Acute Respiratory Tract Acute Respiratory Tract

Infections Infections
(ARI) (ARI)
Prepared by Prepared by- -
Dr. Sunil M. Sagare Dr. Sunil M. Sagare
Specific learning objectives(SLOs) Specific learning objectives(SLOs)
Identify / diagnose ARI case as early as Identify / diagnose ARI case as early as
possible. possible.
Apply appropriate anageent easures Apply appropriate anageent easures Apply appropriate anageent easures Apply appropriate anageent easures
depending upon seriousness of disease. depending upon seriousness of disease.
Assess clinically to diagnose ARI and classify Assess clinically to diagnose ARI and classify
appropriately. appropriately.
Acute Respiratory Infections Acute Respiratory Infections
(ARI) (ARI)
!efinition" !efinition"
Acute infection of respiratory tract caused by Acute infection of respiratory tract caused by
various bacteria# viruses $ ot%er agents $ various bacteria# viruses $ ot%er agents $
clinically c%aracteri&ed by clinically c%aracteri&ed by ' ' clinically c%aracteri&ed by clinically c%aracteri&ed by ' '
(ever (ever
)oug% )oug%
Sore t%roat Sore t%roat
Running nose Running nose
!ifficulty in breat%ing $ !ifficulty in breat%ing $
*ar probles *ar probles
)lassification )lassification
UPPER RESPIRATORY UPPER RESPIRATORY
TRACT INFECTION TRACT INFECTION. .
(URTI (URTI
e.g. e.g.
!O"ER RESPIRATORY !O"ER RESPIRATORY
TRACT INFECTION.(!RTI TRACT INFECTION.(!RTI
e.g. e.g.
e.g. e.g.
)oon cold )oon cold
+%aryngitis +%aryngitis
Otitis Otitis edia edia
e.g. e.g.
*piglottitis *piglottitis
Laryngitis# Laryngitis#
Laryngotrac%eitis Laryngotrac%eitis
,ronc%itis# ,ronc%itis# ,ronc%iolitis ,ronc%iolitis
+neuonia +neuonia
+RO,L*- STAT*-*.T +RO,L*- STAT*-*.T
C#$$#n C#$$#n %au&e #' dea() in %)ildren %au&e #' dea() in %)ildren * + year& #' age in de,el#ping %#un(rie& * + year& #' age in de,el#ping %#un(rie&
India - .anglade&) - Ind#ne&ia - Nepal India - .anglade&) - Ind#ne&ia - Nepal - - C#n(ribu(e C#n(ribu(e /01 /01#' gl#bal ARI #' gl#bal ARI
burden burden
ARI re&p#n&ible '#r ARI re&p#n&ible '#r 20 20- -+01 ,i&i(& (# )eal() 'a%ili(y +01 ,i&i(& (# )eal() 'a%ili(y 3 3 40 40- -/01 )#&pi(al /01 )#&pi(al
ad$i&&i#n& ad$i&&i#n&
In%iden%e #' Pneu$#nia In%iden%e #' Pneu$#nia - -
De,el#ped De,el#ped %#un(rie& %#un(rie& - - 22- -/1 /1
De,el#ping %#un(rie& De,el#ping %#un(rie& - - 40 40- -201 201
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+RO,L*- STAT*-*.T +RO,L*- STAT*-*.T C#NTD C#NTD5 5..
In In "#rld "#rld - -
Dea()& Dea()&- - 2.6 $illi#n& 2.6 $illi#n&
601 #' ARI dea()& are due (# pneu$#nia (U&ually ba%(erial 601 #' ARI dea()& are due (# pneu$#nia (U&ually ba%(erial
C)ildren C)ildren * + yr& * + yr& - - + epi&#de& #' + epi&#de& #' ARI7%)ild7year ARI7%)ild7year
In In India India - - In In India India - -
Dea()& Dea()& - - 6.89 6.89 la:)& la:)& (";O e&(i$a(e& (";O e&(i$a(e&
(6.<6 (6.<6 la:)& la:)& due (# A!RI 3 =0>000 due (# AURI 3 6000 due (# due (# A!RI 3 =0>000 due (# AURI 3 6000 due (#
O(i(i& O(i(i& Media Media
DA!Y& l#&( ?a& 4+.+ $illi#n DA!Y& l#&( ?a& 4+.+ $illi#n
=2 1 inpa(ien( dea()& in pedia(ri% ?ard& are due (# ARI =2 1 inpa(ien( dea()& in pedia(ri% ?ard& are due (# ARI
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*pideiological !*T*R-I.A.TS *pideiological !*T*R-I.A.TS
A. A. A@ENT FACTORS A@ENT FACTORS
.a%(eria .a%(eria
,ordetella ,ordetella +ertussis +ertussis
)ornybacteriu )ornybacteriu dip%t%eria# dip%t%eria#
/. /. Influen&ae Influen&ae
0lebsiella 0lebsiella pneuoniae pneuoniae
Strptococcus Strptococcus pneuoniae pneuoniae
Airu&e& Airu&e& Airu&e& Airu&e&
Adenovirus Adenovirus' 'endeic type (1#2#3) $ epideic type (4#5#6) endeic type (1#2#3) $ epideic type (4#5#6)
*nterovirus *nterovirus' ' *)/O $ )o7sac8ie *)/O $ )o7sac8ie
Influen&a A#,#)# $ Influen&a A#,#)# $ +arainfluen&a +arainfluen&a 1#2#4 1#2#4
)orona virus# R%inovirus )orona virus# R%inovirus
Respiratory Respiratory syncytial syncytial virus virus
-easles -easles
O()er agen(&. O()er agen(&.
