Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-05-04T23:14:16.813Z Has data issue: false hasContentIssue false

49 - Pediatric Respiratory Infections

from Part II - Pediatrics

Published online by Cambridge University Press:  15 December 2009

By
Seema Shah  and
Ghazala Q. Sharieff
Edited by
Rachel L. Chin
Seema Shah
Affiliation:
Attending Emergency Physician, University of California, San Diego School of Medicine, San Diego Rady Children's Hospital and Health Center, San Diego, CA
Ghazala Q. Sharieff
Affiliation:
Associate Clinical Professor of Pediatrics, University of California, San Diego School of Medicine; Medical Director, San Diego Rady Children's Hospital and Health Center, Director of Pediatric Emergency Medicine, Palomar-Pomerado Health System/California Emergency Physicians, San Diego, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
Get access

Summary

INTRODUCTION – AGENTS

Respiratory failure is the most common cause of cardiopulmonary arrest in infants and children. Because morbidity may be time-dependent and appropriate treatment may vary significantly depending on etiology, prompt assessment and management of pediatric respiratory disease is essential. This chapter will discuss the most common respiratory diseases in children focusing on epiglottitis, bacterial tracheitis, croup, retropharyngeal abscess, pertussis, bronchiolitis, and pneumonia.

EPIGLOTTITIS

Epidemiology

Epiglottitis or supraglottitis is a serious, life-threatening infection of the epiglottis and constitutes an airway emergency (see Chapter 8 for a discussion of supraglottitis). It is more common in the winter but can occur throughout the year. Peak incidence is in children between 2 and 8 years of age, but epiglottitis also occurs in infants and adults. Since widespread vaccination against Haemophilus influenzae type B, previously the most common cause, the incidence has decreased from 41 to 4.1 cases per 100,000, and the typical age of presentation is increasing. The most common identified organisms causing epiglottitis are now group A beta-hemolytic Streptococcus, Streptococcus pneumoniae, Klebsiella, Pseudomonas, and Candida.

Clinical Features

Epiglottitis usually presents abruptly within 6–24 hours of a prodromal viral illness. Patients with epiglottitis classically have high fever, irritability, and throat pain that may manifest as unwillingness to eat or drink (Table 49.1).

