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Ari
The document discusses acute respiratory infections (ARIs) in children under 5 years old. It defines ARI and describes the signs and symptoms, including fast breathing and chest indrawing. Common causes are viruses like RSV and bacteria like Streptococcus pneumoniae. ARIs often spread rapidly in young children due to anatomical factors. They are a major cause of mortality, responsible for around 900,000 child deaths per year. Proper treatment with low-cost measures can reduce the death toll from ARIs.
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Ari
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- 2. Life Finds AWay:Life Finds A Way: JustJust Donโt Give UpDonโt Give Up
- 3. Life Finds AWay:Life Finds A Way: JustJust Donโt Give Up โฆDonโt Give Up โฆ
- 4. Life Finds AWay:Life Finds A Way: JustJust Donโt Give Up โฆDonโt Give Up โฆ
- 5. 5 Life Finds AWay:Life Finds A Way: JustJust Donโt Give Up โฆDonโt Give Up โฆ
- 9. A R IAR I
- 10. SIGNS OF RESPIRATORYDISTRESSSIGNS OF RESPIRATORY DISTRESS
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- 15. 15 Definition of AR IDefinition of A R I (Acute Resp. Infection)(Acute Resp. Infection) This term isThis term is usedused by HW to indicate ac. inf. ofby HW to indicate ac. inf. of resp. system in U-5y childrenresp. system in U-5y children In this age group such inf. are often not anatomicallyIn this age group such inf. are often not anatomically localized, rather spreads rapidly to adjacent partslocalized, rather spreads rapidly to adjacent parts An U-5 child getsAn U-5 child gets 3-6 ARIs/y3-6 ARIs/y regardless of livingregardless of living standardstandard HW: health worker. U-5: under 5 years of age. Inf.: infectionHW: health worker. U-5: under 5 years of age. Inf.: infection
- 16. 16 Clinical AnatomyClinical Anatomy โขRT is divided into 3 parts:RT is divided into 3 parts: URT:URT: nosenose โโ tracheatrachea (PNS, mouth, tonsils,(PNS, mouth, tonsils, pharynx, auditory T,pharynx, auditory T, middle-earmiddle-ear, larynx), larynx) LRT:LRT: tracheatrachea โโ bronchibronchi โโ air ductsair ducts Lung parenchymaLung parenchyma
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- 21. 21 Normal Defence ofRSNormal Defence of RS These are unique!These are unique! โข Breathing, coughing, sneezingBreathing, coughing, sneezing โข Mucosal antibodiesMucosal antibodies โข Ciliary sweepingCiliary sweeping โข PhagocytesPhagocytes โข Physical filteringPhysical filtering (Think how less often you catch cold and cough!)(Think how less often you catch cold and cough!)
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- 24. 24 ARI in ChildrenARIin Children Spread Rapidly:Spread Rapidly: โข Shorter & narrower RTShorter & narrower RT โข Cough not strongCough not strong โข Less immuneLess immune โข Auditory tube is:Auditory tube is: โ shortershorter โ narrowernarrower โ straighterstraighter
- 25. Sites A RISites A R I โข RhinitisRhinitis โข SinusitisSinusitis โข TonsillitisTonsillitis โข PharyngitisPharyngitis โข EpiglottitisEpiglottitis โข LaryngitisLaryngitis โข AOMAOM โข TracheitisTracheitis โข BronchitisBronchitis โข BronchiolitisBronchiolitis โข PneumoniaPneumonia โข Bronchitis & Pn.Bronchitis & Pn. (Br.Pn.)(Br.Pn.) Children usually have combinations:Children usually have combinations: Ac. rhinopharyngotonsillitis +/- AOM, ac. LTBAc. rhinopharyngotonsillitis +/- AOM, ac. LTB (croup), Br.Pn, etc.(croup), Br.Pn, etc.
- 26. 26 ARI is asyndrome:ARI is a syndrome: โ cough,cough, breath ratebreath rate โ chest indrawing,chest indrawing, stridorstridor โ +/-+/- 4 general4 general danger signdanger signs (IMCI)s (IMCI) NoNo Dr,Dr, nono stethoscope,stethoscope, nono lab.!lab.!
