acute respiratory tract infection

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acute respiratory tract infection

  1. 1. DR Anwar ahmad COMMUNITY MEDICINE & PUBLIC HEALTH KGMU UP LUCKNOW
  2. 2.  Problem statement  Š ARI RESPONSIBLE FOR 20% OF CHILDHOOD (< 5 YEARS) DEATHS (IN WHICH 90% FROM PNEUMONIA)  Š ARI MORTALITY HIGHEST IN CHILDREN-  HIV-infected  Under 2 year of age  Malnourished  Weaned early  Poorly educated parents  Difficult access to healthcare  Š OUT- PATIENT VISITS  20-60%  Š ADMISSIONS  12-45%
  3. 3.  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
  4. 4.   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
  5. 5.  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
  6. 6.  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)
  7. 7. Anatomy of the Respiratory system
  8. 8.  AGENT FACTORS BACTERIA AGE GROUP AFFECTED CHRACTERISTIC CLINICAL FEATURES Bordetella pertussis Infants & young children Poroxysmal cough Corynebacterium diphtheriae Children diphtheria Hemophilus influenzae Adults Children Acute ex of ch bronchitis Acute 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
  9. 9.  VIRUSES AGE GROUP AFFECTED CHRACTERISTIC 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
  10. 10.  Factors Affecting Type of Illness and Physical Response in Acute Respiratory Infections:
  11. 11. 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.
  12. 12. 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.
  13. 13.  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
  14. 14.  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
  15. 15.  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
  16. 16. The common cold
  17. 17.   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
  18. 18.   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
  19. 19.   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
  20. 20.   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
  21. 21.   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
  22. 22.   Do not examine the throat  Assessment of severity  Degree of stridor  Respiratory rate  Heart rate  Level of consciousness  Pulse oximetry EXAMINATION
  23. 23.   DIAGNOSIS:  “CHERRY RED”APPEARANCE OF EPIGLOTTIS ON LARYNGOSCOPY  THUMB SIGN ON LATERAL NECK RADIOGRAPH ACUTE EPIGLOTTITIS
  24. 24.
  25. 25.
  26. 26.
  27. 27.   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)
  28. 28.   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)
  29. 29.   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
  30. 30.   CLINICAL EXAMINATION  HOARSE VOICE  NORMAL TO MODERATELY INFLAMMED PHARYNX  SLIGHTLY INCREASED RESP RATE WITH PROLONGED INSPIRATION AND INSPIRATORY STRIDOR ACUTE LTB
  31. 31.   DIAGNOSIS  MAINLY A CLINICAL DIAGNOSIS  RADIOGRAPH NECK :- STEEPLE SIGN (UNRELIABLE) ACUTE LTB
  32. 32.
  33. 33.   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
  34. 34.   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
  35. 35.  Tonsillitis  Palatine tonsils (Visible during oral examination)
  36. 36.   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
  37. 37.   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:
  38. 38.   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:
  39. 39.   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
  40. 40.   Clinical features  Sneezing  Nasal discharge  Facial pressure  Fever  Purulent drainage  Headache  Sinus imaging not routinely recommended Clinical features
  41. 41.  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
  42. 42. 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, immunecom promised
  43. 43.  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
  44. 44. 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
  45. 45.   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
  46. 46.  Otitis Media
  47. 47.   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
  48. 48.   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
  49. 49.  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
  50. 50.   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
  51. 51.   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 angina and Quinsy
  52. 52.   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
  53. 53. Diphtheria fibrous pseudomembrane with necrotic epithelium and leukocytes
  54. 54.   Symptomatic  Penicillin for Strep throat  Macrolides for pen allergic patients  Add an anti-anaerobic agent for Vincent’s and Ludwig’s angina Treatment
