presentation on acute respiratory tract infection on pediatric patients in bangladesh

8/10/2019 Presentation on Acute Respiratory Tract infection on pediatric patients in bangladesh

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Presentation on

Acute Respiratory Tract Infection


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Chairperson For

Session

Prof. Dr. ARM Lutful Kabir

ProfessorDepartment of Paediatrics

Co ordinator of Presentation

Dr. Sukhamoy Kangshu Banik

Associate Professor, Neonatology


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Presented By

Elora Tanni

Sakeef Rahman

Amit Bikram Mondal Mehedi Hassan

Junayed Safar Mahmud


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Acute Respiratory tract Infection (ARI)

Upper Respiratory Tract

Infections

Lower Respiratory Tract

Infections

Acute Respiratory tract infectionsinclude:


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Upper Respiratory Tract Infection

Upper Respiratory Tract Infections are thoseaffecting the structures above the larynx.

These include:

Common ColdAcute Pharyngitis

Acute Otitis Media

Acute TonsillitisCroup Causing Condition ( eg. Epiglottitis)


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Lower Respiratory Tract Infections Are thoseaffecting the structures below and including

the larynx. These include:

Pneumonia

Acute Bronchiolitis

Acute laryngotracheobronchitis

Lower Respiratory Tract Infection


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Prevalence of ARI

The incidence of clinical pneumonia in childrenaged less than 5 years in developing countriesworldwide is close to 0.29 episodes per child-year.

This equates to 151.8 millionnew cases everyyear due to ARI

8.7% of which are severe enough to requirehospitalization.

In addition, only 4 million cases occur indeveloped countries worldwide.


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Prevalence: The Global Picture


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Prevalence of ARI in Bangladesh

Only 15 countries in the world combined providethe 3/4thof the new cases to appear throughout

the world. Bangladesh is one of them providing

more than 6 million new cases each year.

According to the study in the year 2005, in

Bangladesh the total under 5 children death

numbered 2,88,000 children. Of these deaths,ARI related deaths were about 51,000 cases,

which stands responsible for around 19% of the

total death toll.


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Diagram showing percentage of

Respiratory disease in relation to other

Diseases


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Pneumonia

Acute BronchiolitisAcute Laryngotracheobronchitis

Specific Topics of Discussion


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Pneumonia


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Pneumonia is defined as an acute respiratory

illness that affect the lung parenchyma

associated with recently developed

radiological pulmonary shadowing which may

be segmental, lobar or multilobar.


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Dont Be Fooled: Pneumonia is a killer


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Types of Pneumonia

Pathologically , It is of two types,

Bronchopneumonia

Lobar pneumonia


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In view of source of the pathogen and publichealth importance, Pneumonia can be of

three types:

Community acquired pneumonia Nosocomial or Hospital acquired pneumonia

Pneumonia in special situation (ie. Aspiration

Pneumonia, Pneumonia in immunocompromisedpatients)

Types of Pneumonia


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Etiology of Pneumonia

Common organisms for ARI includes:AGE ORGANISMS

Neonatal PeriodE. Coli

K. pneumoniae,

Group Bstreptococci

After Neonatal Period S. PneumoniaeH. Influenzae

S. AureusAnd several viruses

Beyond 5 Years Mycoplasma,Chlamydia


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Pathogenesis of Pneumonia

Healthylungs

Stage of redhepatization

Stage of grayhepatization

RECOVERY

COMPLICATION


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Clinical

Manifestationof Pneumonia


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Symptoms of Pneumonia

Symptoms: Fever

Cough

Respiratory Distress


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And there is several General danger signs that

indicates severe disease in children, also

evident in Pneumonia. They are,

Not able to drink or breastfeed.

Lethargic or unconscious.

Vomits everything.

