Acute respiratory infections in children

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DR. Laith Ali Jebur
M.B.CH.B
University of Baghdad \ Alkindy college of medicine

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Acute respiratory infections in children

  1. 1. Prepared by: Laith Ali Jebur Supervised by: Dr. Ali Abdul Razzaq
  2. 2. • Definition of ARI.. • Worldwide, (ARIs) are a major cause of morbidity and mortality in emergencies especially in developing countries including Iraq. • ARI responsible for 20% of childhood (< 5 years) Deaths ,90% from pneumonia. • Six to eight respiratory tract infections per year (2-3years) • 70% of which are upper respiratory infection, 30% are lower respiratory infections.
  3. 3. Upper Respiratory Infections Acute Otitis Media RHINITIS (COMMON COLD OR CORYZA) SINUSITIS ACUTE PHARYNGITIS CROUP PERTUSSIS TONSILITIS TRACHEITIS Lowe Respiratory Infections BRONCHIOLITIS PNEOMONIA
  4. 4.  History • Age • onset, duration, SOB • Is the child coughing? For how long? • Is the child able to drink or feed well? • Has the child had fever ? For how long? • Has the child had convulsions? • Does the child have any other complaints? In addition to: (noisy breathing, sleeping, bluish discoloration, paroxysmal cough, mental state)
  5. 5. Exposure to cold weather Hx of bith problems Poor nutritional status Early weaning Immunization Poor socio-economic status Parental smoking Chronic use of drugs (affect immunity) Family history
  6. 6.  Respiratory rate • Tachypnea 3 months > 60 3 months – 1 year > 50 1year –4 years > 40 >5y >20  Chest indrawing  Listen for stridor  Listen for wheeze. Is it recurrent?  Look for cyanosis  See if the child is abnormally sleepy, difficult to wake, or restless  Body temperature  Signs of malnutrition (Marasmus, Kwashiorkor)
  7. 7. Severity CF Management No pneumonia (mild ARI) Cough Not tachypnoea Supportive measures Antipyretic No antibiotics Pneumonia Or (moderate ARI) Cough Tachypnoea No rib or sternal retraction Supportive measures Antipyretic Antibiotics Severe pneumonia Cough Tachypnoea Rib and sternal retraction Supportive measures Antibiotics Refer to hospital Very severe pneumonia Cough Tachypnoea Chest wall retraction Unable to drink Cyanosis Supportive measures Oxygen Antibiotics Immediate referral
  8. 8. • Most common infectious condition in children in the first 2 years. • Third of cases caused by Rhinovirus . • Average of 5-8 infections per year. • May involve (Nasopharynx, paranasal sinuses, middle ear).
  9. 9. Symptoms: • nasal obstruction • Rhinorrhea • sore throat • occasional non-productive cough • Parenteral diarrhea Signs: • nasal mucosa may reveal swollen, erythematous nasal turbinate's • Sign of moderate respiratory distress in infants • Ear drum is congested 2-3 days
  10. 10. Diagnostic Measures: • Laboratory studies often are not helpful • A nasal smear for eosinophils . Treatment: (No specific therapy) 1.Bed rest 2.Actamenophen1st 1-2 days 3.Relieve nasal obstruction: * Normal saline , xylometazoline nasal drops * Phenylephrine 0.25% nasal drops * highly humidified environment to prevent drying. 4.Rhinorrhea, cough : antihistamins.
  11. 11. • • • • It is an inflammation of the throat. the most common cause of a sore throat. Include: (tonsillitis &pharyngotonsillitis) Commonly caused by viral infections (Adenovirus, influenza v, EBV) • Others caused by bacterial infections(Group A-B hemolytic strptococcus ), fungal infections.
  12. 12. Viral infection 1. All ages 2. Gradual onset 3. Low grade fever 4. cough 5. Hoarseness of voice 6. Redness of the pharynx 7. Conjunctivitis(Adenovi rus) 8. Herpangina(coxachie virus) Bacterial infection 1. 5-15 year old 2. Sudden onset 3. High grade fever 4. Sore throat & difficulty in swallowing 5. Exudates 6. Ant. Cervical LN tenderness
  13. 13. • It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone. • Throat swab and culture. (Gold Standard) • Detection for streptococcal antigen (specific 80 – 85%) • WBC, ESR, CRP count is elevated.
  14. 14. • Viral pharyngitis need no antibiotics, only supportive • Streptococcal pharyngitis 1. Oral penicillin V (125-250)mg 3/day 10 days 2. Benzathine penicillin or procaine penicillin G single IM injection 3. Erythromycin 40 mg/kg/day for 10 days 4. Oral amoxicillin 50 mg/kg/day for 6 days
  15. 15. • 1. 2. 3. 4. 5. 6. 7. 8. 9. Complications are low with viral infection O.M. Mastoiditis. Peritonsillar abscess Sinusitis Involvement of lower respiratory tract Trigger asthma Meningitis Acute GN Mesenteric adenitis
  16. 16. • is a respiratory condition that is usually triggered by an acute infection of the upper airway. The infection leads to swelling inside the throat produces the classical symptoms of a "barking" cough, stridor, and hoarseness. • 75% parainfluenza virus, others inluenza A&B , RSV. • Bacterial infection(epiglotitis,diphtheria,trach eitis) • Usual age 6m – 5y, males, winter &
  17. 17. • • • • • • • 1.Laryngotracheobronchitis. 2.Acute epiglottitis. 3.Acute infectious laryngitis. 4.spasmodic croup. 5.Bacterial tracheitis. 6.Diphtheritic croup. 7.Measles croup.