  55. 55.   BRONCHITIS/BRONCHIOLITIS  PNEUMONIA LOWER RESPIRATORY TRACT INFECTIONS
  56. 56.   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
  57. 57.   Coryza with cough followed by worsening breathlessness  Vomiting  Irritability  Wheeze  Feeding difficulty  Episodes of apnoea CLINICAL FEATURES
  58. 58.   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
  59. 59.   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
  60. 60. 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
  61. 61.   COMPLICATIONS  Pneumonia  Pneumothorax  Dehydration  Respiratory acidosis  Respiratory failure  Heart failure  Prolonged apneic spells  death BRONCHIOLITIS
  62. 62.   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
  63. 63.  Inflammation of the lung parenchyma and is associated with the consolidation of the alveolar spaces  Developed world  Viral infections  Low morbidity and mortality  Š Developing world  Common cause of death  Bacteria and PCP in 65%  Š 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
  64. 64.   Š Vary according to  Age, immune status, where contracted  Š 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
  65. 65.  ETIOLOGY ACCORDING TO AGE AGE GROUP CAUSATIVE ORGANISM NEONATES GROUP B STREPTOCOCCUS E.COLI KLEBSIELLA STAPH AUREUS INFANTS PNEUMOCOCCUS CHLAMYDIA RSV H.INFLUENZA TYPE b CHILDREN 1 TO 5 YRS RESPIRATORY VIRUSES PNEUMOCOCCUS H.INFLUENZA TYPE b C.TRACHOMATIS M.PNEUMONIAE S.AUREUS GP A STREPTOCOCCUS CHILDREN 5 TO 18 YRS M.PNEUMONIAE PNEUMOCOCCUS C.PNEUMONIAE H.INFLUENZA TYPE b
  66. 66.  WHO Classification and management NO 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
  67. 67.   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
  68. 68.   Š 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)
  69. 69.  SIGNS OF RESPIRATORY DISTRESS
  70. 70.  SIGNS OF RESPIRATORY DISTRESS
  71. 71.  Bacterial – Poorly demarcated alveolar opacities with air bronchograms – Lobar or segmental opacification Radiology
  72. 72.  Radiology Š Viral – Perihilar streaking, interstitial changes, air trapping
  73. 73.   Š 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
  74. 74.   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
  75. 75.   Empyema  Lung abscess  Pneumothorax  Pneumatocele  Pleural effusion  Delayed resolution  Respiratory failure  Metastatic septic lesions  Meningitis  Otitis media  Sinusitis  Speticaemia COMPLICATIONS OF PNEUMONIA
  76. 76.   Š 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
  77. 77. 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)
  78. 78.   Š Oxygen  intranasaly  Š Hydration  50 – 80ml/kg/day  Š Temperature control  Š Airway obstruction management  Chest drain :- for fluid or pus collection in chest (empyema) Treatment (contd.)
  79. 79.   Š Most children recover without residual damage  Š Incorrect treatment leads to tissue destruction and bronchiectasis  Š Half of children with pneumonia secondary to measles or adenovirus have persistent airway obstruction Prognosis
  80. 80.  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
  81. 81. as per the “Integrated Management of Neonate & Child Illnesses” (IMNCI) protocol
  82. 82.   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
  83. 83.  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
  84. 84.  2. LOOK FOR CHEST INDRAWING when the child breathes IN 3. LOOK AND LISTEN FOR STRIDOR when the child breathes IN 4. LOOK FOR WHEEZE when the child breathes out 5. FEEL FEVER OR LOW BODY TEMPERATURE 6. CHECK FOR SEVERE MALNUTRITION 7. CHECK FOR CYANOSIS Physical examination cont.
  85. 85.   CHILD BELOW 2 MONTHS Very severe disease Severe pneumonia No pneumonia  CHILD AGED 2 MONTHS UPTO 5 YEARS Very severe disease Severe pneumonia Pneumonia No pneumonia (cold & cough) CLASSIFICATION OF DISEASE
  86. 86. 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
  87. 87. MANAGEMENT OF ARI CHILD 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  NASALFLARI NG  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 FEVER TREAT WHEEZE ADVICE FOR HOME CARE GIVE ANTIBIOTIC TREAT FEVER TREAT WHEEZE ASSESS AND TREAT EAR PROBLEM/ SORE THROAT TREAT FEVER TREAT WHEEZE
  88. 88.  Parenteral – Benzyl Penicillin or Ampicillin & Gentamycin Oral – Cotrimoxazole tablets / suspension Antibiotics recommended
  89. 89.   MEASLES  HIB VACCINE  PNEUMOCOCCAL PNEUMONIA VACCINATION
  90. 90. Questions? THANK YOU

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