This document discusses acute respiratory infections in children. It begins by introducing the most common causes of death in children worldwide and explains why children under 2 are more prone to respiratory infections due to anatomical factors. It then describes the types of respiratory infections, including upper respiratory tract infections like the common cold, pharyngitis, and otitis media, as well as lower respiratory tract infections like bronchiolitis and pneumonia. Key signs, symptoms, causes, and management approaches are outlined for each condition.

1. Acute Respiratory
Infection
by NURUL FARHANA ADWA BINTI BIDIN

2. INTRODUCTION
• Most common cause of death
in children worldwide
• children prone to resp
infection esp < 2 years old dt
- Smaller airways (easily blocked)
- Lower airways resistance and
immunity
• Pathogen:
- Viral caused 80-90% of
childhood resp infection
- Bacterial infection

3. Types of respiratory infection
Upper respiratory Tract infection
(URTI) - fever, cough, runny nose,
sore throat, stridor
• Common cold (Coryza)
• Pharyngitis
• Acute OM
• Acute sinusitis
• Croup
(laryngotracheobronchitis)
• Acute epiglotittis
• Pertussis (whooping cough)
Lower respiratory Tract infection -
fever, productive cough, wheeze,
crepitation, tachypneic, respiratory
distress
• Bronchiolitis
• Pneumonia

4. TACHYPNOEA
• DEFINITION :Very Rapid Respiration
RESPIRATORY RATE
NORMAL ABNORMAL
Age (year) Rate/min Consider Tachypnoea
< 1 20 - 40 Age Rate/min
1 - 2 20-35 < 2 months > 60
2 - 5 20 - 30 2 m/o - 1 y/o > 50
5 - 12 15 - 25 1 - 5 y/o > 40
Sign of increase in work of breathing :
•nasal flaring
•expiratory grunting ( forced expiration against a
partially closed glottis)
•use of accessory muscle ( sternomastoids)
•retraction/recession of chest wall from use of
suprasternal, intercostal and subcostal muscle
•difficulty in speaking/feeding

5. COMMON COLDS (CORYZA)
 Most common infection of childhood
Clinical Features :
- clear/mucopurulent nasal discharge
- nasal blockage
- Sore throat/ scratchy throat
- non productice cough ( persist up to 4 weeks after common
cold )
- Low grade fever (first few day of illness)
Management :
 Self- limiting
 Antipyrexic medication - for fever
 Antibiotics is not necessary
CAUSATIVE AGENTS
Rhinovirus
Coronavirus
Respiratory Synctial Virus (RSV)

6. PHARNGITIS
 Inflammation of pharynx which is back of
throat and soft palate
 Local LN are enlarged and tender
 Spread via close contact with an infected
person
 Etiology :
VIRAL PHARYNGITIS STREPTOCOCCAL PHARYNGITIS
Gradual onset Rapid onset
Patho
gen
- Adenovirus
- Enterovirus
- rhinovirus
Group A beta-haemolytic streptococcus
(Streptococcus Pyogens)
Sign  Tonsillopharyngeal exudate
 Swollen and tender anterior cervical adenopathy
 Palatal petechiae
 Rhinorrhea and conjunctivitis
 Scleral icterus and hepatosplenomegaly (infectious mononucleosis)
MANGEMENT :
1. Antibiotic x 10 days (to completely eradicate
organism, thus prevent rheumatic fever)
- Penicilin V or Erythromycin if penicilin allergy
2. if severe (reduce oral intake, dehydration)
- Hospital admission
- IV fluid, analgesic

7. TONSILITIS
 Inflammation of the pharyngeal tonsils with purulent exudate. It is a form of
pharyngitis.
 Common pathogens are group A beta-haemolytic streptococcus and Epstein-Barr
virus.
 CF :
 Fever, sore thoat, odynophagia, dysphagia
 Enlarged tonsil, Tendercervical LN, Neck stiffness, foul breath
 Clinical diagnosis
 Management : supportive
1. IV fluid - depends on oral intake
2. antipyretic
 Tonsillectomy if recurrent / chronic tonsillitis

