ACUTE RESPIRATORY INFECTIONS

DR Anwar ahmadCOMMUNITY MEDICINE & PUBLIC HEALTHKGMU UP LUCKNOW

Problem statement

ARI RESPONSIBLE FOR 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%

Children with ARI presenting in OPD

Place % of children

London (UK) 35.0

Herston (Australia) 34

Ethiopia (Whole country) 25.5

Sau aulo (Brazil) 41.8

India 38.9

Nepal 37.6

Varied agents – Bacteria and viruses Clinical picture may vary with etiological agent May be present in normal people but may

cause disease in only few.

Epidemiology

Infections of the respiratory tract are described

in a number of different ways according to the general areas of involvement in the more common infections. The upper respiratory tract or upper airway consists of primarily of the nose and pharynx. The lower respiratory tract consists of bronchi and bronchioles, which constitute the reactive protein of the airway because of their smooth muscle content and ability to constrict the alveoli.

ACUTE RESPIRATORY INFECTIONS

May cause 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)

ACUTE RESPIRATORY INFECTIONS(ARI)

Anatomy of the Respiratory system

AGENT FACTORSBACTERIA AGE GROUP

AFFECTEDCHRACTERISTIC CLINICAL FEATURES

Bordetella pertussis Infants & young children

Poroxysmal cough

Corynebacterium diphtheriae

Children diphtheria

Hemophilus influenzae

AdultsChildren

Acute ex of ch bronchitisAcute 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

VIRUSES AGE GROUP

AFFECTEDCHRACTERISTIC CLINICAL FEATURES

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

Factors Affecting Type of

Illness and Physical Response in Acute

Respiratory Infections:

Nature of infectious agent: The respiratory tract is subjected to a wide variety of infectious agents.

Size and frequency of dose: The larger the dose and the more frequent the exposure, the greater the likelihood of a significant infection.

Age of child: Children of preschool and school age are more often exposed to infectious agents generally after 3 months of age infants have less resistance to infections.

Size of child: Airways are smaller in young children and more subjected to considerable narrowing from edema.

Ability to resist invading organisms: School age children have greater resistance to infection than infants and young children.

Presence of great conditions: Malnutrition, anemia, fatigue, chilling of the body and immune deficiencies decrease normal resistance to infection.

Presence of disorders affecting respiratory tract: Allergies, cardiac abnormalities and cystic fibrosis weaken respiratory defense mechanism.

Seasons: The most common respiratory tract pathogens appear in epidemics during winter and spring months.

RHINITIS (COMMON COLD OR CORYZA) RHINOVIRUSES, ENTEROVIRUSES, CORONAVIRUSES

ACUTE EPIGLOTTITIS (SUPRGLOTTITIS) CROUP (ACUTE LARYNGOTRACHEOBRONCHITIS) EAR INFECTIONS (ACUTE OTITIS MEDIA)

VIRUSES, PNEUMOCOCCUS, GABHS, HEMOPHILUS INFLUENZA, MORAXELLA CATARRHALIS

ACUTE INFECTIOUS LARYNGITIS VIRAL/DIPTHERIA

ACUTE PHARYNGITIS ADENOVIRUS, ENTEROVIRUS, RHINOVIRUS, GROUP A BETA HEMOOLYTIC

STREPTOCOCCUS(older children)

TONSILLITIS GROUP A BETA HEMOLYTIC STREPTOCOCCI, EBV

SINUSITIS VIRAL/BACTERIAL

UPPER RESPIRATORY TRACT INFECTIONS

Children average 8 episodes per year, adults

3 episodes per year Etiologies :

Rhinoviruses 30 to 35% Coronaviruses about 10% Miscellaneous known viruses about 20% Influenza and adenovirus-30% Presumed undiscovered viruses up to 35% Group A streptococci 5% to 10%

Parainfluenza was the first respiratory virus isolated (1955)

Seasonal variation Rhinovirus early fall Coronavirus- winter

The Common Cold

Common symptoms are sore throat,

runny nose, nasal congestion, sneezing, Sometimes accompanied by

conjunctivitis, myalgias, fatigue Sinusitis often present by CT scan;

“rhinosinusitis” might be a better term

Common Cold

The common cold

Direct contact is the most efficient means

of transmission: 40% to 90% recovery from hands.

