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Approach to a child with acute respiratory infections
- 1. EVALUATION OF A CHILD WITH ACUTE RESPIRATORY INFECTION BY DR ALEYA REMTULLAH FACILITATOR DR M. NOORANI
- 2. TABLE OF CONTENTS • Introduction • Epidemiology • Etiology • Complications • Differentials • History • Examination • Investigations • Management
- 3. INTRODUCTION • Acute respiratory infections (ARIs) are classified as; Upper respiratory infections (URI) Lower respiratory infections (LRI) • Common cause of illness in under 5’s
- 4. EPIDEMIOLOGY • Prevalence of ARIs in Tanzania- little known • 30-50% of all OPD consultations worldwide • 20-40% of hospitalizations • 50% die due to pneumonia • Most common bacterial etiology in school children was staph aureus (55.3%) • James Samwel et al, 2015, Bacteriological etiology of RTIs among ambulatory children in Moshi. • Bellos et al., the burden of ARI in crisis affected population, 2010
- 6. RISK FACTORS • Age • Nutritional status • Duration of EBF • Immunization status • Passive smoking • Overcrowding • Lack of education • Use of firewood for biofuel • FA Ujunwa et al., Risk factors for Acute RTIs in under five, Nigeria., 2014
- 7. AETIOLOGY
- 8. AETIOLOGY
- 9. COMPLICATIONS • Retropharyngeal abscess • Empyema • Bronchiectasis • Meningitis • Brain abscess • PIGN • Acute rheumatic fever • Otitis media
- 10. DIFFERENTIALS
- 11. EVALUATION • HISTORY • PHYSICAL EXAMINATION • INVESTIGATIONS
- 12. HISTORY
- 13. HISTORY
- 14. HISTORY
- 15. PHYSICAL EXAMINATION • VITALS- RR, Temp, PR, SPO2, BP • Emergency signs- resp distress, cyanosis • R/S: Nasal mucosa- erythema, edema nasal discharge- mostly in viral Foul breath- resident flora process products of inflammation Oral mucosa- pharyngeal erythema, sputum production, palate vesicles or ulcers, ulcerative stomatitis, tonsillar hypertrophy
- 17. PHYSICAL EXAMINATION • Anterior cervical LN- viral and bacterial infections • Conjuctivitis- due to adenovirus infection • Unilateral palatal or tonsillar pillar swelling- peritonsillar abscess • Drooling- epiglotitis • Loss of voice/ dysphonia/ hoarseness • Tripod/ sniffing posture- asthma or epiglotitis
- 19. PHYSICAL EXAMINATION • INSPECTION: • Audible wheezing, stridor • Symmetry of chest expansion • Trachea position (older children) • Rash on chest- scarlet fever rash, cutaneous diphtheria
- 20. SCARLET FEVER RASH CUTANEOUS DIPHTHERIA
- 21. PHYSICAL EXAMINATION • Percussion- resonant, hyper-resonant, dull, stony dull • Auscultation- breath sounds, added sounds
- 22. ACUTE OTITIS MEDIA • Acute onset • Middle ear effusion • Sx of middle ear inflammation • Persistent AOM • Recurrent AOM • Causes • Systematic assesment of TM (COMPLETES)- otoscopy
- 23. TM assessment • Color • Other conditions • Mobility Position • Lighting • Entire surface • Translucency • External auditory canal and auricle • Seal
- 24. INVESTIGATIONS FOR AOM • Culture and sensitivty • CT scan • MRI • Tympanometry • Tympanocentesis
- 25. INVESTIGATIONS
- 26. INVESTIGATIONS
- 27. INVESTIGATIONS
- 28. INVESTIGATIONS
- 29. CXR EPIGLOTITIS (cervical xray lateral) CROUP
- 31. PULMONARY FUNCTION TEST • Studies concerning pulmonary function tests during the ARI episodes have shown: Airway disease with increased resistance to flow later Reduced lung volumes Bronchial hyperactivity Reduced dynamic compliance Reduced diffusing capacity Increase in total gas volume • R. Dhand., the effect of ARIs on pulmonary function tests., 1987
- 32. MANAGEMENT • ABCDs • Manage the underlying cause…
- 33. REFERENCES • Nelson’s pediatric textbook • Medscape • Ncbi.com • Clinical essentials • Hutchinson’s textbook
- 34. • THANK YOU FOR LISTENING!!
Notas del editor
- Urt- from nostrils to pharynx and larynx- includes paranasal sinuses and middle ear. Mostly caused by viruses (90%) then bacteria (35-41%)- Lrt- trachea to alveoli
- Allergy, URI and influenza
- Nasal discharge- profuse, initially is clear, then cloudy white, yellow or green Sputum- yellow or green secretions doesn’t differentiate viral from bacterial But thick yellow secretions are common in viral nasopharyngeal infections Hemoptysis- TB, bronchitis, pneumonia Palatal vesicles or ulcers seen in HSV infection Ulcerative stomatitis- in coxsackie virus infection Tonsills- adherent blue-white or gray-green memb over tonsils and soft palate- diphtheria infection
- Cervical LN- if tender, bacterial etiology Viral- EBV- generalised adenopathy and hsplenomegally HIV- generalized LN Hoarseness- laryngitis, prolonged use of inhaled corticosteroids
- Audible wheezing/ stridor- reactive airway d’se, hypersensitivity, bronchiolitis, FB, croup Assymetry- pneumothorax, massive pleural effusion Trachea- pushed/pulled- pushed in pneumothorax/ massive pleural effusion Pulled- atelectasis, fibrosis Scarlet fever rash- caused by strep infection… small papules over chest and abdomen, rough like sandpaper, appears like a sun burn Spreads to armpits and groin- flushed face. Stays for 2-5 days and then peeling begins Cutaneous diphtheria- scaling rash or as well demarcated ulcers with membranes
- Hyper-resonant- emphysema, pneumothorax Dull- consolidation, atelectasis Stony dull- pleural effusion, empyema Breath sounds- normal- vesicular If diminished- emphysema, pneumothorax, atelectasis, fibrosis, pleural effusion/thickening, consolidation Bronchial breathing- conso, cavitation, collapsed lung, over a pleural effusion Added sounds- wheezes (sign) Crepitations- fine- pulm edema, or pneumonia Coarse- bronchiectasis, pulm fibrosis Frictional rub (pleural)- pleural thickening
- Epiglotitis- thumb sign Croup- steeple sign
- Contraindicated in pneumothorax, MI, recent eye surgery/thoraco abd surgery Indications- cough/ wheeze/ breathlessness/ crackles/ abnormal cxr/ asthma/fibrosis/ copds Reduced lung volumes- indicate widespread interstitial changes in lung Bronchial hyperactivity- seen there is increased closing volume of small airways Dynamic compliance- Diffusion capacity- tells the integrity and size of alveolar blood membrane Increased total gas volume Changes in lung function may persist for several months after radiological clearance has occured