8. ACUTE OTITIS MEDIA
• Inflammation of the middle ear by
viruses(RSV and rhinovirus) or bacteria
(pneumococcus, Haemophilus influenzae
and Moraxella catarrhalis)
• most common in 6-12 months of age.
• Up to 20% will have 3 or more episodes of
AOM.
• Young age prone to AOM because their
Eustachian tubes are short, horizontal and
function poorly.
• Every child with fever must have their
tympanis membranes examined
Investigation:
 Pneumatic otoscopy
 Middle ear fluid C+S
 CT scan for complication.
Management :
 Analgesics such as paracetamol
 Antibiotics eg. amoxicillin
- Antibiotics shorten the duration of the pain
but not to reduce risk of hearing loss.
Complications :
 Mastoiditis
 Meningitis

9. ACUTE SINUSITIS
Inflammation of the lining of the paranasal sinuses.
Aetiological agents
Virus : Rhinovirus(most common), coronavirus, influenza A and B, parainfluenza, RSV,
adenovirus, enterovirus.
Bacteria : Staphylococcus aureus, streptococcus pneumonia, Haemophilus influenzae, P.
aeruginosa.
Symptoms: facial pain/pressure (especially unilaterally), hyposmia/anosmia, nasal congestion, fever,
cough, fatigue, maxillary dental pain, ear fullness/pressure.
Signs:
Mucosal(nose, cheeks, or eyelids) erythema
Facial erythema
Periorbital edema
Tenderness to pressure over the floor of the frontal sinus immediately above the inner canthus
Purulent nasal secretions
Investigation
Nasal cytolog, Nasal-sinus biopsy
Tests for Immunodeficiency are indicated if history findings indicate recurrent infection
CT scan is necessary only in cases of treatment failure or chronic sinusitis.
Management
SYMPTOMATIC :analgesics, topical intranasal steroids, and/or nasal saline irrigation
Antibiotics (usually for 5-10 days) : Amoxicillin, Clarithromycin, Azithromycin

10. CROUP (LARYNGOTRAHEOBRONCHITIS)
• A clinical syndrome chrd by BARKING
COUGH, Inspiratory STRIDOR, Hoarse
of voice and respiratory distress
• 6 months - 6 years (peak at 2nd year)
• Mucosal inflammation and increased
secretions affecting the airway (larynx,
trahea and bronchi) → critical narrowing
of trachea due to oedema of subglottic
area
• Pathogen : Parainfluenza virus (74%),
RSV, Adenovirus, Entrovirus, Rhinovirus,
mumps, measles and rarely Mycoplasma
pneumoniae, corynebacterium Diphtheriae
• Clinical features
- low grade fever, cough, coryza 12-
72H followed by BARKING COUGH
- Stridor at rest/when excited/both
- Respiratory distress varying degree
• CLINICAL DIAGNOSIS
- if severe croup, to examine pharynx at
NICU/ OT
- Neck x-ray only to exclude foreign body
- ABG not helpful as blood parameters may
remans normal to late stage. the process of
blood taking may distress the child

11. cont..
• Clinical assessment of severity
of Croup (Wagener)
MILD : stridor at rest/ when excited,
no resp distress
MODERATE : Stridor at rest +
recession
SEVERE : Stridor at rest + MARKED
recession +  air entry + altered level
of consciousness
MANAGEMENT :
Indication of hospital admission
• moderate-severe croup
• <6 m/o
• poor oral intake
• toxic, sick looking
• logistic issue : house far from
hosp, transportation problem

12. cont..

13. ACUTE EPIGLOTITTIS
 Intense swelling of the epiglottis and surrounding
tissue associated with septicemia → high risk of
respiratory obstruction !!
 1 - 6 years (common)
 Aetiology : Haemophilus Influenza type B
 Clinical features :
i. high fever in an ill, toxic-looking child
ii. intensely painful throat → not speaking, not swallowing, droo
iii. soft inspiratory stridor
iv. child will be sitting immobile, upright, with an open mouth
 Do NOT attempt to lie down the child/examine throat with spatula/lateral neck x-ray as
this will precipitate TOTAL airway obstruction

14. cont..
Management
i. Summon anaesthetist, paediatrician and ENT surgeon.
ii. Transfer the child to ICU.
iii. Perform larynscopy : cherry red, intense sewelling of epiglottis &
surrounding tissue
iv. Intubate the child, give high flow humidified O2 saturation to achieve
maximal alveoli O2 saturation
v. take Blood C+S after airway secured
vi. Start IV antibiotics (2nd/3rd gen Cephalosporin : Ceftriaxone, ceforaxime
) x 2-5 days
vii. Usually remove tracheal tube after 24hr
viii. Prophylaxis rifampicin offered to close household contacts

