Lower respiratory tract infection case study.pptx

Lower respiratory tract infections.pptx

1. Lower Respiratory Tract Infections Right Auxiliary Lymphadenopathy By: Rohit Kumbhar CLASS: TY PHARM D Roll no :17 SUPERVISED BY- DR. KHADE SIR

2. Epidemiology Incidence : 30–40 cases per 1000 children per year in the UK; a GP will see, on average, 1-2 cases per year. Prevalence : Every year, pneumonia contributes to 750,000 – 1.2 million neonatal deaths worldwide: (60% due to S. pneumoniae/H. influenzae) H. influenzae infection is now quite rare amongst UK children due to immunization.

3. Definition & Etiology There is no hard and fast definition of lower respiratory tract infection (LRTI), that is universally adopted. Essentially, it is inflammation of the airways/pulmonary tissue, due to viral or bacterial infection, below the level of the larynx.

4. Viral causes Influenza A Respiratory Syncytial Virus (RSV) Human Metapneumovirus 4 Varicella-Zoster Virus (VZV - Chickenpox) Adenovirus Para-influenza virus

5. Bacterial Agents Streptococcus pneumoniae Hemophilus Influenzae Staphylococcus aureus M Klebsiella pneumoniae Enterobacteria e.g. E. coli Anaerobes

6. Atypical Agents Mycoplasma pneumoniae Legionella pneumophila Chlamydia sp. Coxiella burnetii

7. Clinical Features Presentation Acute febrile illness, possibly preceded by typical viral URTI. Symptoms : Cough Breathlessness ( preventing feeding) Irritability Sleeplessness Chest or abdominal pain in older patients Audible wheezing is rare in LRTI, but can occur

8. Physical Signs Capillary blood oxygen saturation <95% Intercostal and supra-sternal recession Flushing Tachypnea High fever over 38.5 c Nasal flaring in children under 1 yr of age Dullness to percussion over zones of pneumonia consolidation. Cyanosis in advanced cases.

9. Differential Diagnosis Asthma Bronchiolitis (a form of LRTI) Inhaled foreign body Pneumothorax Cardiac dyspnoea Pneumonitis of other cause e.g. extrinsic allergic alveolitis

10. Investigations Chest radiography if fever and tachypnea, oxygen saturation to monitor condition. In hospital consider capillary or arterial blood gases. Culture of sputum or nasopharyngeal discharge/aspirate may be used in hospital but has little to add in primary care. Blood cultures if evidence of septicemia. Blood urea and electrolytes

11. Management Admission for children under 5 years with fever and breathlessness is mandatory. Older children can be managed with close observation at home if not distressed Physiotherapy has no place in treatment of uncomplicated pneumonia in children without pre-existing respiratory disease.

12. Essential Measures Oxygen, IV fluids if unable to feed, Respiratory support in severe cases Cough medicines are not indicated and may be used if cough interferes with feeding or sleep. Honey with lemon may be helpful. Antihistamines are dangerous in young children & should be avoided.

13. Medications Antipyretics (avoid aspirin in young children due to danger of Reye's syndrome ). Antibiotic treatment for bacterial pneumonias. Pneumonia or LRTI following URTI is likely to be viral and will not respond to antibiotic therapy. However, it is difficult to distinguish between viral and bacterial infection and young children can deteriorate rapidly. so consider antibiotic therapy depending on presentation and the clinical judgment of the concerned child.

14. Antibiotics Streptococcal pneumonia is treated with oral penicillin V, or synthetic penicillin such as amoxicillin as first line drugs. Recent research indicates that children with non-severe pneumonia on amoxicillin for 3 days do as well as those who receive it for 5 days If a child is genuinely allergic to penicillin, consider using a macrolide or quinolone. Cephalosporin often cross-react with penicillin.

15. Antibiotics/2 For Hemophilus influenzae cephalosporins or Amoxicillin/Calvulenic acid combination are useful. For Staph pneumonia cloxacillin and flucloxacillin are used and in severe cases parenteral vancomycin is required. Injectable antibiotics are indicated in severe cases

16. Complications Bacterial invasion of the lung tissue can cause: pneumonic consolidation , septicemia, empyema, lung abscess (esp. S. Aureus) pleural effusion . Mycoplasma P. can cause hemolysis Rarely, respiratory failure, hypoxia and death.

17. Prevention It is achieved with pneumococcal vaccine and influenza vaccine Stop indoor smoking. Smoking at home or school is a major risk factor. Zinc supplementation reduces the incidence of pneumonia by over 40% in malnourished children.

18. Demographic Details Name: XYZ Age: 11 years Gender: Female Address: XYZ

19. Patient History No Alcohol No Smoking No Tobacco No past medication history

20. Day 1 S/B : MO C/O :pain in axilla, Fever spike, nausea G/C: Fair Afebrile BP: 104/60mmHg Pulse: 110 bpm Respiration Rate : 28 per min CNS: Drowny P/A: Soft Rx Inj TAXIMAX : 15mg Inj EMSET : 2 ml Inj PAN : 40mg IVF 0.45% DNS : 60ml/ hr

21. Day 2 S/B : MO C/O :Cough on mild cold ,Vomiting Fever on/off G/C: Fair Afebrile BP: 105/62mmHg Pulse: 110 bpm Respiration Rate : 30 per min CNS: Conscious P/A: Soft Rx Inj TAXIMAX : 15mg Inj EMSET : 2 ml Inj PAN : 40mg IVF 0.45% DNS : 60ml/hr

22. Day 3 S/B : MO C/O :Cough Poor intake, Weakness G/C: Fair Afebrile BP: 108/70mmHg Pulse: 110 bpm Respiration Rate : 28 per min CNS: Conscious P/A: Soft Rx Inj TAXIMAX : 15mg Inj EMSET : 2 ml Inj PAN : 40mg IVF 0.45% DNS : 60ml/ hr

23. Day 4 S/B : MO C/O :Cough Fever Spike, Cold G/C: Fair Afebrile BP: 115/70mmHg Pulse: 92 bpm Respiration Rate : 28 per min CNS: Conscious P/A: Soft Rx Inj TAXIMAX : 15mg Inj EMSET : 2 ml Inj PAN : 40mg IVF 0.45% DNS : 60ml/ hr

24. Day 5 S/B : MO C/O :Cough Fever Spike, Cold G/C: Fair Afebrile BP: 110/70mmHg Pulse: 86 bpm Respiration Rate : 32 per min CNS: Conscious P/A: Soft Rx Inj TAXIMAX : 15mg Inj EMSET : 2 ml Inj PAN : 40mg IVF 0.45% DNS : 60ml/ hr Patient got discharged

25. DISCHARGE MEDICATION TAB. AUGMENTATION 625 mg 1-1-1 10 day TAB. R-CINEX 450 mg OD (10 days) (ISONIAZID (300 mg)+ RIFAMPICIN (600 mg)) TAB. BENADON 40 mg 0-1-0 (10 days) (Pyridoxine (vitamin B6)- 40 mg) TAB. RESODIUM 15 mg 1-0-0 ( 10 days) (Tolvaptan 15 mg)

26. Patient Counselling Information about disease Avoid Smoking Avoid alcoholic beverages Wash your hands properly Maintain good hygiene

27. Reference Pharm D APP academicworks.cuny.edu Mediscape