Acute Respiratory Tract Infection PDF

Acute Respiratory Tract Infection Prof. Manal Ibrahim Hanafi Community Medicine Department 1 Identification Sudden Acute respiratory infection is defined as an episode of acute symptoms and signs r...

Acute Respiratory Tract Infection Prof. Manal Ibrahim Hanafi Community Medicine Department 1 Identification Sudden Acute respiratory infection is defined as an episode of acute symptoms and signs resulting from infection of any part of the respiratory tract or related structures (extending for less than 30 days). ARIs are classified according to the site of infection into: - Acute upper respiratory tract infections (AURIs): these are Rhinitis Infections common cold, pharyngitis, and otitis media - Acute lower respiratory infections (ALRIs): these are epiglottitis, laryngitis; trachiitis, bronchitis, bronchiolitis, alveolitis and pneumonia. 2 Identification The clinical features are : 1. Fever, 2. Running nose, 3. Cough, 4. Sore throat , 5. Difficult breathing 6. Ear problems. 3  severty of the disease Factors affecting occurrence of ARIs men I- Agent: 0 via -Viral agents have been estimated to be responsible for over upper 90% of cases of community acquired acute diseases of AURIs and a considerable proportion of ALRIs. lower The most frequent viral agents of ALRI in infants and young RSV children are: Respiratory sentential virus, adenoviruses, Para f influenza and influenza A, B viruses, measles, mumps, and German measles. 4 Factors affecting occurrence of ARIs Many of the viruses invade any part of the respiratory tract; others show affinity for certain anatomical sites. Some predispose to bacterial complications. lessstreptococcal pyogenes -Bacterial agents include : Pertussis, Streptococcus pneumonia and Haemophilus influenza. 5 Factors affecting occurrence of ARIs initien II- Aggravating host d factors: exteremites of age p Severity is worst at earliest ages. Lack of past 1. Age: immunological experience with different agents as well as smaller airways are suitable for the settlement of infections are two risk factors during childhood period. 2. Low birth weight: LBW babies have eight times the risk of death from ARI compared to normal birth weight babies. Phmunity 3. Lack of breast feeding. immunity 6 Factors affecting occurrence of ARIs PEM 4. Malnutrition among children like protein energy malnutrition and anemia. 5. Poor vaccine coverage: For infections having respiratory complications like pertussis and measles. 6. Delayed and improper treatment of cases of ARIs complicated with pneumonia. Iiii sibiling 7. Presence of sibs in schools. aw are at risk to have RTIs. 8. Children attending nurseries 7 Factors affecting occurrence of ARIs III. Environmental factors: no 1. ARIs are common in urban areas than in rural ones. 2. Overcrowding and bad ventilation. 3. Large family size and low socioeconomic condition. 4. Outdoor and indoor air pollution (e.g. Smoking and organic fuel combustion in rural areas ). 5. Unhealthy child care practices. 8  Magnitude of the problem As a group, acute respiratory diseases are one of the leading causes of death from any infectious disease. Morbidity and mortality from acute respiratory diseases are especially significant in children. In adults, relatively high incidence and resulting disability, with consequent economic loss, make acute respiratory diseases a major health problem worldwide. 9  Acute viral Rhinitis (Common cold) An acute catarrhal infection of the upper respiratory tract C characterized by coryza, sneezing, lacrimation, irritation of the nasopharynx, chilliness and malaise lasting 2–7 days. Fever is uncommon in children over 3 and rare in adults. Disability is important because it affects work performance and industrial and school absenteeism; illness may be accompanied by laryngitis, tracheitis or bronchitis and may predispose to more serious complications such as sinusitis and otitis media. 10  Agent - Rhino virus, corona virus, …. Reservoir Susceptible Host - Man as a case Exit Inlet - Respiratory discharge - Respiratory tract Mode of transmission - Direct Contact - Indirect contact 11  Agent Rhinovirus Corona virus others In infants and children, parainfluenza viruses, respiratory one syncytial viruses (RSV), influenza, adenoviruses, certain enteroviruses and coronaviruses cause illnesses similar to common cold. The cause of about half of common colds has not been identified. 12  Occurrence Worldwide, both endemic and epidemic. In temperate zones, incidence rises in autumn, winter and spring; in tropical settings, incidence is highest in the rainy season. Many people, except in small isolated communities, have 1–6 colds yearly. Incidence is highest in children under 5 years and gradually declines with increasing age. 13  Mode of transmission Direct contact transmission: Through inhalation of airborne droplets Indirect contact transmission: Through hands and articles freshly soiled by nose and throat discharges of an infected person. 14 Incubation Period Between 12 hours and 5 days, usually 48 hours, varying with the agent. Period of communicability 24 hours before onset and for 5 days after onset 15  Prevention 1) Educate the public in personal hygiene, such as frequent hand washing, covering the mouth when coughing and sneezing, and safe disposal of oral and nasal discharges. 2) When possible, avoid crowding. 3) Provide adequate ventilation. 