Convulsion

Signs of Pneumonia


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GENERAL DANGER SIGNS (2M-5YR)

Lethargic/ UnconsciousVomits everything

Convulsion Not able to drink or breastfed


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General examination Fast breathingFeatures of Hypoxaemia (Cyanosis, Head nodding)

Respiratory

System

Examination

Inspection

Chest Wall Inspection Chest Indrawing

Movement of Chest Restricted on the affected side

Palpation Position of trachea Central

Position of Apex Beat Normal position

Vocal Fremitus Increased

Percussion Percussion note Woody Dull

Auscultation Breath sounds Bronchial

Vocal resonance Increased

Added sound Coarse crepitation

Signs of Pneumonia


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FAST BREATHINGis the single most sensitive and specificamong clinical signs of pneumonia in under 5 children. Cutof rates for fast breathing depend on the childs age:

Upto 2 months : 60 breaths per minute or more

From 2 months to 1 year : 50 breaths per minute or more

From 1 year to 5 years : 40 breaths per minute or more

CHEST INDRAWING, defined as the inward movement ofthe lower chest wall with inspiration,

Chest indrawing should only be considered present if it isconsistently present in a calm child.

Agitation, a blocked nose or breastfeeding can causetemporary chest indrawing.


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STRIDORis a harsh sound heard during inspiration due

to obstruction of upper airway. Stridor in a calm child

is an acute emergency.

WHEEZEis a musical sound heard during expiration.

Wheezing sound is most often associated with asthmaand bronchiolitis. Sometimes it is difficult to

differentiate between children with bronchiolitis and

those with pneumonia.


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Classification of Pneumonia according

to IMCI

As a leading cause of death, WHO considered

all under 5 children with cough and difficulty

in breathing as possible pneumonia and

classified for management according to theirseverity into three categories:

No Pneumonia : Cough or cold

Pneumonia

Severe Pneumonia or Very Severe Disease.


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SIGN OR SYMPTOMS CLASSIFICATION

No sign of Severe or non-severe

Pneumonia.

NO PNEUMONIA

COUGH OR COLD

SIGN OR SYMPTOMS CLASSIFICATION

Fast Breathing PNEUMONIA

SIGN OR SYMPTOMS CLASSIFICATIONGeneral Danger Sign

or

Chest Indrawing

Stridor in a calm child.

Severe Pneumonia or

Very Severe Disease

Classification of Pneumonia accordingto IMCI


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Management


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Management

When a child suffers from signs & symptoms

of acute respiratory distress initial assessment

is done according to IMCI.

IMCI assessment governs whether the patient

will be treated at home , at the hospital or will

be referred to specialized centers.


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Management According to IMCI

SIGN OR SYMPTOMS CLASSIFICATION TREATMENT

No sign of Severe

or non-severe

Pneumonia.

NO PNEUMONIA

COUGH OR COLD

If Wheezing (even if

disappeared after rapidly acting

bronchodialator) give an

bronchodialator for 5 days.

Soothe the throat and relieve

the cough with a safe remedy.

If coughing more than three

weeks or recurrent wheezing is

present, refer for Tb or asthma.

Advise is given to mother when

to return immediately.

Follow up in 5 days.


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Fast Breathing PNEUMONIA

An appropriate antibiotic for 5

days.

If Wheezing (even if

disappeared after rapidly acting

bronchodialator) give anbronchodialator for 5 days.

Soothe the throat and relieve

the cough with a safe remedy.

If coughing more than three

weeks or recurrent wheezing ispresent, refer for Tb or asthma.

Advise is given to mother when

to return immediately.

Follow up in 2 days.

Management According to IMCI (Contd.)


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General Danger

Sign

or

Chest Indrawing

Stridor in a calm

child.

Severe

Pneumonia or

Very SevereDisease

Give first dose of an appropriate

antibiotic, preferably Ampicillin

(50 mg/kg) and/or Gentamicin

(7.5 mg/kg)

Treat the child to prevent lowblood suger.

URGENT referral to a hospital

Management According to IMCI (Contd.)


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Investigation

X-ray Chest P/A view:

In Consolidation: Homogeneous Radio Opacity in anyarea of lung field

In Bronchopneumonia: Patchy opacities are seen in

different areas of lung field.

BronchopneumoniaConsolidation (Lobar Pneumonia)


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Complete Blood Count: Polymorphoneuclear

Leukocytosis

Sputum C/S

Blood Culture &

Sensitivity

Investigation


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Treatment

Counsel the parents about the disease.