16. WHOOPING COUGH
 highly contagious URTI caused by Bordetella Pertussis
 Violent and rapid coughing continously until the air inside the lungs runs out followed by
forced inhalation with a loud “whooping” sound (cdc)
 CLINICAL FEATURES :
• spasm of cough often worsen at night with inspiratory phase
• during paroxysm, face goes red and blue, mucus flows from mouth and nose
• after vigorous coughing, epitaxis & subconjuctival hemorrhage, fatigue
 Complication
i. 61% will have apnea
ii. 23% get pneumonia
iii. 1.1% will have seizures
iv. 1% will die
v. 0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin), convulsions, bronchiectasis
a week of coryza
(catarrhal phase)
paroxysmal / spasmodic cough
& inspiratory whoop
(paroxysmal phase)
[3-6 weeks]
→
symptoms gradually
decreasing - 100days
cough
(convalescent phase)
→

17. BRONCHIOLITIS
• A common respiratory illness
esp in infants aged 1-6
months old
• most common cause : RSV
(highly infectious)
• Endemic throughout the year
with cyclical periodicity with
annual peak in Nov-Jan
• Risk factor :
- Preterm infants with BPD
- congenital heart disease
• CLINICAL DIAGNOSIS

18. cont (1)
Investigation :
• FBC -TWC, CRP
• NPA respiratory viruses
• ABG/BG - if resp distress
• CXR -
1. Hyperinflated
2. Segmental or lobar
collapse/consilidation

19. cont (2)
Management :
1. keep SpO2 >95%
2. watchout for respiratory distress ( eg tachycardia, tachypneic, desaturation,
apnea in infants)
3. if good oral intake : encourage orally as tolerated
4. If poor oral intake : IVD 2/3 maintance
5. if severe respiratory distress, risk of aspiration, cyanosis, apnoea - fluid
restriction IVD 100ml/kg/day in the absence of dehydration
6. May allow comfort feeding in moderate severe resp distress
7. Neb saline 3% - to increase mucous clearance
8. Neb/MDI Salbutamol
9. Syrup Paracetamol 50mg/kg QID/ PRN
10.Syrup Tamiflu (Oseltamivir) - antiviral for influenza A and B

20. cont (3)
11. Antibiotic if
• suspect secondary bacteria infection/ septicaemia
• recurrent apnea/circulatory impairment
• Acute clinical deterioration
• High TWC
• Progressive infiltrative changes on CXR

21. PNEUMONIA
Inflammation of lungs parenchymal chrd by
• consolidation of afected side or
• filling of alveolar spaces with exudates, inflammatory cells and fibrins
Epidemiology :
Virus most common cause in younger children (RSV, Influenza A, B, Adenovirus, Parainfleunza
virus)
Bacteria more common in older children
Major cause of mortality of childhood in low & middle income country
ANATOMICAL ETIOLOGY
Bronchopneumonia : Febrile illness with :-
Cough + respiratory distress + evidence of
localised / generalised patchy infiltrations
1. Community acquired pneumonia
2. Nocosomial pneumonia
3. Aspiration pneumonia
Lobar pneumonia : Similar as
bronchopneumonia exp physical findings &
radiographs indicates lobar pneumonia

22. cont..

23. cont (2)
HOPI
• Preceded by URTI
• Fever , cough , rapid breathing
, lethargy , poor feeding ,
‘unwell’ child
• Localised chest , abdominal
(lower lobe)& neck pain (upper
lobe) – feature of pleural
irritation (bacterial infection)
• sick contact? if sick contact
school age, need to cover for
atypical pneumonia
Physical examination
• ↑ RR ( sensitive clinical
sign )
• Tachypnoea , nasal flaring,
chest indrawing
• ↓ 02 saturation
• Auscultation :- End –
inspiratory coarse crackles
(affected area)

24. cont
Investigation
• CXR
• FBC- TWC, Plt
• CRP
• NPA respiratory viruses
Management
1. Keep Spo2 > 95%
2. give oxygen
supplementation if required
3. encourage orally as
tolerated, if poor oral intake
start IVD 2/3 maintenance
4. Antibiotic

25. cont (4)
Antibiotic
• 1st line : beta lactams : BenzylPenicilin, moxycilin ,
ampicilin, amoxycilin-clavulanate
• 2nd line: Cephalosporin: cefotaaxime, cefuroxime,
ceftazidime
• 3rd line : carbapenem : imipenem
• other agents : Amimoglycosides : Gentamicin , amikacin