Infectious droplet nuclei Brief exposure (e.g., handshake) transmits

in less than 10% of instances Kissing does not seem to be a common

mode of transmission.

Transmission of rhinoviruses

Incubation period 12-72 hours Nasal obstruction, drainage, sneezing,

scratchy throat Median duration 1 week but 25% can last 2

weeks Pharyngeal erythema is commoner with

adenovirus than with rhino or coronavirus

Clinical characteristics

Main challenge is to distinguish between

uncomplicated cold and streptococcal pharyngitis or bacterial sinusitis Good examination

Marked exudate or pharyngeal erythema suggests Streptococcal infection Adenovirus Diphtheria

Rapid antigen tests for group A streptococcus Rapid techniques for influenza, RSV, parainfluenza Treat with NSAIDs and whatever else your

grandmother advises

Diagnosis and treatment

Life-threatning infection of the epiglottis, the

aryepiglottic folds and arytenoid soft tissue Occurs mostly in winters Peak incidence :- 1 – 6 years Male affected more bacterial infection (Hemophilus influenza type b) Concomitant bacteremia, pneumonia, otitis

media, arthritis and other invasive infections caused by H.influenza type b may be present

ACUTE EPIGLOTTITIS

Clinical features

High fever, sore throat, dyspnea, rapidly progressing respiratory obstruction

Patient may become toxic, difficult swallowing, laboured breathing, drooling, hyperextended neck

Tripod position (sitting upright and leaning forward)

Cyanosis , coma, death Stridor is a late finding

ACUTE EPIGLOTTITIS

Do not examine the throat Assessment of severity

Degree of stridor Respiratory rate Heart rate Level of consciousness Pulse oximetry

EXAMINATION

DIAGNOSIS:

“CHERRY RED”APPEARANCE OF EPIGLOTTIS ON LARYNGOSCOPY

THUMB SIGN ON LATERAL NECK RADIOGRAPH

ACUTE EPIGLOTTITIS

NEED TO BE MANAGED IN ICU WITH ENDOTRACHEAL

INTUBATION HELP FROM ANAESTHETIST AND ENT SURGEON BLOOD CULTURES FLUID AND ELECTROLYTE SUPPORT INTRAVENOUS AMPLICILLIN 100 mg/kg/day OR

CEFTRIAXONE 100 mg/kg/day . OTHER OPTIONS

(CEFUROXIME OR CEFOTAXIME) TOTAL TREATMENT :-7-10 DAYS

CHOLRAMPHENICOL 50-75 mg/kg/day IV RIFAMPICIN PROPHYLAXIS TO CLOSE CONTACTS

TREATMENT (ACUTE EPIGLOTTITIS)

VIRAL INFECTION LEADING TO MUCOSAL

INFLAMMATION OF THE GLOTTIC AND SUBGLOTTIC REGIONS

COMMONLY DUE TO INFLUENZA (TYPE A), PARAINFLUENZA(1, 2, 3) AND RSV

AGE :- 6 MONTHS – 6 YEARS

ACUTE LARYNGOTRACHEOBRONCHITIS

(VIRAL CROUP)

CLINICAL FEATURES

INITIAL :- RHINORRHEA, MILD COUGH, FEVER(LOW GRADE)

LATER (24-48 HOURS) :- BARKING COUGH HOARSENESS OF VOICE NOISY BREATHING (MAINLY ON INSPIRATION)

SYMPTOMS WORSEN AT NIGHT AND ON LYING DOWN CHILDREN PREFER TO BE HELD UPRIGHT OR SIT IN

BED SYMPTOMS RESOLVE WITHIN A WEEK

ACUTE LTB

CLINICAL EXAMINATION

HOARSE VOICE NORMAL TO MODERATELY INFLAMMED PHARYNX SLIGHTLY INCREASED RESP RATE WITH

PROLONGED INSPIRATION AND INSPIRATORY STRIDOR

ACUTE LTB

DIAGNOSIS

MAINLY A CLINICAL DIAGNOSIS RADIOGRAPH NECK :- STEEPLE SIGN

(UNRELIABLE)

ACUTE LTB

TREATMENT

MOIST OR HUMIDIFIED AIR STEROIDS

REDUCE THE SEVERITY AND DURATION / NEED FOR ENDOTRACHEAL INTUBATION

PREDNISOLONE PO 2mg/kg/day FOR 3 DAYS NEBULIZED BUDESONIDE 2mg STAT

NEBULIZED ADRENALINE (EPINEPHRINE)

ACUTE LTB

Tonsillitis is a viral or bacterial infection in the throat

that causes inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the pharyngeal cavity.