Supportive treatment

Specific treatment

Prevention and treatment of complication

Follow up


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Specific Treatment (Antibiotics)

Pneumonia (2 months Upto 5 Years) Amoxicillin (Oral, 30 mg/Kg 8 hourly for 5 days)

Severe Pneumonia (0 day upto 5 years) Hospitalization

Ampicillin (I.V. 50 mg/Kg 6 hourly) or

Amoxicillin (I.V. 60 mg/Kg 6 hourly)


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Ensure appropriate nutrition (breast feeding &other foods, fluid)

O2 Therapy: if cyanosis or saturation of oxygen


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COMPLICATIONS

Pleural Effusion

Empyema

Lung abscess

Pneumothorax

Septicaemia and dissemination to Other organs

eg. Meninges, bones, joints


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Prevention

Breast feeding

Hand washing

Immunization against Pneumococcus, Hib,

Measles, Diptheria, Tetanus.


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Acute

Bronchiolitis


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Acute Bronchiolitis

It is an acute viral infection of the bronchioles and is

characterized by, Cough, Respiratory distress andWheeze that start following an episode of Upper

Respiratory Catarrhal.

Age: This disease occurs in children of


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Clinical Manifestation

Symptoms: Severe respiratory Distress affecting feeding

Wheeze

Cough Low grade fever or no fever

In many cases babies are otherwise playful andafebrile (happy wheezer)


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Respiratory System Examination

Inspection:

Fast breathing

Chest Indrawing

Hyperinflated chest

Percussion note:

Hyper resonant

Auscultation: Breath sound is vesicular with prolonged expiration

Widespread Ronchi.

Sometimes fine crepitation are present


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Investigation

X-ray Chest P/A view:

Hypertranslucency

Hyperinflation (horizontal ribs, Low set diaphrgm)


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Treatment Counsel the parents about the disease.

Mild Cases Home care

Head up position

Normal feeding Cleaning nose with normal saline drop

Bathing with Luke warm water.

When to return to HospitalCentral Cyanosis

Not able to drink

Restlessness

Severe chest indrawing and

Grunting.


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Severe Cases

Hospitalization

Humidified O2 therapy

Nebulization with Salbutamol

Supportive management as in home care.


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AcuteLaryngotracheobronchitis


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Acute Laryngotracheobronchitis

Acute Laryngotracheobronchitis is a viral

inflammation of the lower airway accounting

for 15% of all respiratory tract infections.

Children between 6 months and 3 years Suffer

more.

It occurs mostly during early winter or late

falls.


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Etiology

Virus:Parainfuenza types 1 & 2 (Most common)

Others are,

Influenza A & B

AdenovirusRSV

Metapneumovirus

Bacterial :

Mycoplasma (Rare)


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Pathogenesis

In acute Laryngotracheobronchitis, tracheal

wall becomes oedematous with profuse

mucous secretions. This causes narrowing of

the airway.

In addition there is

also Laryngeal

muscle spasm due to

hypersensitivityresponse towards

Para influenza virus


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Classification

Depending on the extent of inflammation

there may be variable clinical severities, such

as:

Mild

Moderate

Severe

C di l F t f A t


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Cardinal Features of Acute

Laryngotracheobronchitis

Sudden onset of

Characteristic barking cough

Inspiratory stridor

Hoarseness of Voice

Respiratory distress

Suprasternal Recession Cyanosis ()


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Investigation

X-ray neck:

Steeple Sign

(Subglottic Narrowing of

Air column) at trachea is

characteristic.


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Treatment

Treatment option include

Supportive

Others


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Supportive Treatment

Keep the child as comfortable as possible

allowing the patient to remain in the arms of a

parent.

Avoid unnecessary painful interventions that

may cause hesitation and increase oxygen

requirements by the children.


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Other Treatments

Oxygen inhalation Steriod:

Dexamethasone or Prednisolone

Nebulized Budesonide

Adrenalin

Antibiotic:

Only in case of suspected secondary bacterial

infections


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presentation on acute respiratory tract infection on pediatric patients in bangladesh

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