Respiratory problems

Pulmonary Tuberculosis (pTB)

Presentation	Differentials	Investigations	Treatment
Chronic cough Family Hx of TB Anorexia Weight loss Intermittent fever Night sweats	Acute pneumonia LIP CLD Pulmonary KS	CXR: hilar lymphadenopathy, focal or unilateral infiltrates Sputum for GeneXpert-RIF/AAFBs	TB treatment 1-2

A CD4 test is recommended as a baseline while going ahead and starting ARV

Practicalities in QECH:

1 TB treatment is accessed via TB officer (ward 3A), write START TB TREATMENT in notes – you do not need to indicate the doses
2 Follow up of patients in TB-clinic (Wed 9am in U5 OPD, room 1) until end of TB treatment.

Lymphoid Interstitial Pneumonitis (LIP)

Presentation	Differentials	Investigations	Treatment
Chronic cough Age > 2 years Associated clubbing, parotid enlargement, generalized lymphadenopathy	PTB CLD PKS	CXR: typical is hilar lymphadenopathy, diffuse lacelike infiltrates, often bilateral	For acute episodes of shortness of breath and/or O2 requirement: Consider steroids 1,2

1 Prednisolone 2mg/kg/day x 5 days, then 1 mg/kg x 5 days, then 0.5 mg/kg x 5 days
2 if steroids given consider combining this with antibiotic and after excluding active TB disease, if not possible to exclude add full TB treatment.

Chronic Lung Disease (CLD) including bronchiectasis

Presentation	Differentials	Investigations	Treatment
Chronic cough Clubbing	PTB LIP PKS	Not improving on TB or LIP treatment or TB and LIP ruled out CXR: may show bronchiectasis	Amoxicillin-Clavulanate (Amoxicillin if not available) 50 mg/kg in three divided doses for 14 days OR Erythromycin 15mg/kg per dose TDS and Cloxacillin 250-500mg po QDS Consider intermittent antibiotic treatment Physiotherapy

Presentation

Differentials

Investigations

Treatment

Chronic cough
Clubbing

PTB
LIP
PKS

Not improving on TB or LIP treatment
or TB and LIP ruled out

CXR:
may show bronchiectasis

Amoxicillin-Clavulanate (Amoxicillin if not available) 50 mg/kg in three divided doses for 14 days

Erythromycin 15mg/kg per dose TDS
and Cloxacillin 250-500mg po QDS

Consider intermittent antibiotic treatment

Physiotherapy

Pneumocystis Jiroveci (Carinii) Pneumonia (PCP)

Presentation	Differentials	Investigations	Treatment
Marked respiratory distress Clear chest or diffuse fine crepitations Mild or no fever Persistent hypoxia Peak age 3-6 m	Severe pneumonia Bronchiolitis PTB	Clinical suspicion Poor response to standard antibiotics and to O2 CXR: may show bilateral interstitial infiltrates	High dose cotrimoxazole 80mg/kg max 1920mg (4 x 480mg tablets) 8-hourly for 21 days If high suspicion of PJP: prednisolone 2mg/kg/day x 5 days, then 1 mg/kg x 5 days then 0.5 mg/kg x 5 days