This document provides information on acute respiratory infections including pneumonia, viral bronchiolitis, viral croup, and pertussis. It describes the clinical presentation, diagnostic criteria, and management guidelines for each condition. For pneumonia, it outlines the definitions, common causes, symptoms and signs, criteria for hospitalization, and appropriate antibiotic treatment. Viral bronchiolitis is commonly caused by RSV and presents with tachypnea, wheezing, and respiratory distress in infants. Viral croup presents with a barking cough, inspiratory stridor, and respiratory distress that varies in severity. Pertussis causes paroxysmal coughing fits accompanied by a whoop.

1. ACUTE RESPIRATORY
INFECTION
PRESENTERS :
AININ SORAYA BINTI MOHAMAD
NUR ATIKAH BINTI HARUN
SUPERVISOR :
DR TEH SC

2. CONTENT
 Pneumonia
 Viral bronchiolitis
 Viral croup
 Pertussis

3. Case scenario
 2 year 5 month old, boy was brought to emergency department
with a complaint of,
 Fever for 1 week, on and off fever, highest documented temperature 39C
 Cough for 1 week, chesty cough with whitish sputum
 a/w runny nose and post tussive vomiting
 Rapid breathing for 2 day
 No history of taken any antibiotic before
 Otherwise, good oral intake, no loose stool, no sick contact

4.  On examination,
 He was alert, pink, fretful,
tachypneic with subcostal recession, RR 48
 Lungs: equal air entry, no rhonchi
 CVS : DRNM
 Abdomen : soft, not distended

5.  CXR: Bilateral lungs patchy consolidation.

6. Investigations
 FBC
 Wcc 10.49, (P 46.2%, L 39.1)
 Hb 11.7
 Plt 394
 CRP 41.7
 RP
 Na 135, K 4.1, Cl 97, urea 2.5, creat 18
Impression : Bronchopneumonia

7. PNEUMONIA

8. Definitions
 Pneumonia is an inflammatory conditions of the lung- especially
affecting the alveoli and the parenchyma of the lung.
 There are two clinical definitions of pneumonia:
Bronchopneumonia: a febrile illness with cough, respiratory distress
with evidence of localised or generalised patchy infiltrates.
Lobar pneumonia: similar to bronchopneumonia except that the
physical findings and radiographs indicate lobar consolidation.

10. Aetiology
 Specific aetiological agents are not identified in 40% to 60% of
cases.
 It is often difficult to distinguish viral from bacterial disease.
 The majority of lower respiratory tract infections are viral in origin
e.g. Respiratory syncytial virus, Influenza A or B, Adenovirus,
Parainfluenza virus.

11. Clinical manifestations
SYMPTOMS SIGN
Fever Tachypnea
Fast and difficult breathing Chest recession
Cough Grunting and stridor
Chest pain Nasal flaring
Abdominal pain Cyanosis
Poor feeding Dullness on percussion
Irritability Diminished breath sound, rhonchi,
crepitation on auscultation

15. Criteria for hospitalization
 The following indicators can be used as a guide for admission:
 Children aged 3 months and below, whatever the severity of
pneumonia.
 Fever ( more than 38.5 ⁰C ), refusal to feed and vomiting
 Fast breathing with or without cyanosis
 Failure of previous antibiotic therapy
 Recurrent pneumonia
 Severe underlying disorder, e.g. Immunodeficiency

16. Investigations
 Chest radiograph
 Full blood count
 Blood culture
 Non-invasive gold standard for determining the precise aetiology.
 Sensitivity is low: Positive blood cultures only in 10%-30% of patients.
 Do cultures in severe pneumonia or if poor response to first line antibiotics.
 Pleural fluid analysis
 If there is significant pleural effusion, a diagnostic pleural tap will be helpful.
 Serological tests
 Serology is performed in patients with suspected atypical pneumonia, i.e. Mycoplasma pneumoniae,
Chlamydia, Legionella, Moraxella catarrhalis

17. MANAGEMENT
 Fluids
 Withhold oral intake when a child is in severe respiratory distress.
 Oxygen
 Oxygen reduces mortality associated with severe pneumonia.
 It should be given especially to children who are restless, and tachypnoeic with severe chest
indrawing, cyanosis, or is not tolerating feeds.
 Maintain the SpO₂ > 95%.
 Cough medication
 Not recommended as it causes suppression of cough and may interfere with airway clearance.
Adverse effects and overdosage have been reported.

