This document discusses acute respiratory infections (ARIs) which cause 20% of childhood deaths under 5 years old, with pneumonia responsible for 90% of ARI deaths. ARI mortality is highest in children who are HIV-infected, under 2 years old, malnourished, weaned early, from poorly educated families, or with difficult healthcare access. ARIs are classified as upper or lower respiratory tract infections. Treatment depends on classification and severity, ranging from symptomatic treatment at home to hospitalization and intravenous antibiotics. Prevention involves reducing risk factors through vaccination, nutrition, and treating infections early according to IMNCI guidelines.

1. ACUTE RESPIRATORY
INFECTIONS
Dr Deepak Upadhyay
Assistant Profesor
Dept of Community Medicine

2. Epidemiology
• ARI RESPONSIBLE FOR 20% OF CHILDHOOD (<
5 YEARS) DEATHS (IN WHICH 90% FROM
PNEUMONIA)
• ARI MORTALITY HIGHEST IN CHILDREN-
• HIV-infected
• Under 2 year of age
• Malnourished
• Weaned early
• Poorly educated parents
• Difficult access to healthcare
• OUT- PATIENT VISITS
• 20-60%
• ADMISSIONS
• 12-45%

3. ACUTE RESPIRATORY
INFECTIONS(ARI)
• May cause the inflammation of respiratory tract
anywhere from nose to alveoli.
• May be classified as –
AURI – Acute Upper Respiratory Infection
(common cold, pharyngitis, epiglottitis & otitis media etc.)
or
ALRI – Acute Lower Respiratory Infection
(laryngitis, layngotracheitis, bronchitis, bronchiolitis &
pneumonia)

4. Anatomy of the Respiratory
system

5. Upper Respiratory Tract Infections
• Rhinitis (Common Cold Or Coryza)
– Rhinoviruses, Enteroviruses, Coronaviruses
• Ear Infections (Acute Otitis Media)
– Viruses, Pneumococcus, Gabhs, Hemophilus
Influenza, Moraxella Catarrhalis
• Acute Epiglottitis (Suprglottitis)
• Sinusitis
– Viral/Bacterial

6. Upper Respiratory Tract Infections
• Acute Pharyngitis
– ADENOVIRUS, ENTEROVIRUS,
RHINOVIRUS, GROUP A BETA
HEMOOLYTIC Streptococcus(older
Children)
• Tonsillitis
– Group A Beta Hemolytic Streptococci, EBV

7. Lower Respiratory Tract Infections
• Acute Infectious Laryngitis
– Viral/Diptheria
• Croup (Acute Laryngotracheobronchitis)
• Bronchitis/Bronchiolitis
• Pneumonia

8. VIRUSES AGE GROUP
AFFECTED
CHRACTERISTIC
CLINICAL FEATURES
Enterovirus All ages Febrile pharyngitis
Influenza A, B, C All ages variable
Measles Young children variable
Parainfluenza 1, 2, 3 Young children variable
Respiratory Syncytial
Virus
Infants and young
children
Severe bronchiolitis
and pneumonia
Rhinovirus All ages Common cold
Coronavirus All ages Common cold
AGENT FACTORS

9. AGENT FACTORS
BACTERIA
AGE GROUP
AFFECTED
CHRACTERISTIC CLINICAL
FEATURES
Bordetella pertussis
Infants & young
children
Poroxysmal cough
Corynebacterium
diphtheriae
Children diphtheria
Hemophilus influenzae
Adults
Children
Acute ex of ch bronchitis
Acute epiglottitis
Klebsiella pneumoniae Adults Lobar pneumonia
Legionella pneumophila Adults Pneumonia
Staph. pyogenes All ages Lobar and bronchopneumonia
Strep. pneumoniae All ages Pneumonia
Strep. Pyogenes All ages Acute pharyngitis and tonsillitis

