ACUTE RESPIRATORY INFECTIONS

• ARIs are the most common infections causing morbidity and mortality in children

• 1/3rd of the children attending hospitals suffer from ARI.

Classification

• Upper Respiratory Tract Infections– Above the level of larynx

• Ear • Nose • Sinuses • Tonsils • Pharynx

Classification

• Lower Respiratory Tract Infections– At and below the larynx

• Larynx • Trachea • Bronchial tubes• Lung parenchyma

Common cold

• Commonest of all infection

• Mostly viral

• Fever

• Mucopurulent nasal discharge

• Aches and pains

Acute Otitis Media

• Infection of middle ear

• Mostly affects infants

• Pain in the ear

• Fever

• Tympanic membrane becomes red and bulging with loss of normal light reflection

• There may be pussy discharge from the ear

Sinusitis

• Infection of ethmoidal, maxillary, sphenoidal and frontal sinuses

• Occur secondary to viral rhinitis

• Causative agents– Bacteria

• Streptococcus Pneumoniae• Heamophilus Influenzae• Moraxella Catarrhalis

Sinusitis

• Nasal congestion, purulent nasal discharge

• Cough and fever

• Headache

• Erythema and swelling of nasal mucosa with purulent discharge

• Diagnosis is clinical

Pharyngitis • Infection of pharynx

• Causative agents– Viruses

• Adenovirus• Respiratory syncytial virus• Ebstein Barr virus

– Bacteria• H.Influenzae• Streptococcus Pneumoniae

Pharyngitis

• Sore throat with scratchy feeling

• Fever

• No cough

• Headache and GI symptoms

• Viral illness may present with low grade fever, cough, conjunctivitis, rhinorrhoea and hoarse voice

Pharyngitis

• Pharynx is red with red ,swollen uvula

• Pharynx and tonsils may be covered with exudate

• Anterior cervical lymph nodes may be enlarged and tender

Tonsillitis

• Infection of the palatine tonsils

• Most commonly caused by Group A β heamolytic Streptococci

• Also caused by Staphlococcus Aureus and Mycoplasma Pneumoniae

Tonsillitis

• High grade fever with chills and rigors• Dry throat• Malaise with severe myalgias and

headache• Ear ache• Enlarged erythematous tonsils with

exudates• Enlarged and tender jugulodiagastric

lymph nodes

Croup

• Laryngotracheobronchitis

• Mostly viral– RSV– Influenza virus

Croup

• Can cause severe obstruction

• Fever and coryza

• Barking cough

• Harsh stridor

• Hoarseness of voice

Bronchiolitis

• Infection of small bronchioles

• More than 50% of cases are caused by Respiratory Syncytial Virus

• Others include para influenza virus and adenovirus

• Mostly occurs in winters

Bronchiolitis

• Previous history of URTI

• Respiratory difficulty

• Wheezing

• Grunting

Bronchiolitis• Restlessness

• Tachypnoea with intercostal,subcostal recessions

• Cyanosis later

• Difficulty in feeding leading to dehydration

• Tachycardia

• Auscultation reveals expiratory rhonchi, crepitations and decreased breath sounds

Pneumonia

• Infection of lung parenchyma

• Causes – Bacterial

• Pneumococci • Streptococci • Staphylococci • H. Influenzae• Mycoplasma Pneumoniae• Mycobacterium tuberculosis

Pneumonia• Causes

– Viruses• RSV• Adenovirus• Influenza and parainfluenza

– Fungal• Candida

– Protozoal • Pneumocystis Carinii

Pneumonia

• Fever , irritability and restlessness

• Reluctance to feed

• Breathlessness and chest pain

• Cough

Pneumonia

• Tachypnoea, nasal flaring and chest indrawings

• Wheeze

• Bilateral crepitations

• Signs of consolidation– Dull percussion– Decreased breath sounds– Bronchial breathing

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WHO ARI classification

• Respiratory rates at various ages– <2 months 60/min– 2 – 12 months 50/ min– 1 -5 yrs 40/ min

2 months to 5 years

• No Pneumonia– Cold – Cough – Rhinorrhoea – Fever

2 months to 5 years

• Pneumonia – Fever – Cough– Increase R/R according to age

2 months to 5 years

• Severe Pneumonia– Chest indrawings– With or without increase R/R

2 months to 5 years

• Very Severe Disease (danger signs)– Cyanosis – Poor feeding– Stridor in a calm child– Convulsions / fits– Severe malnutrition

– Presence of any 2 signs