Acute Respiratory Infection(ARI) - Causes, Symptoms, Diagnosis and Treatment

Introduction - Acute Respiratory Infection (ARI)

 

ARI is the most common respiratory infection tract. It found in mostly among young children and elder people.

Acute respiratory infection (ARI) is an infection that may interfere with normal breathing and difficult to breathe normally.

Acute respiratory infections (ARIs) can affect in upper respiratory track infection (URIs)  and lower respiratory tract (LRIs).

 ARI commonly occurs as a viral infection, in the nose, trachea (windpipe), or lungs. If the infection is not get treated then it can spread to the entire respiratory system.

 

Classification of ARI

 

1. Upper Respiratory Infection

Causes of upper respiratory infection -

a. Common cold (acute coryza) 

b. Pharyngitis - inflammation of the pharynx,

c. Otitis media - inflammation or infection located in the middle ear

 

2. Lower Respiratory Infection

Causes of lower respiratory infection -

1. Epiglottitis - inflammation of the epiglottis

2. Laryngitis - inflammation of the larynx or voice box

3. Sinusitis - inflammation of the sinuses

4. Laryngotracheitis: Inflammation of the larynx, trachea

5. Bronchitis - Inflammation of the bronchial tubes

6. Bronchiolitis - inflammation and congestion in the small airways (bronchioles) of the lung

7. Pneumonia - infection that inflames the air sacs and air sacs may fill with fluid or pus (purulent material)

 

Causes of Acute Respiratory Infection

 

Adenovirus - Cause acute respiratory infection such as common cold or flu-like symptoms, sore throat, acute bronchitis (inflammation of the airways of the lungs), chest cold and pneumonia

Pneumococcus - Cause pneumonia, sinusitis

Rhinovirus - Most common cause of common cold infection. Chiefly cause upper respiratory tract infections (URTIs)

Epidemiological Triad

 

Agent- The causative agent for ARIs and Pneumonia are bacterial, viral and other agents.

 

Bacterial agent includes -

1. Corynebacterium diphtheria

2. Haemophilus influenza

3. Staphylococcus pyrogenes - Pharyngitis, or sore throat

4. Bordetella pertussis

5. Streptococcus pneumoniae

 

Viral agent includes -

1. Influenza A, B, and C

 2. Human Para influenza (HPIVs)  1, 2 and 3

3. Adenovirus - Cause cold-like symptoms, fever, sore throat, bronchitis, pneumonia, diarrhea, and pink eye (conjunctivitis)

4. Coronavirus

5. Measles

6 Respiratory syncytial virus  (RSV) - usually causes mild, cold-like symptoms

 

Other agent includes

1. Mycoplasma pneumonia

 

Host –  higher among young infants, also high in malnourished children.

Upper respiratory tract infection higher in children.

 

Environmental factor –poor housing condition, indoor air pollution, poor ventilation, industrialization, overcrowded places, passive smoking

 

Mode of Transmission

Route - Respiratory route

 1. Direct Person to person contact

2. Airborne spread

3. Infectious agents in droplets, when a sick person coughs or sneezes or talks.

4. Infected secretions come in contact with nose or eyes, infection occurs

5. Droplet and aerosol transmission

 

Clinical Symptoms of ARI

 

1. Cough or cold

2. Unable to drink

3. Fever

4. Irregular breathing  difficulty breathing

5. Running nose

6. Sore throat

7. Ear problem may occur

8. Body aches, fatigue, and dizziness

9. Congestion - in the nasal sinuses or lungs

10. Chest indrawing- sign of respiratory distress

 

Complications of Acute Respiratory Infection

 

Potential complications of acute respiratory infections include-

1. Respiratory arrest

2. Respiratory failure

3. Congestive heart failure

4. Pneumonia

5. Asthma

6. Meningitis

7. Septicaemia

 

 

Risk Factor for ARI

1. Pollution

2. Lack of Breastfeeding

3. Immunodeficiency

4. Malnutrition

5. Congenital abnormalities of heart or lung

6. Poor economic status

7. Parasitic Infection

8. Parental smoking

Physical Examination

 

1. Count the breath in one minute

2. Look for chest in \drawing

3. Look and listen for breaths (Croup; infection of the upper airway which interferes with air entering the lung)

4. Look for a wheeze sound

 

Laboratory Diagnosis

 

1. Sample of sputum

2. Swab from your nose or mouth

3. X-ray

4. CT scan

5. Serological tests

 

Acute Respiratory Infections in Children

 

ARI infection is the third problem in children after diarrhoea and malnutrition. Acute respiratory infection is an infectious disease that prevents normal respiratory function (breathing).

Acute respiratory infections (ARIs) are classified as  -

 1. Upper respiratory tract infections (URIs)

2.  Lower respiratory tract infections (LRIs)

The URIs covers of the airways from the nostrils to the vocal cords in the larynx, including the paranasal sinuses and middle ear.

The lower respiratory tract covers the continuation of the airways from the trachea and bronchi to the bronchioles and the alveoli

URIs are the most common infectious diseases in children include rhinitis (common cold), sinusitis, ear infections, acute pharyngitis or tonsillopharyngitis, epiglottitis, and laryngitis.

Common Lower Respiratory Tract Infections (LRIs) in children are pneumonia and bronchiolitis.

 

Treatment of ARI

In the case of acute respiratory tract (ARI), antibiotics are not recommended for cough and colds because most cases are caused by virus.

In case of severity

1. Co-trimoxazole drug choice of treatment, but for children below 2 months of age, premature babies and having jaundice, it is not recommended.

 

2. Children are treated with benzylpenicillin which is given intramuscularly (I/M) and started oxygen therapy along with treatment.

3. Procaine penicillin/Ampicillin/ Chloramphenicol/ Amoxicillin given for next 3 days.

4. Nasal decongestants

5. Steam inhalation and gargling

Vaccinations

Widespread use of vaccines against measles, pertussis, diphtheria Hib, pneumococcus, and influenza infection has the potential to reduce the incidence of acute respiratory infection (ARIs) in children in developing countries.

 

Prevention and Control of Acute Respiratory Infection

 

1. Early diagnosis and treatment – counting respiratory rate for one minute

2. Check for chest indrawing

3. Getting vaccination of MMR (measles, mumps, and rubella) and pertussis will lower the risk of getting a respiratory infection and  may also benefit from influenza vaccination and pneumovax (protect against ear infection, sinus infection, pneumonia).

 

Other measures to prevent and control ARIs -

1. Improving living condition

2. Provide better nutrition

3. Reduce indoor pollution

4. Provide much care

5. Avoid touching face, especially eyes and mouth

 

 

FAQ on ARI

 

1. What are the most common respiratory infections?

Most common respiratory illness include - Asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis, Emphysema, Pneumonia, Pleural Effusion.

 

2. What are Types of upper respiratory infection?

Types of upper respiratory infections include (URIs) - common cold (head cold), mild flu, tonsillitis, laryngitis,  sinus infection.