10. Factors Affecting Type of
Illness and Physical
Response in Acute
Respiratory Infections:

11. Agent Factor
• Nature of infectious agent:
– Bacteria > viruses
• Size and frequency of dose:
– The larger the dose
– More frequent the exposure
Host Factor
• Age of child:
– Children of preschool and school age
– Airways are smaller in young children
– considerable narrowing from edema
• Nutritional status of children
• Immunization status
• Birth weight of children

12. • Presence of great conditions:
– Malnutrition, anemia, fatigue, chilling of the body
and immune deficiencies
• Presence of disorders affecting respiratory tract:
– Allergies, cardiac abnormalities and cystic fibrosis
Environmental factors
• Air pollution: Indoor
• Smoking: Passive
• Seasons:
– During winter and spring months
• Living conditions

13. • Primodial prevention (Adoption of healthy life style)
• Primary prevention (Reduction of risk factors)
– Health promotion
– Specific protection
• Secondary prevention (Early diagnosis & Treatment)
– IMNCI approach
– F – IMNCI integration
• Tertiary prevention
– Disease limitation
– Rehabilitation
» Medical
» Psychological
» Social
» Vocational
Prevention of Hypertension
 Quaternary
prevention
 Prevention of
over diagnosis
 Prevention of
resistance

14. Primodial Prevention
• Healthy life style
– Good antenatal care
– Early initiation of breast feeding
– Exclusive Breast feeding
– Proper complementary feeding
– Proper nutrition
• Achieve through health promotion & health
education

15. Primary prevention
• Health promotion
• Adequate nutrition
• Parenthood counselling
• Reduction of passive smoking
• Reduction of indoor pollution
• Improved living condition
• Specific protection
• Vaccination
• Chemoprophylaxis

16. • Vaccination
• Diphtheria & Pertussis
• Measles
• Hib Vaccine
• Pneumococcal Vaccine
• SARS vaccine
• Influenza vaccine
• Chemoprophylaxis
• Vitamin A supplementation
• Antibiotic prophylaxis

17. Secondary prevention
• Early diagnosis & treatment
– IMNCI
– F - IMNCI

18. IMNCI
• Integrated management of neonatal &
childhood illness
• ACT
– Assess
– Classify
– Treatment

19. Assess
• Age –
– < 2 months
– 2 – 12 months
– > 12 moths
• Respiratory rate (Tachypnea)
– In < 2 months (>60 breaths / min)
– In 2 – 12 months (>50 breaths / min)
– In > 12 moths (>40 breaths / min)

20. • Chest in drawing
• Stridor
• Fever
• Danger signs
– Inability to drink or breast feed
– Convulsions
– Lethargy or unconsciousness
– Stridor in calm child

21. SIGNS OF RESPIRATORY DISTRESS

22. SIGNS OF RESPIRATORY DISTRESS

23. Classify
• In children < 2 months
– Serious bacterial infection
• Any danger sign
• Chest in drawing
• Tachypnea
– Bacterial infection (URTI)
• Fever with sneezing / cough

24. • In children > 2 months
– Very Severe pneumonia
• Any danger sign
– Severe pneumonia
• Chest in drawing
• Stridor
• Cyanosis
• Nasal flaring
– Pneumonia
• Tachypnea
– No Pneumonia

25. WHO Classification and management
NO PNEUMONIA COUGH
NO TACHYPNEA
-HOME CARE
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 5 DAYS IF NOT
IMPROVING
PNEUMONIA -COUGH
-TACHYPNEA
-NO RIB OR STERNAL
RETRACTION
-ABLE TO DRINK
- NO CYANOSIS
-HOME CARE
-ANTIBIOTICS FOR 5 DAYS
-SOOTHE THE THROAT AND RELIEVE
COUGH
-ADVISE MOTHER WHEN TO RETURN
-FOLLOWUP IN 2 DAYS
SEVERE PNEUMONIA -COUGH
-TACHYPNEA
-RIB AND STERNAL
RETRACTION
-ABLE TO DRINK
-NO CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT
VERY SEVERE
PNEUMONIA
-COUGH
-TACHYPNOEA
-CHEST WALL RETRACTION
-UNABLE TO DRINK
-CENTRAL CYANOSIS
-ADMIT IN HOSPITAL
-GIVE RECOMMENDED ANTIBIOTICS
-OXYGEN
-MANAGE AIRWAY
-TREAT FEVER IF PRESENT