- 27. 27 Normal breathing rateNormalbreathing rate AgeAge Br. RateBr. Rate Fast breathingFast breathing <2 mo<2 mo <60/min<60/min โฅโฅ6060 (preterm 70)(preterm 70) 2-12mo2-12mo <50/min<50/min โฅ 50โฅ 50 1-5 y1-5 y <40/min<40/min โฅ 40โฅ 40 Counting BreathingCounting Breathing โข The childThe child mustmust be calmbe calm โข Count full 1 minuteCount full 1 minute โข Count the abdominal swelling in inspirationCount the abdominal swelling in inspiration Breathing rate is the most imp. single sign for classification & follow-upBreathing rate is the most imp. single sign for classification & follow-up
- 28. Fast breathingFast breathing Chestindrawing:Chest indrawing: โข Suprasternal, supraclavicular, sternalSuprasternal, supraclavicular, sternal retraction/recessionretraction/recession โข Intercostal spaceIntercostal space ,,,, โข SubcostalSubcostal ,,,, 44 General Danger signs:General Danger signs: โข Lethargic/unconsciousLethargic/unconscious โข Poor feeding/not feedingPoor feeding/not feeding at allat all โข Vomits everythingVomits everything โข ConvulsionConvulsion 28
- 29. 29 DANGER SIGNS CONVULSIONS INABILITY TO DRINK ORBREASTFEED VOMITING LETHARGY UNCONSCIOUSNESS
- 30. 30 Additional SS ofARI for DoctorsAdditional SS of ARI for Doctors โข Cold, sore throatCold, sore throat โข CoughCough,, sputumsputum โข Nasal flareNasal flare โข StridorStridor โข VVoice changeoice change โข GruntingGrunting โข CyanosisCyanosis โข Asymmetry of chest &Asymmetry of chest & its movementits movement โข Tracheal deviationTracheal deviation โข Displaced heartDisplaced heart โข Auscultation:Auscultation:
- 31. 31 Auscultatory FindingsAuscultatory Findings โขPoor or unequal air entryPoor or unequal air entry โข Prolonged expirationProlonged expiration โข Wheeze/ronchiWheeze/ronchi โข Fine +/-coarse crepitationsFine +/-coarse crepitations โข Bronchial breath soundBronchial breath sound โข Post-tussive creps/or ronchiPost-tussive creps/or ronchi
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- 33. 33 Depth of ARIProblemDepth of ARI Problem โข Pneumonia is the biggest U-5 killer (0.9million/y; 16% ofPneumonia is the biggest U-5 killer (0.9million/y; 16% of total:total: mmoreore than AIDS, malaria & TB combinedthan AIDS, malaria & TB combined);); 90%90% in L&MICs (70% in Africa & SEA)in L&MICs (70% in Africa & SEA) โข Commonest admission (Commonest admission (12-45%)12-45%) โข OPD: 20-60% A R IOPD: 20-60% A R I โข V. imp. precipitator of malnutrition, VADXV. imp. precipitator of malnutrition, VADX โข NationalNational Health IndexHealth Index of a countryof a country ((5.6 million U-5 death in 2016: 16,000/d.5.6 million U-5 death in 2016: 16,000/d. 70% from inf.)70% from inf.)
- 34. 34 ARI 54% Diarrhoea 85% Malaria 79% Measles 89% Percentage of deathsoccurring among: Global Disease Burden Borne by U-5 (Y 2000)
- 35. Key facts:Key facts:PneumoniaPneumonia โขKills by hypoxiaKills by hypoxia due to pus & fluid in alveolidue to pus & fluid in alveoli โขC/by viruses, bacteria or fungi. Bacteria can be Rx with ABs,C/by viruses, bacteria or fungi. Bacteria can be Rx with ABs, but only 30% of children get itbut only 30% of children get it โขRx with low-cost, low-tech. drugs & careRx with low-cost, low-tech. drugs & care โขPx. byPx. by immunizationimmunization,, nutritionnutrition && clean environmentclean environment Death from diarrhea has been dramatically lowered byDeath from diarrhea has been dramatically lowered by successful ORTsuccessful ORT 35
- 36. ARI mortality/morbidity highestin U-5yARI mortality/morbidity highest in U-5y โ Lack of breast feedingLack of breast feeding โ Formula feeding,Formula feeding, bottle feedingbottle feeding โ Weaned earlyWeaned early โ HIVHIV โ <2 years of age<2 years of age โ Lack of vaccinationLack of vaccination โ MalnutritionMalnutrition โ VADXVADX โ Poor education, overcrowding, poor clothingPoor education, overcrowding, poor clothing โ Difficult access to healthcare, medicationDifficult access to healthcare, medication
