acute respiratory tract infection
TRANSCRIPT
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ACUTE RESPIRATORY INFECTIONS
DR Anwar ahmadCOMMUNITY MEDICINE & PUBLIC HEALTHKGMU UP LUCKNOW
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Problem statement
ARI RESPONSIBLE FOR 20% OF CHILDHOOD (< 5 �YEARS) DEATHS (IN WHICH 90% FROM PNEUMONIA)
ARI MORTALITY HIGHEST IN CHILDREN-� HIV-infected Under 2 year of age Malnourished Weaned early Poorly educated parents Difficult access to healthcare
OUT- PATIENT VISITS� 20-60%
ADMISSIONS� 12-45%
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Children with ARI presenting in OPD
Place % of children
London (UK) 35.0
Herston (Australia) 34
Ethiopia (Whole country) 25.5
Sau aulo (Brazil) 41.8
India 38.9
Nepal 37.6
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Varied agents – Bacteria and viruses Clinical picture may vary with etiological agent May be present in normal people but may
cause disease in only few.
Epidemiology
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Infections of the respiratory tract are described
in a number of different ways according to the general areas of involvement in the more common infections. The upper respiratory tract or upper airway consists of primarily of the nose and pharynx. The lower respiratory tract consists of bronchi and bronchioles, which constitute the reactive protein of the airway because of their smooth muscle content and ability to constrict the alveoli.
ACUTE RESPIRATORY INFECTIONS
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May cause the inflammation of respiratory tract
anywhere from nose to alveoli. May be classified as – AURI – Acute Upper Respiratory Infection (common cold, pharyngitis, epiglottitis, & otitis media
etc.)
or ALRI – Acute Lower Respiratory Infection (laryngitis, layngotracheitis, bronchitis, bronchiolitis
& pneumonia)
ACUTE RESPIRATORY INFECTIONS(ARI)
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Anatomy of the Respiratory system
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AGENT FACTORSBACTERIA AGE GROUP
AFFECTEDCHRACTERISTIC CLINICAL FEATURES
Bordetella pertussis Infants & young children
Poroxysmal cough
Corynebacterium diphtheriae
Children diphtheria
Hemophilus influenzae
AdultsChildren
Acute ex of ch bronchitisAcute epiglottitis
Klebsiella pneumoniae
Adults Lobar pneumonia
Legionella pneumophila
Adults Pneumonia
Staph. pyogenes All ages Lobar and bronchopneumonia
Strep. pneumoniae All ages Pneumonia
Strep. pyogenes All ages Acute pharyngitis and tonsillitis
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VIRUSES AGE GROUP
AFFECTEDCHRACTERISTIC CLINICAL FEATURES
Enterovirus All ages Febrile pharyngitis
Influenza A, B, C All ages variable
Measles Young children variable
Parainfluenza 1, 2, 3 Young children variable
Respiratory Syncytial Virus
Infants and young children
Severe bronchiolitis and pneumonia
Rhinovirus All ages Common cold
Coronavirus All ages Common cold
AGENT FACTORS
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Factors Affecting Type of
Illness and Physical Response in Acute
Respiratory Infections:
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Nature of infectious agent: The respiratory tract is subjected to a wide variety of infectious agents.
Size and frequency of dose: The larger the dose and the more frequent the exposure, the greater the likelihood of a significant infection.
Age of child: Children of preschool and school age are more often exposed to infectious agents generally after 3 months of age infants have less resistance to infections.
Size of child: Airways are smaller in young children and more subjected to considerable narrowing from edema.
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Ability to resist invading organisms: School age children have greater resistance to infection than infants and young children.
Presence of great conditions: Malnutrition, anemia, fatigue, chilling of the body and immune deficiencies decrease normal resistance to infection.
Presence of disorders affecting respiratory tract: Allergies, cardiac abnormalities and cystic fibrosis weaken respiratory defense mechanism.
Seasons: The most common respiratory tract pathogens appear in epidemics during winter and spring months.
