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Acute Respiratory
Infections
SUDDEN ONSET OF AN INFECTION OF ANY PART OF RESPIRATORY
SYSTEM RIGHT FROM NOSE TO ALVEOLI INCLUDING PAR NASAL
SINUSES, MIDDLE EAR AND PLEURAL CAVITY IS DEFINED AS ARI

Continued

Common among under-five

Infants being hit hardest

50 times more contributing among infants

morbidity and mortality in developing countries as
compared with developed ones

Due to increased prevalence of low birth weight,

malnutrition and indoor pollution

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Magnitude of the problem

20% of infants in developing countries fail to

survive their fifth birth day

30% child mortality is attributable to ARI

In India, about 2million deaths among under-fives

every year

ARI constitutes 40% of total peadiatric OPD and

20% of hospital admissions

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Continued

About 25% of ARI case can be managed at home

by mothers

50% can be managed by trained Health Workers

So the timely intervention, correct treatment and

referral services can save many lives

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Classification of ARI

Etiological Classification

Viral : Adenovirus, Corona virus, Rhino virus,

Influenza-V,Respiratory Synd. V. etc

Bacterial: streptococcus pneumoniae, Heminfluenzae

Fungal

parasitic

Allergic

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Anatomical classification

First Group: Rhinitis,Coryza, Sinusitis,Ottitis

media,Pharyngitis,Tonsillitis,Quinsy

Second Group: Epiglottitis,

Laryngitis,Tracheitis,Bronchitis, Brochiolitis,
Pneumonia, Pleurisy

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WHO Classification

Acute Upper Respiratory infections(AURI) includes

anatomical first group

Acute Lower Respiratory infections (ALRI)

includes anatomical second group

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Etiology

Invasion by one pathogen or variety of pathogens

such as;

Viruses, Bacteria, Fungi, Parasites, Allergens

Simultaneously or primary infection leading to

secondary infection

Usually Viruses cause mild URI and Bacteria

cause severe LRI

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Host Factors

Age : ARI is very common among under-five

children, infants being hit hardest in developing
countries

Sex: incidence is more among male children than

among female children

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Risk factors related to host

are:

Low Birth Weight

Failure of Breast feeding

Under nutrition

Lack of primary immunization

Yong infant age

Vitamin A deficiency

Antecedent viral infection

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Environmental factors

Air pollution following industrialization and

urbanization predisposes people for ARI

Smoking both , active and passive predisposes for

ARI

Season ; winter because of indoor living and over

crowding

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Social factors

Poverty

Illiteracy,

Ignorance,

Lack of personal hygiene

Overcrowding ,

Lack of sanitation

Poor living standard

Non-utilization of health services

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Epidemicity of the disease

Most ARI are endemic

However some ARI such as Measles, Pertusis

,Influenza have the potentiality of occurring in
epidemics, when the case fatality will be very high

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Mode of transmission

Droplet infection

Epidemics occur through air borne route,i.e. by

droplet nuclei

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Neonatal pneumonia

Deserves special mention because;

it is highly fatal

Differs from pneumonia of older infants and

children in etiology, mode of transmission and non
specific features

Causative organisms isolated are; E.Coli,

Streptoagalactiae (groupB)
Pseudomonas,Klebsiella-pneumoniae, staph
aureus

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Mode of infection

New born may get infection :

Either transplacentally from mother during fetal

life

By aspiration of amniotic fluid during birth

By droplet infection after birth

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Clinical features of NP

Signs of toxemia

Respiratory distress(tachycardia ,tachypnea and

hepatomegaly)

Neonatal pneumonia is very common among low

birth weight babies because of their poor
respiratory mechanism

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Prevention & control of ARI

Measures can be taken at 1st three levels of

prevention , namely health promotion, specific
protection and early diagnosis and treatment

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Health promotion

Efficient ante-natal care to reduce the incidence of

LBW

Essential care of new born and special care of

LBW newborn

Promotion of exclusive breast feeding for six

months

Promotion of adequate nutrition for growing

children

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Continued

Improvement of living conditions (housing &

sanitation)

Reduction of parental smoking & smoke pollution

indoors

Limiting the size of the family to prevent over

crowding

Health education of the mothers about correct ARI

case management at home

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ARI Case Management by mothers at home

To increase feeding & to keep the child warm

To clear the nose by instillation of breast milk, if

runny nose interferes with feeding

To relieve cough with home made decoctations

like tea, ginger ,lime juice etc.

To recognize danger signs like fast breathing and

difficult breathing(chest indrawing)

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Specific protection

Strengthening the existing routine primary

immunization

Oral Vitamin A concentrate, 5mega doses, for

children between 9 month to 3 years

Other vaccines which can be given are

pneumococcal Vaccine and Hemophillus-B
influenzae Vaccine

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Early Diagnosis & prompt treatment

ARI can be classified as :

Mild

Moderate

Severe

Very severe

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Mild ARI (no pneumonia)

Characterized by;

No fast breathing

No chest in drawing

Cough, cold , sore throat , ottitis media

With or without fever

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Moderate ARI(Pneumonia)

Fast breathing

No chest in drawing

Cough with or without fever

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Severe ARI (Severe

Pneumonia)

Fast breathing

Chest in drawing

Flaring of alae-nasi

Grunting

Cyanosis

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Very severe ARI(V S

Pneumonia)

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Fast breathing
Chest in drawing

Cyanosis

Cough with fever

Danger signs: inability to drink, convulsions,

abnormally sleepy, stridor and severe malnutrition

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Management of ARI

Mild cases can be treated at home by the home

remedies like , ginger, tea and lime juice

Moderate cases need antibiotics and can be

treated as out patients

Severe cases need immediate hospitalization

Very severe cases need admission in ICU

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Fast breathing

60 per minute or more in a child below 2 months

of age

50 per minute or more in a child between 2 to 12

months of age

40per minute or more in a child between 1 to 5

years of age

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THANKS

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