Basic approach for UG students

1. Approach to a child with
respiratory tract infection
Dr Tushar Jagzape
Associate Professor
Department of Pediatrics
AIIMS , Raipur
10/3/2016 1

2. 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.
10/3/2016 2

3. 10/3/2016 3
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.

4. Respiratory tract
• Components of respiratory tract.
• Upper
• Middle
• Lower respiratory tract
10/3/2016 4

5. 10/3/2016 5
Upper and lower respiratory passage

6. 10/3/2016 6
Symptomatology:-
• Fever
• Coryza
• Cough
• Breathlessness
• Stridor / wheeze
• Chest pain
• Cyanosis
• Convulsion or shock*

7. Approach
• History:
– Age of the child
– Symptoms
– Chronicity
– Diurnal variation
– Aggravating / reliving factors
– Other system involvement – CVS, GIT, CNS,
hematology and immune system
10/3/2016 7

8. • Physical examination:
– General examination*
• Pallor, Cyanosis, clubbing, signs of allergy
– ENT examination
– Respiratory system examination-
• Inspection
• Palpation
• Percussion
• Auscultation – breath sounds, adventitious sounds
10/3/2016 8

9. Investigations
• X ray- Chest , sinus, soft tissue neck,
• ABG
• Transillumination test
• CT chest / MRI
• Fluoroscopy
• Barium swallow
• Pulmonary arteriography and aortogram
• Radionuclide lung scan
10/3/2016 9

10. • Pulmonary function testing: spirometry, body
plethysmography, diffusion capacity.
• Microbiology:
• Airway visualization
– Laryngoscopy
– Bronchoscopy
– Thoracoscopy
• Thoracentesis
• Lung biopsy
10/3/2016 10

11. 10/3/2016 11
Upper Respiratory Tract Infections:-
• Common cold.
• Sinusitis.
• Pharyngitis.
• Tonsilitis.
• Infectious upper airway obstructions ex.
Croup, acute epiglottitis.

12. 10/3/2016 12
Lower respiratory tract infections:-
• Bronchitis
• Bronchiolitis
• Pneumonia

13. 10/3/2016 13
RTI

14. 10/3/2016 14
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.

15. 10/3/2016 15
Management:-
Decide URI or LRI.

16. 10/3/2016 16
Syndromic approach helpful.

17. 10/3/2016 17
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

18. 10/3/2016 18
Common Cold
• Essentially Viral
• Antimicrobial agents >> No
• Prophylactic antibiotics DO NOT
– Shorten the duration
– Prevent Sinusitis/OM/Pneumonia
– Reduce the symptoms

19. 10/3/2016 19
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

20. 10/3/2016 20
Acute Otitis Media
• Erythema
• Fluid
• Impaired Mobility
• Acute Symptoms
• Causative Organisms are same as acute
sinusitis

21. 10/3/2016 21
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

22. 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
10/3/2016 22

23. 10/3/2016 23

24. 10/3/2016 24
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)

25. 10/3/2016 25

26. 10/3/2016 26
No antibiotics Please….
• Acute Laryngotracheobronchitis
• Acute Brochiolitis
Almost always Viral etiology
• Empirical antibiotics no role in
– Early recovery
– Prevention of complications
– Symptomatic relief

27. 10/3/2016 27
Summary
• Respiratory infections are a common problem
in clinical practice.
Common complaints –
cough fever Noisy
breathing
cyanosis
Breathing
difficulty

28. 10/3/2016 28
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.

29. 10/3/2016 29