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RHINITIS (COMMON COLD OR CORYZA) RHINOVIRUSES, ENTEROVIRUSES, CORONAVIRUSES
ACUTE EPIGLOTTITIS (SUPRGLOTTITIS) CROUP (ACUTE LARYNGOTRACHEOBRONCHITIS) EAR INFECTIONS (ACUTE OTITIS MEDIA)
VIRUSES, PNEUMOCOCCUS, GABHS, HEMOPHILUS INFLUENZA, MORAXELLA CATARRHALIS
ACUTE INFECTIOUS LARYNGITIS VIRAL/DIPTHERIA
ACUTE PHARYNGITIS ADENOVIRUS, ENTEROVIRUS, RHINOVIRUS, GROUP A BETA HEMOOLYTIC
STREPTOCOCCUS(older children)
TONSILLITIS GROUP A BETA HEMOLYTIC STREPTOCOCCI, EBV
SINUSITIS VIRAL/BACTERIAL
UPPER RESPIRATORY TRACT INFECTIONS
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Children average 8 episodes per year, adults
3 episodes per year Etiologies :
Rhinoviruses 30 to 35% Coronaviruses about 10% Miscellaneous known viruses about 20% Influenza and adenovirus-30% Presumed undiscovered viruses up to 35% Group A streptococci 5% to 10%
Parainfluenza was the first respiratory virus isolated (1955)
Seasonal variation Rhinovirus early fall Coronavirus- winter
The Common Cold
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Common symptoms are sore throat,
runny nose, nasal congestion, sneezing, Sometimes accompanied by
conjunctivitis, myalgias, fatigue Sinusitis often present by CT scan;
“rhinosinusitis” might be a better term
Common Cold
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The common cold
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Direct contact is the most efficient means
of transmission: 40% to 90% recovery from hands.
Infectious droplet nuclei Brief exposure (e.g., handshake) transmits
in less than 10% of instances Kissing does not seem to be a common
mode of transmission.
Transmission of rhinoviruses
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Incubation period 12-72 hours Nasal obstruction, drainage, sneezing,
scratchy throat Median duration 1 week but 25% can last 2
weeks Pharyngeal erythema is commoner with
adenovirus than with rhino or coronavirus
Clinical characteristics
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Main challenge is to distinguish between
uncomplicated cold and streptococcal pharyngitis or bacterial sinusitis Good examination
Marked exudate or pharyngeal erythema suggests Streptococcal infection Adenovirus Diphtheria
Rapid antigen tests for group A streptococcus Rapid techniques for influenza, RSV, parainfluenza Treat with NSAIDs and whatever else your
grandmother advises
Diagnosis and treatment
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Life-threatning infection of the epiglottis, the
aryepiglottic folds and arytenoid soft tissue Occurs mostly in winters Peak incidence :- 1 – 6 years Male affected more bacterial infection (Hemophilus influenza type b) Concomitant bacteremia, pneumonia, otitis
media, arthritis and other invasive infections caused by H.influenza type b may be present
ACUTE EPIGLOTTITIS
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Clinical features
High fever, sore throat, dyspnea, rapidly progressing respiratory obstruction
Patient may become toxic, difficult swallowing, laboured breathing, drooling, hyperextended neck
Tripod position (sitting upright and leaning forward)
Cyanosis , coma, death Stridor is a late finding
ACUTE EPIGLOTTITIS
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Do not examine the throat Assessment of severity
Degree of stridor Respiratory rate Heart rate Level of consciousness Pulse oximetry
EXAMINATION
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DIAGNOSIS:
“CHERRY RED”APPEARANCE OF EPIGLOTTIS ON LARYNGOSCOPY
THUMB SIGN ON LATERAL NECK RADIOGRAPH