In the first six months of life tonsils provide a useful defense against infections. Tonsillitis is one of the most common ailments in pre-school children, but it can also occur at any age.

Children are most often affected from around the age of three or four, when they start nursery or school and come into contact with many new infections.

A child may have tonsillitis if he/she has a sore throat, a fever and is off food.

Tonsillitis

Tonsillitis

Palatine tonsils (Visible during

oral examination)

Tonsillitis is caused by a variety of

contagious viral and bacterial infections. It is spread by close contact with other

individuals and occurs more during winter periods.

The most common bacterium causing tonsillitis is streptococcus.

Causes of tonsilitis

Encourage bed rest. Introduce soft liquid diet according to the child's

preferences. Provide cool mist atmosphere to keep the mucous

membranes moist during periods of mouth breathing.

Warm saline gargles & paracetamol are useful to promote comfort.

If antibiotics are prescribed, counsel the child's parents regarding the necessity of completing the treatment period

Advice and treatment:

The controversy of tonsillectomy: Surgical removal of chronic tonsillitis

(tonsillectomy) is controversial. Generally, tonsils should not removed before 3 or 4 yrs of age, because of the problem of excessive blood loss & the possibility of re-growth or hypertrophy of lymphoid tissue, in young children.

Management:

Community acquired bacterial sinusitis

S.pneumoniae H. influenzae S. pyogenes

Nosocomial sinusitis Seen in critically ill, mechanically

ventilated S. aureus Pseudomonas aeruginosa Serratia marcescens

fungal

Sinusitis

Clinical features

Sneezing Nasal discharge Facial pressure Fever Purulent drainage Headache

Sinus imaging not routinely recommended

Clinical features

Maxillary: usually uncomplicated Ethmoid: cavernous sinus thrombosis-serious Frontal: osteomyelitis of frontal bone;

cavernous sinus thrombosis; epidural, subdural, or intracerebral abscess; orbital extension

Sphenoid: Rare; extension to internal carotid artery, cavernous sinuses, pituitary, optic nerves; common misdiagnoses include ophthalmic migraine, aseptic meningitis, trigeminal neuralgia, cavernous sinus thrombosis

Acute sinusitis: complications

Otitis externa Acute, localized: often S.

aureus, S. epidermidis or S. pyogenes

Acute diffuse (swimmer’s ear): gram-negative rods, especially Ps. Aeruginosa ; Rx: topical quinolones

Chronic: mainly with chronic otitis media

Malignant: life-threatening infection in diabetics, elderly, immunecompromised

S. pneumoniae and H. influenzae the

leading causes in all age groups (most H. flu is from non-typable strains and not “B”)

Moraxella catarrhalis: 10% of cases Some cases may be viral (RSV, influenza,

enteroviruses) Mycoplasma pneumoniae: inflammation of

the tympanic membrane (“bullous myringitis”)

Acute otitis media

Acute otitis media Critical role of

eustachian tube as conduit between nasopharynx, middle ear, and mastoid air cells

Children have shorter, wider eustachian tubes than adults

Presence of fluid in the middle ear AND Ear pain, drainage, hearing loss The fluid may take weeks to resolve Amoxicillin remains the drug of choice Beta-lactamase producing strains of H.

influenza will need amoxicillin/clavulanic acid or cephalosporins

Diagnosis and treatment

Otitis Media

Inflammatory syndrome of the pharynx

Most cases are viral Most important bacterial cause is Streptococcus

pyogenes (15-20%) Presents with sore or scratchy throat In severe bacterial cases there may be

odynophagia, fever, headache

Acute pharyngitis

Viral: edema and hyperemia of tonsils and

pharyngeal mucosa Streptococcal: exudate and hemorrhage

involving tonsils and pharyngeal walls Epstein-Barr virus (infectious mono): may

also cause exudate, with nasopharyngeal lymphoid hyperplasia

Acute pharyngitis:physical examination

Adenoviral pharyngitis Pharyngeal erythema and exudate

may mimic streptococcal pharyngitis

Conjunctivitis (follicular) present in 1/3 to 1/2 of cases; commonly unilateral but bilateral in 1/4 of cases