- 37. 37 Aetiology of AR IAetiology of A R I โข VirusesViruses โข BacteriaBacteria โข MycoplasmaMycoplasma โข FungusFungus โข Parasites, wormsParasites, worms
- 38. Aetiology โฆAetiology โฆ โขVaries: age, immune status, where contractedVaries: age, immune status, where contracted โข Community acquired pneumonia (CAP)Community acquired pneumonia (CAP) โ L&MICsL&MICs โข VirusesViruses 40%40% โข S. pneumoniae, Hib, S aureus, Moraxella,S. pneumoniae, Hib, S aureus, Moraxella, Mycoplasma, Chlamydia inMycoplasma, Chlamydia in 60%60% โ HICsHICs โข Bacteria:Bacteria: 5-10%5-10%
- 39. Etiology Based onAgeEtiology Based on Age AgeAge OrganismOrganism NeonatesNeonates GBS, E coli, Klebsiella, SGBS, E coli, Klebsiella, S aureusaureus InfantsInfants Pneumococcus, Chlamydia,Pneumococcus, Chlamydia, RSV, Hib, StaphRSV, Hib, Staph 1-5y1-5y Viruses, Pneumococcus, HibViruses, Pneumococcus, Hib Chlamydia, Mycoplasma,Chlamydia, Mycoplasma, Staph, GASStaph, GAS 5-18y5-18y Mycoplasma, Pneumococcus,Mycoplasma, Pneumococcus, Chlamydia, HibChlamydia, Hib
- 40. 40 VirusesViruses โข RhinovirusesRhinoviruses โข RSVRSV โขAdenovirusesAdenoviruses โข Influenza, parainfluenza A B CInfluenza, parainfluenza A B C โข MyxovirusesMyxoviruses โข Corona viruses (SARS, MERS)Corona viruses (SARS, MERS) โข Boca virusBoca virus โข MetapneumovirusMetapneumovirus
- 41. 41 Common BacteriaCommon Bacteria โข** S. pneumoniaeS. pneumoniae โข ** HibHib โข S. pyogenesS. pyogenes โข S. aureusS. aureus โข ** M. tuberculosisM. tuberculosis โข ** C diphtheriaeC diphtheriae โข Enteric bacilliEnteric bacilli โข PseudomonasPseudomonas โข KlebsiellaKlebsiella โข MoraxellaMoraxella *Vaccine available
- 42. 42 Others โข Chlamydia โข Mycoplasma โขFungus: C. albicans, Histoplasma โข Miscellaneous: P. jirovecii (carinii), worms P jirovecii:P jirovecii: yeast-like fungus; causes pn.; an imp. pathogen, particularlyyeast-like fungus; causes pn.; an imp. pathogen, particularly amongamong immunocompromisedimmunocompromised; aka; aka P. cariniiP. carinii
- 43. 43 How A RI HarmsHow A R I Harms โข HypoxiaHypoxia:: convulsion, deathconvulsion, death โข Malnutrition &Malnutrition & VADX:VADX: โข ChestChest: collapse, consolidation, effusion, abscess,: collapse, consolidation, effusion, abscess, bronchiectasis, pneumothoraxbronchiectasis, pneumothorax โข Blood:Blood: sepsis, deranged ABB, dyselectrolytemiasepsis, deranged ABB, dyselectrolytemia โข Meningitis, IgA nephropathyMeningitis, IgA nephropathy VADX: Vitamin A defi. and xerophthalmia. ABB: acid base balanceVADX: Vitamin A defi. and xerophthalmia. ABB: acid base balance
- 44. 44 ARI Causes Malnutrition& VADXARI Causes Malnutrition & VADX โข Poor feedingPoor feeding โข Negative nitrogen balanceNegative nitrogen balance โข VD, F: dehydrationVD, F: dehydration โข Exhaustion of VAExhaustion of VA โข Faulty feeding, tabooFaulty feeding, taboo Mn.: Malnutrition. VD: vomiting diarrhoea. F: fever. VA: vitamin AMn.: Malnutrition. VD: vomiting diarrhoea. F: fever. VA: vitamin A
- 45. 45 Dehydration in ARIDehydrationin ARI:: โข Fast breathingFast breathing โข FeverFever โข NVDNVD โข Runny noseRunny nose โข Poor/faulty feedingPoor/faulty feeding NVD: nausea vomiting diarrheaNVD: nausea vomiting diarrhea
- 46. 46 How A RI killsHow A R I kills AcuteAcute โข HypoxiaHypoxia โข HHypoglycemia, convulsion, cardiac failureypoglycemia, convulsion, cardiac failure โข Septicemia, dehydrationSepticemia, dehydration LateLate โข Malnutrition, VADXMalnutrition, VADX โข Suffocation, aspirationSuffocation, aspiration
- 47. 47 Hospital PictureHospital Picture โขOut of 1690 cases admitted in BMCH pediatricOut of 1690 cases admitted in BMCH pediatric ward 400 (23.7%) had ARIward 400 (23.7%) had ARI โข Peak incidence during Oct-NovPeak incidence during Oct-Nov
