上海交通大学医学院附属新华医院儿科 鲍一笑,Infection Diseases of Respiratory System in Children,Introduction,High Morbidity RateHigh Mortality Rate,Each year, respiratory infection diseases cause about 15 million deaths among children younger than age 5 year through the world.Pediatric pulmonary infection accounts for about 63.89% of all hospitalizations of children, in which 44.6 percent are pneumonia.,Cricoid cartilage,Upper respiratory tract nose, paranasal sinuses,pharynx, eustachian tube, epiglottis, larynx,Lower respiratory tract: trachea, bronchi, bronchioles, alveolus,Anatomy,Anatomy,Upper respiratory tract,Short Nasal passages, nasolacrimal duct and eustachian tube,Significance :These characters make nasal cavity easy to become hyperemia, edema, and congestion which will induce infection. Local infection can spread to nearby organs and tissues easily and cause dyspnea, hoarseness and apnea.,Nasal mucosa Is soft,More vascular,Nasal cavity is short and narrow,Anatomy,Narrowed airway Soft mucous menbrane More vascular Softer and more compliant,Clinical significance: Easy to become hyperemia, edema, and congestion which will induce infection Complication: Pulmonary emphysema and atelectasis,Lower respiratory tract,Physiology,The younger the child The quicker the frequency The less regular the rhythm,Vital capacity (VC) Tidal volume Total lung capacity (TLC),Respiratory frequency and rhythm ： The respiratory frequency is inversely related to age . neonate : 4050 bpm；612mo: 30-35 bpm；1-3 yr : 2530 bpm；49 yr : 20-25 bpm；8-14 yr :1820 bpm。 (2) Some young infants present with irregular rhythm or apnea due to immature respiratory center.,Small,Immune System,Low level of sIgA , IgG on Respiratory MucosaLow level of Th1 function,Acute Upper Respiratory Tract Infection “Common cold”,Acute Upper Respiratory Infection,Introduction,80-90% proportion of visit to clinic.spread to nearby organs and tissues (otitis media, conjunctivitis, lymphadenitis, lymphadenitis and pneumonia) Bronchial asthma, nephritis, myocarditis, measles and pertussis may also follow AURI,90% of AURI are caused by viral infection,Etiology,Rhinovirus Echo virus Coxsackievirus Parainfluenza Influenza Adenovirus RSV(Respiratory Syncytial Virus),Pneumococcus Moraxelle catarrhalis,Haemophilus influenzae Staphylococcus aureus,Bacteria,Mycoplasma Chlamydia Other Microorganisms,Others,Mild symptomNasal congestion, rhinorrhea,sneezing, sore throat Severe symptomHigh fever, convulsion,anorexia, frequency cough,Clinical Manifestation,Symptoms of URI in children of different ages,The pharynx is red Retropharyngeal folliculosis Erythematous enlarged tonsils Enlarged lymph nodes Enterovirus illnesses may be associated with a wide variety of skin rashes,Physical Sign,Herpangina Coxsackievirus A Most often occurs in summer and autumn More often in infants（0-3 yr of age） Characterized by sudden onset of fever, sore throat and dysphagia Characteristic lesions, present on the posterior pharynx, are discrete vesicles and ulcers Duration of illness is usually 7 days,Two Special Types,Occurs typically with type 3,7 adenovirus Most often occurs in spring and summer Children （3 yr ） more often affected Features include: A high temperature that lasts 45 days, pharyngitis, conjunctivitis, cervical lymphadenopathy, and rhinitis. Duration of illness is usually 1-2 weeks,Pharyngoconjunctival Fever,Otitis media Cervical lymphadenitis Bronchitis Pneumonia Septicemia,Complication,Viral Infection Viral Myocarditis Viral Encephalitis Bacterial Infections（streptococcus) Acute Nephritis Rheumatic Fever,Diagnosis,Symptoms sighs,The differential diagnosis of the URl includes other acute infectious disease. In patient with febrile convulsion, central nervous system Infections should also considered. Patients with abdominal pain may have acute abdomen.,Differential diagnosis,Difference Between Mesenteric Lymphadenitis and Acute appendicitis,Prophylaxis,Increase outdoor activities.Improve physical fitness.Enhance immunity function.Patients in collective institutionsshould be isolated.,General treatment Etiological treatmentAnti-virus：RibavirinAvoid the abuse of antibiotics Symptomatic treatment Severe nasal obstructionIrritability-restlessnessHigh feverPharyngeal portion ulcerConjunctivitis,Treatment,Upper respiratory infection is the most common disease in childhood,most of which are caused by viral infections. The severity of clinical manifestations is related to age of the patients. Infants present mild local symptoms and severe systemic symptoms, while older children present on the contrary. A stuffy, congested nose may exist in infants younger than 3 months of age. Treatment for the common cold should be mainly symptomatic. Antibiotics should not be used unless in those young, infant patients which are suspected to complicate bacterial infections.,Summary,Acute bronchitis is inflammation of the tracheobronchial epithelium . Trachea is usually involved，so acute bronchitis is also called acute tracheobronchitis. Acute bronchitis is commonly secondary to an acute viral infection, or just one manifestation of acute infectious disease.,