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
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