Respiratory infections children

Most children with cystic fibrosis are diagnosed within one year of birth. Often the symptoms observed in a child, which eventually lead to diagnosis, are malabsorption, failure to gain weight and recurrent respiratory infections. 

Reduce child mortality Reduction of the indoor air pollution that contributes to respiratory infections that account for up to 20 % of child deaths reduction in the need for gathering and preparing traditional fuels that exposes children to health risks and reduces time spent in child care modem energy leads to fewer bums, accidents and house hres provision of nutritious cooked food, space heating and boiled water contribute to better health cold chain provision allows access to vaccines. 

Candida species and other yeasts are becoming increasingly important as causes of nosocomial infections in both PICUs and NICUs (2,26). Isolation of these fungi usually occurs in association with other bacteria and in a setting of broad-spectrum antibiotic use. Establishing causation for a nosocomial respiratory infection for an identified yeast is usually difficult. However, it is clear that yeasts are responsible for nosocomial pneumonia in some critically ill children. Endogenous spread of the yeasts from other sites on the child accounts for most of these infections. However, exogenous acquisition from health care provider hands or the environment is likely and may be responsible for initial colonization. 

Herpes zoster (shingles) is caused by the varicella (chickenpox) virus. It is highly contagious. The virus causes chickenpox in the child and is easily spread via the respiratory system. Recovery from childhood chickenpox results in the infection lying dormant in the nerve cells. The virus may become reactivated later in life as the older adult s immune system... 

In eight children with juvenile rheumatoid arthritis, who had failed to respond to disease-modifying anti-rheumatic drugs, high-dose etanercept was well tolerated (35). None withdrew because of etanercept-related adverse events. One child reported transient erythema at the injection site after the first injection. Three had mild transient upper respiratory tract infections. There were no laboratory abnormalities. 

Figure 55-4 Postmortem diagnosis of MCAD deficiency by acylcarnitine analysis of blood and bile collected at autopsy.The patient was a 3-year-old, previously healthy child who had symptoms of a viral respiratory tract infection. He was a compound heterozygote for the common 985A>G mutation and another mutation.The symbol marks the internal standards, same amount added to both specimens. A, Blood acylcarnitine profile.The concentrations of acetyicarnitine (C2), hexanoylcarnitine (C6), octanoylcarnltine (C8), and decenoylcarnitine (CIO I) were 2.8,0.3, 1.4,and 0.3pmol/L, respectively (for reference intervals see Table 55-8). B, Bile acylcarnitine profile (after lOx dilution).The concentrations of C2,C6,C8,and C10 i were 52.8, 73.1,665.6, and l8i.3pmo /L, respectively (for reference intervals see Table 55-8).The bile/biood C8 ratio was 475. In postmortem urine, hexanoylglycine was also markedly elevated (69.6mmoi/mol creatinine reference interval 0.1 to 1.3).

It is not uncommon for coughs to persist for several weeks in children after a chest infection. However, the child may have an allergy and be developing asthma. If so, the most likely cause is house dust mite or dander (fur particles) from a household pet. You should ask the mother for further clues for example is he worse in any particular room of the house, or worse after dust is raised, say with vacuuming or with changing the bed sheets Do any other family members suffer from asthma, hayfever or eczema On the other hand the child may have another viral upper respiratory tract infection, but as you are unable to decide the cause you should advise the mother to take him back to the doctor. 

Respiratory syncytial virus is the most common cause of acute bronchiolitis, an infection that mostly affects infants during their first year of life. In the well infant, bronchiolitis is usually a self-limiting viral illness, whereas in the child with underlying respiratory or cardiac disease or both, the child may develop severe respiratory compromise (failure) necessitating in-hospital treatment, such as rehydration, oxygen, and in select patients, bronchodilators, ribavirin aerosol, or both. 

In the well infant, bronchiolitis is usually a self-limiting illness, and reassurance and antipyretics are usually all that are necessary while waiting for resolution of the underlying viral infection. In-hospital support is necessary for the child suffering from respiratory failure or dehydration underlying cardiac and pulmonary diseases potentiate these conditions. 