18. MANAGEMENT
 Temperature control
 Reduces discomfort from symptoms, as paracetamol will not
abolish fever.
 Chest physiotherapy
 This assists in the removal of tracheobronchial secretions:
removes airway obstruction, increase gas exchange and reduce
the work of breathing.

19. ANTIBIOTICS

20. ANTIBIOTICS

21. OUTPATIENT MANAGEMENT
 In children with mild pneumonia, their breathing is fast but there is
no chest indrawing.
 Oral antibiotics can be prescribed.
 Educate parents/caregivers about management of fever, preventing
dehydration and identifying signs of deterioration.
 The child should return in two days for reassessment, or earlier if
the condition is getting worse.

22. VIRAL BRONCHIOLITIS
 Common respiratory illness in infants aged 1 to 6 months old
 Commonest cause – Respiratory syncytial virus (RSV)
 Majority of children has mild ilness
 Symptoms
 Mild coryza and nasal congestion
 Low grade fever
 Cough
 Laboured breathing
 Signs
 Tachypneoa
 Chest wall recession
 Wheezing
 Hyperinflated chest
 Fine crepitation/rhonchi

23. GUIDELINES FOR HOSPITALISATION Home management Hospital management
Age <3 Months No Yes
Toxic looking No Yes
Chest recession Mild Moderate/severe
Central cyanosis No Yes
Wheeze Yes Yes
Crepitation Yes Yes
Feeding Well Difficult
Apnea No Yes
SPO2 >95% <93%

24. Chest X ray :
- Hyperinflated lungs
- Segmental collapse/consolidation
- Lobar collapse/consolidation
Normal CXR Hyperinflated lungs Right upper lobe collapse

25. Management
- Supplemental oxygen
- Maintain SPO2 >95%
- Maintain nutrition and hydration
- Nebulised saline – mucus clearance

26. VIRAL CROUP
 Viral inflammation of larynx, trachea and bronchus
 Clinical syndrome characterised by barking cough, inspiratory stridor, horse voice and respiratory distress
of varying severity
 Pathogen :
- Parainfluenza virus
- RSV
- Influenza virus A and B
- Adenovirus
- Enterovirus
- Measles
- Mumps
- Rhinoviruses

27. Clinical features
- Low grade fever
- Cough
- Coryza
- Increasingly bark-like cough and hoarseness
- Inspiratory stridor
- Respiratory distress of varying degree

28. Clinical assessment of croup (Wagener)
Mild – stridor with
excitement or at rest +
no respiratory distress
Moderate – stridor at
rest + intercostal,
subcostal or sternal
recession
Severe – stridor at rest +
marked recession,
decreased air entry,
altered level
consciousness

29. Management
 Indication for hospitalisation
- Moderate to severe croup
- Age <6 months
- Poor oral intake
- Toxic, sick looking
- Lives long distance from hospital

31. PERTUSSIS
 Also known as whooping cough
 Caused by bacterium Bordatella pertussis (gram negative bacilli)
STAGE CLINICAL FEATURES
1
Catarrhal
•Coryza, Low-grade fever
•Mild, occasional cough (which gradually becomes more severe)
2
Paroxysmal*
•Paroxysms of numerous, rapid coughs due to difficulty expelling thick mucus from the tracheobronchial
tree
•Long inspiratory effort accompanied by a high-pitched “whoop” at the end of the paroxysms
•Cyanosis
•Post-tussive vomiting
Paroxysmal attacks:
•Occur frequently at night, with an average of 15 attacks per 24 hours
•Increase in frequency during the first 1-2 weeks, remain at the same frequency for 2-3 weeks, and then
gradually decrease
3
Convalescent
•Gradual recovery
•Less persistent, paroxysmal coughs that disappear in 2-3 weeks

32. Diagnosis
 Isolation of bordatella pertussis in culture
 Nasopharyngeal swab for PCR
 FBC – absolute lymphocytosis

33. Management
 Adequate hydration and oral intake
 Antibiotic choice (Macrolides) : Erythromycin, Clarithromycin, Azithromycin
 Prevention
- Postexposure prophylaxis – antibiotic within 21 days of exposure
- Immunization

34. Thank you