ACUTE EPIGLOTTITIS
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NEED TO BE MANAGED IN ICU WITH ENDOTRACHEAL
INTUBATION HELP FROM ANAESTHETIST AND ENT SURGEON BLOOD CULTURES FLUID AND ELECTROLYTE SUPPORT INTRAVENOUS AMPLICILLIN 100 mg/kg/day OR
CEFTRIAXONE 100 mg/kg/day . OTHER OPTIONS
(CEFUROXIME OR CEFOTAXIME) TOTAL TREATMENT :-7-10 DAYS
CHOLRAMPHENICOL 50-75 mg/kg/day IV RIFAMPICIN PROPHYLAXIS TO CLOSE CONTACTS
TREATMENT (ACUTE EPIGLOTTITIS)
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VIRAL INFECTION LEADING TO MUCOSAL
INFLAMMATION OF THE GLOTTIC AND SUBGLOTTIC REGIONS
COMMONLY DUE TO INFLUENZA (TYPE A), PARAINFLUENZA(1, 2, 3) AND RSV
AGE :- 6 MONTHS – 6 YEARS
ACUTE LARYNGOTRACHEOBRONCHITIS
(VIRAL CROUP)
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CLINICAL FEATURES
INITIAL :- RHINORRHEA, MILD COUGH, FEVER(LOW GRADE)
LATER (24-48 HOURS) :- BARKING COUGH HOARSENESS OF VOICE NOISY BREATHING (MAINLY ON INSPIRATION)
SYMPTOMS WORSEN AT NIGHT AND ON LYING DOWN CHILDREN PREFER TO BE HELD UPRIGHT OR SIT IN
BED SYMPTOMS RESOLVE WITHIN A WEEK
ACUTE LTB
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CLINICAL EXAMINATION
HOARSE VOICE NORMAL TO MODERATELY INFLAMMED PHARYNX SLIGHTLY INCREASED RESP RATE WITH
PROLONGED INSPIRATION AND INSPIRATORY STRIDOR
ACUTE LTB
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DIAGNOSIS
MAINLY A CLINICAL DIAGNOSIS RADIOGRAPH NECK :- STEEPLE SIGN
(UNRELIABLE)
ACUTE LTB
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TREATMENT
MOIST OR HUMIDIFIED AIR STEROIDS
REDUCE THE SEVERITY AND DURATION / NEED FOR ENDOTRACHEAL INTUBATION
PREDNISOLONE PO 2mg/kg/day FOR 3 DAYS NEBULIZED BUDESONIDE 2mg STAT
NEBULIZED ADRENALINE (EPINEPHRINE)
ACUTE LTB
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Tonsillitis is a viral or bacterial infection in the throat
that causes inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the pharyngeal cavity.
In the first six months of life tonsils provide a useful defense against infections. Tonsillitis is one of the most common ailments in pre-school children, but it can also occur at any age.
Children are most often affected from around the age of three or four, when they start nursery or school and come into contact with many new infections.
A child may have tonsillitis if he/she has a sore throat, a fever and is off food.
Tonsillitis
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Tonsillitis
Palatine tonsils (Visible during
oral examination)
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Tonsillitis is caused by a variety of
contagious viral and bacterial infections. It is spread by close contact with other
individuals and occurs more during winter periods.
The most common bacterium causing tonsillitis is streptococcus.
Causes of tonsilitis
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Encourage bed rest. Introduce soft liquid diet according to the child's
preferences. Provide cool mist atmosphere to keep the mucous
membranes moist during periods of mouth breathing.
Warm saline gargles & paracetamol are useful to promote comfort.
If antibiotics are prescribed, counsel the child's parents regarding the necessity of completing the treatment period
Advice and treatment:
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The controversy of tonsillectomy: Surgical removal of chronic tonsillitis
(tonsillectomy) is controversial. Generally, tonsils should not removed before 3 or 4 yrs of age, because of the problem of excessive blood loss & the possibility of re-growth or hypertrophy of lymphoid tissue, in young children.
