Acute respiratory tract infections

1. ACUTE
RESPIRATORY
INFECTIONS
WITH IT’S ROLE
PLAY

2. INTRODUCTION
 ARI responsible for 20% of childhood(<5yrs) death
90% from pneumonia
ARI mortality highest in children
HIV infected
Under 2yr of age
Malnourished
Weaned early
Poorly educated parents
Difficult assess to health
Out patient visits
30-50%
Admissions
20-40%
ARI & TB influenced by HIV

3. CONT.
 ARI can affect anywhere from nose to alveoli.
 ARIs can be classified into –
Acute upper respiratory tract infections (common
cold,pharyngitis& otitis media).
Acute lower respiratory tract
infections(Epiglottitis,Laryngitis,Laryngotracheitis,Br
onchitis,Bronchiolitis,Pneumoniae).
In less developed countries measles and whooping
cough are major cause of respiratory tract infections.

4. EPIDEMIOLOGICAL DETERMINANTS
Agent
Host
Environment

5. CONT.
AGENT FACTORS
BACTERIA
Bordetella pertusis
Corynebacterium diptheri
Haemophilus influenzae
Klebsiella pneumoniae
Staphylococcus pyogenes

6. VIRUSES
Adenoviruses endemic types(1,2,5),epidemic
types(3,4,7)
Enterovirus(ECHO&COXSACKIE)
InfluenzaA,B,C
Measles
RSV
OTHERS
Chlamydia type B
Coxiella burnetti
Mycoplasma pneumoniae

7. HOST FACTORS
AGE- Small children are most vulnerable.
-upper respiratory tract infection is more
common in chidren than adults.
-Illness rate more common in younger children
and decreases with increasing age.
Under FIVE years children
SEX –Equal ,but reporting MALE >FEMALE
In adults , FEMALE > MALE
(Due to more association with children)

8. IMMUNE STATUS – Nutritional status :
1. Healthy
2. malnourished
3. low birth weight
HISTORY OF VACCINATION:
1. DPT
2. PNEUMOCOCCAL VACCINE
3. BCG
4. MEASLES,etc.
SOCIOECONOMIC STATUS:- In low socioeconomic
status more chances of acute respiratory infection.

9. ENVIRONMENTAL FACTORS
SOCIAL :-
 Overcrowding
 poor housing
 low standard of living
 poor knowledge/awareness/ignorance
 Indoor smoke pollution
 Maternal smoking
 Level of industrialization
BIOLOGICAL :-
 Bacterial
 Viruses , etc.
SEASONAL:- In winter season , more ACUTE RESPIRATORY
INFECTION

10. MODE OF TRANSMISSION
 AIR BORNE ROUTE
 PERSON TO PERSON

11. TOP TEN CAUSES OF DEATH:WORLDWIDE TOP TEN CAUSES OF DEATH:DEVELOPING WORLD
1 Ischemic heart disease 12.2%
2 Cerebrovascular
disease
9.7%
3 Lower respiratory
infection(accounts for
most ARIs)
7.1%
4 Chronic obstructive
pulmonary disease
5.1%
5 Diarrheal diseases 3.7%
6 HIV/AIDS 3.5%
7 Tuberculosis 2.5%
8 Trachea,bronchus,lun
g cancers
2.3%
9 Road traffic accidents 2.2%
10 Prematurity & low
birthweight
2.0%
1 Lower respiratory
infection(accounts
for more ARIs)
11.2%
2 Ischemic heart
disease
9.4%
3 Diarrheal diseases 6.9%
4 HIV/AIDS 5.7%
5 Cerebrovascular
disease
5.6%
6 Chronic obstructive
pulmonary disease
3.6%
7 Tuberculosis 3.5%
8 Neonatal infections 3.4%
9 Malaria 3.3%
10 Prematurity & low
birthweight
3.2%

12. Etiology in special groups

Group Organisms Antibiotic
Immune
compromised
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)

13. CLASSIFICATION OF ILLNESS
(child aged 2 months to 5 yrs)
 Classifying the illness means making decisions about
the type and severity of the disease . The sick child
should be put in to one of the four classification:
VERY SEVERE DISEASE
SEVERE PNEUMONIA
PNEUMONIA(NOT SEVERE)
NO PNEUMONIA

