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DTM&H > Respiratory Infections in the Tropics > Flashcards

Respiratory Infections in the Tropics Flashcards

1
Q

What proportion of deaths in children <5y/o is accounted for by acute respiratory infections?

A

1/3rd

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2
Q

What is the most reliable clinical sign of LRTI?

A

Raised RR

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3
Q

What are the risk factors for respiratory infection in children?

A
  1. Young age
  2. LBW
  3. Malnutrition
  4. Exposure to indoor smoke
  5. HIV
  6. Cardiac abnormalities
  7. CP
  8. Poor immunisation coverage
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4
Q

What is the sensitivity of blood cultures in pulmonary infection?

A

<30%

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5
Q

In the tropics, is acute respiratory infection in children more likely to be bacterial or viral?

A

Bacterial
Also more severe and more likely to be fatal, with that difference in severity being due to socio-economic factors rather than climate

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6
Q

What are the most common causative organisms of LRTI in the tropics in neonates, HIV +ve and the malnourished?

A
  1. S.aureus
  2. K.pneumonia
  3. E.coli
  4. Salmonella sp. (NTS)
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7
Q

What are the most common causative bacteria of LRTI in the tropics in children >2 months?

A
  1. S.pneumonia
  2. H.influenza
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8
Q

What are the most common causative viruses implicated in LRTI in the tropics in children >2 months?

A
  1. RSV
  2. Influenza
  3. Parainfluenza
  4. Measles
  5. Human metapneumovirus
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9
Q

What is the most common causative fungi implicated in LRTI in the tropics in children >2 months?

A

Pneumocystis jirovecii (causing PCP)

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10
Q

How should non-severe pneumonia with wheeze in children be treated?

A

No Abx -likely to be viral

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11
Q

How should non-severe pneumonia without wheeze in children be treated?

A

Oral amox for 5 days (3 days where low HIV prevalence)

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12
Q

How should severe pneumonia in children be treated?

A

IV ampicillin or IV benpen AND IV gent

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13
Q

What Abx should be used if first-line treatment for severe pneumonia in children has failed?

A

Ceftriaxone

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14
Q

What is GAPPD?

A

The integrated global action plan for pneumonia and diarrhoea (GAPPD), the purpose being to end preventable child deaths from pneumonia and diarrhoea by 2025

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15
Q

What are the principles of GAPPD?

A

P - PROTECT
P - PREVENT
T - TREAT

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16
Q

What are the principles of the PROTECT part of GAPPD?

A
  1. Exclusive breastfeeding to 6/12
  2. Adequate complimentary feeding
  3. Vitamin A supplementation
17
Q

What are the principles of the PREVENT part of GAPPD?

A
  1. Vaccination - pertussis, measles, Hib, PCV, rotavirus
  2. Hand-washing with soap
  3. Safe drinking water and sanitation
  4. Reduce household air pollution
  5. HIV prevention
  6. Co-trimoxazole prophylaxis for HIV-infected and exposed children
18
Q

What are the principles of the TREAT part of GAPPD?

A
  1. Improved care seeking and referral
  2. Case management at health facility and community level
  3. Supply access - low osmolarity ORS, zinc, Abx, O2
  4. Continued feeding (inc. breastfeeding)
19
Q

What is the most common cause of acute respiratory infection in adults?

A

S.pneumoniae

20
Q

High incidence of acute respiratory infection in adults is secondary to what factors?

A
  1. HIV
  2. High carriage rates in children
  3. Large family size
  4. Overcrowding
  5. Exposure to domestic and tobacco smoke
  6. Impaired immunity secondary to poor diet and parasitic infection
  7. Pregnancy
  8. DM
  9. Alcohol
  10. Poor splenic function e.g. sickle cell disease
21
Q

What is the impact of biomass fuel on respiratory disease?

A

Particulate smoke and poor ventilation = increased susceptibility to acute and chronic pulmonary infection, women and children being particularly susceptible to these exposures, the fuels being used in cooking

22
Q

What are the unique occupational exposures of the tropics?

A

Melioidosis - in SE asian rice farmers
Gnathostomiasis and paragonomiasis - in fishermongers
Schistosomiasis - in fishermen

23
Q

What occupational exposure are fisherman at risk of?

A

Schistosomiasis

24
Q

What occupational exposure are fishmongers at risk of?

A

Gnathostomiasis and paragonomiasis

25
Q

What occupational exposure are SE asian rice farmers at risk of?

A

Melioidosis

26
Q

What are the broad, over-arching causes of respiratory disease in the tropics?

A
  1. Acute respiratory infection
  2. Asthma and allergy (more common in malnutrition)
  3. Biomass fuel
  4. Tobacco
  5. Occupational lung disease
  6. Parasitic disease
  7. Tropical pulmonary eosinophilia - occurs in areas where Wuchereria bancrofti and Brugia malayi are endemic. Responds to anti-filarial treatment
  8. Others - penumothorax, PE (no prophylaxis in hospital), pulmonary HTN secondary to PE/HIV, sarcoid, effusions secondary to TB etc.

DTM&H (8 decks)

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