- 48. 48 Death from ARIis DecliningDeath from ARI is Declining** โข Br. feedingBr. feeding โข No bottle feedingNo bottle feeding โข Socioeconomic &Socioeconomic & environ. changeenviron. change โข Falling malnutritionFalling malnutrition โข HPVAC distributionHPVAC distribution โข EPIEPI HPVAC: high potency vitamin A capsuleHPVAC: high potency vitamin A capsule โข Family planningFamily planning โข Modern health careModern health care โข Better & cheap drugsBetter & cheap drugs โข Female literacyFemale literacy โข Health awarenessHealth awareness * Previously 4million, now 0.9Previously 4million, now 0.9
- 49. ManagementManagement According toAccording to IMCIIMCI[[[[ IMCI:integrated management of childhood illnessesIMCI: integrated management of childhood illnesses
- 50. History TakingHistory Taking 1.General Danger Signs1. General Danger Signs 2. Main Symptoms2. Main Symptoms a. Cougha. Cough โโ b. Diarrheab. Diarrhea c. Feverc. Fever d. Ear Problemsd. Ear Problems 3. Nutritional Status3. Nutritional Status 4. Immunization Status4. Immunization Status 5. Other Problems5. Other Problems IMCI Record FormIMCI Record Form
- 51. 51 Assess whether thechild hasAssess whether the child has โข No pneumoniaNo pneumonia (cold-cough; chr. cough)(cold-cough; chr. cough) โข Pneumonia orPneumonia or โข Severe PneumoniaSevere Pneumonia In babies <2mo any pneumonia isIn babies <2mo any pneumonia is severe pneumoniasevere pneumonia
- 52. 52 Fast breathing +Fastbreathing + chest indrawing orchest indrawing or Stridor in a calmStridor in a calm child. (Any GD sign)child. (Any GD sign) SevereSevere PneumoniaPneumonia oror (Very Severe Disease)(Very Severe Disease) Fast breathingFast breathing PneumoniaPneumonia No signs ofNo signs of pneumonia or verypneumonia or very severe diseasesevere disease No pneumonia:No pneumonia: cough or coldcough or cold
- 53. 53 Limitations โฆLimitations โฆ Pneumoniain IMCI may be actuallyPneumonia in IMCI may be actually โข BronchiolitisBronchiolitis โข Br. AsthmaBr. Asthma โข DiphtheriaDiphtheria โข PertussisPertussis โข HGFHGF โข CCFCCF No pneumonia may be TBNo pneumonia may be TB
- 54. PneumoniaPneumonia โข Inflam. oflung parenchyma ยฑ consolidationInflam. of lung parenchyma ยฑ consolidation โข Fast breathingFast breathing โข HICs:HICs: viral:viral: Low morbidity-mortalityLow morbidity-mortality โข L&MICs:L&MICs: โ Bacteria in 65%Bacteria in 65% โ Cheap oral ABT: Amoxicillin can causeCheap oral ABT: Amoxicillin can cause 84%84% reduction in deathreduction in death
- 55. 55 Severe PneumoniaSevere Pneumonia โขVery sick,Very sick, not able to feednot able to feed โข Tachypnoea,Tachypnoea, tachycardiatachycardia โข Chest indrawingChest indrawing โข Creps, wheezeCreps, wheeze โข Cyanosis, convulsionCyanosis, convulsion โข DrowsinessDrowsiness +/- Fever+/- Fever
- 56. 56 Lab. Dx. ofPneumoniaLab. Dx. of Pneumonia (not for HW/IMCI)(not for HW/IMCI) โข CXRCXR โข CBC filmCBC film โข CS of blood, tracheal & lung aspirateCS of blood, tracheal & lung aspirate โข Throat swabThroat swab
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- 58. 58 Pneumococcal pneumoniaPneumococcal pneumonia Rupper lobe consolidationR upper lobe consolidation
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- 61. 61 Air-fluid level inLung AbscessAir-fluid level in Lung Abscess
- 63. Complications of pneumoniaComplicationsof pneumonia IntrathoracicIntrathoracic โข Pleural effusion, empyemaPleural effusion, empyema โข Collapse, consolidationCollapse, consolidation โข Lung abscess, pneumatoceleLung abscess, pneumatocele โข PneumothoraxPneumothorax ExtrathoracicExtrathoracic โข Septicemia, meningitisSepticemia, meningitis โข DehydrationDehydration โข Myocarditis, pericarditisMyocarditis, pericarditis โข Acidosis, dyselectrolytemiasAcidosis, dyselectrolytemias