26. Treatment
• Place of treatment
• No pneumonia
• pneumonia
Domiciliary treatment
• Severe pneumonia
• Very severe pneumonia
Hospital treatment
• Serious bacterial infection Hospital treatment
• Acute URTI Domiciliary treatment

27. • Type of Treatment
• No pneumonia Symptomatic treatment
• Pneumonia Oral Antibiotics + Symptomatic treatment
• Severe pneumonia Injectable Antibiotics + Symptomatic
treatment
• Very severe
pneumonia
Injectable Antibiotics + Symptomatic
treatment
• Serious bacterial
infection
Injectable Antibiotics + Symptomatic
treatment
• Acute URTI Symptomatic treatment

28. • Drugs used
Symptomatic treatment
Fever – Paracetamol
Cough and sneezing – H-1 antagonist (not preferred
in children < 6 months)
Nasal obstruction
Nasal saline drops
Nasal decongestants (not preferred in children
< 6 months
Antibiotics
Oral antibiotics - Cotrimoxazole
Injectable antibiotics
Benzyl penicillin
Ampicillin
Chloramphenicol( preferred drug in Very
sever disease
Gentamycin

29. • Dosage of drugs
• Symptomatic treatment
– CPM(0.1 mg/kg wt/dose)
– Paracetamol (15mg/kg/dose)
• Oral antibiotics
Oral Antibiotics (Cotrimoxazole)
Age / Weight Paediatric tablet:
Sulphamethoxazole
100 mg &
Trimethoprim 20 mg
Paediatric syrup; each spoon
(5ml): Sulphamethoxazole 200 mg
and Trimethoprim 40 mg
<2 months (Wt. 3-5
kg)
1 tablet BD Half spoon (2.5 ml) twice a day
2-12 months (wt 6-9
kg)
2 tablets BD One spoon (5 ml) twice a day
1-5 years (wt 10-19 kg) 3 tablets BD One & half spoon (7.5 ml) twice
a day
Reassess the child after 48 hrs
If improved = continued antibiotics for 3 days
No improvement = continued for another 48 hr (only one cycle)
Deterioration = refer to hospital for injectable antibiotics

30. • Injectable antibiotics
Injectable Antibiotics (2 Months - 5 Years)
Dose Interval Mode
First 48 hours –
Benzyl penicillin Or
Ampicillin Or
Chloramphenicol
50000lU
per kg/dose
50 mg/kg/dose
25 mg/kg/dose
6 hourly
6 hourly
6 hourly
IM
IM
IM
1. If condition IMPROVES, then for the next 3 days give:
Procaine penicillin Or
Ampicillin or
Chloramphenicol
50000 IU/kg (maximum 4 lac IU)
50 mg/kg/dose
25 mg/kg/dose
Once
6 hourly
6 hourly
IM
Oral
Oral
2. If NO IMPROVEMENT, then for the next 48 hour: CHANGE
ANTIBIOTIC –
If ampicillin is used change to chloramphenicol IM;
If chloramphenicol is used, change to cloxacillin 25mg/kg/dose, every 6
hours along with gentamycin 2.5 mg/kg/dose, every eight hours.
If condition improves continue treatment orally

31. • Injectable antibiotics
children aged less than 2 months
ANTIBIOTIC DOSE Frequency
< 7 days Age 7
days to 2
months
Inj. Benzyl penicillin or 50000IU/kg/dose 12 hourly 6 hourly
Inj. Ampicillin 50 mg/kg/dose 12 hourly 8 hourly
and
Inj. Gentamycin 2.5 mg/kg/dose 12 hourly 8 hourly

32. Questions?
THANK YOU