for Undergraduates of MBBS.

1. ACUTE RESPIRATORY INFECTION
• Dr. Bushra Jabeen,
• Assistant Professor
• Department of Community Medicine
• ESIC Medical College Kalaburagi

2. INTRODUCTION TO ARI
Most common human ailment
Source of discomfort, disability and loss of time
Morbidity and mortality among young children and elderly
Inflammation of the respiratory tract anywhere from nose to alveoli with
combination of symptoms and signs.
Classification by clinical syndromes depending on site:
ARI of upper
respiratory tract
Common cold
Laryngitis
Otitis media
ARI of lower
respiratory tract
Epiglottitis
Laryngitis
Laryngotracheitis
Bronchitis,
bronchiolitis
Pneumonia
Clinical features
Running nose,
cough, sore throat,
difficulty breathing,
er problem. Fever

3. MAGNITUDE OF ARI
• Lancet-
• In 2016, pneumonia was responsible for 13-16%of
all deaths in children younger than 5 years.
• Stretococcus pneumoniae = 78% of the lobar
pneumonia cases and 13% of
bronchopneumonia cases.
• Other common cause - Haemophilus influenzae
type b.
• India
• 13% of Inpatients deaths in paediatrics = ARI
• 2018 = 4.2 crore cases, 3.7 thousand deaths due to
ARI; 9 lakh cases and 4.2 thousand deaths due to
pneumonia.

4. EPIDEMIOLOGICAL DETERMINANTS
Bacteria – B. pertussis, H. influenzae, Pneumoniae,
Staphylococcus, Streptococcus
Agent : Viruses – Adenoviruses, Enteroviruses, Influenza ABC, Measles,
RSV, Rhinoviruses, Coronavirus
Others – Psittacosis, Mycoplasma pneumoniae, Coxiella Brunetti
Host: infants, young children, elderly
LBW, Malnutrition, lack of immunization, antecedent viral
infection
Environmental factors:
Climatic condition, housing, level of
industrialization, Socio-economic
development, Air pollution, passive smoking,
pollution from biomass fuel, overcrowding
Acute
Respiratory
Infection
Severity of Infection: occurrence of
secondary bacterial infection
Mode of transmission: airborne route.

5. CLINICAL
ASSESSMENT
Age of the child
cough -duration
and frequency
Able to drink,
feed
Antecedent
infections like
measles
H/S/O:
Fever
Excessively
drowsy
Difficulty to wake
Convulsions
Irregular
breathing
Short periods of not breathing or
the child turning blue
H/O treatment
during illness.

6. CLASSIFICATION OF RESPIRATORY TRACT
Upper
respiratory
tract
infections:
Common cold
Pharyngitis
Laryngitis
Tracheitis
Epiglottitis
Otitis media
Lower
respiratory
tract
infections:
Bronchitis
Bronchiolitis
pneumonias

7. PHYSICAL EXAMINATION
Count the
breaths in one
minute
Look for chest
indrawing
Look and listen
for stridor
Look for wheeze
See if the child is
abnormally
sleepy or difficult
to wake
Feel for fever or
low body
temperature
Check for severe
malnutrition
Check for
cyanosis

8. LOOK LISTEN AND FEEL
Age of the child Respiratory rate
Less than 2 months >60 breathes per minute
2 months -12
months
>50 breathes per minute
12 months - 5 years >40 breathes per minute
Fast Breathing Criteria
Chest indrawing
• Inward movement of the lower chest wall when the child
breathes in and is a sign of respiratory distress.
Stridor
• Harsh noise heard when a sick child breathes in.
• due to swelling or obstruction in the child's upper
airway.
Wheeze
• High-pitched whistling sound near the end of expiration.
• Due to narrowing of the small air passages of the lung.

9. CLASSIFY THE ILLNESS
• Purpose:
• To make decision about
severity of disease
• Choose line of action or
treatment
• It is done based on
danger signs and
respiratory rate.
Colour Code Treatment
Very Severe Disease Pink Refer Urgently To Hospital
Severe Pneumonia Pink Refer Urgently To Hospital
Pneumonia (Not Severe) Yellow
Give An Antibiotic And
Home Care
No Pneumonia Green Home Care

10. CLASSIFICATION OF ILLNESS
Classifying illness of young infant
Very severe
pneumonia
Severe pneumonia No Pneumonia
A child aged 2 months upto 5 years
Very severe
disease
Severe
pneumonia
Pneumonia
(not severe)
No pneumonia:
cough or cold

11. DANGER SIGNS

12. DIFFERENTIAL DIAGNOSIS OF A
CHILD WITH DIFFICULT
BREATHING
WHEEZE-DIFFERENTIAL DIAGNOSIS

13. 2 MONTHS TO 5 YEARS YOUNG INFANTS
MANAGEMENT OF VERY SEVERE DISEASE

14. 2 MONTHS TO 5 YEARS YOUNG INFANTS
MANAGEMENT OF SEVERE PNEUMONIA
• Chest indrawing
• Recurrent wheezing
S
igns
• S
evere Pneumonia
Classify as
• Refer urgently to hospital
• Give first dose of an antibiotic
• Treat fever,if present
• Treat wheezing,if present
• If referral is not feasible treat with an
antibiotic and follow closely
Treatment
• S
evere chest indrawing,or
• Fast breathing
S
igns
• S
evere Pneumonia
Classify as
• Refer urgently to hospital
• Keep the young infant warm
• Give first dose of an antibiotic
• If referral is not feasible,treat with an
antibiotic and follow closely.
Treatment

