Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Acute Respiratory Infections in Children (ARI) by awais

16,266 views

Published on

Published in: Health & Medicine
  • Penis Enlargement and Enhancement Techniques: What REALLY Works?!? ★★★ http://t.cn/Ai88iYkP
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • SECRET: Men usually out of emotion, not logic. Take advantage of this and get your Ex back today! See how at: ■■■ http://scamcb.com/exback123/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • I am so thankful and thrilled to know that someone had found a solution to such a disturbing problem in this country! There are too many women and men that are suffering from this horrendous disease! Before I ordered your program, I used to itch and scratch constantly sometimes all night long. Above all the annoyance it was very embarrassing, especially at work. Since I started your system, I don't use drugs or creams anymore to bring me through the nightmare of yeast infections that was my reality for too long! The constant itching and rashes that sometimes continued for mouths are completely gone. Additionally, the lack of energy and heartburn which I now know were caused by candida overgrowth have also disappeared in a matter of weeks. I feel so rejuvenated and lucky to have found your system. I am also amazed and thankful that your product worked so fast and well. ◆◆◆ https://tinyurl.com/y4uu6uch
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • How I Cured My Yeast Infection, Ex Sufferer reveals secret system, For Lasting Candida Freedom ★★★ https://tinyurl.com/y4uu6uch
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD FULL. BOOKS INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Acute Respiratory Infections in Children (ARI) by awais

