Acute Respiratory Illness(Ari)

ACUTE RESPIRATORY ILLNESS

DR.PARTH GURAGAIN

ACUTE RESPIRATORY ILLNESS(ARI)

Most common Major cause of mortality and morbidity. Can affect anywhere from nose to alveoli. Can be classified into ALRI(Epiglottitis, laryngitis, laryngotrachietis,

LTB, bronchitis, bronchiolitis, pneumonia) AURI(Common cold, pharyngitis,otitis media) In less developed countries measles and

whooping cough are major cause of Respiratory tract infection.

PROBLEM STATEMENT

ARI in young children is responsible for 3.9 million death world-wide.

Bangladesh,India,Indonesia and Nepal together account for 40% of global mortality.

90% of ARI death is due to pneumonia. Most is bacterial in origin. Incidence of pneumonia in developed

countries 3-4%, in developing countries 20-30%

ARI in below 5yrs child is responsible for 30-50% of hospital visit..

20-40% of hospital admission. It is leading cause of deafness as result

of otitis media.

EPIDEMIOLOGICAL DETERMINANTS

Agent factors Bacteria - Bordetella pertusis - Coryneabacterium diptheriae - Haemophilus influenzae - Klebsiella pneumonia - Staphylococcus pyogenes.

Virus - Adenoviruses-endemic

types(1,2,5),epidemic type (3,4,7) - Enterovirus (ECHO and Coxsackie) - Influenza A,B,C - Measles - RSV

Others - Chlamydia type B - Coxiella burnetti - Mycoplasma pneumoniae

HOST FACTORS

Small children are most vulnerable Fatality more common in young infants,

malnourished children, elderly. In developing countries fatality more due

to malnutrition and LBW. URTI is more common in children than

adults. Illness rate more common in younger

children and decreases with increasing age.

At third decade of life there is surge in infection due to cross infection from their children.

Women are more affected due to their exposure to small children.

RISK FACTORS

Climatic condition Housing Level of industrialization Overcrowding Poor-nutrition LBW Indoor smoke pollution Maternal smoking

Mode of transmission

Air borne route

Person to Person

CONTROL OF ARI

By improving primary medical care service

Developing better method for: Early detection Treatment If possible prevention Education of mother can be effective

tool in reducing mortality and morbidity from ARI.

CLINICAL ASSESMENT - Access the child condition - Ask for: Age Duration of cough Is child able to drink (2mth-5yrs) Has child stopped feeding (<2mths) Had child suffered from any illness (e.g.: measles) Does child have fever Is child excessively drowsy Did child have convulsion Is there irregular breathing Short period of not breathing(apnea) Has child turned blue Any H/O T/t

PHYSICAL EXAMINATION

Count the breathing in 1 min. Fast breathing present if: RR 60b/min or more for <2mths. RR 50b/min or more for 2mths to

12mths. RR 40b/min or more for 12mths to 5yrs.

Phy. Exam: contd…..

Look for chest indrawing Look and listen for Stridor (is the sound

produced while breathing in aka croup) Look for Wheeze (sound produced when

breathing out is difficult) Abnormally sleepy and difficult to wake. Feel for fever or low temperature. Check for severe malnutrition Look for cyanosis.

CLASSIFICATION OF ILLNESS

A. Child aged 2mths -5yrs 1. Very severe disease 2. Severe Pneumonia 3. Pneumonia 4. No Pneumonia- cough, cold

VERY SEVERE DISEASE SIGNS Not able to drink Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Severe malnutrition CLASSIFY AS-VERY SEVERE DISEASE TREATMENT Refer urgently to hospital Give 1st dose of antibiotics T/t of fever if present T/t of wheezing if present If cerebral malaria give anti malarial

SEVERE PNEUMONIA SIGNS Childs RR(if exhausted child’s RR may not be raised) Chest indrawing plus wheezing OTHER SIGNS -Nasal flaring -Grunting (sound made with voice if difficulty in

breathing) -Cyanosis CLASSIFY AS –SEVERE PNEUMONIA

TREATMENT Refer urgently to hospital First dose of antibiotics T/t of fever T/t of wheezing

PNEUMONIA SIGNS Fast breathing Absence of chest indrawing CLASSIFY AS-PNEUMONIA

TREATMENT Home care Antibiotics T/t of fever T/t of wheezing Advice for re-assessment after 2days or if

condition of child worsen

NO PNEUMONIA

Cough/cold If cough more than 30 days needs

assessment Look for ENT problem Home care T/t for fever T/t for wheezing

B.CLASSIFYING THE ILLNESS IN YOUNG INFANTS(<2MTHS)

Signs may be difficult to find in young children

Non-specific signs as poor feeding, fever,low body temperature,further mild chest indrawing may be present in young infants.

CLASSIFIED AS Very severe disease Severe pneumonia No pneumonia

VERY SEVERE DISEASE SIGNS Stopped feeding well Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Wheezing Fever or low body temperature

TREATMENT Refer urgently to hospital Keep warm Antibiotics

SEVERE PNEUMONIA

Severe chest indrawing RR 60 OR more

TREATMENT Refer urgently Keep warm Antibiotics

NO PNEUMONIA

SIGNS No severe chest indrawing No fast breathing

TREATMENT Keep warm Breast feed Return if sick , ↑RR, Difficulty in feeding

TREATMENT Treatment for 2mths to 5yrs (Pneumonia)

Age/weight Paed tab Paed syp. Sulpha 100mg 5ml: Sulpha-200mg Trim 20mg Trim-40mg <2mths 1tab BD Half spoon (3-5kgs) 2.5ml BD

2-12mths 2tab BD One spoon (6-9kgs) 5ml BD

1-5yrs 3tab BD One and half spoon

(10-19kgs) 7.5ml BD

SEVERE PNEUMONIA(CHEST IND)

ANTIBIOTICS

DOSE INTERVAL MODE

A. In 1st 48hrsBenzyl penicillin or

50000 IU per kg/dose

6hrly IM

Ampicillin 50mg/kg /dose

6hrly IM

Chloramphenicol

25mg/kg/dose

6hrly IM

B1.IF CONDITION IMPROVES ,THEN FOR NEXT 3 DAYS

Procaine Penicillin OR

50000 IU/KG(MAX UPTO 4 lac IU)

Once IM

Ampicillin or 50 mg/kg/dose 6hrly Oral

Chloramphenicol

25 mg/kg/dose 6hrly Oral

B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS

Change antibiotics If Ampicillin –Change to Chloramphenicol IM If Chloramphenicol-Change to Cloxacillin

25mg/kg/dose 6hrly with gentamycin 2.5mg/kg/dose 8hrly

If condition improves continue t/t orally C. Provide symptomatic t/t for fever and

wheezing D. Monitor fluid and food intake E. Advice mother on home management

VERY SEVERE DISEASE

Should be treated in centre with respiratory support

Chloramphenicol IM is drug of choice If condition improves Oral Chloramphenicol for 10 days If condition worsen Inj Cloxacillin plus inj gentamycin

B.<2mths child

Drug Dose Age <7DAYS Age 7-2 mths

Inj Benzyl Penicillin or

50000IU/KG/DOSE

12 Hrly 6Hrly

Inj Ampicillin and

50mg/kg/dose 12 Hrly 8Hrly

Inj Gentamycin 2.5mg/kg/dose 12 Hrly 8Hrly

NO PNEUMONIA

Symptomatic t/t Home care No antibiotics

PREVENTION

Improve living condition Better nutrition Remove smoke pollution indoor Better MCH Immunization