Management:
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Community acquired bacterial sinusitis
S.pneumoniae H. influenzae S. pyogenes
Nosocomial sinusitis Seen in critically ill, mechanically
ventilated S. aureus Pseudomonas aeruginosa Serratia marcescens
fungal
Sinusitis
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Clinical features
Sneezing Nasal discharge Facial pressure Fever Purulent drainage Headache
Sinus imaging not routinely recommended
Clinical features
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Maxillary: usually uncomplicated Ethmoid: cavernous sinus thrombosis-serious Frontal: osteomyelitis of frontal bone;
cavernous sinus thrombosis; epidural, subdural, or intracerebral abscess; orbital extension
Sphenoid: Rare; extension to internal carotid artery, cavernous sinuses, pituitary, optic nerves; common misdiagnoses include ophthalmic migraine, aseptic meningitis, trigeminal neuralgia, cavernous sinus thrombosis
Acute sinusitis: complications
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Otitis externa Acute, localized: often S.
aureus, S. epidermidis or S. pyogenes
Acute diffuse (swimmer’s ear): gram-negative rods, especially Ps. Aeruginosa ; Rx: topical quinolones
Chronic: mainly with chronic otitis media
Malignant: life-threatening infection in diabetics, elderly, immunecompromised
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S. pneumoniae and H. influenzae the
leading causes in all age groups (most H. flu is from non-typable strains and not “B”)
Moraxella catarrhalis: 10% of cases Some cases may be viral (RSV, influenza,
enteroviruses) Mycoplasma pneumoniae: inflammation of
the tympanic membrane (“bullous myringitis”)
Acute otitis media
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Acute otitis media Critical role of
eustachian tube as conduit between nasopharynx, middle ear, and mastoid air cells
Children have shorter, wider eustachian tubes than adults
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Presence of fluid in the middle ear AND Ear pain, drainage, hearing loss The fluid may take weeks to resolve Amoxicillin remains the drug of choice Beta-lactamase producing strains of H.
influenza will need amoxicillin/clavulanic acid or cephalosporins
Diagnosis and treatment
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Otitis Media
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Inflammatory syndrome of the pharynx
Most cases are viral Most important bacterial cause is Streptococcus
pyogenes (15-20%) Presents with sore or scratchy throat In severe bacterial cases there may be
odynophagia, fever, headache
Acute pharyngitis
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Viral: edema and hyperemia of tonsils and
pharyngeal mucosa Streptococcal: exudate and hemorrhage
involving tonsils and pharyngeal walls Epstein-Barr virus (infectious mono): may
also cause exudate, with nasopharyngeal lymphoid hyperplasia
Acute pharyngitis:physical examination
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Adenoviral pharyngitis Pharyngeal erythema and exudate
may mimic streptococcal pharyngitis
Conjunctivitis (follicular) present in 1/3 to 1/2 of cases; commonly unilateral but bilateral in 1/4 of cases
Pharyngoconjuntival fever
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Herpangina
Uncommon Due to coxsackieviruss Small, 1-2 mm vesicles on the soft palate,
uvula, and anterior tonsillar pillars which rupture to form small white ulcers
Occurs mainly in children Also think of Herpes simplex virus when
you see vesicular lesions
Vesicular lesions
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Vincent’s angina: anaerobic pharyngitis
(exudate; foul odor to breath) Ludwig’s angina- cellulitis of dental origin Quinsy: peritonsillitis/peritonsillar abscess.
