ACUTE RESPIRATORY

INFECTIONS
• ARIs are the most common infections
causing morbidity and mortality in children
• 1/3rd of the children attending hospitals
suffer from ARI.
 Classification
• Upper Respiratory Tract Infections
– Above the level of larynx
• Ear
• Nose
• Sinuses
• Tonsils
• Pharynx
 Classification
• Lower Respiratory Tract Infections
– At and below the larynx
• Larynx
• Trachea
• Bronchial tubes
• Lung parenchyma
 Common cold
• Commonest of all infection
• Mostly viral
• Fever
• Mucopurulent nasal discharge
• Aches and pains
 Acute Otitis Media
• Infection of middle ear
• Mostly affects infants
• Pain in the ear
• Fever
• Tympanic membrane becomes red and
bulging with loss of normal light reflection
• There may be pussy discharge from the
ear
 Sinusitis
• Infection of ethmoidal, maxillary,
sphenoidal and frontal sinuses
• Occur secondary to viral rhinitis
• Causative agents
– Bacteria
• Streptococcus Pneumoniae
• Heamophilus Influenzae
• Moraxella Catarrhalis
 Sinusitis
• Nasal congestion, purulent nasal
discharge
• Cough and fever
• Headache
• Erythema and swelling of nasal mucosa
with purulent discharge
• Diagnosis is clinical
 Pharyngitis
• Infection of pharynx
• Causative agents
– Viruses
• Adenovirus
• Respiratory syncytial virus
• Ebstein Barr virus
– Bacteria
• H.Influenzae
• Streptococcus Pneumoniae
 Pharyngitis
• Sore throat with scratchy feeling
• Fever
• No cough
• Headache and GI symptoms
• Viral illness may present with low grade
fever, cough, conjunctivitis, rhinorrhoea
and hoarse voice
 Pharyngitis
• Pharynx is red with red ,swollen uvula
• Pharynx and tonsils may be covered with
exudate
• Anterior cervical lymph nodes may be
enlarged and tender
 Tonsillitis
• Infection of the palatine tonsils
• Most commonly caused by Group A β
heamolytic Streptococci
• Also caused by Staphlococcus Aureus and
Mycoplasma Pneumoniae
 Tonsillitis
• High grade fever with chills and rigors
• Dry throat
• Malaise with severe myalgias and
headache
• Ear ache
• Enlarged erythematous tonsils with
exudates
• Enlarged and tender jugulodiagastric
lymph nodes
 Croup
• Laryngotracheobronchitis
• Mostly viral
– RSV
– Influenza virus
 Croup
• Can cause severe obstruction
• Fever and coryza
• Barking cough
• Harsh stridor
• Hoarseness of voice
 Bronchiolitis
• Infection of small bronchioles
• More than 50% of cases are caused by
Respiratory Syncytial Virus
• Others include para influenza virus and
adenovirus
• Mostly occurs in winters
 Bronchiolitis
• Previous history of URTI
• Respiratory difficulty
• Wheezing
• Grunting
 Bronchiolitis
• Restlessness
• Tachypnoea with intercostal,subcostal
recessions
• Cyanosis later
• Difficulty in feeding leading to dehydration
• Tachycardia
• Auscultation reveals expiratory rhonchi,
crepitations and decreased breath sounds
 Pneumonia
• Infection of lung parenchyma
• Causes
– Bacterial
• Pneumococci
• Streptococci
• Staphylococci
• H. Influenzae
• Mycoplasma Pneumoniae
• Mycobacterium tuberculosis
 Pneumonia
• Causes
– Viruses
• RSV
• Adenovirus
• Influenza and parainfluenza
– Fungal
• Candida
– Protozoal
• Pneumocystis Carinii
 Pneumonia
• Fever , irritability and restlessness
• Reluctance to feed
• Breathlessness and chest pain
• Cough
 Pneumonia
• Tachypnoea, nasal flaring and chest
indrawings
• Wheeze
• Bilateral crepitations
• Signs of consolidation
– Dull percussion
– Decreased breath sounds
– Bronchial breathing
Mov00522.3gp
 WHO ARI classification
• Respiratory rates at various ages
– <2 months 60/min
– 2 – 12 months 50/ min
– 1 -5 yrs 40/ min
2 months to 5 years
• No Pneumonia
– Cold
– Cough
– Rhinorrhoea
– Fever
 2 months to 5 years
• Pneumonia
– Fever
– Cough
– Increase R/R according to age
 2 months to 5 years
• Severe Pneumonia
– Chest indrawings
– With or without increase R/R
 2 months to 5 years
• Very Severe Disease (danger signs)
– Cyanosis
– Poor feeding
– Stridor in a calm child
– Convulsions / fits
– Severe malnutrition

– Presence of any 2 signs