Acute Respiratory Infections in Children PDF

Acute Respiratory Infections in Children  Overview of ARIs in Children  URIs: Causes and Complications  LRIs: Types and Symptoms  Viral Impact on ARIs (RSV, Influenza)  Vaccination for ARI Prevention  Ear Infections and Long-term Effects  ARI Management and Treatment  Global...

Acute Respiratory Infections in Children  Overview of ARIs in Children  URIs: Causes and Complications  LRIs: Types and Symptoms  Viral Impact on ARIs (RSV, Influenza)  Vaccination for ARI Prevention  Ear Infections and Long-term Effects  ARI Management and Treatment  Global Burden of ARIs in Developing Countries Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs) or lower respiratory tract infections (LRIs). The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and the middle ear. The lower respiratory tract covers the continuation of the airways from the trachea and bronchi to the bronchioles and the alveoli. ARIs are not confined to the respiratory tract and have systemic effects because of possible extension of infection or microbial toxins, inflammation, and reduced lung function. Diphtheria, pertussis (whooping cough), and measles are vaccine-preventable diseases that may have a respiratory tract component but also affect other systems. Causes of ARIs and the Burden of Disease 1. Upper Respiratory Tract Infections URIs are the most common infectious diseases. They include rhinitis (common cold), sinusitis, ear infections, acute pharyngitis or tonsillopharyngitis, epiglottitis, and laryngitis—of which ear infections and pharyngitis cause the more severe complications (deafness and acute rheumatic fever, respectively). The vast majority of URIs have a viral etiology. Rhinoviruses account for 25 to 30 percent of URIs; respiratory syncytial viruses (RSVs), parainfluenza and influenza viruses, adenoviruses for 25 to 35 percent; corona viruses for 10 percent; Because most URIs are self-limiting, their complications are more important than the infections. Acute viral infections predispose children to bacterial infections of the sinuses and middle ear, and aspiration of infected secretions and cells can result in LRIs A. Acute Pharyngitis Acute pharyngitis is caused by viruses in more than 70 percent of cases in young children. Mild pharyngeal redness and swelling and tonsil enlargement are typical. Streptococcal infection is rare in children under five and more common in older children. In countries with crowded living conditions and populations that may have a genetic predisposition, post streptococcal sequelae such as acute rheumatic fever and carditis are common in school-age children but may also occur in those under five. Acute pharyngitis in conjunction with the development of a membrane on the throat is nearly always caused by Corynebacterium diphtheriae in developing countries. However, with the almost universal vaccination of infants with the DTP (diphtheria- tetanus-pertussis) vaccine, diphtheria is rare B. Acute Ear Infection Acute ear infection occurs with up to 30 percent of URIs. In developing countries with inadequate medical care, it may lead to perforated eardrums and chronic ear discharge in later childhood and ultimately to hearing impairment or deafness. Chronic ear infection following repeated episodes of acute ear infection is common in developing countries, affecting 2 to 6 percent of school-age children. The associated hearing loss may be disabling and may affect learning. Repeated ear infections may lead to mastoiditis, which in turn may spread infection to the meninges. Mastoiditis and other complications of URIs account for nearly 5 percent of all ARI deaths worldwide. 2. Lower Respiratory Tract Infections The common LRIs in children are pneumonia and bronchiolitis. The respiratory rate is a valuable clinical sign for diagnosing acute LRI in children who are coughing and breathing rapidly. The presence of lower chest wall in drawing identifies more severe disease. Currently, the most common causes of viral LRIs are RSVs. They tend to be highly seasonal, unlike parainfluenza viruses, the next most common cause of viral LRIs. The epidemiology of influenza viruses in children in developing countries ask for urgent investigation because safe and effective vaccines are available. Before the effective use of measles vaccine, the measles virus was the most important viral cause of respiratory tract–related morbidity and mortality in children in developing countries. A. pneumonia Both bacteria and viruses can cause pneumonia. Bacterial pneumonia is often caused by Streptococcus pneumonia (pneumococcus) or Haemophilus influenza, mostly type b (Hib), and occasionally by Staphylococcus aureus or other streptococci. Just 8 to 12 of the many types of pneumococcus cause most cases of bacterial pneumonia, although the specific types may vary between adults and children and between geographic locations. Other pathogens, such as Mycoplasma pneumonia and Chlamydia pneumonia, cause atypical pneumonias. B. Bronchiolitis Bronchiolitis occurs predominantly in the first year of life and with decreasing frequency in the second and third years. The clinical features are rapid breathing and lower chest wall in drawing, fever in one-third of cases, and wheezing. Inflammatory