ACUTE
RESPIRATORY
INFECTIONS/PNEUMO
NIA
DR.VISHAL BATHMA
(MD, MHA)
COMMUNITY MEDICINE

ACUTE RESPIRATORY
ILLNESS(ARI)
 Most common
 Major cause of mortality and morbidity.
 Can affect anywhere from nose to alveoli.
 Can be classified into
 ALRI(Epiglottitis, laryngitis, laryngotrachietis,
bronchitis, bronchiolitis, pneumonia)
 AURI(Common cold, pharyngitis,otitis media)
 In less developed countries measles and
whooping cough are major cause of
Respiratory tract infection.

Anatomy of the Respiratory
system

PROBLEM STATEMENT
 ARI in young children is responsible for 3.9
million death world-wide.
 Bangladesh, India, Indonesia and Nepal
together account for 40% of global mortality.
 90% of ARI death is due to pneumonia.
 Most is bacterial in origin.
 Incidence of pneumonia in developed
countries 3-4%, in developing countries 20-
30%

 ARI in below 5yrs child is responsible for 30-
50% of hospital visit..
 20-40% of hospital admission.
 It is leading cause of deafness as result of
otitis media.

 In india during the year2014
 34.81million ARI case reported
 About 2,932 are died of ARI
 2,661 died of pneumonia

EPIDEMIOLOGICAL
DETERMINANTS
 Agent factors
 Bacteria
- Bordetella pertusis
- Coryneabacterium diptheriae
- Haemophilus influenzae
- Klebsiella pneumonia
- Staphylococcus pyogenes.

 Virus
- Adenoviruses-endemic types(1,2,5),epidemic type
(3,4,7)
- Enterovirus (ECHO and Coxsackie)
- Influenza A,B,C
- Measles
 Others
- Chlamydia type B
- Coxiella burnetti
- Mycoplasma pneumoniae

HOST FACTORS
 Small children are most vulnerable
 Fatality more common in young infants,
malnourished children, elderly.
 In developing countries fatality more due to
malnutrition and LBW.
 URTI is more common in children than adults.
 Illness rate more common in younger children
and decreases with increasing age.
 Women are more affected due to their exposure
to small children.

RISK FACTORS
 Climatic condition
 Housing
 Level of industrialization
 Overcrowding
 Poor-nutrition
 LBW
 Indoor smoke pollution
 Maternal smoking

Mode of transmission
 Air borne route
 Person to Person

CONTROL OF ARI
 By improving primary medical care service
 Developing better method for:
 Early detection
 Treatment
 If possible prevention
 Education of mother can be effective tool in
reducing mortality and morbidity from ARI.

CLINICAL ASSESMENT
- Access the child condition
- Ask for:
 Age
 Duration of cough
 Is child able to drink (2mth-5yrs)
 Has child stopped feeding (<2mths)
 Had child suffered from any illness (e.g.: measles)
 Does child have fever
 Is child excessively drowsy
 Did child have convulsion
 Is there irregular breathing
 Short period of not breathing(apnea)
 Has child turned blue
 Any H/O T/t

1. COUNTING THE NUMBER OF BREATHS IN
ONE MINUTE - to assess fast breathing
Respiratory rate cut-offs:
>/= 60 breaths per minute in a child less than 2
months
>/=50 breaths per minute in child aged 2month upto
12 months
>/=40 breaths per minute in child aged 12 months
upto 5 years
Physical examination

2. LOOK FOR CHEST INDRAWING
when the child breathes IN
3. LOOK AND LISTEN FOR STRIDOR
when the child breathes IN
4. LOOK FOR WHEEZE
when the child breathes out
5. FEEL FEVER OR LOW BODY
TEMPERATURE
6. CHECK FOR SEVERE MALNUTRITION
7. CHECK FOR CYANOSIS
Physical examination cont.

SIGNS OF RESPIRATORY DISTRESS

SIGNS OF RESPIRATORY DISTRESS

 CHILD BELOW 2 MONTHS
1. Very severe disease
2. Severe pneumonia
3. No pneumonia
 CHILD AGED 2 MONTHS UPTO 5 YEARS
1. Very severe disease
2. Severe pneumonia
3. Pneumonia
4. No pneumonia (cold & cough)
CLASSIFICATION OF DISEASE

SIGNS
 STOPPED
FEEDING WELL
 CONVULSIONS
 ABN. SLEEPY
 STIDOR IN
CALM CHILD
 WHEEZE
 FEVER/LOW
BODY TEMP.
 SEVERE CHEST
IDRAWING
 FAST
BREATHING
 NO SEVERE
CHEST
INDRAWING
 NO FAST
BREATHING
CLASSIFY AS VERY SEVERE
DISEASE
SEVERE
PNEUMONIA
NO PNEUMONIA
TREATMENT REFER URGENTLY
KEEP WARM
GIVE FIRST DOSE
OF ANTIBIOTIC
REFER URGENTLY
KEEP WARM
GIVE FIRST DOSE
OF ANTIBIOTIC
ADVICE FOR
HOME CARE
EXPLAIN DANGER
SIGNS
MANAGEMENT OF ARI
CHILDREN BELOW 2 MONTHS

