ACUTE RESPIRATORY INFECTIONS ARI Dr Pracheth R Assistant

ACUTE RESPIRATORY INFECTIONS (ARI) Dr. Pracheth R Assistant Professor, Community Medicine, YMC.

OUTLINE • Introduction • Problem statement • Epidemiological determinants • Clinical features and Classification of illness • Prevention and Control

INTRODUCTION • Definition – Nose to Alveoli • Classification üAURI: common cold, pharyngitis, otitis media üALRI: Epiglottitis, laryngotracheitis, Bronchitis, bronchiolitis, pneumonia.

PROBLEM STATEMENT • 3. 9 million deaths • 30% child mortality – ARI • India – 2 million deaths • ARI – 20% of hospital infections 40% of total pediatric outpatients • 5 episodes of ARI every year

EPIDEMIOLOGICAL DETERMINANTS • Agent factors : Bacteria, Viruses, Others • Host factors : Age, Sex, LBW, Breast feeding, Immunization, Antecedent Viral infections

Bacteria • B. pertussis, C. diphtheria • H. influenza, K. pneumoniae • L. pneumophillia • S. pyogenes, S. pneumoniae • Staph. pyogenes

Viruses • Adenovirus, Enterovirus • Influenza, Measles • RSV • Rhinovirus, Coronavirus • Other agents: Chlamydia B, Mycoplasma pneumoniae.

Continued • Risk factors : Environmental and Climatic conditions, Overcrowded Dwellings, Low SES • Mode of transmission – airborne

CLINICAL ASSESSMENT • History taking and Clinical examination • History – Age of child, duration of cough, ability to drink or breast feed, antecedent illness, drowsiness, convulsions, irregular breathing • How long cough, able to drink, stopped feeding Fever, difficult to wake

PHYSICAL EXAMINATION • Count breaths in one minute • Look for chest indrawing • Look and listen for stridor • Look for wheeze • See if child is abnormally sleepy • Feel for fever or low body temperature • Check for severe malnutrition

Chest indrawing

CLASSIFICATION OF ILLNESS • Two categories 1. Child aged 2 months up to 5 years 2. Young infant ( < 2 months )

2 months to 5 years 1. Very severe disease 2. Severe pneumonia 3. Pneumonia 4. No pneumonia

Very severe disease SIGNS TREATMENT Not able to drink Refer urgently Convulsions Give first dose of antibiotic Abnormally sleepy / difficult to wake Stridor in calm child Treat fever, if present Severe Malnutrition Give antimalarial if cerebral malaria is present Treat wheezing, if present

SEVERE PNEUMONIA Chest in drawing + No Chest in drawing Fast breathing (may/may not) Fast breathing + Urgent referral Advise mother to give home care First dose of Antibiotic Give Antibiotic Treat fever, wheeze if + Advise mother follow up after 2 days

Additional signs : severe pneumonia

No Pneumonia • No chest in drawing or fast breathing • Assess and treat ear problem or sore throat if + • Assess and treat other problems • Advise mother to give home care • Treat fever and wheeze if present

Young Infant 1. Very severe disease: danger signs 2. Severe Pneumonia: chest indrawing/fast breathing 3. No Pneumonia: no signs

Danger signs of severe disease 1. Convulsions, abnormally sleepy or difficult to awake 2. Stridor when calm 3. Stopped feeding well 4. Wheezing 5. Fever or low body temperature

VERY SEVERE DISEASE SEVERE PNEUMONIA NO PNEUMONIA Stopped feeding Severe chest in drawing No chest in drawing or fast breathing Convulsions Fast breathing Abnormally sleepy URGENT REFERRAL ADVISE MOTHER Keep infant warm Give first dose of antibiotic Breast feed frequently Follow up if danger signs occur

Respiratory distress

TREATMENT (2 months-5 years) • Cotrimoxazole is the drug of choice • Dosage: üTab Cotrimoxazole – Sulphamethoxazole 100 mg and Trimethoprim 20 mg ü Syp Cotrimoxazole – double the dose of tab per 5 ml

Continued AGE/WEIGHT TABLET SYRUP < 2 months Wt – 3 -5 kg One tab twice 2. 5 ml or half spoon twice 2 – 12 months Wt – 6 -9 kg Two tabs twice One spoon ( 5 ml) twice 1 -5 years Wt - 10 -19 kg Three tabs twice One and half spoon (7. 5 ml) twice

SEVERE PNEUMONIA • First 48 hours ØBenzyl Penicillin – 50, 000 IU per kg/dose ØAmpicillin – 50 mg/kg/dose ØChloramphenicol – 25 mg/kg/dose q 6 th hourly IM • After 48 hours ØProcaine penicillin once IM ØOral Ampicillin or Chloramphenicol for 3 days

VERY SEVERE DISEASE • Oxygen, intensive monitoring • Chloramphenicol IM : Drug of choice • After 48 hours: oral chloramphenicol: 10 days • Worsens/no improve: IM cloxacillin/gentamycin

<2 months ANTIBIOTICS DOSE < 7 DAYS TO 2 MONTHS Inj Benzyl Penicillin 50, 000 IU/kg/dose 12 th hourly 6 th hourly Inj Ampicillin 50 mg/kg/dose 12 th hourly 8 th hourly Inj Gentamycin 2. 5 mg/kg/dose 12 th hourly 8 th hourly

PREVENTION • Improved living conditions • Better nutrition • Reduction of indoor air pollution • Better MCH Care • Health promotional activities • Immunization

IMMUNIZATION • Measles vaccine • HIB vaccine – 6, 10 and 14 weeks of age • Pneumococcal pneumonia vaccine ØPPV 23 ØPCV – PCV 10 & 13, 3 primary dose

SUMMARY

Questions 1. Name 5 bacterial agents that cause ARI in children. How are children suffering from ARI are classified? Write indications for referrals (1+3+2=6) 2. Discuss the role of cotrimoxazole in treatment of pneumonia among under-five children (3 marks) 3. Explain the epidemiology of ARI in children (3 marks)

Continued…. 4. Enumerate danger signs of pneumonia (2 marks) 5. Mention what to look and listen for in physical examination for ARI in a child aged under-five years (2 marks)

MCQs 1. Cut-off for fast breathing in a child less than 2 months of age is a. 60 breaths per minute and more b. 40 breaths per minute and more c. 50 breaths per minute and more d. 70 breaths per minute and more

Continued…. 2. A child aged 1 year has chest indrawing. This child probably has a. Very severe disease b. Severe pneumonia c. Pneumonia d. No pneumonia

Continued…. 3. Which of these vaccines has a role to play in prevention of pneumonia? a. Rubella Vaccine b. BCG c. Influenza Vaccine d. DPT

Continued…. 4. The drug of choice for severe pneumonia is a. Gentamicin b. Cotrimoxazole c. Benzyl Penicillin d. Chloramphenicol

Continued…. 5. One of these is an upper respiratory tract infection a. Epiglottitis b. Bronchiolitis c. Pharyngitis d. Laryngitis

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