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Acute Respiratory infecions
This document discusses acute respiratory infections (ARIs) which cause 20% of childhood deaths under 5 years old, with pneumonia responsible for 90% of ARI deaths. ARI mortality is highest in children who are HIV-infected, under 2 years old, malnourished, weaned early, from poorly educated families, or with difficult healthcare access. ARIs are classified as upper or lower respiratory tract infections. Treatment depends on classification and severity, ranging from symptomatic treatment at home to hospitalization and intravenous antibiotics. Prevention involves reducing risk factors through vaccination, nutrition, and treating infections early according to IMNCI guidelines.
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Acute Respiratory infecions
- 1. ACUTE RESPIRATORY INFECTIONS Dr DeepakUpadhyay Assistant Profesor Dept of Community Medicine
- 2. Epidemiology • ARI RESPONSIBLEFOR 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. ACUTE RESPIRATORY INFECTIONS(ARI) • Maycause 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. Anatomy of theRespiratory system
- 5. Upper Respiratory TractInfections • 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. Upper Respiratory TractInfections • Acute Pharyngitis – ADENOVIRUS, ENTEROVIRUS, RHINOVIRUS, GROUP A BETA HEMOOLYTIC Streptococcus(older Children) • Tonsillitis – Group A Beta Hemolytic Streptococci, EBV
- 7. Lower Respiratory TractInfections • Acute Infectious Laryngitis – Viral/Diptheria • Croup (Acute Laryngotracheobronchitis) • Bronchitis/Bronchiolitis • Pneumonia
- 8. VIRUSES AGE GROUP AFFECTED CHRACTERISTIC CLINICALFEATURES 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. AGENT FACTORS BACTERIA AGE GROUP AFFECTED CHRACTERISTICCLINICAL 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. Factors Affecting Typeof Illness and Physical Response in Acute Respiratory Infections:
- 11. Agent Factor • Natureof 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. • Presence ofgreat 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. • 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. Primodial Prevention • Healthylife style – Good antenatal care – Early initiation of breast feeding – Exclusive Breast feeding – Proper complementary feeding – Proper nutrition • Achieve through health promotion & health education
- 15. Primary prevention • Healthpromotion • Adequate nutrition • Parenthood counselling • Reduction of passive smoking • Reduction of indoor pollution • Improved living condition • Specific protection • Vaccination • Chemoprophylaxis
- 16. • Vaccination • Diphtheria& Pertussis • Measles • Hib Vaccine • Pneumococcal Vaccine • SARS vaccine • Influenza vaccine • Chemoprophylaxis • Vitamin A supplementation • Antibiotic prophylaxis
- 17. Secondary prevention • Earlydiagnosis & treatment – IMNCI – F - IMNCI
- 18. IMNCI • Integrated managementof neonatal & childhood illness • ACT – Assess – Classify – Treatment
- 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. • Chest indrawing • Stridor • Fever • Danger signs – Inability to drink or breast feed – Convulsions – Lethargy or unconsciousness – Stridor in calm child
- 21. SIGNS OF RESPIRATORYDISTRESS
- 22. SIGNS OF RESPIRATORYDISTRESS
- 23. Classify • In children< 2 months – Serious bacterial infection • Any danger sign • Chest in drawing • Tachypnea – Bacterial infection (URTI) • Fever with sneezing / cough
- 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. WHO Classification andmanagement 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. Treatment • Place oftreatment • No pneumonia • pneumonia Domiciliary treatment • Severe pneumonia • Very severe pneumonia Hospital treatment • Serious bacterial infection Hospital treatment • Acute URTI Domiciliary treatment
- 27. • Type ofTreatment • 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. • Drugs used Symptomatictreatment 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. • Dosage ofdrugs • 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. • Injectable antibiotics InjectableAntibiotics (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. • Injectable antibiotics childrenaged 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.