Pharyngoconjuntival fever

Herpangina

Uncommon Due to coxsackieviruss Small, 1-2 mm vesicles on the soft palate,

uvula, and anterior tonsillar pillars which rupture to form small white ulcers

Occurs mainly in children Also think of Herpes simplex virus when

you see vesicular lesions

Vesicular lesions

Vincent’s angina: anaerobic pharyngitis

(exudate; foul odor to breath) Ludwig’s angina- cellulitis of dental origin Quinsy: peritonsillitis/peritonsillar abscess.

Medial displacement of the tonsil; often spread of infection to carotid sheath

Vincent’s anginaand Quinsy

Classic diphtheria (Corynebacterium

diphtheriae): slow onset, then marked toxicity

Arcanobacterium hemolyticum (formerly Cornyebacterium hemolyticum): exudative pharyngitis in adolescents and young adults with diffuse, sometimes pruritic maculopapular rash on trunk and extremities

Diphtheria

Diphtheria fibrous pseudomembrane with necrotic epithelium and leukocytes

Symptomatic Penicillin for Strep throat Macrolides for pen allergic patients Add an anti-anaerobic agent for Vincent’s and

Ludwig’s angina

Treatment

BRONCHITIS/BRONCHIOLITIS

PNEUMONIA

LOWER RESPIRATORY TRACT INFECTIONS

Inflammatory disease of the bronchioles Peak age of onset : 6 months Most common agent :- rsv Male : female :- 2:1 Occurs mostly in winter/spring

BRONCHIOLITIS

Coryza with cough followed by worsening

breathlessness Vomiting Irritability Wheeze Feeding difficulty Episodes of apnoea

CLINICAL FEATURES

Rapid shallow breathing (60-80/min) Cyanosis / pallor Flaring of alae nasi Use of accessory muscles of respiration

Subcostal /intercostal recessions Expiratory wheeze / grunting Prolonged expiration Hyper-resonant percussion notes Chest hyperinflation Liver/spleen palpable Bronchiolitis obliterans

EXAMINATION FINDINGS IN BRONCHIOLITIS

DIAGNOSIS

Chest X-ray Hyperinflation, increased lucency and

increased bronchovascular markings and mild infiltrates

Pulse oximetry Nasopharyngeal swabs (viral culture) Viral antibody titers (iat for rsv)

BRONCHIOLITIS

A chest X-ray demonstrating lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis

COMPLICATIONS

Pneumonia Pneumothorax Dehydration Respiratory acidosis Respiratory failure Heart failure Prolonged apneic spells death

BRONCHIOLITIS

TREATMENT

Mainly supportive Prop up (30 – 40 degrees) Oxygen inhalation (achieve o2 >92%) If tachypneic, limit the oral feeds and use a ng tube

for feeding Parenteral fluids to limit dehydration Correct resp acidosis and electrolyte imbalance Bronchodilators for wheeze (nebulized adrenaline) Mechanical ventilation (severe resp distress or

apnoea)

BRONCHIOLITIS

Inflammation of the lung parenchyma and is associated with

the consolidation of the alveolar spaces Developed world

Viral infections Low morbidity and mortality

Developing world� Common cause of death Bacteria and PCP in 65%

ARI case management WHO� 84% reduction in mortality Respiratory rate, recession, ability to drink Cheap, oral and effective antibiotics, Co-trimoxazole,

amoxycillin Maternal education Referral

PNEUMONIA

Vary according to �

Age, immune status, where contracted Community acquired (CAP)�

Developing countries S. pneumoniae, H. influenzae, S aureus Viruses 40% Other: Mycoplasma, Chlamydia, Moraxella

Developed countries Viruses: RSV, Adenovirus, Parainfluenza, Influenza Mycoplasma pneumoniae and Chlamydia pneumoniae Bacteria: 5-10%