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- 67. 67 Rx: General PrinciplesRx:General Principles โข O2,O2, air way careair way care โข Nebulized beta-agonist, anticholinergicNebulized beta-agonist, anticholinergic โข Antibiotics (parenteral)Antibiotics (parenteral) โข Feeding, warmthFeeding, warmth โข FEBFEB โข Vitamin AVitamin A โข ZincZinc โข CounselingCounseling โข FUFU
- 68. 68 Rx. Severe PneumoniaRx.Severe Pneumonia โข Admission must,Admission must, OO22 โข Airway patency:Airway patency: โ suction clearancesuction clearance โ Nebulized bronchodilator, anti-secretoryNebulized bronchodilator, anti-secretory โข Parenteral ABTParenteral ABT โข Lowering HGFLowering HGF โข Feeding, FEB, warmthFeeding, FEB, warmth โข Vitamin A, zincVitamin A, zinc
- 69. 69 Antibiotics in PneumoniaAntibioticsin Pneumonia Pneumonia is mostly viral but 2y infx. is commonPneumonia is mostly viral but 2y infx. is common โข Injectable: usuallyInjectable: usually >1 AB>1 AB โข Minimum 10d. Up to 3wMinimum 10d. Up to 3w โข Penicillin +gentamicin/amikacin are goodPenicillin +gentamicin/amikacin are good โข Staph coverage for babies <2yrStaph coverage for babies <2yr
- 70. 70 When You DeferABWhen You Defer AB โข The child is stable, playful, no HGFThe child is stable, playful, no HGF โข EBF, no bottle feedingEBF, no bottle feeding โข Taking feeds normallyTaking feeds normally โข SupervisedSupervised
- 71. 71 Rx for Cough& Cold (no pn.)Rx for Cough & Cold (no pn.) โข Exclude AOMExclude AOM โข Ensure feedingEnsure feeding โข Treat feverTreat fever โข Clean noseClean nose โข Steam therapySteam therapy โข Honey+tulsiHoney+tulsi Chr./rec. CoughChr./rec. Cough โข TB?TB? โข Congenital HD?Congenital HD? โข FB?FB? โข Reactive airway?Reactive airway? โข GERD?GERD?
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- 73. 73 Follow up forPneumoniaFollow up for Pneumonia โข Count breath (most important single sign)Count breath (most important single sign) โข Watch activities: smiles, plays, feeds. Urine outputWatch activities: smiles, plays, feeds. Urine output If the child stays at homeIf the child stays at home โข Teach mom how to observe for SoB, count breathTeach mom how to observe for SoB, count breath โข Nose cleaning, feeding, warmthNose cleaning, feeding, warmth โข Ask to return immediately:Ask to return immediately: s/of deterioration (fast br., chest indrawing)s/of deterioration (fast br., chest indrawing) poor feedingpoor feeding
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- 76. 76 Prevention of AR IPrevention of A R I โข Breast feedingBreast feeding โข No formula, no feederNo formula, no feeder โข ImmunizationImmunization โข HPVAC, ZincHPVAC, Zinc โข Rx malnutritionRx malnutrition โข Warmth, warm clothingWarmth, warm clothing โข No air pollutionNo air pollution โข No smoking!No smoking! โข Female literacyFemale literacy โข Family Planning,Family Planning, birth spacingbirth spacing โข SanitationSanitation โข No overcrowdingNo overcrowding
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- 78. ACUTE EPIGLOTTITISACUTE EPIGLOTTITIS โขLife-threatening inf. of epiglottis,Life-threatening inf. of epiglottis, aryepiglottic folds & arytenoidaryepiglottic folds & arytenoid (sudden suffocation)(sudden suffocation) โข Mostly in wintersMostly in winters โข Peak :-1โ6 y old. M:F 3:2Peak :-1โ6 y old. M:F 3:2 โข Commonly bacteria: Hib. Concomitant bacteremia, pn.,Commonly bacteria: Hib. Concomitant bacteremia, pn., AOM, arthritis, etc. by Hib may be presentAOM, arthritis, etc. by Hib may be present
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- 80. AC. EPIGLOTTITISAC. EPIGLOTTITIS akasupraglottitisaka supraglottitis CFCF โ Usually nocturnal; midnightUsually nocturnal; midnight โ HGF, sore throat, SoB, rapidlyHGF, sore throat, SoB, rapidly progressing res. obstructionprogressing res. obstruction โ toxic, dysphagic, chest indrawing, drooling,toxic, dysphagic, chest indrawing, drooling, hyperhyper extended neck, tripod positionextended neck, tripod position โ stridor is a late finding; cyanosis, coma, deathstridor is a late finding; cyanosis, coma, death โ mouth is open, jaw thrust forwardmouth is open, jaw thrust forward ((sniffing positionsniffing position).). Barking cough is rareBarking cough is rare
