Chest medicine

Symptoms of respiratory disease, Pneumonia, Atypical pneumonia, Legionnaires' disease, Recurrent pneumonia, Nosocomial pneumonia, Aspiration pneumonia, Management of pneumonia: adults, Viral pneumonia SARS and HN, Management of pneumonia: children, Paediatric acute respiratory, infections: epiglottitis, Acute laryngotracheobronchitis: croup, Bacterial tracheitis, Bronchiolitis, Whooping cough, Lymphocytic interstitial pneumonitis, Diphtheria, Pleural effusion, Lung abscess, Fungal pulmonary infections, Paragonimiasis lung flukes, Tropical pulmonary eosinophilia, Asthma, Acute severe asthma, Chronic obstructive pulmonary disease, Bronchiectasis, Lung cancer, Interstitial lung disease, Acute respiratory distress syndrome, Pulmonary embolism, Pneumothorax

Demographic Characteristics of Children Diagnosed with Bacterial Tracheitis

Objectives: Examine the presentation and clinical course of patients with bacterial tracheitis (BT). Identify if socioeconomic differences exist among children who present with BT. Methods: This was a retrospective case series from a tertiary care pediatric medical center. The study group included patients less than 18 years old who were diagnosed with BT from January 2011 to March 2019. Patients with a tracheostomy and those who developed BT after prolonged hospitalization were excluded. Patient demographics were compared with the demographics of the counties surrounding the hospital. Results: 33 patients with BT met inclusion criteria. The most common presenting symptoms were difficulty breathing, stridor, and sore throat (81.8% each), followed by cough (78.8%). Median length of stay was 3 days [interquartile range (IQR):2-4]. 19 patients (57.5%) were admitted to the intensive care unit. Intubation was required for 13 patients (39.4%), for a median length of 2 days [IQR:2-2]. Methicillin sensitive staphylococcus aureus was the most common bacterial etiology (33%). Mean presenting age was 8.58 years [95% confidence interval:7.3-9.9] and 14 patients were female (42.4%). 31 patients were white (93.9%), 1 was black (3%), and 1 was Hispanic (3%). BT patients were more likely to have private insurance compared to comparison (81.8% vs 63.4%, P < .001). Conclusion: Children who presented with BT were more likely to be privately insured than a comparison population.

Croup Is One of the Clinical Manifestations of Novel Coronavirus in Children

The manifestations of novel coronavirus are diverse and can manifest through respiratory, gastrointestinal, and even nervous symptoms. Respiratory involvement is usually an upper tract infection or pneumonia but can also present as other forms of pulmonary disorders. A 3-year-old boy presented with cough, hoarseness, and stridor. He was treated with dexamethasone and nebulized adrenaline and a clinical diagnosis of croup was established. After treatment, his symptoms improved for a short time, but suddenly cough exacerbated and was accompanied by respiratory failure and seizures. He was then intubated and mechanically ventilated. Because of the coronavirus epidemic, Reverse-Transcription Polymerase Chain Reaction (RT-PCR) assay was taken from the pharyngeal secretions and was positive. The child was isolated. Due to excessive respiratory secretions and worsening of the general condition, bronchoscopy was performed depicting an image compatible with bacterial tracheitis. He was treated with broad-spectrum antibiotics, antivirals, and supportive care. Finally, after 4 weeks of treatment, the child was discharged in good general condition. Croup is one of the respiratory symptoms of novel coronavirus and can be a risk factor for bacterial tracheitis. Therefore, the presence of clinical manifestations of croup indicates the need for coronavirus PCR testing.

Pediatric Respiratory Emergencies

Respiratory emergencies are common in children, and emergency providers must anticipate respiratory compromise and intervene early. Respiratory emergencies can be broadly categorized into upper and lower respiratory diseases. Sometimes the diagnosis is classic and easily made based on history and confirmed by key physical examination findings. Other times, the diagnosis can be more challenging to confirm, and there may be presentation overlap. This chapter discusses the classic and atypical presentation of many important pediatric respiratory conditions, including croup, bronchiolitis, pneumonia, asthma, epiglottitis, bacterial tracheitis, and anaphylaxis. Key diagnostic features and aids to differentiating the disease from common mimics are emphasized.

Pediatric Bacterial Tracheitis—A Variable Entity: Case Series with Literature Review

Objective To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key presenting symptoms and clinical outcomes of children diagnosed with bacterial tracheitis. Study Design Case series with literature review. Setting Tertiary children’s hospital and available literature. Subjects and Methods Case series of children with bacterial tracheitis retrospectively reviewed at a tertiary children’s hospital. Those with a tracheostomy or those who developed bacterial tracheitis as a complication of prolonged intubation were excluded. Results Thirty-six children were identified (mean ± SD age, 6.7 ± 4.5 years). The most common presenting symptom was cough (85%), followed by stridor (77%) and voice changes/hoarseness (67%). A concurrent viral illness was found for 55%, and the most common bacteria cultured was methicillin-sensitive Staphylococcus aureus. Pediatric intensive care admission occurred for 69%, and 43% required intubation. No patient required tracheostomy. One patient (2.7%) died secondary to airway obstruction and subsequent respiratory arrest. Four patients had recurrence of bacterial tracheitis 4 to 12 months following their initial presentation. Conclusion Bacterial tracheitis is an uncommon condition with an atypical presentation and variable clinical course but serious consequences if left unrecognized. Staphylococcus is the most common bacteria identified, and many patients will have a prodromal viral illness. Changes in patient epidemiology and presentation may have occurred over time.