Etiology

ETIOLOGY ACCORDING TO AGEAGE GROUP CAUSATIVE ORGANISM

NEONATES GROUP B STREPTOCOCCUSE.COLIKLEBSIELLASTAPH AUREUS

INFANTS PNEUMOCOCCUSCHLAMYDIARSVH.INFLUENZA TYPE b

CHILDREN 1 TO 5 YRS RESPIRATORY VIRUSESPNEUMOCOCCUSH.INFLUENZA TYPE bC.TRACHOMATISM.PNEUMONIAES.AUREUSGP A STREPTOCOCCUS

CHILDREN 5 TO 18 YRS M.PNEUMONIAEPNEUMOCOCCUSC.PNEUMONIAEH.INFLUENZA TYPE b

WHO Classification and managementNO 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

Significant risk factors are younger age (2-6 months), low

parental education, smoking at home, prematurity, low birth weight, weaning from breast milk at < 6 months, a negative history of diphtheria, pertussis and tetanus vaccination, anaemia, malnutrition and overcrowding.

Infection rate higher in siblings of school children who introduce infection in the household.

Other risk factors Congenital lung cysts Chronic lung disease Immunodeficiency Cystic fibrosis Sickle cell disease Tracheostomy in situ

HIGH RISK CHILDREN FOR PNEUMONIA

Sign of respiratory distress; nasal flaring & �

chest indrawing Younger than 2 months Decreased level of consciousness Stridor when calm Severe malnutrition Associated symptomatic HIV/AIDS

Danger Signs (IMCI)

SIGNS OF RESPIRATORY DISTRESS

SIGNS OF RESPIRATORY DISTRESS

Bacterial– Poorly demarcated

alveolar opacities with air bronchograms

– Lobar or segmental opacification

Radiology

Radiology

� Viral– Perihilar streaking, interstitial changes, air trapping

Clues to other specific �

organisms Staphylococcus – areas

of break-down Klebsiella, anaerobes,

H. influenza or TB –cavitating or expansile pneumonia

TB, S. aureus, H. influenza pleural effusion and

empyema

Radiology

White cell count and CRP

>15,000 – 40,000/mm3 neutrophil predominance Blood cultures

25% positive NASOPHARYNGEAL ASPIRATE

Viral immunoflorescence in infants Sputum specimen

Gram staining Acid fast bacilli

Pleural fluid examination (if present) ASO titer (in case of streptococcal pneumonia) Tuberculin skin test Viral Titres

culture antigen

Diagnosis

Empyema Lung abscess Pneumothorax Pneumatocele Pleural effusion Delayed resolution Respiratory failure Metastatic septic lesions

Meningitis Otitis media Sinusitis Speticaemia

COMPLICATIONS OF PNEUMONIA

Antibiotics�

Under 5 yrs First line treatment :- amoxicillin Alternatives : coamoxiclav, cefaclor,(for typical)

macrolides (for atypical) Over 5 yrs

First line treatment :- amoxicillin or macrolides Alternatives :- macrolide or flucloxacillin +

amoxicillin Severe pneumonia

Co-amoxiclav, cefotaxime or cefuroxime Special categories (as per the suspected

organism)

Treatment

Treatment in special groups

GROUP ORGANISMS ANTIBIOTICS

IMMUNOCOMPROMISED -GRAM NEGATIVE-S. AUREUS-OPPORTUNISTIC PNEUMOCYSTIS JIROVECI-M. TUBERCULOSIS

AMPICILLIN + CLOXACILLIN +AMINOGLYCOSIDE

LESS THAN 3 MONTHS -GRAM NEGATIVE-GROUP B STREPTOCOCCUS-S.AUREUS

AMPICILLIN +AMINOGLYCOSIDE

HOSPITAL ACQUIRED PNEUMONIA

-GRAM NEGATIVE-METHICILLIN RESISTANT S. AUREUS

AMINOGLYCOSIDE + VANCOMYCIN + CEPHALOSPORIN (3RD GENERATION)

Oxygen�

intranasaly Hydration�

50 – 80ml/kg/day Temperature control� Airway obstruction management� Chest drain :- for fluid or pus collection in

chest (empyema)

Treatment (contd.)