)%laydia type , (+sittacosis) )%laydia type , (+sittacosis)
)o7iella )o7iella burnetti burnetti (9 fever) (9 fever)
-ycoplasa -ycoplasa +neuoniae +neuoniae
Se,eri(y #' illne&& i& de(er$ined by ?)e()er #r n#( Se,eri(y #' illne&& i& de(er$ined by ?)e()er #r n#(
&e%#ndary ba%(erial in'e%(i#n #%%ur&(!RTI &e%#ndary ba%(erial in'e%(i#n #%%ur&(!RTI
.. .. ;#&( 'a%(#r& ;#&( 'a%(#r&
Age Age
Rates %ig% in Rates %ig% in young infants $ alnouris%ed c%ildren young infants $ alnouris%ed c%ildren
)%ildren : 4 yrs )%ildren : 4 yrs affected ore often $ ore severely affected ore often $ ore severely
Adult ;oen e7perience ore illness t%an en. Adult ;oen e7perience ore illness t%an en.
C. C. Ri&: Fa%(#r& Ri&: Fa%(#r&
Overcro;ding Overcro;ding Overcro;ding Overcro;ding
+oor nutrition +oor nutrition
L,< L,<
Intense indoor so8e pollution Intense indoor so8e pollution
Level of industriali&ation and socioeconoic developent Level of industriali&ation and socioeconoic developent
Lo; socioeconoic conditions Lo; socioeconoic conditions
-aternal cigarette so8ing -aternal cigarette so8ing
+resc%ool c%ildren attending day care canters +resc%ool c%ildren attending day care canters
MODE OF TRANSMISSION
!irect !irect
!roplet infection !roplet infection
!roplet nuclei !roplet nuclei
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!roplet nuclei !roplet nuclei
PORTAL OF ENTRY
Respiratory tract Respiratory tract
)O.TROL O( ARI )O.TROL O( ARI
I$pr#,ing I$pr#,ing priary edical care services priary edical care services
!evelopent of !evelopent of be((er $e()#d& be((er $e()#d& for early for early
detection# treatent $ ;%ere possible# prevention of detection# treatent $ ;%ere possible# prevention of detection# treatent $ ;%ere possible# prevention of detection# treatent $ ;%ere possible# prevention of
ARIs is best strategy ARIs is best strategy
Recoendations by </O for anageent of ARIs Recoendations by </O for anageent of ARIs
in c%ildren $ t%e practical guidelines for outpatient in c%ildren $ t%e practical guidelines for outpatient
care are follo;ed in India care are follo;ed in India
)linical Assessent )linical Assessent
;i&(#ry (a:ing 3 %lini%al a&&e&&$en( i& ,ery I$p. in $anage$en( ;i&(#ry (a:ing 3 %lini%al a&&e&&$en( i& ,ery I$p. in $anage$en(
#' ARI #' ARI
During )i&(#ry (a:ing ?e a&: '#r During )i&(#ry (a:ing ?e a&: '#r - -
Age of c%ild
!uration of coug%ing $ fever
<%et%er t%e c%ild is able to =
!rin8 (5 t%s to 3 yrs) OR
(eeding ;ell (:5 t%s)
<%et%er c%ild is dro;sy or difficult to ;a8e# If yes ' %o; long>
)onvulsions ' present or not
Irregular breat%ing (s%ort periods of not breat%ing)
)olour of baby' ,lue or not
+%ysical *7aination +%ysical *7aination
=. =. !##: 3 li&(en !##: 3 li&(en - -
)ount t%e breat%s in one inute )ount t%e breat%s in one inute
Fa&( brea()ing pre&en( ?)en Fa&( brea()ing pre&en( ?)en' '
? @A breat%s/in in c%ild : 2 ont%s (Boung infant) ? @A breat%s/in in c%ild : 2 ont%s (Boung infant)
? 3A breat%s/in in c%ild ? 3A breat%s/in in c%ild ' ' aged 2 aged 2' '12 ont%s 12 ont%s ? 3A breat%s/in in c%ild ? 3A breat%s/in in c%ild ' ' aged 2 aged 2' '12 ont%s 12 ont%s
