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Respiratory Diseases

Respiratory Diseases. Lin Guangyu Department of Pediatrics, The Second Affiliated Hospital to Medical College, Shantou University. General Introduction.

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Respiratory Diseases

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  1. Respiratory Diseases Lin Guangyu Department of Pediatrics, The Second Affiliated Hospital to Medical College, Shantou University

  2. General Introduction • Respiratory diseases that include inflammation of upper and lower respiratory tract, allergic diseases, pleura diseases, foreign body, pulmonary tumors and congenital disorders is a significant cause of death and chronic illness in children. • Pediatric pulmonary diseases account for almost 50% of deaths in children under age 1 year and about 20% of all hospitalization of children under age 15 years.

  3. General Introduction • Respiratory infections are the most frequently occurring illness in childhood. • Pneumonia accounts for almost 28% of deaths in children under age 5 years. • Approximately 7% of children have some sort of chronic disorder of the lower respiratory system

  4. Pneumonia

  5. Classification • Classified by anatomy • Lobar Pneumonia • Bronchopneumonia • Interstitial Pneumonia • Bronchiolitis

  6. Classification • Classified by etiology • Viral Pneumonia • Respiratory Syncytial Virus (RSV ) • Adenovirus • Rhinoviruses • Parainfluenza or influenza viruses • Enteroviruses • Cytomegalovirus (CMV) • Measles virus

  7. Human metapneumovirus • Human bocavirus • SARS coronavirus

  8. About Human Metapneumovirus • It is classified by paramyxovirus. • It is about over 10% of all children with respiratory infection in winter. • It is nearly not covert infection at all. • It is one of the most important pathogens that cause the wheeze. • It is mainly cause bronchopneumonia and bronchiolitis.

  9. About Human Bocavirus • It is classified by parvoviridae. • It is about 1.5~11.3% of all children with respiratory infection. • It is one of the most important pathogens that cause the wheeze. • It is mainly cause bronchopneumonia and bronchiolitis. • Is it a pathogen?

  10. Aboutcoronavirus Type 1 —— Mammal Type 2 —— Mammal Type 3 —— Aves Type 4 —— SARS Coronaviruses

  11. Classification • Bacterial Pneumonia • Gram-positive coccus • Streptococcus Pneumoniae • Staphylococcus aureus ,CNS! • Gram-negative bacillus • Pneumobacillus • Escherichia coli • Pseudomonas • Haemophilus influenzae • Klebsiella • Legionella pneumophila • Anaerobe

  12. Classification • Mycoplasmal pneumonia • Mycoplasma pneumoniae • Chlamydial pneumonia • Chlamydia • Fungal Pneumonia • Cryptococcus • Candida • Coccidioides • Histoplasma

  13. Classification • Protozoal pneumonia • Pneumocystis Carinii • Noninfectious pneumonia • Inhalation Pneumonia • Eosinophilic pneumonia

  14. Classification • Classified by course • Acute Pneumonia: <1 month • Deferred Pneumonia: 1~3 months • Chronic Pneumonia: >3 months

  15. Classification • Classified by patient’s condition • Mild pneumonia • Severe pneumonia

  16. Classification • Others • Typical pneumonia • Atypical pneumonia Pneumonia caused by SARS coronavirus • Community acquired pneumonia (CAP) • Hospital acquired pneumonia (HAP)

  17. Bronchopneumonia

  18. Introduction • Bronchopneumonia, accounting for 24.5%~56.2% of all hospitalizatons of children, is the most frequently occurring illness in childhood. • The incidence is higher in early childhood than in any other period of life. • There are significant difference in the incidence of bronchopneumonia by season and geographic region.

  19. Etiology • Most pneumonia in children are caused by viruses and bacteria. • Viruses • RSV • Parainfluenza viruses (1, 2 and 3) • Influenza viruses (A and B) • Adenovirus • RSV, parainfluenza and influenza are responsible for more than 75% of cases.

  20. Etiology • Bacteritic • Streptococcus Pneumoniae (the most common cause of bacterial infection) • Staphylococcus aureus ,CNS • Haemophilus influenzae • Klebsiella • Pneumobacillus • Escherichia coli • Pseudomonas • Mycoplasma pneumoniae

  21. Different organisms affect different age groups Age Bacterium Virus others 1d-20d Group B H Streptococcus Cytomegalovirus Gram-negative bacilli(E.coli) 3w-3m Streptococcus pneumoniae RSV Chlamydia trachomatis Bordetella pertusssis Parainfluenza virus Staphylococcay aureus 4m-4y Streptococcus pneumoniae RSV Mycoplasma pneumoniae Haemophilus influenzae Parainfluenza virus Mycobacterium tuberculosis Influenze virus Adenovirus Rhinoviruses 5y-15y Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydial pneumonice

  22. Etiology • Other causes • Age • Season of the year • Immune status of the host • Environmental factors

  23. Pathology • Inflammatory cell infiltration, exudate, edema and localized hemorrhage of bronchiolar submucosa, Interstitium, alveoli, Interalveolar septa and lymphatic vessels • Necrosis of bronchiolar and alveolar epithelium • Hyperinflation or collapse of the distal lung tissue

  24. Pathology • Lesions of viral or bacterial infection result in tracheitis, bronchitis, interstitial pneumonia and lobuli pneumonia. • Interstitial involvement is relatively common in viral pneumonia. • Bacterial pneumonia is characterized by the presence of damages of lung tissue.

