Acute Respiratory Infections Pt.2

Severe Pneumonia

Lower chest wall indrawing

• Problems in recognizing children who should be urgently referred
• “Retractions” suggested as indication of severe disease but multiple definitions existed
• Studies found lower chest wall indrawing best identified children who required assessment or admission
• must be definite, present all the time

Recognition

• Urgently refer children with Cough or difficult breathing AND
• Lower chest wall indrawing OR
• Stridor when calm OR
• Any general danger sign 

Clinical signs

+ = always present += Present sometimes

A combination of clinical signs indicates need for referral and further assessment

Identification of potentially life threatening diseases must be made by a proper physical examination at a higher level facility

Antibiotics

• Invasive bacterial organisms warrant injectable antibiotics
• Delivered to the blood and/or meninges
• Incessant vomiting or shock prohibit oral antibiotics
• Penicillin –IM
• Inexpensive
• Widely available
• Limited organisms treated
• Poor CSF penetration

Acute Respiratory Infections Pt.1

Acute respiratory infection is one of the major childhood illnesses that lead to death of children ages five years old below. For the comprehensive list of acute respiratory infections here is the following to let you inform each one of them.


Sensitivity and Specificity 

Definitions

• Sensitivity-the proportion of those with the disease who are correctly identified by sign. It measures how sensitive the sign is in detecting the disease.
• Specificity -the proportion of those without the disease who are correctly called free of the disease by using the sign.
• Low sensitivity of diagnosis is a more serious problem than low specificity.
• Respiratory cut-off rates determined by ROC curve. 

Pneumonia 

Recognition

• Based on fast breathing, and lower chest wall indrawing
• “Cough OR difficult breathing,” not “cough AND difficult breathing”
• Fewer than 25 percent of children with cough also have difficult breathing
• Many causes of difficult breathing not related to cough
• Using both can cause false positives

Fast breathing

• Fast breathing based on age-specific thresholds
• 2 to 12 months >50
• 12 months up to 5 years >40
• If rate is below cut-offs (plus no danger signs and no chest wall indrawing) the classification is no pneumonia, cough and cold.
• Use timing device to count rate for one full minute (preferably)
• Best to count rate in a quiet and alert child
• Fever can affect respiratory rates, but do not wait for fever to subside
• Initial WHO respiratory rate cut-off of 50/minute based on Goroka, Papua New Guineastudies
• Studies in Gambia and Philippines showed this cut-off rate was not specific enough for children 1 to 4 years
• Threshold for older children was lowered to 40/minute and confirmed with studies
• Two rates may cause confusion but advantage is increased sensitivity

Antibiotics

• Cotrimoxazole
• Inexpensive, twice a day dosage
• Few adverse effects
• Resistance to S. pneumoniae and H.influenzae
• Amoxicillin
• More expensive, 3 times daily
• Drug reactions are less common, but include diarrhoea
• Clinically effective against penicillin-resistant pneumococci