Medial displacement of the tonsil; often spread of infection to carotid sheath
Vincent’s anginaand Quinsy
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Classic diphtheria (Corynebacterium
diphtheriae): slow onset, then marked toxicity
Arcanobacterium hemolyticum (formerly Cornyebacterium hemolyticum): exudative pharyngitis in adolescents and young adults with diffuse, sometimes pruritic maculopapular rash on trunk and extremities
Diphtheria
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Diphtheria fibrous pseudomembrane with necrotic epithelium and leukocytes
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Symptomatic Penicillin for Strep throat Macrolides for pen allergic patients Add an anti-anaerobic agent for Vincent’s and
Ludwig’s angina
Treatment
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BRONCHITIS/BRONCHIOLITIS
PNEUMONIA
LOWER RESPIRATORY TRACT INFECTIONS
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Inflammatory disease of the bronchioles Peak age of onset : 6 months Most common agent :- rsv Male : female :- 2:1 Occurs mostly in winter/spring
BRONCHIOLITIS
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Coryza with cough followed by worsening
breathlessness Vomiting Irritability Wheeze Feeding difficulty Episodes of apnoea
CLINICAL FEATURES
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Rapid shallow breathing (60-80/min) Cyanosis / pallor Flaring of alae nasi Use of accessory muscles of respiration
Subcostal /intercostal recessions Expiratory wheeze / grunting Prolonged expiration Hyper-resonant percussion notes Chest hyperinflation Liver/spleen palpable Bronchiolitis obliterans
EXAMINATION FINDINGS IN BRONCHIOLITIS
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DIAGNOSIS
Chest X-ray Hyperinflation, increased lucency and
increased bronchovascular markings and mild infiltrates
Pulse oximetry Nasopharyngeal swabs (viral culture) Viral antibody titers (iat for rsv)
BRONCHIOLITIS
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A chest X-ray demonstrating lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis
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COMPLICATIONS
Pneumonia Pneumothorax Dehydration Respiratory acidosis Respiratory failure Heart failure Prolonged apneic spells death
BRONCHIOLITIS
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TREATMENT
Mainly supportive Prop up (30 – 40 degrees) Oxygen inhalation (achieve o2 >92%) If tachypneic, limit the oral feeds and use a ng tube
for feeding Parenteral fluids to limit dehydration Correct resp acidosis and electrolyte imbalance Bronchodilators for wheeze (nebulized adrenaline) Mechanical ventilation (severe resp distress or
apnoea)
BRONCHIOLITIS
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Inflammation of the lung parenchyma and is associated with
the consolidation of the alveolar spaces Developed world
Viral infections Low morbidity and mortality
Developing world� Common cause of death Bacteria and PCP in 65%
ARI case management WHO� 84% reduction in mortality Respiratory rate, recession, ability to drink Cheap, oral and effective antibiotics, Co-trimoxazole,
amoxycillin Maternal education Referral
PNEUMONIA
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Vary according to �
Age, immune status, where contracted Community acquired (CAP)�
Developing countries S. pneumoniae, H. influenzae, S aureus Viruses 40% Other: Mycoplasma, Chlamydia, Moraxella
Developed countries Viruses: RSV, Adenovirus, Parainfluenza, Influenza Mycoplasma pneumoniae and Chlamydia pneumoniae Bacteria: 5-10%
Etiology
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ETIOLOGY ACCORDING TO AGEAGE GROUP CAUSATIVE ORGANISM
NEONATES GROUP B STREPTOCOCCUSE.COLIKLEBSIELLASTAPH AUREUS
INFANTS PNEUMOCOCCUSCHLAMYDIARSVH.INFLUENZA TYPE b
CHILDREN 1 TO 5 YRS RESPIRATORY VIRUSESPNEUMOCOCCUSH.INFLUENZA TYPE bC.TRACHOMATISM.PNEUMONIAES.AUREUSGP A STREPTOCOCCUS
CHILDREN 5 TO 18 YRS M.PNEUMONIAEPNEUMOCOCCUSC.PNEUMONIAEH.INFLUENZA TYPE b
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WHO Classification and managementNO PNEUMONIA COUGH
NO TACHYPNEA-HOME CARE-SOOTHE THE THROAT AND RELIEVE COUGH-ADVISE MOTHER WHEN TO RETURN-FOLLOWUP IN 5 DAYS IF NOT IMPROVING
PNEUMONIA -COUGH-TACHYPNEA-NO RIB OR STERNAL RETRACTION-ABLE TO DRINK- NO CYANOSIS
-HOME CARE-ANTIBIOTICS FOR 5 DAYS-SOOTHE THE THROAT AND RELIEVE COUGH-ADVISE MOTHER WHEN TO RETURN-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH-TACHYPNEA-RIB AND STERNAL RETRACTION-ABLE TO DRINK-NO CYANOSIS
-ADMIT IN HOSPITAL-GIVE RECOMMENDED ANTIBIOTICS-MANAGE AIRWAY-TREAT FEVER IF PRESENT
VERY SEVERE PNEUMONIA -COUGH-TACHYPNOEA-CHEST WALL RETRACTION-UNABLE TO DRINK-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL-GIVE RECOMMENDED ANTIBIOTICS-OXYGEN-MANAGE AIRWAY-TREAT FEVER IF PRESENT
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Significant risk factors are younger age (2-6 months), low
parental education, smoking at home, prematurity, low birth weight, weaning from breast milk at < 6 months, a negative history of diphtheria, pertussis and tetanus vaccination, anaemia, malnutrition and overcrowding.