14. INFECTIONS OF THE
RESPIRATORY
TRACT
Upper &lower respiratory
tract separated at base of
epiglottis

15. CLASSIFICATION AND MANAGEMENT
( AGE BETWEEN 2 MONTHS UPTO 5 YEARS)
CLASSIFY AS CLINICAL SIGNS TREATMENT
NO
PNEUMONIA
COUGH,
NO T ACHYPNOEA
SUPPORTIVE MEASURES,
ANTIPYRETIC,
NO ANTIBIOTICS
PNEUMONIA COUGH,
TACHYPNOEA,
NO RIB OR STERNAL
RETRACTION
SUPPORTIVE MEASURES,
ANTIPYRETIC,
ANTIBIOTICS
SEVERE
PNEUMONIA
COUGH,
T ACHYPNOEA,
RIB OR STERNAL RETRACTION
SUPPORTIVE MEASURES,
ANTIBIOTICS,
REFER TO HOSPITAL
VERY SEVERE
DISEASE
COUGH,
TACHYPNOEA,
CHESTWALL RETRACTION,
UNABLE TO DRINK,
CYANOSIS,
CONVULSIONS,
ABNORMALLY SLEEPY OR DIFFICULT
REFER URGENTLY TO HOSPITAL,
GIVE 1st DOSE OF AN
ANTIBIOTIC,ANTIPYRETIC IF FEVER
PRESENT,TREAT WHEEZING IF
PRESENT

16. CLASSIFICATION&MANAGEMENT OF ILLNESS IN YOUNG INFANTS (
LESS THAN 2 MONTHS)
CLASSIFY AS SIGNS TREATMENT
NO
PNEUMONIA:
COUGH OR
COLD
NO SEVERE CHEST
INDRAWING & NO FAST
BREATHING ( RR < 60/MIN.)
ADVICE MOTHER TO GIVE THE FOLLOWING HOME
CARE :
•KEEP YOUNG INFANT WARM
•BREAST FEED FREQUENTLY
•CLEAR NOSE IF IT INTERFERES WITH FEEDING.
•RETURN QUICKLY IF
:-
•BREATHING BECOME DIFFICULT
•BREATHING BECOMES FAST
•FEEDING BECOMES A PROBLEM ,THE INFANT
BECOMES SICKER.
SEVERE
PNEUMONIA
SEVERE CHEST
INDRAWING,OR FAST
BREATHING(60 Per min or
more)
REFER URGENTLY TO HOSPITAL.
KEEP YOUNG INFANT WARM.
GIVE FIRST DOSE OF AN ANTIBIOTIC.
VERY SEVERE
DISEASE
STOPPED FEDING WELL,
CONVULSIONS,
ABNORMALLY SLEEPY OR
DIFFICULT TO WAKE,
STRIDOR IN CALM CHILD,
WHEEZING,OR FEVER or LOW
REFER URGENTLY TO HOSPITAL,
KEEP YOUNG INFANT WARM,
GIVE FIRST DOSE OF AN ANTIBIOTIC.

17. TREATMENT OF PNEUMONIA IN CHILDREN
(AGED LESS THAN 2MONTHS )
ANTIBIOTIC DOSE FREQUENCY
Age<7days Age7 days to
2month
Inj . Benzyl
penicillin OR
50,000IU/kg/dose 12hourly 6hourly
Inj. Ampicillin
AND
50mg/kg/dose 12hourly 8hourly
Inj . Gentamycin 2.5mg/kg/dose 12hourly 8hourly

18. DANGER SIGNS
HIGH RISK OF DEATH FROM
RESPIRATORY
ILLNESS:-
- Younger than two months
- Decreased level of consciousness
- Stridor when calm
- Severe malnutrition
- Associated symptomatic HIV/AIDS

19. TACHYPNOEA
Less than 3 month >60 breaths per minute
3 months to 12 months >50 breaths per minute
1 year to 4 years > 40 breaths per minute

20. MEASURES BEFORE
TRANSFERRING TO HOSPITAL
Antipyretics
Oxygen
-40% by mask or prongs
Suctioning of secretions
Stomach tube
- For decompression
-Give fluids
Severely distressed,IV fluids
Intravenous penicillin