  25. Pathophysiology • Respiratory disorder (acute respiratory failure) • Ventilation and /or perfusion disorder (V/Q mismatch) • Diffusion defects • Intrapulmonary shunt

  26. Pathophysiology • Circulatory disorders • Viral and/or toxipathic myocarditis • Pulmonary hypertension • Heart failure • Circulatory failure ( shock) • Disseminated intravascular coagulation (DIC)

  27. Pathophysiology • Anomalies of central nervous system • Cerebral edema (toxic encephalopathy) • Hypoxemia • Hypercapnia • Metabolic Acidemia • Energy metabolism disorder • Toxin

  28. Pathophysiology • Anomalies of Alimentary system • Toxic enteroparalysis • Gastrointestinal bleeding • Hypoxemia and hypercapnia • Abnormalities of electrolyte balance • Toxaemia • shock • Acute stress ulcer • Hepatic injury

  29. Pathophysiology • Acute renal failure • Adrenal crisis (insufficiency) • Abnormalities of water, electrolyte and pH balance SIRS→MODS→MOF

  30. Bronchia mucosa edema Alveolus edema air exchange air entry Respiratory failure Metabolic acidosis Respiratory acidosis toxic encephalopathy Gastrointestinal breeding Heart failure Toxic enteroparalysis Toxaemia

  31. Clinical Manifestations • Symptoms and sings • General symptoms and sings • Fever • Body temperature is higher in bacterial infection than viral infection • Hypothermia (infant) • symptoms and sings of generalized toxicity • Myalgia, Malaise and headache

  32. Clinical Manifestations • Symptoms of respiratory system • Cough • Dry cough • Productive cough • Tachypnea • Dyspnea • Rapid, shallow respirations( 40~80/ min) • Nasal flaring • Intercostal, subcostal, and suprasternal retraction • Cyanosis • Respiratory fatigue

  33. Clinical Manifestations • Signs of respiratory system • Widespread moist rales and wheezing • Signs of substantial variations • Decreased breath sounds • Dullness to percussion • diminished tactile or vocal fremitus • Bronchial breath sounds

  34. Clinical Manifestations • Severe Pneumonia • Circulatory system • Rival or toxic myocarditis • Heart failure

  35. Heart failure • Rapid, shallow respirations≥60/min • Rapid heart rates ≥180/min • Dyspnea with intercostal and subcostal retractions, cyanosis, pale and gray of face , irritability, and peripheral pallor • Muffled and distant heart sounds, and a gallop rhythm • Liver enlargement • Edema of the face and extremities,oliguria or anuria

  36. Clinical Manifestations • Nervous system • Toxic encephalopathy • Alimentary system • Toxic enteroparalysis • Gastrointestinal bleeding • DIC • SLADH • MODS

  37. Complications • Empyema • Pneumothorax • tension pneumothorax • Pyopneumothorax • Pneumatocele

  38. Laboratory Test • Tests for etiologic agent • Bacterial culture • Blood culture • Culture of material from the respiratory tract secretion • Culture of Pleural effusion • Other culture

  39. Laboratory Test • Laboratory diagnosis of viral infections • Antigen or nucleic acid detection • Isolation of viruses by culture of the respiratory tract secretions • Use of special antibodies

  40. Laboratory Test • Isolation and culture of other etiologic agent • Mycoplasma pneumoniae • Chlamydia • Fungi • Specific antibody detection on the pathogens • Tests of molecular biology • DNA probs • Polymerase chain reaction (PCR)

  41. Laboratory Test • Blood test • White blood cell counts • Bacterial pneumonia ↑↓ • Rival pneumonia↓ • NBT test • NBT-positive cells>10% • C-reactive protein (CRP) • CRP ≥15μg/ml • Blood gas analysis

  42. Chest X-ray Findings • Perihilar streaking • Increased interstitial markings • Peribronchial cuffing • Patchy infiltrates in the lung • Development of pneumatoceles • Hyperinflation of the lung • Atelectasis • Lobar consolidation (as in bacterial pnuemonia) • Radiographic findings of pleural effusion

  43. Diagnosis and Differential Diagnosis • Diagnosis • According to symptoms, signs, and Radiographic findings, bronchopneumonia are easily diagnosed. • A key decision in evaluating children with bronchopneumonia is to determine whether the illness is mild or severe, or whether a secondary infection or complication is present

  44. Diagnosis and Differential Diagnosis • Differential Diagnosis • Acute bronchitis • Pulmonary tuberculosis Acute miliary tuberculosis of the lungs • Foreign body in bronchus

  45. Acute bronchitis

  46. Acute miliary tuberculosis of the lungs

  47. Acute miliary tuberculosis of the lungs

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