Infection rate higher in siblings of school children who introduce infection in the household.
Other risk factors Congenital lung cysts Chronic lung disease Immunodeficiency Cystic fibrosis Sickle cell disease Tracheostomy in situ
HIGH RISK CHILDREN FOR PNEUMONIA
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Sign of respiratory distress; nasal flaring & �
chest indrawing Younger than 2 months Decreased level of consciousness Stridor when calm Severe malnutrition Associated symptomatic HIV/AIDS
Danger Signs (IMCI)
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SIGNS OF RESPIRATORY DISTRESS
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SIGNS OF RESPIRATORY DISTRESS
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Bacterial– Poorly demarcated
alveolar opacities with air bronchograms
– Lobar or segmental opacification
Radiology
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Radiology
� Viral– Perihilar streaking, interstitial changes, air trapping
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Clues to other specific �
organisms Staphylococcus – areas
of break-down Klebsiella, anaerobes,
H. influenza or TB –cavitating or expansile pneumonia
TB, S. aureus, H. influenza pleural effusion and
empyema
Radiology
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White cell count and CRP
>15,000 – 40,000/mm3 neutrophil predominance Blood cultures
25% positive NASOPHARYNGEAL ASPIRATE
Viral immunoflorescence in infants Sputum specimen
Gram staining Acid fast bacilli
Pleural fluid examination (if present) ASO titer (in case of streptococcal pneumonia) Tuberculin skin test Viral Titres
culture antigen
Diagnosis
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Empyema Lung abscess Pneumothorax Pneumatocele Pleural effusion Delayed resolution Respiratory failure Metastatic septic lesions
Meningitis Otitis media Sinusitis Speticaemia
COMPLICATIONS OF PNEUMONIA
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Antibiotics�
Under 5 yrs First line treatment :- amoxicillin Alternatives : coamoxiclav, cefaclor,(for typical)
macrolides (for atypical) Over 5 yrs
First line treatment :- amoxicillin or macrolides Alternatives :- macrolide or flucloxacillin +
amoxicillin Severe pneumonia
Co-amoxiclav, cefotaxime or cefuroxime Special categories (as per the suspected
organism)
Treatment
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Treatment in special groups
GROUP ORGANISMS ANTIBIOTICS
IMMUNOCOMPROMISED -GRAM NEGATIVE-S. AUREUS-OPPORTUNISTIC PNEUMOCYSTIS JIROVECI-M. TUBERCULOSIS
AMPICILLIN + CLOXACILLIN +AMINOGLYCOSIDE
LESS THAN 3 MONTHS -GRAM NEGATIVE-GROUP B STREPTOCOCCUS-S.AUREUS
AMPICILLIN +AMINOGLYCOSIDE
HOSPITAL ACQUIRED PNEUMONIA
-GRAM NEGATIVE-METHICILLIN RESISTANT S. AUREUS
AMINOGLYCOSIDE + VANCOMYCIN + CEPHALOSPORIN (3RD GENERATION)
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Oxygen�
intranasaly Hydration�
50 – 80ml/kg/day Temperature control� Airway obstruction management� Chest drain :- for fluid or pus collection in
chest (empyema)
Treatment (contd.)
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Most children recover without residual �
damage Incorrect treatment leads to tissue �
destruction and bronchiectasis Half of children with pneumonia secondary to �
measles or adenovirus have persistent airway obstruction
Prognosis
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Early diagnosis of pneumonia and the
warning signs of severe disease and prompt management – key factors which determine the outcome of disease
Guidelines have been given by WHO regarding management and use of antibiotics.