  18. 18. • The most common type. Involve the glottic and subglottic regions. • Manifestations of Upper infection + croup • Severe at night • Relieved by sitting • Neck X-Ray showing subglottic narrowing (Steeple sign)
  19. 19. • Almost all cases caused by viral infection. • It involves mainly subglottic area. • Characterized by URTI then sore throat and croup. • It is generally mild and respiratory distress unusual except in infants. • In severe cases: Hoarsness, stridor, dyspnea. • Laryngoscope shows inflammed vocal cord & subglottic tissue.
  20. 20. • • • • • • • • Commonly caused by H.influenzae b. Affect 2-7 years old. Male to female 3:2. It is a medical emergency because of the risk of sudden airway obstruction. Characterized by high fever, dyspnea, dysphagia, sore throat, drooling. stridor and tripod position. the mouth is opened, and the jaw thrust forward (sniffing position) Barking cough is rare.
  21. 21. Diagnosis: • Lateral neck X-ray shows enlarged epiglottis (thumb print sign) • Direct laryngoscope my show a cherry red epiglottis (supraglottis) but it is not recommended because of laryngeal spasm.
  22. 22. • • • • • • • Progressive stridor at rest Temp>39c Respiratory distress Cyanosis & pallor Hypoxia & restlessness Impaired consciousness Toxic appearing child
  23. 23. • Put the child in cold steam from nebulizer or hot steam from vaporizer may relieve symptoms. • Monitoring of respiratory rate and respiratory distress. • IV fluid to reduce insensible water loss from tachypnea. • Oxygen in moderate to severe respiratory distress. • Tracheostomy & intubation if there is deterioration. • Sedatives are contraindicated. Cough expectorants are unhelpful.
  24. 24. • Age less than 3 years age. • caused by S. aureus. • Characterized by barking cough, high fever, stridor, copious thick purulent discharge, toxic appearance. • The usual treatment of croup is ineffective. Diagnosis: • culture of the thick, mucopurulent subglottic debris. Treatment: • Antibiotics against Staphylococcus like cloxacillin, methicillin, third generation cephalosporin or vancomycin. • Endotracheal intubation or tracheostomy. • Oxygen .
  25. 25. • Age: second 6 months • Caused by: 1- H.influenzae. 2- Strept.pneumonae. 3- Moraxella catarrhalis. • It is very common in children. Symptoms: • earache, convulsions, sometimes diarrhea & vomiting, continuos crying (irritability) & sleep disturbances. Signes: • Otorrhea or bulged , congested TM. • The tympanic membrane is intact in infants.
  26. 26. Treatment: • Broad-spectrum antibiotics. • Analgesics. • vasoconstrictive nasal drops . • Aural toilet, Myringotomy.
  27. 27. • Age only 1% of infants. 5% of children. 15% of adolescent. • Allergic rhinitis is the most common predisposing factor. • Anatomical abnormalities: • Deviated septum • Polypoid mass
  28. 28. • • • • • • • • • • Cough mainly at night Rhinorrhea Nasal speech Halitosis Facial pain, tender Facial swelling Headache Fever Irritability Trigger asthma & O.M
  29. 29. • Culture • Plain X ray • CT scan May show sinus clouding Mucosal thichening Air fluid level. • Antibiotics • Suportive therapy
  30. 30. • Bordetella pertussis • Affect young children, non immunized. • Spread by droplet, direct or indirect contact with nasal scretions. • Manifestations: • Catarrhal stage..1-2 w URTI. • Paroxysmal stage..2-4w parox. Cough, whooping. • Convalescent stage..1-2w only cough for months. • Investigations: • CBC: WBC mainly lymph. • CXR prehilar infiltrate. • Culture, PCR, IFA.
  31. 31. • Admit severe cases • Erythromycine 2w • Azithromycin or clarithromycin 1w • TMP-Sulfa • • • • Pneumonia Super infection Atelactasis seizures
  32. 32. • • • • It is a common inflammation of the bronchioles. AGE less than two years With a peak at age 6th month. ( RSV ) more than 50% . Rarely by mycoplasma. * There is Bronchiolar obstruction due to edema & accumulation of mucous & cellular debris & by invasion by viruses.
  33. 33. • Presents as a progressive respiratory illness that is similar to the common cold in its early phase with cough, dyspnea and rhinorrhea. • It progresses over 3 to 7 days to noisy breathing with noisy breathing. • fever accompanied in young children by irritability. • May have apnea as the first sign of infection.
