This document summarizes a presentation on acute respiratory infections (ARI). It begins by defining upper and lower ARI, including common types like pneumonia. Pneumonia is then discussed in more detail, noting that it accounts for 90% of ARI deaths, is a leading cause of childhood death worldwide, and has a high burden in India. Epidemiological determinants of ARI are presented, including infectious agents like bacteria and viruses, and host/environmental factors. The integrated management of neonatal and childhood illness approach is described for assessing, classifying, and treating ARI in children. Prevention strategies like immunization, nutrition, and the WHO's global action plan for pneumonia are also outlined.
4. Specific Learning Objectives
At the end of the session, the students will be able to:
a) list the types and clinical features of Acute Respiratory infections (ARI)
b) classify the illness based on signs during clinical assessment
c) describe the elements of management of ARI
d) explain the epidemiological determinants of ARI
e) enumerate various preventive measures for control of ARI
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5. Introduction
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I. Upper ARI (AURI)
Common cold, pharyngitis, otitis
media, epiglottitis, laryngitis
II. Lower ARI (ALRI)
Laryngotracheitis, bronchitis,
bronchiolitis, pneumonia
Clinical features: running nose,
cough, sore throat, ear problem,
fever, difficult breathing
Dr Tanveer Rehman PSM JIPMER
6. Pneumonia
a. 90% of ARI deaths
b. Deadliest childhood disease
c. Nearly one-fifth of childhood
deaths worldwide
d. In India – 18% of all ‘under five
years’ deaths
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7. Pneumonia
a. 90% of ARI deaths
b. Deadliest childhood disease
c. Accounts for 15% of under 5 childhood deaths worldwide
d. only one third of children with pneumonia receive the antibiotics they need
e. In India – 18% of all ‘under five years’ deaths
f. India had the second-highest number of deaths of children under the age
of five in 2018 due to pneumonia
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11. Epidemiological determinants
Host
1. Infants and young children
2. Elderly
3. Adult women
4. Nutritional status
5. Low birth weight
Environment
a) Overcrowding
b) Indoor air pollution
c) Climate
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12. Epidemiological determinants
1. Transmission
2. The viruses and bacteria that are commonly found in a child's nose or
throat, can infect the lungs if they are inhaled. They may also spread via
air-borne droplets from a cough or sneeze. In addition, pneumonia may
spread through blood, especially during and shortly after birth. More
research needs to be done on the different pathogens causing pneumonia
and the ways they are transmitted, as this is of critical importance for
treatment and prevention.
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14. Clinical assessment
• History taking
• Physical examination
1. Count the breaths in one minute
2. Look for chest indrawing
3. Look and listen for stridor and wheeze
4. Check if abnormally sleepy or difficult to wake
5. Check for severe malnutrition and fever/hypothermia
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15. Integrated Management of Neonatal and Childhood
Illness (IMNCI)
Elements for management of a sick child
1. Assess: danger signs, examine, checking nutrition and
immunization status
2. Classify: colour-coded triage
3. Identify specific treatment
4. Treatment instructions
5. Counsel and follow up care
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16. Classification
A. Child aged 2 months – 5 years
I. Very severe disease /
Severe pneumonia
II. Pneumonia
III. No pneumonia: cough or cold
B. Child aged less than 2 months
I. Very severe disease /
Severe pneumonia
II. Local bacterial infection
III. Severe disease or local
infection Unlikely
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19. Child aged 2 months – 5 years
Danger signs:
1. Unable to drink, or
2. Convulsions, or
3. Abnormally sleepy, or
4. Stridor- calm child, or
5. Severe malnutrition
Classify:
VERY SEVERE
DISEASE/ SEVERE
PNEUMONIA
Treatment:
1. Refer
URGENTLY to
hospital
2. Give first dose
of an appropriate
antibiotic
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20. Child aged 2 months – 5 years
Examination:
1. Fast breathing, or
2. Chest indrawing
Classify:
PNEUMONIA
Treatment:
1. Give oral
Amoxicillin for 5 days
2. Relieve the cough
3. Advise mother
when to return
4. Follow up – 3 days
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21. Child aged 2 months – 5 years
Examination:
No signs of fast
breathing or chest
indrawing
Classify:
COUGH or COLD
Treatment:
1. Advise mother to
give home care
2. No antibiotic
3. Follow up – 5 days if
not improving
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22. Child aged less than 2 months
Examination (any 1):
1. Not feeding well
2. Convulsions
3. Fast breathing
4. Chest indrawing
5. Fever/ hypothermia
Classify:
VERY SEVERE
DISEASE/ SEVERE
PNEUMONIA
Treatment:
1. Refer
URGENTLY to
hospital
2. Give first dose of
IM antibiotic
3. Prevent low
blood sugar
4. Keep the infant
warm
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23. Child aged less than 2 months
Examination:
1. Umbilicus
draining pus/ red
2. Skin pustules
Classify:
LOCAL BACTERIAL
INFECTION
Treatment:
1. Give an
appropriate oral
antibiotic
2. Advise mother
home care
3. Follow up – 2
days
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24. Child aged less than 2 months
Examination:
No signs of fast
breathing, chest in
drawing or local
bacterial infection
Classify:
Severe disease or
local infection
UNLIKELY
Treatment:
Advise mother to
give home care
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25. Prevention of ARI
1. Living conditions
2. Nutrition including EBF
3. Maternal and child care
4. Immunization
a. Measles Rubella (MR) and Vitamin A vaccine
b. Haemophilus influenza type B (Hib) vaccine & Pertussis
c. Pneumococcal conjugate vaccine (PCV)
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26. Global action plan for pneumonia and diarrhoea
(GAPPD)
The WHO and UNICEF integrated response
• protect children from pneumonia including promoting exclusive breastfeeding and
adequate complementary feeding;
• prevent pneumonia with vaccinations, hand washing with soap, reducing household
air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and
exposed children;
• treat pneumonia focusing on making sure that every sick child has access to the
right kind of care -- either from a community-based health worker, or in a health
facility if the disease is severe -- and can get the antibiotics and oxygen they need
to get well;
• a 75% reduction in incidence of severe pneumonia and diarrhoea from 2010 levels
among children under five, and the virtual elimination of deaths from both diseases
in the same age-group.
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27. Global action plan for pneumonia and diarrhoea
(GAPPD)
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High prevalence of malnutrition, Pneumonia is a form of acute respiratory infection that affects the lungs. the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. Pneumonia is the single largest infectious cause of death in children worldwide.
Pneumocystis jiroveci – HIV infected infants
Pneumocystis jiroveci – HIV infected infants
Count – erratic, calm
Assigning degree of urgency or order of treatment
† Not able to drink, persistent vomiting, convulsions, lethargic or unconscious, stridor in a calm child or severe malnutrition
