Infeksi saluran pernafasan akut (ispa)

5/23/12

Dr. Fifi Sofiah,Master subtitle style Click to edit SpA

Infeksi Saluran Pernafasan Akut (ISPA)

Acute Respiratory Infection (ARI):

1. Acute Upper Respiratory Infection (AURI): - Cold - Otitis media - Pharyngitis

2. Acute Lower Respiratory Infection (ALRI): - Croup

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Acute Respiratory Infections (ARI)

Developed and developing countries

High morbidity 5 8 episodes/year/child 30 50 % outpatient visit 10 30 % hospitalization High mortality 30 70 times higher than in developed 5/23/12 countries

Developing countries

ARI-ASSOCIATED DEATH RATE BY AGE TEKNAF, BANGLADESH, 1982-1985

140 120 100 80 60 40 20 0 1-5 6-11 12-23 Age in Months 24-35 36-50

Deaths per 1000 children

Distribution of 12.2 million deaths among children less than 5 years old in all developing countries, 1993
ARI/Malaria (1.6%) Malaria (6.2) ARI (26.9%)

Other (33.1%)

Malnutritio n (29%)

ARI/Measles (5.2%) Measles (2.4%) Diarrhoea/measle s (1.9%) Diarrhoea (22.8%)

RISK FACTORS FOR PNEUMONIA OR DEATH FROM ARI Malnutritio n, poor breast Lack of feeding Vitamin A immunizatio practicesdeficiency Young Low birth n Increas age weight
e risk of ARI

Crow ding High prevalence of nasopharyn

Cold weather or Exposure to air chilling pollution Tobacco smoke 5/23/12 Biomass smoke

Magnitude of the Problem in Indonesia

Pneumonia in children (< 5 years of age)

Morbidity Rate 10-20 % Mortality Rate 6 / 1000 Pneumonias kill

50.000 / a year / a month / a day = passengers of 1 jumbo jet plane / an hour

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12.500 416 17

Pneumonia is a no 1 killer for infants (Balita)

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Pneumonia
Classifications

Anatomical classification

Lobar pneumonia pneumonia pneumonia

Lobular

Intertitial

Bronchopneumonia

Etiological classification
Bacterial Viral

pneumonia pneumonia

pneumonia
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Mycoplasma

Etiology of Pneumonia

Predominantly : bacterial and viral In developing countries: bacterial > viral

(Shann,1986): In 7 developing countries: bacterial 60 %

(Turner, 1987): In developed countries: 5/23/12 bacterial 19 %, viral 39 %

Bacterial etiology

Streptococcus pneumoniae Hemophilus influenzae Staphylococcus aureus Streptococcus group A B Klebsiella pneumoniae Pseudomonas aeruginosa Chlamydia spp Mycoplasma pneumoniae
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BACTERIA ISOLATED FROM LUNG ASPIRATES IN 370 UNTREATED CHILDREN WITH PNEUMONIA
%
50 40 30 20 10 0

S Pneumoniae

H Influenzae

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S Aureus

Characteristic features

S pneumoniae
mucosal alveolar

inflammation lesion exudates lobar pneumonia

frequently

H influenzae, S viridans, Virus

invasion

and destruction of mucous membrane of tissues multiple abscesses 5/23/12

Staphylococcus, Klebsiella
destruction

Simple Clinical Signs of Pneumonia (WHO)

Fast breathing (tachypnea)
Respiratory thresholds Age Breaths/minute 60 50 40

< 2 months 2 - 12 months 1 5 years

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Integrated Management Childhood Illness (IMCI)

Classification Severe Pneumonia Pneumonia Sign/Symptom Management Tachypnea (+) Refer Chest indrawing (+) Tachypnea (+) Antibiotic Chest indrawing (-) Tachypnea (-) No antibiotic Chest indrawing (-)
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Cough Not Pneumonia

Pathology and Pathogenesis

Bacteriae peripheral lung tissues tissues reaction oedematous

Red Hepatization Stadium

alveoli consist of : leucocyte, fibrine, erythrocyte, bacteria

Grey Hepatization Stadium fibrine deposition, phagocytosis Resolution Stadium

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Bronchopneumonia Early stages of acute bronchopneumonia. Abundant inflammatory cells fill the alveolar spaces. The alveolar capillaries are distended and engorged.

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Bronchopneumonia Acute bronchopneumonia. The alveolar spaces contain abundant PMNs and an inflammatory infiltrate rich in fibrin.

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Acute Bronchopneumonia Acute bronchopneumonia; the alveolar spaces are full and distended with PMNs and a proteinaceous exudate. Only the alveolar septa allow identification of the tissue as lung.

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Radiographic patterns
1. Diffuse alveolar and interstitial pneumonia (perivascular and interalveolar changes)

2.Bronchopneumonia (inflammation of airways and parenchyma) 3. Lobar pneumonia (consolidation in a whole lobe) 4. Nodular, cavity or abscess lesions 5/23/12 (esp.in immunocompromised

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Blood Gas Analysis & Acid Base Balance

Hypoxemia (PaO2 < 80 mm Hg)

with O2 3 L/min O2

52,4 %

without

100 %

Ventilatory insufficiency
(PaCO2

< 35 mmHg) 87,5 % > 45 mmHg ) 4.8 %

Ventilatory failure
(PaCO2

Metabolic Acidosis
poor
5/23/12 intake and/or hypoxemia 44,4 %

Management
Severe Pneumonia

Hospitalization Antibiotic administration

Amphycillin Chloramphenicol

or Gentamycin

Intra Venous Fluid Drip Oxygen Detection and management of 5/23/12 complications

Complications

Pleural effusion (empyema) Piopneumothorax Pneumothorax Pneumomediastinum

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Bronchiolitis

Bronchioles inflammation syndromes: fast breathing, retractions, wheezing < 2 years of age (2 6 months)

Clinical

Predominantly Difficult

to differentiate with pneumonia

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Bronchiolitis

Etiology Predominantly RSV (Respiratory Syncytial Virus), adenovirus etc. Diagnosis Etiological diagnosis

Microbiologic examination and symptoms of infection

Clinical diagnosis
Signs Age Resource
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Bronchiolitis

Clinical Manifestations cough, cold, fever, fast breathing, retraction, wheezing, irritable, vomitus, poor intake Physical Examinations tachypnea, tachycardia, retraction, expiration >, wheezing, fever, pharyngitis, conjunctivitis, otitis media.

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Bronchiolitis

Radiologic examination
diffuse hyperinflation
flat

diaphragm, > space >

subcostal

retrosternal

peribronchial infiltrates pleural effusion (rare)

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Bronchiolitis

Management
Supportive Severe

disease

hospitalization intra venous fluid drip oxygen (antibiotics)

Bronchodilator: Corticosteroid:

controversial controversial
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Bronchiolitis

Natural history & complications

Improved Improved

clinical findings : in 3-4 days radiological features: in 9 days

Persistent respiratory obstruction : 20% Respiratory failure : 25 % Lung collaps (rare)

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Bronchiolitis

Correlation with Asthma

30

% - 50 % becomes asthmatic patients in : - pathogenic mechanisms - pathologic disorders

Similarity

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Thank you
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