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Acute Respiratory infecions

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Community Medicine point of teaching incorporating epidemiology with agent, host and environmental factors and IMNCI approach

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Acute Respiratory infecions

  1. 1. ACUTE RESPIRATORY INFECTIONS Dr Deepak Upadhyay Assistant Profesor Dept of Community Medicine
  2. 2. Epidemiology • ARI RESPONSIBLE FOR 20% OF CHILDHOOD (< 5 YEARS) DEATHS (IN WHICH 90% FROM PNEUMONIA) • ARI MORTALITY HIGHEST IN CHILDREN- • HIV-infected • Under 2 year of age • Malnourished • Weaned early • Poorly educated parents • Difficult access to healthcare • OUT- PATIENT VISITS • 20-60% • ADMISSIONS • 12-45%
  3. 3. ACUTE RESPIRATORY INFECTIONS(ARI) • 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)
  4. 4. Anatomy of the Respiratory system
  5. 5. Upper Respiratory Tract Infections • Rhinitis (Common Cold Or Coryza) – Rhinoviruses, Enteroviruses, Coronaviruses • Ear Infections (Acute Otitis Media) – Viruses, Pneumococcus, Gabhs, Hemophilus Influenza, Moraxella Catarrhalis • Acute Epiglottitis (Suprglottitis) • Sinusitis – Viral/Bacterial
  6. 6. Upper Respiratory Tract Infections • Acute Pharyngitis – ADENOVIRUS, ENTEROVIRUS, RHINOVIRUS, GROUP A BETA HEMOOLYTIC Streptococcus(older Children) • Tonsillitis – Group A Beta Hemolytic Streptococci, EBV
  7. 7. Lower Respiratory Tract Infections • Acute Infectious Laryngitis – Viral/Diptheria • Croup (Acute Laryngotracheobronchitis) • Bronchitis/Bronchiolitis • Pneumonia
  8. 8. 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
  9. 9. 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
  10. 10. Factors Affecting Type of Illness and Physical Response in Acute Respiratory Infections:
  11. 11. Agent Factor • Nature of infectious agent: – Bacteria > viruses • Size and frequency of dose: – The larger the dose – More frequent the exposure Host Factor • Age of child: – Children of preschool and school age – Airways are smaller in young children – considerable narrowing from edema • Nutritional status of children • Immunization status • Birth weight of children
  12. 12. • Presence of great conditions: – Malnutrition, anemia, fatigue, chilling of the body and immune deficiencies • Presence of disorders affecting respiratory tract: – Allergies, cardiac abnormalities and cystic fibrosis Environmental factors • Air pollution: Indoor • Smoking: Passive • Seasons: – During winter and spring months • Living conditions
  13. 13. • Primodial prevention (Adoption of healthy life style) • Primary prevention (Reduction of risk factors) – Health promotion – Specific protection • Secondary prevention (Early diagnosis & Treatment) – IMNCI approach – F – IMNCI integration • Tertiary prevention – Disease limitation – Rehabilitation » Medical » Psychological » Social » Vocational Prevention of Hypertension  Quaternary prevention  Prevention of over diagnosis  Prevention of resistance
  14. 14. Primodial Prevention • Healthy life style – Good antenatal care – Early initiation of breast feeding – Exclusive Breast feeding – Proper complementary feeding – Proper nutrition • Achieve through health promotion & health education
  15. 15. Primary prevention • Health promotion • Adequate nutrition • Parenthood counselling • Reduction of passive smoking • Reduction of indoor pollution • Improved living condition • Specific protection • Vaccination • Chemoprophylaxis
  16. 16. • Vaccination • Diphtheria & Pertussis • Measles • Hib Vaccine • Pneumococcal Vaccine • SARS vaccine • Influenza vaccine • Chemoprophylaxis • Vitamin A supplementation • Antibiotic prophylaxis
  17. 17. Secondary prevention • Early diagnosis & treatment – IMNCI – F - IMNCI