- 81. EXAMINATIONEXAMINATION โข Do notDonot examine the throatexamine the throat โข Assess severityAssess severity โ degree of stridor, resp. rate, HRdegree of stridor, resp. rate, HR โ pulse oximetry, arousalpulse oximetry, arousal โข Dx:Dx: โ โโcherry redโ epiglottischerry redโ epiglottis โ โโthumb signโ on lateral neck XRthumb signโ on lateral neck XR โ blood CS, electrolytesblood CS, electrolytes
- 82. โข Direct laryngoscopy:Directlaryngoscopy: cherry redcherry red epiglottisepiglottis But not recommended!But not recommended! ACUTE EPIGLOTTITIS โฆACUTE EPIGLOTTITIS โฆ
- 83. Lateral neck XR:Lateralneck XR: (thumb sign)(thumb sign)
- 84. Rx (AC. EPIGLOTTITIS)Rx(AC. EPIGLOTTITIS) A medical emergency!A medical emergency! โข ICUICU โข endotracheal intubation may be neededendotracheal intubation may be needed โข help from anesthetist & ENT surgeonhelp from anesthetist & ENT surgeon โข IV Amplicillin/Ceftriaxone (100 mg/kg/d) x10dIV Amplicillin/Ceftriaxone (100 mg/kg/d) x10d โข O2, ABB, IVF, nutritionO2, ABB, IVF, nutrition โข Rifampicin prophylaxis to close contactsRifampicin prophylaxis to close contacts
- 85. A L TB (croup)A L T B (croup) โข Mucositis of glottis-subglottisMucositis of glottis-subglottis;; usually viral:usually viral: parainfluenza 1,2,3 (75%),parainfluenza 1,2,3 (75%), influenza A,B; RSV,influenza A,B; RSV, epiglottitis, diphtheriaepiglottitis, diphtheria โข TracheitisTracheitis โข Age : 6moโ6yAge : 6moโ6y ALTB: Ac. LaryngotracheobronchitisALTB: Ac. Laryngotracheobronchitis (CROUP)(CROUP)
- 86. โข Inflam. swellingof throat: classical:Inflam. swelling of throat: classical: stridorstridor,, "barking" cough"barking" cough,, hoarsenesshoarseness (within 1-2d)(within 1-2d) โข Features of URTI + croupFeatures of URTI + croup โข LGF, prolonged inspirationLGF, prolonged inspiration โข Severe at night, on lyingSevere at night, on lying โข Relieved by sitting upRelieved by sitting up โข Neck XR: subglotticNeck XR: subglottic narrowingnarrowing (Steeple sign)(Steeple sign)
- 87. Dx: mainly clinical.XRDx: mainly clinical. XR neck: steeple signneck: steeple sign (unreliable)(unreliable)
- 88. DD/causes of croup:DD/causesof croup: โข ALTBALTB โข Ac. infectious laryngitisAc. infectious laryngitis โข Ac. epiglottitisAc. epiglottitis โข Spasmodic croupSpasmodic croup โข Bacterial tracheitisBacterial tracheitis โข DiphtheriaDiphtheria โข Measles croupMeasles croup Ac. Laryngotracheobronchitis (ALTB)Ac. Laryngotracheobronchitis (ALTB)
- 89. DD: Ac. LTBand Ac. EpiglottitisDD: Ac. LTB and Ac. Epiglottitis CroupCroup EpiglottitisEpiglottitis CourseCourse daysdays hourshours ProdromeProdrome coryzacoryza CoughCough barkingbarking slight if any, thickslight if any, thick FeedingFeeding ableable nono MouthMouth closedclosed droolingdrooling ToxicToxic nono yesyes FeverFever <38.5<38.500 CC >38.5>38.5 00 CC StridorStridor raspingrasping softsoft VoiceVoice hoarsehoarse Weal/silentWeal/silent
- 90. A L TB: RxA L T B: Rx โข humidified airhumidified air โข steroidssteroids โข reduce severity and duration/need forreduce severity and duration/need for intubationintubation โขprednisolone p.o. 2mg/kg/d x3dprednisolone p.o. 2mg/kg/d x3d โข nebulized budesonidenebulized budesonide โข nebulized adrenalinenebulized adrenaline
- 91. โข Very commonin childrenVery common in children โข Age: 2-6 mo.:Age: 2-6 mo.: โ S. pneumoniaeS. pneumoniae, Hib, M. catarrhalis, Hib, M. catarrhalis Symptoms:Symptoms: โข earache,earache, inconsolable cryinconsolable cry & sleep disturbances, fit,& sleep disturbances, fit, sometimes DVsometimes DV Signs:Signs: โข Otorrhea or bulged congested TM, PEDOtorrhea or bulged congested TM, PED PED: perforated eardrumPED: perforated eardrum