Type
Chapter
Information
Emergency Management of Infectious Diseases , pp. 295 - 306
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Bachur, R, Perry, H, Harper, M B. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med 1999;33(2):166–73.CrossRefGoogle ScholarPubMed
Blackstock, P, Adderhey, R J, Steward, D J. Epiglottitis in young infants. Anesthesiology 1987;67:97–100.CrossRefGoogle ScholarPubMed
Bordley, W C, Viswanathan, M, King, V J, et al. Diagnosis and testing in bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 2004;158(2):119–26.CrossRefGoogle ScholarPubMed
Broughton, R A. Nonsurgical management of deep neck infections in children. Pediatr Infect Dis J 1992;11(1):14–8.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). Pertussis. Epidemiology and prevention of vaccine-preventable diseases (The Pink Book) course textbook, 79–96.
Centers for Disease Control and Prevention (CDC). Progress toward eliminating Haemophilus influenzae type b disease among infants and children – United States, 1987–1997. MMRW 1998;47(46):993–8.
Cooper, W O, Griffin, M R, Arbogast, P, et al. Very early exposure to erythromycin and infantile hypertrophic pyloric stenosis. Arch Pediatr Adolesc Med 2002 Jul;156(7):647–50.CrossRefGoogle Scholar
Coulthard, M, Isaacs, D.Retropharyngeal abscess. Arch Dis Child 1991;66:1227–30.CrossRefGoogle ScholarPubMed
Craig, F W, Schunk, J E. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003;111:1394–8.CrossRefGoogle ScholarPubMed
Cunningham, M J. The old and new of acute laryngotracheal infection. Clin Pediatr 1992;31(1):56–64.CrossRefGoogle Scholar
Denny, F W, Murphy, T F, Clyde, W A Jr, et al. Croup: an 11-year study in a pediatric practice. Pediatrics 1983;71(6):871–6.Google Scholar
Donaldson, D, Poleski, D, Knipple, E, et al. Intramuscular versus oral dexamethasone for the treatment of moderate-to-severe croup: a randomized, double blind trial. Acad Emerg Med 2003;10(1):16–21.CrossRefGoogle ScholarPubMed
Donaldson, J D, Mathby, C C. Bacterial tracheitis in children. J Otolaryngol 1989;18(3);48:101–4.Google ScholarPubMed
Duncan N O, Sprecher R C. Infections of the airway. In Cummings, C W, ed, Otolaryngology – head and neck surgery, 3rd ed. St. Louis, MO: Mosby, 1998:388–400.Google Scholar
Geelhoed, G C, Macdonald, W B. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol 1995 Dec;20(6):362–8.CrossRefGoogle Scholar
Geelhoed, G C, Turner, J, Macdonald, W B. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ 1996;313(7050):140–2.CrossRefGoogle ScholarPubMed
Greenberg, D P, Konig, C H, Heininger, U.Health burden of pertussis in infants and children. Pediatr Infect Dis J 2005;24(5Supp):S39–43.CrossRefGoogle ScholarPubMed
Gupta, V K, Cheifitz, I M. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med 2005;6(2):204–11.CrossRefGoogle Scholar
Heininger, U, Klich, K, Stehr, K, Cherry, J D. Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study. Pediatrics 1997;100(6):E10.CrossRefGoogle ScholarPubMed
Johnson, D W, Jacobson, S, Edney, P C, et al. A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup. N Engl J Med 1998;339(8):498–503.CrossRefGoogle ScholarPubMed
Jones, R, Santos, J I, Overall, J C Jr.Bacterial tracheitis. JAMA 1979;242(8):721–6.CrossRefGoogle ScholarPubMed
Kelley, P B, Simon, J E. Racemic epinephrine use in croup and disposition. Am J Emerg Med 1992;10(3):181–3.CrossRefGoogle ScholarPubMed
King, V J, Viswanathan, M, Bordley, W C, et al. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med 2004;158(2):127–37.CrossRefGoogle ScholarPubMed
Klassen, T P, Craig, W R, Moher, D, et al. Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized control trial. JAMA 1998;279(20):1629–32.CrossRefGoogle Scholar
Ledwith, C, Shea, L.The use of nebulized racemic epinephrine in the outpatient treatment of croup. Pediatr Emerg Care 1993;9:318.CrossRefGoogle Scholar
Loos, G D. Pharyngitis, croup and epiglottitis. Prim Care 1990;17(2):335–45.Google ScholarPubMed
Mansbach, J M, Edmond, J A, Camargo, C A. Bronchiolitis in U.S. emergency departments 1992 to 2000: epidemiology and practice variation. Pediatr Emerg Care 2005;21:242–7.CrossRefGoogle ScholarPubMed
Mauro, R D, Poole, S R, Lockhart, C H. Differentiation of epiglottitis from laryngotracheitis in the child with stridor. Am J Dis Child 1988 Jun;142(6):679–82.Google Scholar
McIntosh, K.Community-acquired pneumonia in children. N Engl J Med 2002;346(6):429–37.CrossRefGoogle ScholarPubMed
Melendez, E, Harper, M B. Utility of sepsis evaluation in infants 90 days of age or younger with fever and clinical bronchiolitis. Pediatr Infect Dis J 2003;22(12):1053–6.CrossRefGoogle ScholarPubMed
Morrison, J E, Pashley NRT: Retropharyngeal abscesses in children: A 10-year review. Pediatr Emerg Care 1988;4:9–11.CrossRefGoogle Scholar
Plint, A C, Johnson, D W, Wiebe, N.Practice variation among pediatric emergency departments in the treatment of bronchiolitis. Acad Emerg Med 2004;11:353–60.CrossRefGoogle ScholarPubMed
Rothrock, S G, Green, S M, Fanella, J M, et al. Do published guidelines predict pneumonia in children presenting to an urban ED?Pediatr Emerg Care 2001;17(4):240–3.CrossRefGoogle Scholar
Scolnik, D, Coates, A L. Controlled delivery of high vs. low humidity vs. mist therapy for croup in emergency departments: a randomized controlled trial. JAMA 2006 Mar 15;295(11):1274–80.CrossRefGoogle Scholar
Shah, S S, Alpern, E R, Zwerling, L, et al. Risk of bacteremia in young children with pneumonia treated as outpatients. Arch Pediatr Adolesc Med 2003 Apr;157(4):389–92.CrossRefGoogle Scholar
Shroeder, L L, Knapp, J F. Recognition and Emergency management of infectious causes of upper airway obstruction. Semin Respir Infect 1995;10(1):21–30.Google Scholar
Skolnik, N S. Treatment of croup: a critical review. Am J Dis Child 1989;143(9):1045–9.CrossRefGoogle ScholarPubMed
Toikka, P, Virkki, R, Mertsola, J, et al. Bacteremic pneumococcal pneumonia in children. Clin Infect Dis 1999;29:568–72.Google ScholarPubMed
Zorc, J J, Levine, D A, Platt, S L, et al. Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Pediatrics 2005;116(3):644–8.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Pediatric Respiratory Infections
    • By Seema Shah, Attending Emergency Physician, University of California, San Diego School of Medicine, San Diego Rady Children's Hospital and Health Center, San Diego, CA, Ghazala Q. Sharieff, Associate Clinical Professor of Pediatrics, University of California, San Diego School of Medicine; Medical Director, San Diego Rady Children's Hospital and Health Center, Director of Pediatric Emergency Medicine, Palomar-Pomerado Health System/California Emergency Physicians, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.050
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Pediatric Respiratory Infections
    • By Seema Shah, Attending Emergency Physician, University of California, San Diego School of Medicine, San Diego Rady Children's Hospital and Health Center, San Diego, CA, Ghazala Q. Sharieff, Associate Clinical Professor of Pediatrics, University of California, San Diego School of Medicine; Medical Director, San Diego Rady Children's Hospital and Health Center, Director of Pediatric Emergency Medicine, Palomar-Pomerado Health System/California Emergency Physicians, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.050
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pediatric Respiratory Infections
    • By Seema Shah, Attending Emergency Physician, University of California, San Diego School of Medicine, San Diego Rady Children's Hospital and Health Center, San Diego, CA, Ghazala Q. Sharieff, Associate Clinical Professor of Pediatrics, University of California, San Diego School of Medicine; Medical Director, San Diego Rady Children's Hospital and Health Center, Director of Pediatric Emergency Medicine, Palomar-Pomerado Health System/California Emergency Physicians, San Diego, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.050
Available formats
×