obstruction of the small airways, which leads to hyperinflation of the lungs, and collapse of segments of the lung occur. Because the signs and symptoms are also characteristic of pneumonia, health workers may find differentiating between bronchiolitis and pneumonia difficult. Two features that may help are a definition of the seasonality of RSVs in the locality and the skill to detect wheezing. RSVs are the main cause of bronchiolitis worldwide and can cause up to 70 or 80 percent of LRIs during high season. Other viruses that cause bronchiolitis include parainfluenza virus and influenza viruses. C. Influenza Even though influenza viruses usually cause URIs in adults, they are increasingly being recognized as an important cause of LRIs in children and perhaps the second most important cause after RSVs of hospitalization of children with an ARI. Although influenza is considered infrequent in developing countries, its epidemiology remains to be investigated thoroughly. The potential burden of influenza as a cause of death in children is unknown. Influenza virus type A may cause seasonal outbreaks, and type B may cause sporadic infection. Recently, avian influenza virus has caused infection, disease, and death in small numbers of individuals, including children. Interventions to control ARIs can be divided into four basic categories: immunization against specific pathogens, early diagnosis and treatment of disease, improvements in nutrition, and safer environments. The first two fall within the purview of the health system, whereas the last two fall under public health and require multispectral involvement. Vaccinations Widespread use of vaccines against measles, diphtheria, pertussis, Hib, pneumococcus, and influenza has the potential to substantially reduce the incidence of ARIs in children in developing countries. Hib Vaccine Currently three Hib conjugate vaccines are available for use in infants and young children. The efficacy of Hib vaccine in preventing invasive disease (mainly meningitis, but also pneumonia). Pneumococcal Vaccines Two kinds of vaccines are currently available against pneumococci: a 23-valent polysaccharide vaccine (23-PSV), which is more appropriate for adults than children, and a 7-valent protein-conjugated polysaccharide vaccine (7-PCV). HISTORY AND PHYSICAL EXAMINATION Case Scenario: ARI in a Pediatric Patient Patient: Sara Ahmed, 3-year-old female from rural Iraq. Symptoms: 3-day history of cough, fever, difficulty breathing, nasal congestion Examination: Temp: 38.5°C, Respiratory rate: 50 breaths/min, Oxygen saturation: 92% Chest wall in-drawing, crackles in lower lung fields Write what is your diagnosis and then management.  Diagnosis: Likely bacterial pneumonia Treatment: Antibiotics: Amoxicillin-clavulanate Supportive care: Oxygen, fluids, paracetamol for fever Outcome: Improved after 48 hours; discharged after 5 days Public Health Note: Early diagnosis and timely intervention are key in managing ARIs, especially in resource-limited settings. Case Scenario: Bronchiolitis in a Pediatric Patient Patient: Omar Ali, 9-month-old male from an urban area in Baghdad Symptoms: 2-day history of rapid breathing, wheezing, mild fever, poor feeding Examination: Temp: 37.8°C, Respiratory rate: 60 breaths/min, Oxygen saturation: 90% Wheezing, chest wall retraction, nasal flaring Diagnosis: Bronchiolitis, likely caused by Respiratory Syncytial Virus (RSV)Treatment:Supportive care: Oxygen therapy, nasal suctioning, fluids No antibiotics as it's viralOutcome: Oxygen saturation improved after 3 days; discharged after 5 days with instructions for home care. Public Health Note: Bronchiolitis is a common viral LRI in infants, and early detection with supportive care is crucial to avoid complications. Case Scenario: Acute Pharyngitis in a Pediatric Patient Patient: Layla Hussein, 6-year-old female from a suburban area Symptoms: 4-day history of sore throat, fever, difficulty swallowing, and mild cough Examination: Temp: 39°C, Heart rate: 110 beats/min Red, swollen tonsils with white patches, tender cervical lymph nodes Diagnosis: Acute bacterial pharyngitis, likely Streptococcal infectionTreatment: Antibiotics: Oral penicillin for 10 days Supportive care: Paracetamol for fever, plenty of fluids Outcome: Symptoms improved after 48 hours; completed antibiotic course without complications Public Health Note: Prompt treatment of streptococcal pharyngitis is crucial to prevent complications like acute rheumatic fever, especially in areas with limited access to healthcare. Case Scenario: Acute Otitis Media (Ear Infection) in a Pediatric Patient Patient: Zain Malik, 2-year-old male from a rural community Symptoms: 3-day history of ear pain, irritability, fever, and pulling at his right ear Examination: Temp: 38.7°C Red, bulging tympanic membrane in the right ear Mild nasal congestion Diagnosis: Acute otitis media (middle ear infection)Treatment:Antibiotics: Amoxicillin for 7 daysSupportive care: Ibuprofen for pain and fever, nasal saline dropsOutcome: Pain and fever resolved in 48 hours; completed antibiotic course without further issuesPublic Health Note: Early treatment of ear infections helps prevent complications like hearing loss, especially in children from rural areas with limited follow-up care.