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- 94. DxDx โข History, autoscopyHistory,autoscopy โข MyringotomyMyringotomy โข CBC, pus CSCBC, pus CS 94
- 95. TreatmentTreatment โขBroad-spectrum ABTBroad-spectrum ABT โขAnalgesic,decongestant (local/systemic)Analgesic, decongestant (local/systemic) โข Saline nose washSaline nose wash โขMyringotomy SOSMyringotomy SOS โขLocal AB drop for PEDLocal AB drop for PED โขNo bath in PEDNo bath in PED
- 96. Complications of OMComplicationsof OM โข MastoiditisMastoiditis โข MeningitisMeningitis โข Brain abscessBrain abscess โข PEDPED โข Deafness-dumbness, poor learningDeafness-dumbness, poor learning โข ConvulsionConvulsion 96
- 97. 97 MCQMCQ โข HPVAC isan imp. intervention to prevent ARIHPVAC is an imp. intervention to prevent ARI โข Feeding bottle is a baby killerFeeding bottle is a baby killer โข Cut-off mark of fast breathing at 9 mo is 40Cut-off mark of fast breathing at 9 mo is 40 โข Any pneumonia in <6o-days of age is severe pn.Any pneumonia in <6o-days of age is severe pn. โข O2 is the most important Rx for severe pn.O2 is the most important Rx for severe pn. โข Bacterial pneumonia can cause lung abscessBacterial pneumonia can cause lung abscess
- 98. MCQMCQ โข Parenteral ABTis recommended for severe pn.Parenteral ABT is recommended for severe pn. โข Zn has an imp. role in shortening of duration &Zn has an imp. role in shortening of duration & prevention of recurrence of ARI in childrenprevention of recurrence of ARI in children โข Commonest c/of ac. epiglottitis is HibCommonest c/of ac. epiglottitis is Hib โข Ac. epiglottitis is usually Dx by direct laryngoscopy โข Croup means stridor, hoarseness, barking cough โข EPI has significant contribution in lowering ARI 98
- 100.
Editor's Notes
- #21ย Alveolar epithelium comprises 2 main cell types: type I & type II. Type I cell is a complex branched cell with multiple cytoplasmic plates that are greatly attenuated & relatively devoid of organelles; these plates represent the gas exchange surface in the alveolus. Type II cell acts as the &quot;caretaker&quot; of the alveolar compartment. It responds to damage of the vulnerable type I cell by dividing and acting as a progenitor cell for both type I and type II cells. In addition, it synthesises, stores & releases surfactant, where it acts to optimize gas exchange
- #24ย Goblet cellย is a glandular, modified simple columnar cell; secrete gel-forming mucins. Mucin: hydratedย mucinogen,ย containsย CHOย suchย asย thoseย fromย theย gobletย cellsย ofย gut, submaxillaryย g, etc. Itย isย alsoย presentย in theย groundย substance ofย con. tissue, esp.ย mucousย CT, isย solubleย inย alkalineย water, & isย precipitatedย byย aceticย a;ย mucins lubricate & protectย body cavityย linings
- #31ย SS: symptoms and signs
- #35ย 5.6 million U-5 died in 2016: 15,000/d. Leading c/of death are preterm, pn., HIE, D &malaria
- #37ย Under-five mortality: situation: 5.9 millionย died in 2015, 16000/d Highest in ย Africaย (90/1000 lb), x7 higher than that in Europe (12/1000lb). Manyย countriesย still have v high mortality โ particularly those in Africa,ย homeย to 11 of 12 countries with a rate &gt;100/1000lb. In 2013, the U-5MR in low-income countries was 76/1000lb โ x13 theย average rateย in high-income countries (6/1000lb). Reducing these inequities across countries and savingย moreย childrenโs lives by ending preventable child deaths are important priorities
- #57ย HW: health worker
- #58ย G+ve capsulated diplococcus. Some have a halo: capsule. The capsule gives a survival advantage
