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Approach to a child with respiratory tract infection

Dr Tushar JagzapeAssociate Professor

Department of PediatricsAIIMS , Raipur

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Learning objectives:

• At the end of this session the students should be able to :

• Enumerate the parts of respiratory tract.• Enlist common respiratory tract infections• Describe clinical features of common upper

respiratory tract infections• Describe treatment in short.

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Introduction:-

• Respiratory infections are a common problem in all age groups.

• Upper respiratory infections consist of almost 40-50 % of all OPD cases.

• Children are more prone.• Morbidity and mortality high in children.• Pneumonias are among top three causes of

infant mortality.

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Respiratory tract

• Components of respiratory tract.• Upper • Middle• Lower respiratory tract

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Upper and lower respiratory passage

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Symptomatology:-

• Fever • Coryza• Cough• Breathlessness• Stridor / wheeze• Chest pain• Cyanosis• Convulsion or shock*

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Approach

• History: – Age of the child– Symptoms– Chronicity– Diurnal variation – Aggravating / reliving factors– Other system involvement – CVS, GIT, CNS,

hematology and immune system

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• Physical examination: – General examination*• Pallor, Cyanosis, clubbing, signs of allergy

– ENT examination– Respiratory system examination-• Inspection• Palpation• Percussion• Auscultation – breath sounds, adventitious sounds

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Investigations

• X ray- Chest , sinus, soft tissue neck, • ABG• Transillumination test• CT chest / MRI• Fluoroscopy • Barium swallow• Pulmonary arteriography and aortogram• Radionuclide lung scan

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• Pulmonary function testing: spirometry, body plethysmography, diffusion capacity.

• Microbiology: • Airway visualization – Laryngoscopy– Bronchoscopy– Thoracoscopy

• Thoracentesis • Lung biopsy

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Upper Respiratory Tract Infections:-

• Common cold.• Sinusitis.• Pharyngitis.• Tonsilitis.• Infectious upper airway obstructions ex.

Croup, acute epiglottitis.

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Lower respiratory tract infections:-

• Bronchitis• Bronchiolitis• Pneumonia

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RTI

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Etiology:-• Viral-Rhinovirus, coronaviruses,RSV, influenza and parainfluenza,

adenovirus.

• Bacterial infections:-Streptococcus pneumoniae, H.influenzae, Moraxella catarrhalis, Staph aureus, E-coli, Klebsiella, pseudomonas.

• Atypical organisms:-mycoplasma, chlamydia.

• Fungi.

• Helmenthic infections.

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Management:-

Decide URI or LRI.

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Syndromic approach helpful.

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Symptomatic and specific therapy.

• Non pharmacological– Hydration– Position– Small frequent feeds– Saline nasal drops– Avoidance of physical exercise

• Antipyretics, • antihistaminics and decongestant.• Bronchodilators and nebulization

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Common Cold

• Essentially Viral • Antimicrobial agents >> No

• Prophylactic antibiotics DO NOT– Shorten the duration– Prevent Sinusitis/OM/Pneumonia– Reduce the symptoms

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Acute Sinusitis

• Organisms• S. Pneumoniae• Non typable H. Influ• M.Catarrhalis

• Antibiotics– Amoxycillin / Cefuroxime / Co-amoxiclav / Macrolide

• If Severe / failure to 1st line– IV Ceftriaxone/Cefotaxime Oral Cefpodoxime

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Acute Otitis Media

• Erythema• Fluid• Impaired Mobility• Acute Symptoms• Causative Organisms are same as acute

sinusitis

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AOM T/t

• < 2 yr• Analgesics• Antibiotics• Amoxycillin– Co amoxiclav– 2nd line

• Cefuroxime• Cefpodoxime• Cefdinir

• Above 2 yrs • No urgency to start AB• Wait & watch - 48 hrs• DOC: amoxy 40mg/kg day

for 7-10 days• Injectable 3rd gen

Cephalosporins only if not responding to oral/vomiting/severe

Acute Tonsillopharyngitis

• Viral > 65%, GABHS :15% > 3yrs

• Clinical diagnosis– No Cough– Pharyngeal erythema

with Exudates over tonsils

– Tender Cx LN• Prevent Rheumatic

Fever

• Criteria developed for adults and modified for children by McIsaac give 1 point to

- history of temperature >38°C (100.4°F);

- absence of cough; - tender anterior cervical

adenopathy;- tonsillar swelling or

exudates; and age 3-14 yr

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Antibiotics for Ac bact TP

• No penicillin allergy– Oral Penicillin (10d)– Amoxycillin– Benzathine penicillin single dose

• Allergy to penicillins– Macrolide (eg Azithro)– 1st gen Cephalosporins (eg cephalexin)

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No antibiotics Please….

• Acute Laryngotracheobronchitis• Acute Brochiolitis Almost always Viral etiology• Empirical antibiotics no role in – Early recovery– Prevention of complications– Symptomatic relief

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Summary

• Respiratory infections are a common problem in clinical practice.

Common complaints –

cough fever Noisy breathing

cyanosisBreathing difficulty

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Summary:-

• Viral etiology common for URI, whereas bacterial infections common in LRTI.

• Children - vulnerable for complications and mortality due to respiratory infections.

• Proper diagnosis and treatment - important to prevent the same.

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Thank you!