2. INTRODUCTION
It causes inflammation of the respiratory tract anywhere
from nose to alveoli with combination of signs and
symptoms
It is classified depending upon the site:
• Acute Upper Respiratory Infections (AURI)
• Acute Lower Respiratory Infections (ALRI)
3. .
• AURI includes common
cold, pharyngitis and ear
infection
• ALRI includes epiglottitis,
laryngitis, bronchitis,
bronchiolitis and
pneumonia.
4. Epidemiological Determinants
AGENT FACTORS:
The microbial agents that cause ARI are numerous and
include bacteria and viruses
• Even within species they show wide diversity of antigenic
type
• Severity of illness is determined by whether secondary
bacterial infection occurs or not
5. Bacterial agents
Agent Age groups frequently
affected
Characteristic clinical
features
Bordetella pertusis Infant, young children Paroxysmal cough
Corynebacterium
diphtheriae
children Nasal/tonsillar/pharyngeal
membraneous exudate,
severe toxemia
Streptococcus pneumoniae All ages specifically under
5 children
Lobar and multilobular
pneumonia, acute
exacerbations of chronic
bronchitis
Streptococcus pyogenes All ages Acute pharyngitis and
tonsillitis
Staphylococcus pyogenes All ages Lobar and
bronchopneumonia, lung
abscess
Haemophilus inflenzae children Acute epiglottitis (type B)
Klebsiella pneumoniae Adults Lobar pneumonia , lung
abscess
Legionella pneumoniae Adults Pneumonia
6. Viral agents
Agent Age group frequently
affected
Characteristic clinical
features
Adenovirus endemic
types(1,2,5)
Young children LRTI
Epidemic types(3,4,7) Older children , young
adults
Pharyngitis , flu like
illness
Influenza A, B,C All ages, school children Variable respiratory
symptoms, occasional
primary pneumonia
Parainfluenza 1,2,3 Young children and
infants
Croup
Respiratory syncytial
virus
Infants, young children Severe bronchilitis and
pneumonia
Rhinovirus All ages Common cold
Corona virus All ages Common cold
Measles Young children Variable respiratory with
rash
7. Host factors
• Case fatality rates are higher in young infants and
malnourished children
• In developing countries like India, malnutrition and low
birth weight is often a major problem, the rates are
highest in those children
• The rate of pharyngitis increase from infancy to peak
at the age of 5 years
9. Mode of transmission
• Air borne route
• Chain of transmission is maintained by direct person-
person contact
10. Clinical assessment
• History to be elicited:
• Age of the child
• Since how long the child is coughing
• Young infant stopped feeding well (less than 2 months)
• The child is able to drink (2 months to 5 years)
• Child is excessively drowsy/difficult to wake
• Irregular breathing
• Convulsions
• The child turning blue
11. Physical examination
• Count the breaths in one minute
• Fast breathing depend upon the age of the child
• It should be seen for 1 full minute looking at the
abdominal movement or lower chest when the child is
calm
12. Fast Breathing
Age Fast breathing
Less than 2months 60 breaths /more
2months to 1 year 50 breaths/more
1 to 5 years 40 breaths/more
13. Chest indrawing
• The child has chest
indrawing if the lower
chest wall goes in
when the child
breathes in
• It occurs when the
effort required to
breathe in is much
greater than normal
14. Stridor when calm
• Stridor makes a harsh noise when the child breaths IN
• It occurs when there is narrowing of the larynx, trachea or
epiglottis which interferes with air entering the lungs
• This condition is called croup
15. Wheezing
• Wheezing is soft whistling noise when the child breathes
OUT
• It is caused by narrowing of air passage in lung
• Breathing out phase takes longer than normal and effort
• If so, the child is classified as having recurrent wheeze
16. Severe malnutrition
• High risk factor
• Case fatality rates are higher in these children
• In a severely malnourished children with pneumonia, fast
breathing and chest indrawing may not be as evident
• Impaired/absent response to hypoxia and a weak/absent
cough reflex
• These children need careful evaluation and
management for pneumonia
17. Classification of illness
Child aged 2 months – 5 years:
• Very severe disease
• Severe pneumonia
• Pneumonia
• No pneumonia
Infants less than 2 months:
• Very severe pneumonia
• Severe pneumonia
• No pneumonia
18.
19. Management of AURI
• DO NOT require treatment with antibiotics
• Causative agents are viruses
• Increase resistant strains and cause side effects
• Symptomatic treatment and care at home
22. Pneumococcal Pneumonia vaccine
a)PPV23:
• It is a polysaccharide, non conjugate vaccine containing
capsular antigens of 23 serotypes, available for children
above 2 years and adults
• Single IM / subcutaneous dose is given in deltoid muscle
• It should never be mixed with other vaccines in the same
syringe, it can be given at the same time as separate
injection in other arm
23. b) PCV- Pneumococcal Conjugate
Vaccine
• Two conjugate vaccines are available PCV10 and PCV 13
• It is given in infants as 3 primary doses/2 primary and 1
booster dose
• Initiated as early as 6 weeks with an interval of 4-8 weeks
Doses at 6,10,14 weeks/2,4,6 months
One booster dose is given at 9-15 months