MANAGEMENT OF ARI
CHILD AGED 2 MONTHS UPTO 5 YEARS
SIGNS
 NOT ABLE TO
DRINK
 CONVULSIONS
 ABNORMALLY
SLEEPY OR
DIFFICULT TO
WAKE
 STRIDOR IN A
CALM CHILD
 SEVERE
MALNUTRITION
 FAST
BREATHING
 CHEST
INDRAWING
 NASALFLARI
NG
 GRUNTING
 FAST
BREATHING
ONLY
 NO CHEST
INDRAWING
 NO FAST
BREATHING
 NO CHEST
INDRAWING
CLASSIFY AS VERY SEVERE
DISEASE
SEVERE
PNEUMONIA
PNEUMONIA NO PNEUMONIA/
COLD & COUGH
TREATMENT REFER URGENTLY
GIVE FIRST DOSE
OF ANTIBIOTIC
TREAT FEVER, IF
PRESENT
TREAT WHEEZE, IF
PRESENT
REFER
URGENTLY
GIVE FIRST
DOSE OF
ANTIBOTIC
TREAT FEVER
TREAT WHEEZE
ADVICE FOR
HOME CARE
GIVE ANTIBIOTIC
TREAT FEVER
TREAT WHEEZE
ASSESS AND
TREAT EAR
PROBLEM/ SORE
THROAT
TREAT FEVER
TREAT WHEEZE

TREATMENT drug of choice
(cotrimoxazol)
 Treatment for 2mths to 5yrs (Pneumonia)
Age/weight Paed tab Paed syp.
Sulpha 100mg 5ml: Sulpha-200mg
Trim 20mg Trim-40mg
 <2mths 1tab BD Half spoon
(3-5kgs) 2.5ml BD
 2-12mths 2tab BD One spoon
(6-9kgs) 5ml BD
 1-5yrs 3tab BD One and half spoon
(10-19kgs) 7.5ml BD

Case of pneumonia
1. Cotrimoxazole should not be given to
premature babies and case of neonatal
jaundice*
2. In children less than 2 months cotrimoxazole
is not recommended*
3. Chloramphenicol is not recommended as the
first line of treatment in young infant*

SEVERE PNEUMONIA(CHEST
IND)
ANTIBIOTICS DOSE INTERVAL MODE
In 1st 48hrs
Benzyl penicillin or
50000 IU per kg/dose 6hrly IM
Ampicillin 50mg/kg /dose 6hrly IM
Chloramphenicol 25mg/kg/dose 6hrly IM
A.

B1. IF CONDITION IMPROVES
,THEN FOR NEXT 3 DAYS
Procaine
Penicillin OR
50000 IU/KG (MAX
UPTO 4 lac IU)
Once IM
Ampicillin or 50 mg/kg/dose 6hrly Oral
Chloramphenico
l
25 mg/kg/dose 6hrly Oral

B.2 IF NO IMPROVEMENT THEN
FOR NEXT 48 HRS
 Change antibiotics
 If Ampicillin –Change to Chloramphenicol IM
 If Chloramphenicol-Change to Cloxacillin
25mg/kg/dose 6hrly with gentamycin
2.5mg/kg/dose 8hrly
 If condition improves continue t/t orally
C. Provide symptomatic t/t for fever and
wheezing
D. Monitor fluid and food intake
E. Advice mother on home management

VERY SEVERE PNEUMONIA
 Should be treated in centre with respiratory
support
 Chloramphenicol IM is drug of choice*
 If condition improves
 Oral Chloramphenicol for 10 days
 If condition worsen
 Inj Cloxacillin + inj gentamycin IM

<2mths child
Drug Dose Age <7DAYS Age 7-2
mths
Inj Benzyl
Penicillin or
50000IU/KG/DOSE 12 Hrly 6Hrly
Inj Ampicillin
and
50mg/kg/dose 12 Hrly 8Hrly
Inj Gentamycin 2.5mg/kg/dose 12 Hrly 8Hrly

NO PNEUMONIA
 Symptomatic t/t
 Home care
 No antibiotics

PREVENTION
 Improve living condition
 Better nutrition
 Remove smoke pollution indoor
 Better MCH
 Immunization
A. Measles Vaccine
B. HIB vaccine
C. Pneumococcal pneumonia vaccine: PPV 23 etc.

The integrated Global action plan for the
prevention and control of pneumonia and
diarrhea (GAPPD)
1. The specific goal for 2025 are to:
- reduce mortality from pneumonia in children <5
year of age to <3 per 1000 live births
- reduce mortality from diarrhea in children less
than 5 year of age to <1 per 1,000 live births
- reduce the incidence of severe pneumonia by
75% in children <5 year of age compare to
2010 level
- reduced by 40% the Global number of children
<5 years of age who are stunted compare to
2010 levels

Coverage targets
 By the end of 2025
- 90% full dose coverage of each relevant
vaccine( with 80% coverage in every district)
- 90% access to appropriate pneumonia and
diarrhea case management( with 80%
coverage in every district)
- at least 50% coverage of exclusive
breastfeeding during the first six months of life
- virtual elimination of pediatric HIV

 By the end of 2030
- universal access to basic drinking water in
Healthcare facilities and homes
- universal access to adequate sanitation in
Healthcare facilities by 2030 and in homes by
2040
- universal access to hand washing facilities( water
and soap) in health care facilities and homes
- universal access to clean and safe energy
technologies in Healthcare facilities and homes.

THANK YOU