Respiratory Problems in Children
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1 Respiratory Problems in Children A/Prof Alex Tang all that glitters is not gold, all the wheezes is not asthma
2 Objective Describe an overview of respiratory problems in children Define common respiratory problems in childhood and their management
3 Major Causes of Death in Children <5 Years of Age and in Neonates Major Causes of Death in Children <5 Years of Age Major Causes of Death in Neonates Injuries 3% Other 10% Preterm 28% Congenital 8% Pneumonia 19% Malaria 8% Measles 4% Diarrhea 17% Neonatal 37% HIV/AIDS 3% Other 7% Asphyxia 23% Tetanus 7% Sepsis or Diarrhea 3% Pneumonia 26% Adapted from Bryce J, et al. Lancet. 2005;365:
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5 Respiratory problems in Children What are the common infective agents?
6 Age Pathogens Newborn Group B streptococcus, E.coli, Klebsiella species, Enterobacteticeae 1 3 mo Chlamydia trachomatis, respiratory syncytial virus (RSV), other respiratory viruses, Bordetella pertussis 2-5 yo Respiratory viruses, S. pneumoniae, Hib, NTHI, M. pneumoniae, Chlamydia pneumoniae 6-18 yo M. pneumoniae, S. pneumoniae, C. pneumoniae, NTHI, influenza A or B, adenovirus, other respiratory viruses Ismail H, Ng HP, Thomas T 2008, Paediatric Protocols For Malaysian Hospital. 2nd Ed n, KKM, Selangor, p. 88.
7 Respiratory problems in Children Throat
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11 Respiratory problems in Children Throat Nose
12 Nasopharyngeal Colonization S. pneumoniae can be a normal inhabitant of the nasopharynx 1 Global nasopharyngeal (NP) colonization/carriage ranges: 10% to 85% in children <5 years of age 2,3 4% to 45% in adults 2-4 AOM Sinusitis Spread to other individuals Pneumonia Bacteremia Meningitis NP colonization is generally a prerequisite for mucosal and invasive pneumococcal disease 2,4 Image adapted from: 1. Hull MW, et al. Infect Dis Clin North Am. 2007;21: Cardozo DM, et al. Braz J Infect Dis. 2006;10: Regev-Yochay G, et al. Clin Infect Dis. 2004;38: Chi DH, et al. Am J Rhinol. 2003;17:
13 % Incidence Nasopharyngeal Carriage rates in Children 70 38%-60% %-35% 9%-25% 0 Preschool Grammar School Jr. High School Fedson DS et al. In: Plotkin SA. Vaccines
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15 Acute Otitis Media Acute otitis media is an inflammation of the middle ear It is one of the most common infectious diseases in children Symptoms of otitis media can include: Ear pain Discharge from the middle ear Difficulty hearing Nonspecific symptoms include: fever, irritability, headache, apathy, lack of appetite, vomiting, and diarrhea Klein, p 215, 220
16 Respiratory problems in Children Throat Nose Larynx
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21 Respiratory problems in Children Throat Nose Larynx Trachea
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24 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus
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26 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles
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29 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma
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36 Pneumonia Episodes per Child-year Worldwide (WHO Estimate) Nearly three-quarters of all pneumonia episodes worldwide in children <5 years of age occur in just 15 countries* Episodes per child-year WHO=World Health Organization *India, China, Pakistan, Bangladesh, Nigeria, Indonesia, Ethiopia, Democratic Republic of the Congo, Vietnam, Philippines, Sudan, Afghanistan, United Republic of Tanzania, Myanmar, Brazil Adapted from Rudan I, et al. Bull WHO. 2008;86:
37 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Thoracic cavity
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40 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Thoracic cavity Tuberculosis
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44 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Tuberculosis Cystic fibrosis
45 Cystic Fibrosis
46 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Tuberculosis Cystic fibrosis Childhood Asthma
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48 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Tuberculosis Cystic fibrosis Childhood Asthma Bronchopulmonary Dysplasia (BPD)
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51 Respiratory problems in Children Throat Nose Larnyx Trachea Bronchus Bronchioles Lung Parenchyma Tuberculosis Cystic fibrosis Childhood Asthma Bronchopulmonary Dysplasia (BPD) Respiratory failure
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53 What are the causes of cough and breathlessness in children?
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55 Light at the end of the tunnel
1/9/ :00:00AM 1/9/ :40:15AM 6/9/2017 9:19:16AM A/c Status. Test Name Results Units Bio. Ref. Interval. Nasal Swab
LL - LL-ROHINI (NATIONAL REFERENCE 135091523 Age 36 Years Gender Female 1/9/2017 120000AM 1/9/2017 114015AM 6/9/2017 91916AM Ref By Final RESIRATORY COMREHENSIVE ANEL (33 ATHOGENS) RESIRATORY ANEL 1 #
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