21. Clinical picture
 Neonates may have non-specific signs
– Lethargy, failure to feed, temperature instability,
apnoea or tachypnoea
 Older children
– Runny nose , sore throat followed by cough, fever and
tachypnoea
 More serious pneumonia
– Tachypnoea, chest indrawing, feeding difficulty
 Respiratory failure
– Severe tachypnoea, chest indrawing, restlessness,
grunting, tachycardia and central cyanosis

22. EXAMINATION
o Altered breath sounds and crackles
o Signs of lobar pneumonia in minority
- dullness to percussion , bronchial breathing
o Mild pneumonia only tachypnoea
o Measure severity of hypoxia with transcutaneous
saturation monitor
o Sudden deterioration suggestive of complication
-Pneumothorax , pyopneumothorax

23. DIAGNOSIS
White cell count and CRP
Blood cultures
-25% positive
Sputum specimen
-Induced specimen
 PCP
 TB
Lung aspirates
Tuberculin skin test
Viruses
- Culture
- Antigen

24. TREATMENT
ANTIBIOTICS
-Primary care level
 Amoxicillin,co-trimoxazole
-Regional hospital
 Amoxycillin,cloxacillin,penicillin,erythromycin
OXYGEN
Blood transfusion
Hydration
-50-80ml/kg/day
Temperature control
Airway obstruction
Other e.g.Vit-A

25. TREATMENTS WITH NO PROVEN
BENEFIT IN ACUTE PNEUMONIA
IN CHILDREN
Mucolytics
Chest physiotherapy
Postural drainage
Nebulization

26. FAILURE TO RESPOND
 Incorrect or inadequate dose of antibiotic
 Resistant or not suspected organism
 Empyema or other complications
 TB
 Suppressed immunity
 Underlying cause
E.g.Foreign body or bronchiectasis
 Left heart failure and not pneumonia
 Refer if no improvement after 3-5 days

27. PROGNOSIS
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

28. PREVENTIVE MEASURES
 Taking action against poverty, improving standards of
living & addressing the envoirnmental factor that create
the conditions for the spread of disease can dramatically
reduce ARIs. Other , more targeted streategies are:
MALNUTRITION:-
• Exclusive breastfeeding before six month
• Breastfeeding & complementary foods until age two.
• Access to appropriate nutritional supplements.
• Commitment from governments & the international
community to combat malnutrition.

30. AIR POLLUTION:-
o Wider access to cleaner fuels for cooking & heating .
o Support & education to help people change their cooking
habits.
o More research into the relationship between indoor air
pollution & health.
o Motor vehicle & industrial emission controls .
o Improved public transportation system to reduce to motor
vehicle use.
CLEANER COOKING FUELS ,REDUCED TOBACCO USE, &
VEHICLE EMISSION CONTROLS REDUCE POLLUTION & ARIs.

31. INDOOR AIR POLLUTION OUTDOOR AIR POLLUTION

32. TOBACCO
 Raise tobacco prices.
• Enforce no-smoking policies .
• Provide education about the harms of smoking &
second hand smoke.
• Ban all forms of tobacco advertising & marketing.
• Expand the use of health warnings on cigarettes .
SMOKERS ARE SIGNIFICANTLY MORE LIKELY TO DEVELOP A
VARIETY OF RESPIRATORY ILLNESSES ,INCLUDING PNEUMONIA
,INFLUENZA & TUBERCULOSIS & THEIR CASES ARE MORE LIKELY
TO BE SEVERE.

33. TOBACCO CONTROL REDUCES SMOKING. EXPOSURE
TO SECOND HAND SMOKE & RISK OF ARIs.

34. OVERCROWDING
 ARIs are less likely to spread in communities with well
–ventilated houseing that meets density standards .
GLOBAL IMPACT
 By 2015 ,more than 75% of the worlds slum dwellers will live in sub –
Saharan Africa & parts of Asia ,in conditions that promote the
spread of ARIs.
 By 2050 ,almost 70% of the worlds Popullation will live in cities .
 Alleviating overcrowding is closely tied to broader efforts to address
poverty ,manage growth improve urban infrastructure ,& foster
economic development .