralesoccurafter3-4dayslPatchyinfiltratesandconsolidationwithhyperinflation.Adenovirus pneumoniaFrontalviews:Chest radiographs revealsdiffuseinterstitialandpatchyalveolarinfiltrates,peribronchialthickening,andfocalconsolidationthroughoutbothlungfield.Staphylococcal pneumonial lMorecommoninneonateandinfantsMorecommoninneonateandinfantsl lPresentasuddenonsetandprogressquicklyPresentasuddenonsetandprogressquicklyl lSignsinclude:Signsinclude:rashes,severe toxicsymptoms,digestivesymptoms,convulsionandshocklSignsvarywithstageofdiseaselConsolidationoflungisobviouslChestX-rayrevealsinfiltrates,abscessandbullaeoflungAbscessoflungFrontal views:Multiple round high density shadow in both sidesPyopneumothoraxEncapsulatedpleuraleffusionPulmonaryBullaFemale，7 day，hyperpyrexia and no cryingCXR:multiple giantair-containing cavity lCommoncauseofsymptomaticpneumoniainolderchildrenlFever,drycougharecommonsymptomslExtrapulmonarycomplicationssometimesoccurlChestradiographsareuntypical,usuallydemonstrateinterstitialorbronchopneumonicinfiltrates Mycoplasma pneumoniaInterstitial infiltrates in Interstitial infiltrates in MycoplasmaMycoplasma pneumoniapneumoniaA 5-year-old boycomplainoffeverandcough.MP antibody(+)Frontal views of CXR:IncreasedlungmarkingsDiffusepatchyinfiltratesVolumelossoflowerlobesofbilaterallungEnlargedhilarshadowl l Peak ag