? 5A breat%s/in in c%ild ? 5A breat%s/in in c%ild ' ' aged 12 t%s aged 12 t%s' '3 yrs 3 yrs
4. 4. !##: '#r %)e&( !##: '#r %)e&( indra?ing indra?ingB B
Occours Occours ;%en t%e effort reCuired to breat% in# is uc% greater t%an ;%en t%e effort reCuired to breat% in# is uc% greater t%an
noral noral
2 2 !##: 3 !i&(en !##: 3 !i&(en &(rid#r &(rid#rB B
Stridor Stridor' ' a %ars% noise ;%en a %ars% noise ;%en breat%ing in breat%ing in
Indicates narro;ing of t%e laryn7# trac%ea or epiglottis Indicates narro;ing of t%e laryn7# trac%ea or epiglottis' ' interfere interfere
entry of air entry of air
/ / !##: '#r ?)eeCeB !##: '#r ?)eeCeB
<%ee&e <%ee&e' ' Soft ;%istling noise %eard ;%en Soft ;%istling noise %eard ;%en breat%ing out breat%ing out
As8 about //O previous episode of ;%ee&e As8 about //O previous episode of ;%ee&e
+. +. See ?)e()er %)ild i& abn#r$ally &leepy #r See ?)e()er %)ild i& abn#r$ally &leepy #r
di''i%ul( (# ?a:e. di''i%ul( (# ?a:e.
<. <. Feel '#r 'e,er #r l#? b#dy (e$pera(ure. Feel '#r 'e,er #r l#? b#dy (e$pera(ure.
9. 9. C)e%: '#r &e,er $alnu(ri(i#n. C)e%: '#r &e,er $alnu(ri(i#n. 9. 9. C)e%: '#r &e,er $alnu(ri(i#n. C)e%: '#r &e,er $alnu(ri(i#n.
<eig%t of c%ild less t%an e7pected <eig%t of c%ild less t%an e7pected
Response to %ypo7ia absent Response to %ypo7ia absent
<ea8 or absent coug% refle7 <ea8 or absent coug% refle7
8. 8. Cyan#&i& Cyan#&i&- - .lui&) %#l#ra(i#n #' &:in. .lui&) %#l#ra(i#n #' &:in.
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)lassification of illness )lassification of illness
C)ild aged bel#? 4 $#n()& C)ild aged bel#? 4 $#n()&
(Y#ung In'an( (Y#ung In'an(
C)ild aged 4 $#n()& up C)ild aged 4 $#n()& up
(# + year& (# + year&
=. =. N# pneu$#nia N# pneu$#nia
=. =. N# Pneu$#nia N# Pneu$#nia
4. 4. Se,ere Pneu$#nia Se,ere Pneu$#nia
2. 2. Aery &e,ere pneu$#nia Aery &e,ere pneu$#nia
=. =. N# Pneu$#nia N# Pneu$#nia
4. 4. Pneu$#nia Pneu$#nia
2. 2. Se,ere pneu$#nia Se,ere pneu$#nia
/. /. Aery &e,er pneu$#nia Aery &e,er pneu$#nia
)lassification of illness )lassification of illness
A C)ild A C)ild aged 4 $#n()& aged 4 $#n()& up(# up(# + year& + year&
1. 1. .o .o +neuonia +neuonia
2. 2. +neuonia +neuonia
4. 4. Severe Severe pneuonia pneuonia
5. 5. Dery Dery sever sever pneuonia pneuonia
1. 1. .o pneuonia .o pneuonia 1. 1. .o pneuonia .o pneuonia
)oug% )oug% or cold or cold
.o fast breat%ing .o fast breat%ing
.o c%est .o c%est indra;ing indra;ing
2. 2. +neuonia +neuonia
)oug% or cold )oug% or cold
(ast (ast breat%ing breat%ing
.o )%est .o )%est indra;ing indra;ing
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2. 2. Severe pneuonia Severe pneuonia
)%est )%est indra;ing indra;ing
-ay or ay not ;it% fast breat%ing -ay or ay not ;it% fast breat%ing
.asal flaring .asal flaring
Erunting (S%ort snorting sound) Erunting (S%ort snorting sound)
)yanosis )yanosis )yanosis )yanosis
4. 4. Dery severe pneuonia Dery severe pneuonia
.ot able to drin8 .ot able to drin8
)onvulsions )onvulsions
Abnorally sleepy or difficult to ;a8e Abnorally sleepy or difficult to ;a8e
Stridor Stridor in cal c%ild in cal c%ild