  1. 1. ACUTE RESPIRATORY TRACT INFECTIONS BY DR SYED AWAIS UL HASSAN SHAH TRAINEE PAEDIATRICS
  2. 2. INTRODUCTION• Š ARI responsible for 20% of childhood (< 5 years) deaths – 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. INTRODUCTION• In Pakistan ARI constitutes 30-60% of patients in a hospital OPD – 80% - acute upper respiratory infections – 20% - acute lower respiratory infections• 250,000 children < 5 yrs of age die due to pneumonia in Pakistan every year• Bacterial pneumonia is more common in Pakistan. In contrast, pneumonia in developed countries is mostly viral
  4. 4. INTRODUCTION• Š Upper and lower respiratory tract separated at base of epiglottis• Upper respiratory tract consists of airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear• The lower respiratory tract covers the continuation of the airways from the trachea and bronchi to the bronchioles and the alveoli• The children < 5 yrs of age get an average of three to six episodes of ARIs annually regardless of where they live or what their economic situation• The severity of LRIs in children under five is worse in developing countries
  5. 5. UPPER RESPIRATORY TRACT INFECTIONS• ACUTE EPIGLOTTITIS (SUPRGLOTTITIS)• CROUP (ACUTE LARYNGOTRACHEOBRONCHITIS)• RHINITIS (COMMON COLD OR CORYZA) – RHINOVIRUSES, ENTEROVIRUSES, CORONAVIRUSES• 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
  6. 6. ACUTE EPIGLOTTITIS• 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
  7. 7. ACUTE EPIGLOTTITIS• 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
  8. 8. EXAMINATION• DO NOT EXAMINE THE THROAT• ASSESSMENT OF SEVERITY – DEGREE OF STRIDOR – RESP RATE – H.R – LEVEL OF CONSCIOUSNESS – PULSE OXIMETRY
  9. 9. ACUTE EPIGLOTTITIS• DIAGNOSIS: – “CHERRY RED”APPEARANCE OF EPIGLOTTIS ON LARYNGOSCOPY – THUMB SIGN ON LATERAL NECK RADIOGRAPH
  10. 10. ACUTE EPIGLOTTITIS• EPIGLOTTITIS IS A MEDICAL EMERGENCY
  11. 11. TREATMENT (ACUTE EPIGLOTTITIS)• 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
  12. 12. ACUTE LTB (VIRAL CROUP)• 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
  13. 13. ACUTE LTB• 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
  14. 14. ACUTE LTB• CLINICAL EXAMINATION – HOARSE VOICE – NORMAL TO MODERATELY INFLAMMED PHARYNX – SLIGHTLY INCREASED RESP RATE WITH PROLONGED INSPIRATION AND INSPIRATORY STRIDOR
  15. 15. ACUTE LTB• DIAGNOSIS – MAINLY A CLINICAL DIAGNOSIS – RADIOGRAPH NECK :- STEEPLE SIGN (UNRELIABLE)
  16. 16. ACUTE LTB• 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)
  17. 17. DIFFRENTIATING BETWEEN ACUTE LTB AND ACUTE EPIGLOTTITIS CROUP EPIGLOTTITIS TIME COURSE DAYS HOURS PRODROME CORYZA NONE COUGH BARKING SLIGHT IF ANY FEEDING CAN DRINK NO MOUTH CLOSED DROOLING SALIVA TOXIC NO YES FEVER <38.5 C >38.5 C STRIDOR RASPING SOFT VOICE HOARSE WEAL OR SILENT
  18. 18. LOWER RESPIRATORY TRACT INFECTIONS• BRONCHITIS/BRONCHIOLOITIS• PNEUMONIA
  19. 19. BRONCHIOLITIS• INFLAMMATORY DISEASE OF THE BRONCHIOLES• PEAK AGE OF ONSET : 6 MONTHS• MOST COMMON AGENT :- RSV• MALE : FEMALE :- 2:1• OCCURS MOSTLY IN WINTER/SPRING
  20. 20. CLINICAL FEATURES• CORYZA WITH COUGH FOLLOWED BY WORSENING BREATHLESSNESS• VOMITING• IRRITABILITY• WHEEZE• FEEDING DIFFICULTY• EPISODES OF APNOEA
  21. 21. EXAMINATION FINDINGS IN BRONCHIOLITIS• 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
  22. 22. BRONCHIOLITIS• DIAGNOSIS – CXR • HYPERINFLATION, INCREASED LUCENCY AND INCREASED BRONCHOVASCULAR MARKINGS AND MILD INFILTRATES – PULSE OXIMETRY – NASOPHARYNGEAL SWABS (VIRAL CULTURE) – VIRAL ANTIBODY TITERS (IAT FOR RSV)
  23. 23. A chest X-ray demonstrating lung hyperinflation with aflattened diaphragm and bilateral atelectasis in the right apicaland left basal regions in a 16-day-old infant with severebronchiolitis