- #65ย Pneumatoceles are thin-walled, air-filled cysts within lung; can be single emphysematous but are more often multiple. Most often seen in ac. Pn., commonly byย S aureus; also withย S pneumoniae,ย Hib,ย E coli,ย GAS, Serratia marcescens, K pneumoniae,ย adenovirus, TB; generally seen soon after pn. but can be observed initially. Noninf. causes: hydrocarbon ingestion, trauma, and PP ventilation. In preemies with RDS, pneumatoceles result mostly from ventilator-induced lung injury. Mostly they are asymptomatic and do not require surgery.ย Rx of pneumonia with ABT is the first-line therapy. Close observation in the early stages and periodic FU care is usually adequate. The natural course is slow with no further clinical sequelae. Invasive approaches should only be reserved for patients who develop complications
- #66ย 1A: CXR: ill-defined R perihilar opacity obscuring R heart border & contains no air bronchograms. 1B: a corresponding triangular opacity with its base abutting the sternum and its apex directed toward hilum. Note anterior displacement of oblique fissure and elevation of R hemi-diaphragm. Dx: : R Middle Lobe Atelectasis
- #69ย ABT: usually ampi-genta, chloramphenicol When the child is kept at home, teach the mother how to observe s/of breathlessness. Ask her to report to the HC immediately if there is deterioration
- #70ย WHO classification and Rx of childhood pn. at health facilities 2 major changes: (A) now just 2 categories of pn. instead of 3 (โpn.โ which is treated at home with oral amoxicillin and โsevere pn.โ which requires Injectable AB and (B) oral amoxicillin replaces oral cotrimoxazole as DoC, preferably in 250mg dispersible tablet form, 2/d x5d which can be reduced to 3 in low HIV settings
- #72ย For persistent cough (&gt;30d) full Ix are required to exclude TB, cong. HD, FB, atopy, etc.
- #85ย Epiglottis: ceftriaxone is DoC. This is broad-spectrum against gram-negative, lower efficacy against gram-positive: 100mg/kg/d IV on first day; follow with 50 mg/kg on day 2 or 75 mg/kg qDay for 10-14 days
- #86ย Croup is a commonย resp.ย problem in young children. Common in the fall and winter. Main symptom is a harsh, barking cough. Causes edema in larynx, trachea, bronchi. This can make it hard for your child to breathe. It can be scary, but rarely serious; usually better in several days with rest and care at home C/by the same viruses of common cold.
- #89ย Laryngitis is one of the most common conditions in the larynx. It manifests in both acute and chronic forms. Ac laryngitis is usually self-limited. If &gt;3w, it isย chronic. The etiology of AL: vocal misuse, exposure to noxious agents, URTI. Mostly viral but sometimes bacterial. Pix: larynx of a 62y F with an intermittent exudative AL treated conservatively. Rarely, laryngitis is autoimmune (RA,ย relapsing polychondritis, Wegener granulomatosis, sarcoidosis). CL may be c/by cigarette smokeย or polluted air (chemicals), irritation fromย asthmaย inhalers, vocal misuse, or GERD. Vocal misuse: increased adducting force of the vocal folds: increased contact and friction between folds. The area becomes swollen.ย Vocal therapyย has the greatest benefit in the patient with CL Although AL is usually not a result of vocal abuse, vocal abuse is often a result of AL. The underlying inf/inflam results in a hoarse voice. Typically, the pt exacerbates dysphonia by misuse of the voice in an attempt to maintain premorbid phonating ability
- #99ย Zinc is imp for cellular growth, cellular differentiation and metabolism. Deficiency limits growth and decreases immunity. Although severe deficiency is rare, mild to moderate may be common worldwide. Zinc may reduce frequency and severity of ARI. Zinc deficient children are at increased risk of restricted growth and developing D, ARI. D and pn. are the 2 most common c/of U-5MR in LICs. Undernutrition is considered the underlying c/of 50% of pn.. Pn alone kills more than AIDS, malaria or measles combined. Zn may reduce the number of episodes and severity of bronchiolitis and pn. Zinc and ORS is the basis of management of D.