A study on pattern of lower respiratory tract infections in children below 12 years of age admitted to KIMS hospital, amalapuram.

Background : Acute respiratory infections (ARI) in children less than five years are the leading causes of mortality. A study was conducted to know the incidence of different types of LRTIs and the common causative organisms. Methods: Routine investigations were carried out on 824 hospitalized children over 18 months and with special investigations like X-ray chest, USG chest, blood culture, pleural fluid analysis, tuberculin skin test, and CBNAAT for tuberculosis.the data were analyzed. Results: Out of 100 cases, 2 cases were diagnosed as tuberculosis. Others, i.e., 97 improved and discharged. The minimum hospital stay was 3 days, and the maximum was 21 days. The incidence of LRTI in children was maximum (48%) in 1 – 4 years age and Protein-energy malnutrition (PEM ) was detected in 72% children. PEM I was maximum (35%) followed by PEM II (16%), PEM III (12%) and PEM IV (9%. Bronchopneumonia was diagnosed maximum (52%) followed by bronchiolitis (12%). Mantoux test was positive in 21%. Staphylococcus aureus was isolated maximum and no significant drug resistance was identified. Conclusion: Maximum incidence of LRTIs were detected between the age group of 1 – 4 years, malnutrition was an associated factor.

Modifiable risk factors were lack of breastfeeding, overcrowding, undernutrition, delayed weaning, and pre lacteal feeding. Other associated conditions like PEM, infectious diseases, and secondary bacterial infections make the child more vulnerable to mortality and morbidity. The etiological agents of LRTI are viral, bacterial in origin or both together [4]. With these, study was conducted to evaluate to find various LRTIs in children below 5 years age. Routine investigations such as Hb%, total, differential leukocyte count and ESR were carried out in the laboratory immediately after an admission. Special investigations like lumbar puncture and ECG done wherever necessary, x-ray chest done in all the 100 cases after admission.

Methods
Chest X ray was repeated in some of the cases after clinical deterioration, and compared with an X ray was taken at admission, Mantoux (TST) was done to all. Throat swab, sputum (if productive) for acid-fast bacilli (AFB), culture sensitivity and gram stain were done. In non-productive cough and in infants who do not bring out the sputum gastric aspiration was done, and stained for AFB and sent for CBNAAT.
In this study, 72% children were associated with PEM, which predominantly observed in serious diseases like Empyema and pneumonia. The incidence PEM was highest (35%) in grade I PEM followed by PEM II (16%), PEM III (12%) and PEM IV (9%). Serious illness was noted in PEM grade-III and IV.
Out of a total of 100 cases, 21% positive Mantoux test. In these, 11 had immunized with BCG vaccination during infancy and 1 was positive HIV serology (    gender distribution between the two groups [12]. In the present study, a higher incidence of LRTIs were found in the age group 1 -4 years, while broncho pneumonia less than 2 years of age.
This high incidence of LRTI is probably due relative Malnutrion was mentioned to be 54.3% by Yellanthoor et al study [13]. Measles associated with severe pneumonia carries more than twice the risk of mortality than severe pneumonia in children without measles does, because pneumonia has a central role in measlesrelated mortality [15]. In the present study, the measles vaccine not received by 16 children, and out of the ten children had a history of measles associated LRTI in history, and measles was the contributing factor for respiratory infection for 2 cases in present admission.
Out of 100 children in this study, 65 children belong to the lower class as per the modified kuppuswamy scale. Twenty-five children belong to the middle socio-economic class, and ten children belong to the upper socio-economic class, which shows that LRTI incidence is more in Lower socioeconomic class.