Severe alnutrition Severe alnutrition
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. C)ild aged bel#? 4 $#n()& . C)ild aged bel#? 4 $#n()&
1. 1. .o pneuonia .o pneuonia
2. 2. Severe +neuonia Severe +neuonia
4. 4. Dery severe pneuonia Dery severe pneuonia
1. 1. .o pneuonia .o pneuonia
)oug% or cold )oug% or cold
.o c%est .o c%est indra;ing indra;ing or fast breat%ing or fast breat%ing
2. 2. Severe pneuonia Severe pneuonia
Severe c%est Severe c%est indra;ing indra;ing or fast breat%ing or fast breat%ing
4. 4. Dery severe pneuonia Dery severe pneuonia
Stop feeding ;ell Stop feeding ;ell
)onvulsions )onvulsions
Abnorally sleepy or difficult to ;a8e Abnorally sleepy or difficult to ;a8e
<%ee&ing <%ee&ing
(ever or lo; body tep. (ever or lo; body tep. 18 18
Treatent Treatent
A C)ildren aged 4 $#n()& A C)ildren aged 4 $#n()& DD + yr& + yr&
=. =. N# Pneu$#nia N# Pneu$#nia
Syptoatic treatent Syptoatic treatent
4. 4. Pneu$#nia (C)ild "i() C#ug) 3 Fa&( .rea()ing Pneu$#nia (C)ild "i() C#ug) 3 Fa&( .rea()ing
Advise Advise about %oe care about %oe care
Eive Eive antibiotic i.e. antibiotic i.e. Septran Septran
Treatent Treatent of fever# ;%ee&ing of fever# ;%ee&ing Treatent Treatent of fever# ;%ee&ing of fever# ;%ee&ing
(ollo; (ollo;' 'up up in 2 days for reassessent of fever in 2 days for reassessent of fever
Age Age Tab. Tab. Septran Septran
( (Paed Paed.) .)
Syrup Syrup Septran Septran
< 2 months < 2 months 1 BD 1 BD tsf BD tsf BD
22- -12 months 12 months 2 BD 2 BD 1 tsf BD 1 tsf BD
11- -5 years 5 years 3 BD 3 BD 1& 1/2 1& 1/2 tsf tsf BD BD
2. 2. Se,ere pneu$#nia Se,ere pneu$#nia
Refer Refer urgently to speciali&ed %ospital urgently to speciali&ed %ospital
Eive Eive first dose of antibiotic first dose of antibiotic
Treatent Treatent of fever $ ;%ee&ing of fever $ ;%ee&ing
Antibiotic Antibiotic' ' (irst 5F %rs (irst 5F %rs
,en&yl penicillin ,en&yl penicillin' '3A#AAA 3A#AAA IG/0g/dose IG/0g/dose' '@%rly @%rly' 'I- I- OR OR
Apicillin Apicillin' '3A 3A g/0g/dose g/0g/dose' '@%rly @%rly' 'I- I- OR OR
)%lorap%enicol )%lorap%enicol' ' 23 g/0g/dose 23 g/0g/dose' '@%rly @%rly' 'I- I-
If iproveent t%en for ne7t 4 days give If iproveent t%en for ne7t 4 days give If iproveent t%en for ne7t 4 days give If iproveent t%en for ne7t 4 days give
+rocain +rocain penicillin penicillin' ' 3A#AAA IG/0g 3A#AAA IG/0g' 'once once' 'I- I- OR OR
Apicillin Apicillin' '3A g/0g/dose 3A g/0g/dose' '@%rly @%rly' 'Oral Oral OR OR
)%lorap%enicol )%lorap%enicol' ' 23 g/0g/dose 23 g/0g/dose' '@%rly @%rly' 'Oral Oral
If If no iproveent no iproveent' ' )%ange antibiotic )%ange antibiotic
)lo7acillin )lo7acillin' '23g/0g/dose 23g/0g/dose' '@%rly @%rly
Eentaycin Eentaycin' ' 2.3g/0g/dose 2.3g/0g/dose' 'F%rly F%rly
Treatent Treatent of fever# ;%ee&ing of fever# ;%ee&ing
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/. /. Aery &e,ere pneu$#nia Aery &e,ere pneu$#nia
Refer urgently to speciali&ed %ospital Refer urgently to speciali&ed %ospital' 'o7ygen t%erapy o7ygen t%erapy
Eive first dose of antibiotic Eive first dose of antibiotic' ' Inj. Inj. )lo7acillin )lo7acillin# Inj. # Inj.
