ACUTE RESPIRATORY ILLNESS(ARI) Most common Major cause of mortality and morbidity. Can affect anywhere from nose to alveoli. Can be classified into ALRI(Epiglottitis, laryngitis, laryngotrachietis, LTB, bronchitis, bronchiolitis, pneumonia) AURI(Common cold, pharyngitis,otitis media) In less developed countries measles and whooping cough are major cause of Respiratory tract infection.
PROBLEM STATEMENT ARI in young children is responsible for 3.9 million death world-wide. Bangladesh,India,Indonesia and Nepal together account for 40% of global mortality. 90% of ARI death is due to pneumonia. Most is bacterial in origin. Incidence of pneumonia in developed countries 3-4%, in developing countries 20-30%
ARI in below 5yrs child is responsible for 30-50% of hospital visit.. 20-40% of hospital admission. It is leading cause of deafness as result of otitis media.
Virus - Adenoviruses-endemic types(1,2,5),epidemic type (3,4,7) - Enterovirus (ECHO and Coxsackie) - Influenza A,B,C - Measles - RSV Others - Chlamydia type B - Coxiella burnetti - Mycoplasma pneumoniae
HOST FACTORS Small children are most vulnerable Fatality more common in young infants, malnourished children, elderly. In developing countries fatality more due to malnutrition and LBW. URTI is more common in children than adults. Illness rate more common in younger children and decreases with increasing age.
At third decade of life there is surge in infection due to cross infection from their children. Women are more affected due to their exposure to small children.
Mode of transmission Air borne route Person to Person
CONTROL OF ARI By improving primary medical care service Developing better method for:
If possible prevention
Education of mother can be effective tool in reducing mortality and morbidity from ARI.
CLINICAL ASSESMENT - Access the child condition - Ask for: Age Duration of cough Is child able to drink (2mth-5yrs) Has child stopped feeding (<2mths) Had child suffered from any illness (e.g.: measles) Does child have fever Is child excessively drowsy Did child have convulsion Is there irregular breathing Short period of not breathing(apnea) Has child turned blue Any H/O T/t
PHYSICAL EXAMINATION Count the breathing in 1 min. Fast breathing present if:
RR 60b/min or more for <2mths.
RR 50b/min or more for 2mths to 12mths.
RR 40b/min or more for 12mths to 5yrs.
Phy. Exam: contd….. Look for chest indrawing Look and listen for Stridor (is the sound produced while breathing in aka croup) Look for Wheeze (sound produced when breathing out is difficult) Abnormally sleepy and difficult to wake. Feel for fever or low temperature. Check for severe malnutrition Look for cyanosis.
CLASSIFICATION OF ILLNESS A. Child aged 2mths -5yrs 1. Very severe disease 2. Severe Pneumonia 3. Pneumonia 4. No Pneumonia- cough, cold
VERY SEVERE DISEASE SIGNS Not able to drink Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Severe malnutrition CLASSIFY AS-VERY SEVERE DISEASE TREATMENT Refer urgently to hospital Give 1st dose of antibiotics T/t of fever if present T/t of wheezing if present If cerebral malaria give anti malarial
SEVERE PNEUMONIA SIGNS Childs RR(if exhausted child’s RR may not be raised) Chest indrawing plus wheezing OTHER SIGNS -Nasal flaring -Grunting (sound made with voice if difficulty in breathing) -Cyanosis CLASSIFY AS –SEVERE PNEUMONIA TREATMENT Refer urgently to hospital First dose of antibiotics T/t of fever T/t of wheezing
PNEUMONIA SIGNS Fast breathing Absence of chest indrawing CLASSIFY AS-PNEUMONIA TREATMENT Home care Antibiotics T/t of fever T/t of wheezing Advice for re-assessment after 2days or if condition of child worsen
NO PNEUMONIA Cough/cold If cough more than 30 days needs assessment Look for ENT problem Home care T/t for fever T/t for wheezing
B.CLASSIFYING THE ILLNESS IN YOUNG INFANTS(<2MTHS) Signs may be difficult to find in young children Non-specific signs as poor feeding, fever,low body temperature,further mild chest indrawing may be present in young infants. CLASSIFIED AS
Very severe disease
VERY SEVERE DISEASE SIGNS Stopped feeding well Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Wheezing Fever or low body temperature TREATMENT Refer urgently to hospital Keep warm Antibiotics
SEVERE PNEUMONIA Severe chest indrawing RR 60 OR more TREATMENT Refer urgently Keep warm Antibiotics
NO PNEUMONIA SIGNS No severe chest indrawing No fast breathing TREATMENT Keep warm Breast feed Return if sick , ↑RR, Difficulty in feeding
TREATMENT Treatment for 2mths to 5yrs (Pneumonia) Age/weight Paed tab Paed syp. Sulpha 100mg 5ml: Sulpha-200mg Trim 20mg Trim-40mg
<2mths 1tab BD Half spoon
(3-5kgs) 2.5ml BD
2-12mths 2tab BD One spoon
(6-9kgs) 5ml BD
1-5yrs 3tab BD One and half spoon
(10-19kgs) 7.5ml BD
SEVERE PNEUMONIA(CHEST IND)
B1.IF CONDITION IMPROVES ,THEN FOR NEXT 3 DAYS
B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS Change antibiotics If Ampicillin –Change to Chloramphenicol IM If Chloramphenicol-Change to Cloxacillin 25mg/kg/dose 6hrly with gentamycin 2.5mg/kg/dose 8hrly If condition improves continue t/t orally C. Provide symptomatic t/t for fever and wheezing D. Monitor fluid and food intake E. Advice mother on home management
VERY SEVERE DISEASE Should be treated in centre with respiratory support Chloramphenicol IM is drug of choice If condition improves Oral Chloramphenicol for 10 days If condition worsen Inj Cloxacillin plus inj gentamycin
NO PNEUMONIA Symptomatic t/t Home care No antibiotics