Glezen WP, Taber LH, Frank AL, Kasel JA (1986) Risk of primary infection and reinfection with respiratory syncytial vims. Am J Dis Child 140 543-546... 

An antitussive medication would suppress the cough reflex, which would result in stasis of thick tenacious secretions remaining in the lung and predispose the child to lung infections and possibly respiratory failure. The nurse would question this medication. 

In an analysis of data from the Mother and Child Cohort study in Norway, where foods are not fortified, wheezing and lower respiratory tract infections during the first 18 months of life were examined in 32 077 children born between 2000 and 2005 in relation to maternal reported intake of folic acid 400 mg/day and cod liver oil 5 ml/day [29 , 30" ]. The relative risks in the infants of mothers who took folate supplements during the first trimester were 1.06 (95% Cl = 1.03, 1.10) for wheezing, 1.09 (95% Cl = 1.02, 1.15) for lower respiratory tract infections, and 1.24 (95% Cl = 1.09, 1.41) for hospitalization associated with lower respiratory tract infections. Although small, these relative risks were statistically significant. 

Because of the difficulty in accurately establishing the diagnosis of a hospital-acquired pneumonia or tracheitis in a critically ill child, a standardized approach for defining these infections offers the best opportunity for interhospital comparisons. The Centers for Disease Control and Prevention (CDC) definitions for lower respiratory tract infections in children are included in Tables 2 and 3 (27). However, pneumonia and tracheitis may still be diagnosed and treated in children who do not satisfy these criteria. Also, children who fulfill these criteria may not truly have a nosocomial LRI. This occurs most commonly when the child exhibits a deterioration in his or her underlying pulmonary condition. 

Most bacterial nosocomial lower respiratory tract infections occur by aspiration of bacteria that colonize the oropharynx or upper gastrointestinal tract of the child. Both intubation and mechanical ventilation alter or circumvent some of the patient s natural barrier defenses against infection. These interventions allow organisms from the oropharyngeal or upper gastrointestinal tract greater access to the lower respiratory tract. The aspiration of contaminated materials may be obvious or, more commonly, it is subclinical. The normal respiratory flora of children admitted to a hospital consists of both gram-positive and... 

Obtaining samples from patients who are intubated on mechanically assisted ventilation is relatively simple. However, interpretation of the results obtained from sampling of these respiratory tract secretions through an endotracheal tube is not always straightforward. The correlation between culture results obtained from endotracheal suction specimens and those from samples obtained directly from the lung, pleural cavity, or blood is frequently poor (61,62). In most cases, the presence of bacteria in specimens obtained by suctioning the endotracheal tube represents colonization rather than an invasive infection, such as pneumonia or tracheitis. The physician caring for the child... 

McIntosh K, Kurachek SG, Cairns LM, Burns JC, Goodspeed B. Treatment of respiratory viral infection in an immunodeficient infant with ribavirin aerosol. Am J Dis Child 1984 138 305-308. 

A 21-month-old girl was prescribed erythromycin for an upper respiratory tract infection. At the same time, her parents had been giving her approximately 300 mg of aspirin every 4 hours. The child s condition deteriorated and 2 days later she was admitted to hospital with a temperature of 105°F. She was then prescribed more aspirin, and shortly thereafter had a convulsion for which she was given phenobarbitonc, dexamethasone and tetracycline. Fluid therapy was started, but there was no urine output, and she became progressively obtunded and hyperpnoeic. The patient was transferred to another hospital where the diagnosis to salicylate poisoning was made. She appeared well hydrated, the arterial blood pH was 7.26 and the serum salicylate concentration was 470 Mg/ml. Forced alkaline diuresis was started but had to be restricted because of poor urine output, periorbital oedema and hyponatraemia. The plasma osmolality fell to 264 mOsm/1. Diuresis with recovery eventually followed fluid restriction and administration of mannitol (20 -). 

Leonard et al. (1979a) reported the fifth child of consanguineous Pakistani parents who presented with mild respiratory distress and a metabolic acidosis at birth. After initial treatment, her development to 9 months was normal but she then re-presented with a mild upper respiratory tract infection, vomiting... 

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