  18. 18. IMNCI • Integrated management of neonatal & childhood illness • ACT – Assess – Classify – Treatment
  19. 19. Assess • Age – – < 2 months – 2 – 12 months – > 12 moths • Respiratory rate (Tachypnea) – In < 2 months (>60 breaths / min) – In 2 – 12 months (>50 breaths / min) – In > 12 moths (>40 breaths / min)
  20. 20. • Chest in drawing • Stridor • Fever • Danger signs – Inability to drink or breast feed – Convulsions – Lethargy or unconsciousness – Stridor in calm child
  21. 21. SIGNS OF RESPIRATORY DISTRESS
  22. 22. SIGNS OF RESPIRATORY DISTRESS
  23. 23. Classify • In children < 2 months – Serious bacterial infection • Any danger sign • Chest in drawing • Tachypnea – Bacterial infection (URTI) • Fever with sneezing / cough
  24. 24. • In children > 2 months – Very Severe pneumonia • Any danger sign – Severe pneumonia • Chest in drawing • Stridor • Cyanosis • Nasal flaring – Pneumonia • Tachypnea – No Pneumonia
  25. 25. 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
  26. 26. Treatment • Place of treatment • No pneumonia • pneumonia Domiciliary treatment • Severe pneumonia • Very severe pneumonia Hospital treatment • Serious bacterial infection Hospital treatment • Acute URTI Domiciliary treatment
  27. 27. • Type of Treatment • No pneumonia Symptomatic treatment • Pneumonia Oral Antibiotics + Symptomatic treatment • Severe pneumonia Injectable Antibiotics + Symptomatic treatment • Very severe pneumonia Injectable Antibiotics + Symptomatic treatment • Serious bacterial infection Injectable Antibiotics + Symptomatic treatment • Acute URTI Symptomatic treatment
  28. 28. • Drugs used Symptomatic treatment Fever – Paracetamol Cough and sneezing – H-1 antagonist (not preferred in children < 6 months) Nasal obstruction Nasal saline drops Nasal decongestants (not preferred in children < 6 months Antibiotics Oral antibiotics - Cotrimoxazole Injectable antibiotics Benzyl penicillin Ampicillin Chloramphenicol( preferred drug in Very sever disease Gentamycin
  29. 29. • Dosage of drugs • Symptomatic treatment – CPM(0.1 mg/kg wt/dose) – Paracetamol (15mg/kg/dose) • Oral antibiotics Oral Antibiotics (Cotrimoxazole) Age / Weight Paediatric tablet: Sulphamethoxazole 100 mg & Trimethoprim 20 mg Paediatric syrup; each spoon (5ml): Sulphamethoxazole 200 mg and Trimethoprim 40 mg <2 months (Wt. 3-5 kg) 1 tablet BD Half spoon (2.5 ml) twice a day 2-12 months (wt 6-9 kg) 2 tablets BD One spoon (5 ml) twice a day 1-5 years (wt 10-19 kg) 3 tablets BD One & half spoon (7.5 ml) twice a day Reassess the child after 48 hrs If improved = continued antibiotics for 3 days No improvement = continued for another 48 hr (only one cycle) Deterioration = refer to hospital for injectable antibiotics
  30. 30. • Injectable antibiotics Injectable Antibiotics (2 Months - 5 Years) Dose Interval Mode First 48 hours – Benzyl penicillin Or Ampicillin Or Chloramphenicol 50000lU per kg/dose 50 mg/kg/dose 25 mg/kg/dose 6 hourly 6 hourly 6 hourly IM IM IM 1. If condition IMPROVES, then for the next 3 days give: Procaine penicillin Or Ampicillin or Chloramphenicol 50000 IU/kg (maximum 4 lac IU) 50 mg/kg/dose 25 mg/kg/dose Once 6 hourly 6 hourly IM Oral Oral 2. If NO IMPROVEMENT, then for the next 48 hour: CHANGE ANTIBIOTIC – If ampicillin is used change to chloramphenicol IM; If chloramphenicol is used, change to cloxacillin 25mg/kg/dose, every 6 hours along with gentamycin 2.5 mg/kg/dose, every eight hours. If condition improves continue treatment orally
  31. 31. • Injectable antibiotics children aged less than 2 months ANTIBIOTIC DOSE Frequency < 7 days Age 7 days to 2 months Inj. Benzyl penicillin or 50000IU/kg/dose 12 hourly 6 hourly Inj. Ampicillin 50 mg/kg/dose 12 hourly 8 hourly and Inj. Gentamycin 2.5 mg/kg/dose 12 hourly 8 hourly
  32. 32. Questions? THANK YOU

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