4) Avoid smoking in households with children, whose risk of pneumonia increases when exposed to passive smoke. 16  Control 1- Sterilization and disinfection of articles contaminated with respiratory discharge of infected person. 2- Symptomatic treatment of the patient 3- Adequate nutrition 4- Environmental sanitation 17  COVID-19 Incubation period: Around 5 days (range: 2-14 days) Symptoms: COVID-19 is a complex disease, which in no way consists only of a respiratory infection. Many symptoms are unspecific. It could be represented by cough, sputum, shortness of breath, and fever, musculoskeletal symptoms (myalgia, joint pain, headache, and fatigue), enteric symptoms (abdominal pain, vomiting, and diarrhea), otolaryngeal symptoms (anosmia and hyposmia). 18  COVID-19 It may also presented by coronary heart disease, thrombosis, embolism, dermatological lesions, renal and hepatic manifestations. Diagnosis: - Laboratory investigations, Chest X-ray and CT findings. TR 19 Susceptible person for sever COVID 19 1. Cancer patients 8. Pregnancy 2. COPD 9. Sickle cell anemia 3. Obesity 10. Heart disease 4. Immune impairment 11. Chronic kidney disease Lex orderly 5. Pregnancy 12. Cerebrovascular disease 6. Smoking …etc. 7. Type 2 DM 20 Prevention - Primary prevention Masks, social distancing, …. And vaccination??? - Secondary prevention Early discovery of cases and their treatment (Swabs) - Tertiary prevention Rehabilitation in case of impairment 21 Control - Agent: Disinfection and sterilization of contaminated objects Healthcare workers - Wear masks and PPE (for HCWs) - Case detection , isolation and treatment - Surveillance for contacts - Social distancing - Adequate nutrition - Environmental and occupational measures 22  Vaccine Preventable Respiratory Diseases Disea Taccine Tupe 23  Robulla Measles, Mumps, Rubella German measles, Chicken pox Diphtheria, Whooping cough, T.B, Meningitis, Hemophilus influenza 24  why compained vaccine Vaccination: injection hazard Type: concentration of preservative II 6 5,41 It is a live-attenuated vaccine. Dose and administration: Single 0.5 ml subcutaneous dose is recommended for routine immunization of children aged 18 months and for immunization of children up to 12 years of age who have not had varicella. The effectiveness: It ranges from 85-90% for prevention of the disease and 100% for prevention of the severity. 25  Whooping Cough Vaccination 1.Whole cell pertussis vaccine: Type: It is a killed vaccine. Administration: Usually given in combination with diphtheria and tetanus toxoids (DPT) in three intra-muscular injections for infants aged 2, 4, 6 months. A booster dose followed the primary immunization at 18 months of age. 26 Adverse events following immunization : Erythema, swelling and pain at the injection site, fever and other mild systemic events (e.g. drowsiness and anorexia.). More severe systemic events (e.g. Convulsions, acute encephalopathy, shock like state.) occur less frequently. Concerns about safety prompted the development of more purified (acellular) pertussis vaccines that are associated with a lower frequency of adverse events. 27  without cell just the immunogenic part of 2.Acellular pertussis vaccine (DTaP): o Pertussis vaccine contains purified, inactivated components of bordetella pertussis cells( pertussis toxin & filamentous haemagglutinin). compained with Diphtheria Tetanus as DPT 28  Diphtheria Type Active immunization with diphtheria toxoid. Immunization is initiated in infancy with a preparation containing diphtheria toxoid, tetanus toxoid and either acellular pertussis antigens (DaPT) or whole cell pertussis vaccine ( DPT ). 29  Tuberculosis BCG vaccination: 20th a p Type: Live attenuated variant prepared from bovine tubercle bacilli. Dose, mode and time of administration: 8 5412.1 Intradermal at the site of left deltoid insertion of 0.1ml. In newborn the dose is 0.05 ml It could be administered immediately after birth since cell mediated maternal immunity cannot be transferred to the fetus. 30  Meningitis Vaccination: Type: Purified meningococcal polysaccharides are : available. It is either monovalent (A or C) or bivalent (A&C) or polyvalent (A-C-Y W135). No effective vaccine against group B meningococci is available. Administration: Single subcutaneous injection for those above 2 years of age. Post vaccination immunity starts after 10 days of vaccination and lasts for about three years (booster dose every three years is recommended in case of continuous exposure). 31 Vaccination The pneumococcal conjugate vaccine, PCV13 , is currently recommended for all children younger than 2 years of age, all adults 65 years or older, and persons 2 through 64 years of age with certain medical conditions and adults 19 through 64 years old who smoke cigarettes. 32  Haemophilus influenza Haemophilus influenzae type b (Hib) disease is a serious disease caused by bacteria. It usually infects under 5 years children causing mainly sever meningitis. Hib vaccine as aType polysaccharide conjugate vaccine It may be monovalent vaccine or polyvalent vaccine given with others (pentavaccine: DPT + IPV + Hib) 33  Haemophilus influenza Pneumovax® is a 23-valent pneumococcal polysaccharide vaccine (PPSV23) that is currently recommended for use in all adults 65 years of age or older and for persons who are 2 years and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immuno-compromising conditions). PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma. 34 35