  34. 34. • Tachypnea, falaring of ala nasi • intercostal retractions &subcostal retractions . • air trapping with hyper expansion of the lungs with hepatosplenomegaly by dispacement. • percussion of the chest reveals hyper resonance. • Auscultation reveals prolonged expiratory phase with diffuse wheezes and crepitation. • In more severe cases cyanosis.
  35. 35. • WBC & differential counts are normal. • Antigen tests (IFA or ELISA) of nasopharyngeal secretions for RSV, para-influenza, influenza viruses, and adenoviruses are the most sensitive tests to confirm. • Chest X-ray shows: 1- signs of hyper expansion of the lungs, including increased lung radiolucency. 2-flattened or depressed diaphragms.
  36. 36. • • • • • • • 1- bronchial asthma. 2- congestive heart failure. 3- foreign body in the trachea. 4- pertusis. 5- cystic fibrosis. 6- bacterial bronchopneumonia. 7- obstructive emphysema.
  37. 37. 1. Young age<3 month old. 2. Moderate to marked resp. distress 3. Hypoxemia(PO2<60mmHg or Oxygen saturation<92% on room air). 4. Apnea 5. Inability to tolerate oral feeding 6. Lack of appropriate care available at home.
  38. 38. • consists of supportive therapy, including: 1-Nebulizer, control of fever 2-good hydration 3- upper airway suctioning and oxygen administration. 4- I.V. fluid indicated in case of sever tachypnea which interrupt feeding. 5-Ribavirin is anti viral agent administered by aerosol. 6-Temperorary use of bronchodilators may improve wheezing &respiratory distress.
  39. 39. • inflammation of the parenchyma of the lungs. classified anatomically as : • Lobar or lobular. • Bronchopnemonia:is involvement of the bronchi & the surrounding alveolar tissue which is more profuse & bilateral. • interstitial pneumonia. • Pathologically there is consolidation of alveoli or infiltration of the interstitial tissue with inflammatory cell or both.
  40. 40. 1-Viral: RSV 70%, influenza, parainfluenza or adenovirus. 2-Bacterial: In first 2 months the common agents include klebsiella, E. coli, and staphylococci. • Between 3 month to 3 years common bacteria include S. pneumonia, H. influenza and staphylococci. • After 3 years of age common bacteria include S. pneumonia and staphylococci. 3-Atypical organism: Chlamydia and Mycoplasma. 4-Pnemuocystis carinii: causes pneumonia in imunnocompromised children.
  41. 41. • Onset of pneumonia may be insidious starting with URTI or may be acute with high fever, dypsnea and grunting respiration. Respiratory rate is always increased. • Rarely pneumonia may be present with acute abdominal emergency which is due to referred pain from the pleura. • On examination there is flaring of alae nasi, retraction of lower chest and intercostal spaces. • Signs of consolidation(diminished expansion, dull percussion note, increased tactile vocal fremitus/vocal resonance, bronchial breathing with localized crepitation ) can be seen in lobar pneumonia.
  42. 42. • Viral pneumonia :- low grade fever, cough, wheeze .the lesion is usually diffuse and bilateral. its broncho pneumonia. • WBC is not so high with lymphocytosis. • Bacterial pneumonia:- patient presented with high fever,herpetic lesion at the lips, pleuretic chest pain. • WBC leukocytosis with neutrophilia. • S. pneumoniae often resulting in focal lobar involvement. • Group A. streptococcus infection results in interstitial pneumonia. • S. aureus causes bronchopneumonia which is often unilateral with cavitations.
  43. 43. • Diagnosis mainly clinical. • 1- chest x- ray:
  44. 44. 1. Sputum for gram stain and culture. 2. blood culture. 3. virological study by culture &florescent antibody technique. 4. in case of pleural effusion aspirate pleural fluid for gram stain and culture also for acid fast bacilli.
  45. 45. • 1-less than 3 month of age. • 2- moderate to sever respiratory distress. • 3- failure of out patient treatment. • 4-immunocompromised patient. • 5- neonate with congenital pneumonia. • 6- staphylococcal pneumonia. • 7- complications like pleural effusion, empyema.
  46. 46. • The empiric treatment of suspected bacterial pneumonia is parenteral cefotaxim or ceftriaxone. • If clinical features suggest staphylococcal pneumonia, vancomycin. • For mildly ill children amoxicillin (80–90 mg/kg/24 hr). • For school-aged children and in those in whom infection with M. pneumoniae a macrolide antibiotic such as azithromycin. • In adolescents, a respiratory fluoroquinolone (levofloxacin) may be considered for atypical pneumonias. • If viral pneumonia is suspected, it is reasonable to withhold antibiotic therapy. supportive by 1- oxygen 2- IVF. 3antipyretic for fever. ribavirin for RSV.
  47. 47. • • • • • • A- Pulmonary complications 1- pleural effusion. 2- empyema. 3- lung abscess. 4- pneumatocele. 5- pneumothorax. • • • • • B- Extra pulmonary complications 1- meningitis. 2- arithritis. 3- osteomyelitis. 4- pericarditis.
  48. 48. • • • • • • • Health education. Keep child warm. Immunization. Nutrition. Prevent nearby smoking. Personal hygiene. Visit doctor.

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