Eentaycin Eentaycin Eentaycin Eentaycin
If fever If fever' ' Antipyretic Antipyretic
Treat ;%ee&ing Treat ;%ee&ing
,) )%ildren aged less t%an 2 ont%s ,) )%ildren aged less t%an 2 ont%s
=. =. N# pneu$#nia N# pneu$#nia- -
Syptoatic Treatent Syptoatic Treatent
.o antibiotic reCuired .o antibiotic reCuired
4. 4. Se,ere pneu$#nia Se,ere pneu$#nia- - 4. 4. Se,ere pneu$#nia Se,ere pneu$#nia- -
Refer urgently to %ospital Refer urgently to %ospital
0eep young infant ;ar 0eep young infant ;ar
Eive first dose of antibiotic Eive first dose of antibiotic
a) a) Inj. ,en&yl +enicillin Inj. ,en&yl +enicillin' '3A#AAAIG/0g/!ose 3A#AAAIG/0g/!ose' '12%rly (:6 days)#@%rly 12%rly (:6 days)#@%rly
(6days (6days' '2ont%s) OR 2ont%s) OR
b) b) Inj. Inj. Apicillin Apicillin ' '3A g /0g/dose 3A g /0g/dose' '12%rly#F%rly OR 12%rly#F%rly OR
c) c) Inj.Eentaycin Inj.Eentaycin' '2.3 g/0g/dose 2.3 g/0g/dose' '12%rly#F%rly 12%rly#F%rly
2. 2. Aery &e,ere pneu$#nia Aery &e,ere pneu$#nia- -
Refer Refer urgently to speciali&ed %ospital urgently to speciali&ed %ospital
0eep 0eep young infant ;ar young infant ;ar
Eive Eive first dose of first dose of antibiotic antibiotic
-anageent -anageent of a case of of a case of ;%ee&ing ;%ee&ing' '
Ca&e ?i() Re&pira(#ry di&(re&& Ca&e ?i() Re&pira(#ry di&(re&& - -
Oral Oral Salbutaol Salbutaol' '
:1A 0g :1A 0g == give 1g every F give 1g every F %rly %rly :1A 0g :1A 0g == give 1g every F give 1g every F %rly %rly
1A 1A' '1H 8g 1H 8g' ' give 2 g every F give 2 g every F %rly %rly
(Treatent only for fe; days) (Treatent only for fe; days)
Re&pira(#ry di&(re&& ?i() re%urren( ?)eeCing Re&pira(#ry di&(re&& ?i() re%urren( ?)eeCing DD
.ebulised .ebulised Salbutaol Salbutaol (3g/l) (3g/l) ' ' A.3 l A.3 l Salbutaol Salbutaol I 2 l Sterile I 2 l Sterile
;ater ;ater
(-ay repeat after 2A in.) (-ay repeat after 2A in.)
Subcutaneous *pinep%rine Subcutaneous *pinep%rine ' ' adrenaline 1"1AAAJA.1K# A.1 l/0g adrenaline 1"1AAAJA.1K# A.1 l/0g
Subcutaneous Subcutaneous terbutalin terbutalin' ' A.1l/0g A.1l/0g
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OT/*R +R*D*.TID* -*ASGR*S OT/*R +R*D*.TID* -*ASGR*S
Iproved living conditions Iproved living conditions
,etter nutrition ,etter nutrition
Reduction of indoor so8e pollution Reduction of indoor so8e pollution
Iuni&ation Iuni&ation of vaccine preventable diseases of vaccine preventable diseases
Iproving Iproving t%e priary edical care services t%e priary edical care services
!eveloping better et%ods for early detection# Treatent $ !eveloping better et%ods for early detection# Treatent $ !eveloping better et%ods for early detection# Treatent $ !eveloping better et%ods for early detection# Treatent $
+revention +revention
Acute Respiratory !isease )ontrol Acute Respiratory !isease )ontrol +rograe +rograe In India In India'' ''Started in Started in
1HHA 1HHA
' 'In 1HH2 In 1HH2' 'H4# H4# prograe prograe becoe part of )SS- becoe part of )SS-
' ' In 1HH6# In 1HH6# prograe prograe becoe part of R)/ becoe part of R)/
I-.)I (Integrated -anageent of .eonatal $ )%ild%ood Illnesses) I-.)I (Integrated -anageent of .eonatal $ )%ild%ood Illnesses)
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