  24. 24. BRONCHIOLITIS• COMPLICATIONS – PNEUMONIA – PNEUMOTHORAX – DEHYDRATION – RESPIRATORY ACIDOSIS – RESPIRATORY FAILURE – HEART FAILURE – PROLONGED APNEIC SPELLS  DEATH
  25. 25. BRONCHIOLITIS• 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)
  26. 26. Pneumonia• 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
  27. 27. Etiology• 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%
  28. 28. ETIOLOGY ACCORDING TO AGEAGE GROUP CAUSATIVE ORGANISMNEONATES GROUP B STREPTOCOCCUS E.COLI KLEBSIELLA STAPH AUREUSINFANTS PNEUMOCOCCUS CHLAMYDIA RSV H.INFLUENZA TYPE bCHILDREN 1 TO 5 YRS RESPIRATORY VIRUSES PNEUMOCOCCUS H.INFLUENZA TYPE b C.TRACHOMATIS M.PNEUMONIAE S.AUREUS GP A STREPTOCOCCUSCHILDREN 5 TO 18 YRS M.PNEUMONIAE PNEUMOCOCCUS C.PNEUMONIAE H.INFLUENZA TYPE b
  29. 29. WHO Classification and managementNO PNEUMONIA COUGH -HOME CARE NO TACHYPNEA -SOOTHE THE THROAT AND RELIEVE COUGH -ADVISE MOTHER WHEN TO RETURN -FOLLOWUP IN 5 DAYS IF NOT IMPROVINGPNEUMONIA -COUGH -HOME CARE -TACHYPNEA -ANTIBIOTICS FOR 5 DAYS -NO RIB OR STERNAL -SOOTHE THE THROAT AND RETRACTION RELIEVE COUGH -ABLE TO DRINK -ADVISE MOTHER WHEN TO - NO CYANOSIS RETURN -FOLLOWUP IN 2 DAYSSEVERE PNEUMONIA -COUGH -ADMIT IN HOSPITAL -TACHYPNEA -GIVE RECOMMENDED -RIB AND STERNAL RETRACTION ANTIBIOTICS -ABLE TO DRINK -MANAGE AIRWAY -NO CYANOSIS -TREAT FEVER IF PRESENTVERY SEVERE PNEUMONIA -COUGH -ADMIT IN HOSPITAL -TACHYPNOEA -GIVE RECOMMENDED -CHEST WALL RETRACTION ANTIBIOTICS -UNABLE TO DRINK -OXYGEN -CENTRAL CYANOSIS -MANAGE AIRWAY -TREAT FEVER IF PRESENT
  30. 30. HIGH RISK CHILDREN FOR PNEUMONIA• CONGENITAL LUNG CYSTS• CHRONIC LUNG DISEASE• IMMUNODEFICIENCY• CYSTIC FIBROSIS• SICKLE CELL DISEASE• TRACHEOSTOMY IN SITU
  31. 31. Danger Signs (IMCI)• Š High risk of death from respiratory illness• Younger than 2 months• Decreased level of consciousness• Stridor when calm• Severe malnutrition• Associated symptomatic HIV/AIDS
  32. 32. VERY SEVERE PNEUMONIA
  33. 33. SIGNS OF RESPIRATORY DISTRESS
  34. 34. SIGNS OF RESPIRATORY DISTRESS
  35. 35. RadiologyBacterial– Poorly demarcated alveolar opacities with air bronchograms– Lobar or segmentalopacification
  36. 36. RadiologyŠ Viral– Perihilarstreaking, interstitial changes,air trapping
  37. 37. Radiology• 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
  38. 38. Diagnosis• 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
  39. 39. COMPLICATIONS OF PNEUMONIA• EMPYEMA• LUNG ABSCESS• PNEUMOTHORAX• PNEUMATOCELE• PLEURAL EFFUSION• DELAYED RESOLUTION• RESPIRATORY FAILURE• METASTATIC SEPTIC LESIONS – MENINGITIS – OTITIS MEDIA – SINUSITIS – SPETICAEMIA
  40. 40. Treatment• 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)
  41. 41. Treatment in special groupsGROUP ORGANISMS ANTIBIOTICSIMMUNOCOMPROMISED -GRAM NEGATIVE AMPICILLIN + -S. AUREUS CLOXACILLIN + -OPPORTUNISTIC AMINOGLYCOSIDE PNEUMOCYSTIS JIROVECI -M. TUBERCULOSISLESS THAN 3 MONTHS -GRAM NEGATIVE AMPICILLIN + -GROUP B STREPTOCOCCUS AMINOGLYCOSIDE -S.AUREUSHOSPITAL ACQUIRED -GRAM NEGATIVE AMINOGLYCOSIDE +PNEUMONIA -METHICILLIN RESISTANT S. VANCOMYCIN + AUREUS CEPHALOSPORIN (3RD GENERATION)
  42. 42. Treatment (contd)• Š Oxygen – When? – Methods of delivery• Š Hydration – 50 – 80ml/kg/day• Š Temperature control• Š Airway obstruction• Chest drain :- for fluid or pus collection in chest (empyema)
  43. 43. Failure to respond• Š Incorrect or inadequate dose of antibiotic• Š Resistant or not suspected organism• Š Empyema or other complication• Š TB• Š Suppressed immunity• Š Underlying cause – e.g. foreign body or bronchiectasis• Š Left heart failure and not pneumonia Refer if no improvement after 3 – 5 days
  44. 44. Prognosis• 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
  45. 45. THANKYOU

×