Recent changes – Management as per the IMNCI protocol
PREVENTION AND CONTROL OF ARIs
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Management of ARI
as per the “Integrated Management of Neonate & Child
Illnesses” (IMNCI) protocol
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History taking and clinical assessment very
important Age of the child, for how long the child has
been coughing, whether the child is able to drink, has the young infant stopped feeding well, does the child have fever, is the child drowsy or difficult to wake, did the child have convulsions, is there irregular breathing, any history of treatment.
Clinical Assessment
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1. COUNTING THE NUMBER OF BREATHS IN ONE MINUTE - to assess fast breathing Respiratory rate cut-offs:
>/= 60 breaths per minute in a child less than 2 months
>/=50 breaths per minute in child aged 2month upto 12 months
>/=40 breaths per minute in child aged 12 months upto 5 years
Physical examination
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2. LOOK FOR CHEST INDRAWING when the child breathes IN3. LOOK AND LISTEN FOR STRIDOR when the child breathes IN4. LOOK FOR WHEEZE when the child breathes out5. FEEL FEVER OR LOW BODY TEMPERATURE6. CHECK FOR SEVERE MALNUTRITION7. CHECK FOR CYANOSIS
Physical examination cont.
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CHILD BELOW 2 MONTHS
Very severe diseaseSevere pneumoniaNo pneumonia
CHILD AGED 2 MONTHS UPTO 5 YEARS Very severe disease Severe pneumonia Pneumonia No pneumonia (cold & cough)
CLASSIFICATION OF DISEASE
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SIGNS
STOPPED FEEDING WELL
CONVULSIONS
ABN. SLEEPY STIDOR IN
CALM CHILD WHEEZE FEVER/LOW
BODY TEMP.
SEVERE CHEST IDRAWING
FAST BREATHING
NO SEVERE CHEST INDRAWING
NO FAST BREATHING
CLASSIFY AS VERY SEVERE DISEASE
SEVERE PNEUMONIA
NO PNEUMONIA
TREATMENT REFER URGENTLY
KEEP WARM
GIVE FIRST DOSE OF ANTIBIOTIC
REFER URGENTLY
KEEP WARM
GIVE FIRST DOSE OF ANTIBIOTIC
ADVICE FOR HOME CARE
EXPLAIN DANGER SIGNS
MANAGEMENT OF ARI CHILDREN BELOW 2 MONTHS
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MANAGEMENT OF ARICHILD AGED 2 MONTHS UPTO 5 YEARS
SIGNS
NOT ABLE TO DRINK
CONVULSIONS ABNORMALLY
SLEEPY OR DIFFICULT TO WAKE
STRIDOR IN A CALM CHILD
SEVERE MALNUTRITION
FAST BREATHING
CHEST INDRAWING
NASALFLARING
GRUNTING
FAST BREATHING ONLY
NO CHEST INDRAWING
NO FAST BREATHING
NO CHEST INDRAWING
CLASSIFY AS VERY SEVERE DISEASE
SEVERE PNEUMONIA
PNEUMONIA NO PNEUMONIA/COLD & COUGH
TREATMENT REFER URGENTLY
GIVE FIRST DOSE OF ANTIBIOTIC
TREAT FEVER, IF PRESENT
TREAT WHEEZE, IF PRESENT
REFER URGENTLY
GIVE FIRST DOSE OF ANTIBOTIC
TREAT FEVERTREAT WHEEZE
ADVICE FOR HOME CARE
GIVE ANTIBIOTIC
TREAT FEVERTREAT WHEEZE
ASSESS AND TREAT EAR PROBLEM/ SORE THROAT
TREAT FEVER TREAT WHEEZE
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Parenteral – Benzyl Penicillin or Ampicillin & Gentamycin
Oral – Cotrimoxazole tablets / suspension
Antibiotics recommended
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MEASLES HIB VACCINE PNEUMOCOCCAL PNEUMONIA
VACCINATION
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Questions?
THANK YOU