This document discusses acute respiratory infections, focusing on acute bronchiolitis. It defines acute respiratory infections as infections of the respiratory tract from the nostrils to the alveoli. It then classifies infections as either upper respiratory tract infections like rhinitis, laryngitis, or pharyngitis, or lower respiratory tract infections like pneumonia or bronchitis. The document goes on to discuss acute bronchiolitis specifically, noting that it is a common disease in infancy caused by viruses like RSV that results in inflammatory obstruction of the smaller airways, with symptoms like wheezing, respiratory distress, and cough. Treatment focuses on supportive measures like humidified oxygen, positioning, maintaining hydration, and nebulized bronch

1. ACUTE RESPIRATORY INFECTIONS
Dr Shambhavi Sharma

2. Definition
acute infection of the respiratory tract
from nostrils to alveoli

3. Classification
 Acute upper respiratory tract infections:
Rhinitis
Laryngitis
Acute epiglottis
Pharyngitis
Croup
Otitis media
tracheitis
Lower respiratory tract infections:
Pneumonia
Bronchiolitis
Bronchitis
Bronchial asthma

4. Approach to a wheezing child

5. Wheezing
 Wheezing occurs due to rapid passage of air
through narrowed airways
 High-pitched, musical, adventitious sound

6. Causes of wheezing
 Asthma
 Infections
 Bronchiolitis
 Pneumonia
 Bronchitis
 GER
 Tropical pulmonary
eosinophilia
 Foreign body
aspiration
 CHF
 Cystic fibrosis
 Mediastinal masses
 Tracheobronchial
anomalies
 Congenital vascular
abnormalities

7. Approach Age at onset
 Pattern
 Episodic/persistent
 Seasonality
 Relation to feeding
 Onset
 Cough
 Relation with position
 Past history
 Family history

8. Approach Respiratory distress: nasal flaring, grunting,
retractions
 ?audible without stethoscope
 Nutritional status
 Detailed resp examination

9. Acute Bronchiolitis

10. Acute Bronchiolitis
 Common disease in infancy
 Inflammatory obstruction of smaller airways

11. Etiology
 RSV (> 50%)
 Parainfluenzae 3, 1, 2
 Influenza
 Adeno
 Mycoplasma pneumoniae

12.  Age group: 1-6 months predominantly
 < 2yrs
 Winter & early spring
 Male
 Babies without breast feeding
 Overcrowding

13. Clinical Features Initially: mild URTI
 Sneezing, rhinorhea
 Fever
 Resp. distress
 Cough
 Dyspnea
 Chest retractions
 Irritability
 Cyanosis

14. Examination Tachypnea
 Chest retractions
 Hyperinflation
 Wheeze
 Prolonged expiration
 P/A
 Liver, spleen: pushed down

15. Investigation
 CXR
 Hyperinflation
 TLC/ DLC
 Usually normal

17. D/D
 Asthma
 Bronchopneumonia
 Foreign body inhalation
 CHF
 Tracheomalacia

18. Treatment
 Patient with resp. distress  hospitalization
 Cool humidified Oxygen
 Positioning
 Sitting with head & chest elevated at 300 with neck
extended
 NPO
 Maintain hydration

19. Treatment Bronchodilators
 Nebulized Adrenaline
 Nebulized β2 agonists
 Hypertonic saline (3%) nebulization
 Corticosteroid: ?? Role
 Antiviral: RIBAVARIN
 Aerosolized
 Esp indicated for infants with
 CHD
 CLD