Introduction to Bacterial Tracheitis

 Infectious Diseases, Respiratory System  No Responses »
Jan 042011
 
Definition and Epidemiology
  • This acute bacterial infection of the trachea often also involves the larynx and bronchi. It has been called bacterial laryngotracheobronchitis and pseudomembranous croup.
  • A cause of acute airway obstruction, this condition may potentially be life threatening.
  • Most patients are <3 years of age (usually 3 months to 2 years), although older children may be affected. There are no clear sex differences in incidence or severity.
  • There seems to be no seasonal preferences.

Etiology and Pathophysiology
  • The most common cause is Staphylococcus aureus, but other encountered agents are H. influenzae, S. pneumoniae, and Moraxella catarrhalis. Anaerobic organisms have also been reported.
  • Invasion of opportunistic bacterial organisms, often following an upper airway viral infection, causes subglottic edema with ulcerations, copious and purulent secretions, and pseudomembrane formation.
Clinical Presentation
  • The typical presentation involves a history of an upper respiratory infection (URI) for approximately 3 days characterized by a low-grade fever and a “brassy” cough. The illness then evolves rapidly with high fever and onset of stridor, resulting in progressive deterioration and development of acute respiratory distress.
  • Patients generally appear toxic. Continue reading »
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Allergic Rhinitis and Conjunctivitis in Children

 Respiratory System  No Responses »
Nov 242010
 
Rhinitis is the most common manifestation of allergic disease, affecting 10 to 22% of adults and 10 to 42% of children.
Symptoms frequently become apparent during the first 5 years of life and may occur in a seasonal and/or perennial (year-round) pattern. Because sensitization to individual allergens requires repeated exposures, several seasons of exposure are necessary for the development of allergy to pollens or molds. This may explain why children with allergic rhinitis under the age of 5 years are typically sensitized to perennial indoor allergens, such as dust mites and animal danders, rather than seasonal allergens such as ragweed.
Pathophysiology:
The symptom complex of allergic rhinoconjunctivitis results from the biochemical mediators elaborated during a type I (IgE-mediated) hypersensitivity reaction. Following the inhalation of aeroallergens into the nose, water-soluble antigens enter and diffuse through the mucous blanket that covers the respiratory tract mucosa. Interaction of these allergens with allergen-specific IgE on the surface of mast cells initiates cellular activation, culminating in the release of a multitude of preformed and newly synthesized bioactive molecules, including histamine and prostaglandin D2. These mediators produce symptoms shortly after allergen exposure and remit relatively quickly. However, symptoms frequently recur several hours later, coincident with a rise in many of the same mediators seen in the early response, along with a rise in cytokines (eg, IL-4 and IL-5) and the influx of helper T cells and eosinophils. This late allergic response is responsible for the inflammation seen in allergic rhinitis and contributes to the chronicity of the condition.

Symptoms:
Nasal congestion is the most frequently reported symptom by patients with allergic rhinitis. Continue reading »
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Treatment Options for Bronchiolitis in Children

 Respiratory System  1 Response »
Jul 262010
 

Treatment of an infant with wheezing depends on the underlying etiology. Response to bronchodilators is unpredictable, regardless of cause, but suggests a component of bronchial hyperreactivity. It is appropriate to administer albuterol aerosol and objectively observe the response. For infants <3 yr of age, it is acceptable to continue to administer inhaled medications through an MDI with mask and spacer if a therapeutic benefit is demonstrated. Therapy should be continued in all patients with asthma exacerbations from a viral illness.

The use of ipratropium bromide in this population is controversial, but it appears to be somewhat effective as an adjunct therapy. It is also useful in infants with significant tracheal and bronchial malacia who may be made worse by ?-2 agonists such as albuterol because of the subsequent decrease in smooth muscle tone.

A trial of inhaled steroids may be warranted in a patient who has responded to multiple courses of oral steroids, has moderate to severe wheezing, or a significant history of atopy including food allergy or eczema. Inhaled steroids are appropriate for maintenance therapy in patients with known reactive airways but are controversial when used for episodic or acute illnesses.

Oral steroids are generally reserved for atopic wheezing infants thought to have asthma that is refractory to other medications. Their use in first-time wheezing infants or those infants that do not warrant hospitalization is controversial.

Infants with acute bronchiolitis who are experiencing respiratory distress should be Continue reading »

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