Most children recover without residual �

damage Incorrect treatment leads to tissue �

destruction and bronchiectasis Half of children with pneumonia secondary to �

measles or adenovirus have persistent airway obstruction

Prognosis

Early diagnosis of pneumonia and the

warning signs of severe disease and prompt management – key factors which determine the outcome of disease

Guidelines have been given by WHO regarding management and use of antibiotics.

Recent changes – Management as per the IMNCI protocol

PREVENTION AND CONTROL OF ARIs

Management of ARI

as per the “Integrated Management of Neonate & Child

Illnesses” (IMNCI) protocol

History taking and clinical assessment very

important Age of the child, for how long the child has

been coughing, whether the child is able to drink, has the young infant stopped feeding well, does the child have fever, is the child drowsy or difficult to wake, did the child have convulsions, is there irregular breathing, any history of treatment.

Clinical Assessment

1. COUNTING THE NUMBER OF BREATHS IN ONE MINUTE - to assess fast breathing Respiratory rate cut-offs:

>/= 60 breaths per minute in a child less than 2 months

>/=50 breaths per minute in child aged 2month upto 12 months

>/=40 breaths per minute in child aged 12 months upto 5 years

Physical examination

2. LOOK FOR CHEST INDRAWING when the child breathes IN3. LOOK AND LISTEN FOR STRIDOR when the child breathes IN4. LOOK FOR WHEEZE when the child breathes out5. FEEL FEVER OR LOW BODY TEMPERATURE6. CHECK FOR SEVERE MALNUTRITION7. CHECK FOR CYANOSIS

Physical examination cont.

CHILD BELOW 2 MONTHS

Very severe diseaseSevere pneumoniaNo pneumonia

CHILD AGED 2 MONTHS UPTO 5 YEARS Very severe disease Severe pneumonia Pneumonia No pneumonia (cold & cough)

CLASSIFICATION OF DISEASE

SIGNS

STOPPED FEEDING WELL

CONVULSIONS

ABN. SLEEPY STIDOR IN

CALM CHILD WHEEZE FEVER/LOW

BODY TEMP.

SEVERE CHEST IDRAWING

FAST BREATHING

NO SEVERE CHEST INDRAWING

NO FAST BREATHING

CLASSIFY AS VERY SEVERE DISEASE

SEVERE PNEUMONIA

NO PNEUMONIA

TREATMENT REFER URGENTLY

KEEP WARM

GIVE FIRST DOSE OF ANTIBIOTIC

REFER URGENTLY

KEEP WARM

GIVE FIRST DOSE OF ANTIBIOTIC

ADVICE FOR HOME CARE

EXPLAIN DANGER SIGNS

MANAGEMENT OF ARI CHILDREN BELOW 2 MONTHS

MANAGEMENT OF ARICHILD AGED 2 MONTHS UPTO 5 YEARS

SIGNS

NOT ABLE TO DRINK

CONVULSIONS ABNORMALLY

SLEEPY OR DIFFICULT TO WAKE

STRIDOR IN A CALM CHILD

SEVERE MALNUTRITION

FAST BREATHING

CHEST INDRAWING

NASALFLARING

GRUNTING

FAST BREATHING ONLY

NO CHEST INDRAWING

NO FAST BREATHING

NO CHEST INDRAWING

CLASSIFY AS VERY SEVERE DISEASE

SEVERE PNEUMONIA

PNEUMONIA NO PNEUMONIA/COLD & COUGH

TREATMENT REFER URGENTLY

GIVE FIRST DOSE OF ANTIBIOTIC

TREAT FEVER, IF PRESENT

TREAT WHEEZE, IF PRESENT

REFER URGENTLY

GIVE FIRST DOSE OF ANTIBOTIC

TREAT FEVERTREAT WHEEZE

ADVICE FOR HOME CARE

GIVE ANTIBIOTIC

TREAT FEVERTREAT WHEEZE

ASSESS AND TREAT EAR PROBLEM/ SORE THROAT

TREAT FEVER TREAT WHEEZE

Parenteral – Benzyl Penicillin or Ampicillin & Gentamycin

Oral – Cotrimoxazole tablets / suspension

Antibiotics recommended

MEASLES HIB VACCINE PNEUMOCOCCAL PNEUMONIA

VACCINATION

Questions?

THANK YOU