15. MANAGEMENT
OF PNEUMONIA
• Fast breathing
• No Chest indrawing
Signs
• Pneumonia
Classify as
• Advice mother to give home care
• Give an antibiotic
• Treat wheezing/ fever if present
• Advice mother to return with child
after 2 days for reassessment/
earlier if the child is getting worst
Treatment
2 MONTHS TO 5 YEARS

16. REASSESSMENT

17. 2 MONTHS TO 5 YEARS YOUNG INFANTS
MANAGEMENT OF NO PNEUMONIA
• No Chest indrawing
• No fast breathing
S
igns
• No Pneumonia:Cough or Cold
Classify as
• If coughing > 30 days – refer for
assessment
• Assess and treat ear problem/ sore
throat
• Assess and treat other problems
• Advise mother to give home care
• Treat fever if present
• Treat wheezing,if present.
Treatment
• No severe chest indrawing and
• No fast breathing
S
igns
• No Pneumonia:cough or cold
Classify as
• Advise the mother to give the
following home care:
• Keep young infant warm
• Breast-feed frequently
• Clear nose if it interferes with feeding
• Return quickly if:-
• Breathing becomes difficult/ fast
• Feeding becomes aproblem
• The young infant becomes sicker.
Treatment

18. PREVENTION & CONTROL

19. KEY STRATEGIES FOR PREVENTION AND
CONTROL OF ARI
Case management at all levels
Improvement of nutrition and reduction of LBW
Vaccination
Control of indoor pollution
Prevention and management of infections

20. PREVENTIVE
MEASURES
Immunization against common respiratory pathogens
Cough etiquette &
Sputum and room disinfection
Individual
Level
Improving ventilation at home
Avoiding overcrowding
Reducing indoor air pollution
Family
Level
Reducing air pollution
Communit
y Level
Implementing air-borne infection control measures
Institution
al Level

21. AIRBORNE
INFECTION
CONTROL
PRACTICES AT
DIFFERENT
LEVELS

22. CONTROL OF ARI
Improving medical care services
Better methods of early detection, treatment
Prevention is the best control strategy
• Compliance with treatment
• Observing signs of pneumonia
• Seeking care promptly
Education of mother
Following WHO guidelines

23. IMMUNIZATION
Measeles vaccine
Hib Vaccine
Pneumococcal pneumonia
vaccine

24. THE INTEGRATED
GLOBAL ACTION PLAN
FOR THE PREVENTION
AND CONTROL OF
PNEUMONIA AND
DIARRHOEA

25. CASE SCENARIO

26. CASE
SCENARIO
Rohan aged 6 months, son of Mr. Sasi and Smt. Santha, both working as daily
labourers at a construction site has been admitted to ESIC hospital with
complaints of fever, cough and difficulty in breathing. His problem started 3
days ago with running nose, fever and cough for which his mother gave a
syrup bought from a chemist’s shop. Child’ condition became worse and
developed difficulty in breathing. O/e. respiratory rate was 56/minute; and
chest in-drawing was present. Though Santha used to breastfeed Rohan,
occasionally she used to leave him the whole day with his grandmother when
she went for work. He was born in Taluk hospital and his birth weight was
2200gms. Rohan’ family has total 7 members including his parents, grand
parents, and 2 elder siblings aged 2 years and 4 years.

27. QUESTIONS
1.What is the probable diagnosis in this case?
2.List the points in favour of your diagnosis.
3.List the known risk factors of this condition and list those which are present in this case.
4.Comment on the socio-economic background of this patient and list additional items of information you would like to
include while eliciting detailed clinical and socio-economic history in this patient.
5.Describe the WHO approved guidelines for clinical management of this condition in your hospital for this patient.
6. List the items you will include while advising the child’s mother to prevent recurrence of this problem in this child.

28. MANAGEMENT OF CHILD WITH
COUGH OR DIFFICULT
BREATHING
• Assessing the child by asking
• Classifying the illness of the child
• Decision for treatment
• Follow-up of cases.

29. TREATMENT
GUIDELINES
• Young infants (0-2 months)
• Children 2 months to 5 years
Age/weight Pediatric tablet:
Sulphamethoxazole
100mg and
Trimethoprim 20 mg
Pediatric syrup:
Each spoon (5 ml):
Sulphamethoxazole 200
mg and Trimethoprim 40
mg
< 2 months
(wt. 3-5 Kg)
One tablet twice a day Half spoon (2.5 ml)
twice a day
2-12 months
(wt. 6-9 Kg)
Two tablets twice a day One spoon (5 ml)
twice a day
1-5 years
(wt. 10-19 Kg)
Three tablets twice a
day
One and half spoon (7.5
ml)
twice a day

30. TREATMENT OF SEVERE
PNEUMONIA
(2 MONTHS – 5 YEARS)

31. SUMMARY

32. REFERENCES
• Park K, textbook of preventive and social medicine, 26th edition.
• Sarvar Rana, Community medicine, A Practical manual for clinico-social
cases. Paras medical books.

33. THANK YOU . . .