Acute Respiratory Infections Quiz

Acute Respiratory Infections in Children

• Acute respiratory infections (ARIs) are categorized as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs).
• URIs involve airways from the nostrils to the vocal cords, including sinuses and the middle ear.
• LRIs encompass the airways from the trachea to the bronchi, bronchioles and alveoli.
• ARIs can have systemic effects due to infection spread or microbial toxins, inflammation, and decreased lung function.
• Infections like diphtheria, pertussis (whooping cough), and measles are vaccine-preventable but can impact other systems besides the respiratory tract.

Overview of ARIs in Children

• URIs are the most common infections in children, including rhinitis (common cold), sinusitis, ear infections, pharyngitis, epiglottitis, and laryngitis.
• Viral infections account for approximately 25-30% (rhinoviruses), 25-35% (respiratory syncytial viruses, parainfluenza, influenza, adenoviruses), and 10% (corona viruses) of URIs.
• Complications from URIs are more significant than the infections as they include deafness, rheumatic fever, bacterial infections of sinuses or middle ear, and aspiration of infected secretions.
• Ear infections and pharyngitis are responsible for the most severe URI complications.

LRIs: Types and Symptoms

• Common LRIs in children include pneumonia and bronchiolitis.
• Respiratory rate is an essential clinical sign for diagnosing acute LRI. Rapid breathing and chest wall in drawing are associated with more severe disease.
• Respiratory syncytial viruses (RSVs) are the common causes of viral LRIs and are often seasonal, unlike parainfluenza viruses.
• Pneumococcus and Haemophilus influenzae type b (Hib) are common causes of bacterial pneumonias.

Viral Impact on ARIs (RSV, Influenza)

• RSV is a leading cause of viral LRIs (bronchiolitis) in infants and young children. It accounts for a significant proportion (up to 70-80%) of LRIs during high season.
• Influenza viruses can cause both seasonal and sporadic respiratory infections in children.
• Influenza viruses can cause infections, disease, and death in children.

Vaccination for ARI Prevention

• Vaccines against measles, diphtheria, pertussis, Hib, pneumococcus, and influenza can reduce the incidence of ARIs in children.
• Widespread vaccination programs are instrumental in managing ARI in developing countries

Ear Infections and Long-term Effects

• Acute ear infections occur in up to 30% of URIs and are more prevalent in developing countries.
• Repeated ear infections can lead to complications including hearing loss, mastoiditis, and meningeal infections.

ARI Management and Treatment

• Early intervention, accurate diagnosis, and proper treatment are key factors for managing ARIs, especially in resource-limited settings.

Global Burden of ARIs in Developing Countries

• The burden of ARIs is significantly higher in developing countries, due to factors like crowded populations, inadequate healthcare access and lack of resource.
• Early diagnosis and treatment is essential especially in these populations impacted more heavily by this burden.

Assessment

• Assessing a child with suspected ARI involves asking about age, cough duration, ability to drink, fever history, and any convulsions.
• Assessing the patient involves counting breaths per minute, checking for chest indrawing, stridor, and/or wheezing.
• Assess for abnormal sleepiness or difficulty waking, fever, and undernutrition.

Case Scenarios (Examples)

• Bacterial Pneumonia: A 3-year-old, previously healthy child from rural Iraq with a 3-day history of cough, fever, difficulty breathing, and nasal congestion.

• Examination: Temperature 38.5°C, Resp rate 50/min, O2 Sat 92%, chest wall indrawing, and crackles; Diagnosis: Possible bacterial pneumonia.

• Treatment: Antibiotics (amoxicillin-clavulanate), supportive care with oxygen, fluids, and fever relief.

• Bronchiolitis: A 9-month-old from Baghdad with a 2-day respiratory history of rapid breathing, wheezing, mild fever, and poor feeding.

• Examination: Temp 37.8°C, Resp rate 60/min, O2 Sat 90%, wheezing, chest wall retraction, and nasal flaring; Diagnosis: Bronchiolitis, likely RSV

• Treatment: Supportive care, including oxygen therapy, nasal suctioning, and fluids.

• Acute Pharyngitis: A 6-year-old child from a suburban area with a 4-day history of sore throat, fever, swallowing difficulties, and mild cough.

• Examination: Temp: 39°C, heart rate 110/min, swelling and white patches on tonsils and tender cervical lymph nodes; Diagnosis: Acute bacterial pharyngitis, likely streptococcal.

• Treatment: Antibiotics, supportive care with paracetamol for fever relief and plenty of fluids.

• Acute Otitis Media: A 2-year-old from a rural community with a 3-day history of ear pain, irritability, fever, and pulling at the ear.

• Examination: Temp 38.7°C, red and bulging tympanic membrane in right ear and mild nasal congestion; Diagnosis: Acute otitis media.

• Treatment: Antibiotics (amoxicillin), pain relief and supportive treatment, including nasal saline.

Test your knowledge on acute respiratory infections with this quiz. It covers causes, complications, and the role of viruses in upper respiratory tract infections. Challenge yourself to see how well you understand this important medical topic.