Rajiv Gandhi University of Health Sciences s107

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA. ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

DR. PUNNAPU SHRUTHI 1. NAME OF THE CANDIDATE AND ADDRESS DEPARTMENT OF PAEDIATRICS. (In block letters) VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE. #82, E.P.I.P. AREA,WHITEFIELD, BANGALORE-560066.

2. NAME OF THE INSTITUTION VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE, BANGALORE-560066 3. COURSE OF STUDY AND SUBJECT M.D (PAEDIATRICS) 4. DATE OF ADMISSION TO COURSE 20TH APRIL 2011

5. TITLE OF THE TOPIC CLINICAL AND MICROBIOLOGICAL STUDY OF UPPER RESPIRATORY TRACT INFECTION IN CHILDREN

6.1 NEED FOR THE STUDY:

1 6.1 NEED FOR THE STUDY:

Upper respiratory tract infection (URI) represents the most common acute illness

evaluated in the outpatient setting. URIs range from the common cold--typically a mild, self-limited, catarrhal syndrome of the nasopharynx--to life-threatening illnesses such as epiglottitis. Viruses account for most URIs. Bacterial primary infection or superinfection may require targeted therapy.1

Acute respiratory infections accounts for 20–40% of outpatient and 12–35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections.2

The etiology of upper respiratory tract infection in young children is still not fully understood and numerous clinical and laboratory investigations has been carried out in an attempt to elucidate this problem.

The present study is to find out clinical and microbiological profile of pediatric patients who present to the institute. The findings may be of interest in treatment intervention appropriate to the microbial etiology of upper respiratory tract infection in pediatric age group.

2 REVIEW OF LITERATURE

The vast majority of acute upper respiratory tract infections are caused by viruses.

Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis areS. pneumoniae, H. influenzae, M. catarrhalis,S. aureus andS. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic.Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10–14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.2 Upper respiratory tract infections (including otitis media) are the most common illnesses affecting children.3

The cause of these respiratory mucosal infections most commonly is viral but can be bacterial. Rhinosinusitis is caused by Viruses such as Rhino virus, Corona virus,Entero virus, Para influenza,Influenza,Respiratory syncitial virus, Adenovirus,Metapneumo virus and Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae,

Moraxella catarrhalis, Staphylococcus aureus,Streptococcus pyogenes.Pharyngitis is caused by Viruses such as adenovirus, respiratory syncytial virus, Epstein

Barrvirus,Cytomegalo virus,para influenza, influenza virus and Bacteria such as

Streptococcus pyogenes,Group C and G Streptococci,Mycoplasma pneumonia.4 REVIEW OF LITERATURE

3 A study was conducted by Shreshta et al with aims to identify the causative bacterial agents of upper respiratory tract infection ( URTI ) among pediatric patients and to reveal the antibiotic susceptibility pattern of the major pathogens. The study concluded that despite the existence of so many pathogens, and the susceptible antibiotics, Amoxycillin has been found to be the most effective against the pathogens causing URTI among pediatric population.5

A study was done by Anita Roche et al to estimate the prevalence of nasopharyngeal

(NP) carriage of pneumococcus (Streptococcus pneumonia) and to describe the antibiotic resistance patterns and serotypes in young children attending group day care in London.

The study concluded that the prevalence of pneumococcal NP carriage was high. The penicillin resistance rate is lower than in many other countries.6

4 6.3 OBJECTIVES OF THE STUDY: To evaluate the clinical and microbiological profile of patients of upper respiratory tract infections in children in the age group of 6 months to 14 years.

6.3 Inclusion and Exclusion criteria: INCLUSION CRITERIA 1. All patients with clinical profile suggestive of upper respiratory tract infections referred to the department of pediatrics. 2. Age group for the study: Children aged 6 months to 14years.

EXCLUSION CRITERIA 1. Children with lower respiratory tract infections. 2. Children on antibiotics.

5 STATISTICAL ANALYSIS:

Data analysis will be done by using chi square.

7.0 MATERIALS AND METHODS

7.1 Source of Data: A study of patients from pediatric OPD and inpatient wards at the Vydehi Institute of medical sciences and research centre.

7.2 Methods of collection of data (including sampling procedure, if any) A minimum of 500 patients attending pediatric out patient department with suggestive clinical features of upper respiratory tract infection. A detailed clinical evaluation will be recorded including age, sex, clinical features suggestive of upper respiratory tract infection like nasal discharge, nasal obstruction , nasal congestion, sneezing , sore throat, ear discharge, mild to moderate cough and sometimes associated with fever, myalgia ,malaise and fatigue . The throat, nasal and ear swab samples from upper respiratory tract infection children will be obtained and sent for culture and sensitivity for antibiotics will be tested.

Place of study: Dept of Pediatrics, VIMS AND RC , BANGALORE .

Duration of study: Study will be a one year cross sectional study, (January 2012- December 2012).

7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.

YES Nasal, Throat and Ear swab from the patients suspected with upper respiratory tract infection.

6 7.4 Has ethical clearance been obtained from your institution in case of 7.3? YES. Copies enclosed.

8 List of References: 1. Anne Meneghetti, Zab Mosenifa et al.Upper respiratory tract infections accessed on 15.10.11 from http://emedicine.medscape.com/article/302460-overview

2. Neemisha jain, Lodha R, Kabra .S. K.Upper respiratory tract infections.Indian Journal of pediatrics.2001;68(12):1135-1138.

3.Monto AS. Epidemiology of viral respiratory infections.American Journal of Medicine 2002;112(6A):4S– 12S.

4.Behrman RE. The Common Cold. Acute Pharyngitis. Nelson textbook of pediatrics.18th edition. Philadelphia: W.B. Saunders Company.2008;376-378:1747-1752.

5.A.Shreshta et al. Bacteriological study of URTI in pediatric patients. Journal of institute of medicine.2006;25(3):1993-2979.

6. Anita Roche, Paul T Heath et al. Prevalence of nasopharyngeal carriage of pneumococcus in pre school children attending day care in london. Archives of Disease in Children 2007; 92:1073-1076.

9. Signature of Candidate :

10. Remarks of the Guide :Forwarded.

11. Name & Designation of (in block letters)

: Prof. Dr. K.NAGENDRA. 11.1 Guide M.D. Pediatrics.

11.2 Signature

11.3 Co-guide

7 11.4 Signature

11.5 Head of the Department

DR.M.G.JAVALI PROFESSORAND HEAD OF THE DEPARTMENT OF PAEDIATRICS

11.6 Signature of the Head of the Department

12. 12.1 Remarks of the Chairman and Principal

12.2 Signature